New emergency preparedness requirements included in a Centers for Medicare & Medicaid Services (CMS) final rule titled Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, became effective Nov. 15, 2016 and the implementation date is Nov. 15, 2017.

All Hazards Focus

Emergency Preparedness Plans (EPPs) must now comprehensively focus on the “All Hazards” approach to emergency management.  An “All Hazards” approach includes mitigation, preparedness, response, and recovery, and must address protocols to eliminate or minimize disruptions to providers during emergency incidents.

The new CMS rule requires that providers prepare for natural and/or man-made disasters following nationally recognized protocols and requirements. The Federal Emergency Management Agency (FEMA), National Incident Management System (NIMS), and the Incident Command System (ICS) are referenced throughout the CMS rule. There are also specifications that providers coordinate their EPP with local, state, and federal agencies.

Together with the providers’ state and local requirements for emergency management policies, the EPP must outline a comprehensive response plan for a full spectrum of emergencies and disasters. There are three overarching concepts in the new rule: safeguard human resources, maintain business continuity, and protect physical assets. There are four categories for implementation: risk assessment and emergency planning, policies and procedures, communication plan, and training and testing.

Follow this Basic Format

The rule does not specify a template to follow in the development of the emergency preparedness plan. However, adopting the protocols of FEMA, NIMS, and ICS, as referenced in the CMS rule, is recommended. The following basic format includes FEMA protocols as well as the required components of a hazard vulnerability analysis (HVA) and starts with the section titled: “Purpose.”

Purpose

Describe how your EPP is an “All-Hazards” approach for emergency planning and response: All-Hazards is an integrated approach to emergency preparedness planning that places a focus on capabilities/capacities that are essential for effectively responding to emergencies and disasters. The EPP applies to all members of program administration and staff in all departments. The EPP also applies to non-staff members who perform work at the site including clinical providers, technicians, contractors, students, volunteers, and ancillary staff.

Services Available

Describe your facility and operation. An example for a nursing home could include square footage, number of rooms and beds, clinical and other services offered, programming, and departments, etc. Mention whether the facility can potentially serve to temporarily support an influx of injured or medically compromised patients during a disaster.   

Authority, Situation, and Assumptions

Detail oversight authority of the operation (i.e., board of directors [BOD], CEO, executive director, etc). Outline positions responsible for day-to-day management. Describe who’s in charge when senior staff are absent. In the case of an emergency after normal working hours—a worst case scenario—detail emergency preparedness plan protocol that applies to most senior staff on duty.  

Situation description for a skilled nursing facility would include physical plant outline, 24/7 operation, bed-capacity, departments, number of staff, and that the facility is responsible for the safety and protection of its residents and staff. Merge into the Assumptions category by revealing that facility staff have received EPP training for a worst-case scenario and will mobilize off-duty personnel to mitigate vulnerabilities and assumptions:  

Assumption examples:

• Emergencies and disasters can occur without notice, any day, and on any shift.  
• Local authorities can declare an emergency and the disaster may be local or state-wide
• The facility may receive requests for resource support (supplies, equipment, staffing, or shelter) from other health care facilities.
• Facility security may be compromised during an emergency.
• Emergency may exceed the facilities’ capabilities and external emergency resources may not be available. Therefore, the facility will manage the incident without these resources.

Mitigation

Mitigation is the procedure for risk analysis and emergency planning. The goal of mitigation is to eliminate or minimize the impact of emergencies/disasters on day-to-day operations. During mitigation, internal/external hazards that pose potential harm to the operation will be identified and analyzed. Mitigation activities are dynamic and should occur both before, during, and following a disaster/emergency.

HVA is the primary mitigation tool to highlight threats and measure potential impact on the operation. HVA is a new concept for long term care providers and the tendency is to over-analyze the technicality of the process—but keep it simple. Below is an example of an HVA that addresses a full-spectrum of potential threats with a simple classification and measurement system:​