The Emergency Preparedness Final Rule (81 Fed. Reg. 63860, September 16, 2016) sets the requirements for all providers and suppliers in regard to planning, preparing and training for emergency situations. The rule includes requirements for emergency plans, policies and procedures, communications and staff training. The Emergency Preparedness Final Rule has been enforced since November 15, 2017. The regulations require that skilled nursing centers include provisions for an all-hazards approach to planning, maintenance of safe temperatures during an emergency and the development and maintenance of training programs.
The Centers for Medicare and Medicaid Services (CMS) released revisions to the interpretive guidance on February 1, 2019, in QSO letter 19-06. CMS is adding “emerging infectious diseases” to the current definition of all-hazards approach. CMS has determined that it is critical for skilled nursing centers to include planning for infectious diseases within their emergency preparedness program. In light of events such as the Ebola Virus and Zika, CMS believes that skilled nursing centers should include infection prevention within their all-hazards approach, which covers both natural and man-made disasters. Skilled nursing providers may use resources developed by ASPR TRACIE for infectious disease emergency preparedness.
Since the release of the Interpretive Guidelines for Emergency Preparedness in 2017, providers and stakeholders have asked for additional clarifications related to portable/mobile generators. Skilled nursing centers should use the most appropriate energy source or electrical system based on their review of their facility’s all-hazards risk assessment and as required by existing regulations or state requirements. The alternate sources of energy the skilled nursing center chooses to utilize, it must be in accordance with local and state laws, manufacturer requirements, as well as applicable Life Safe Code.
On the same day that CMS issued the Emergency Preparedness letter, the U. S. Senate Minority Office sent CMS a letter requesting answers. The Senate Minority leader stressed the importance of temperature controls during an emergency and offered recommendations to improve emergency preparedness in skilled nursing centers. The letter referred to the report “Sheltering in Place” that was written by the Senate Finance Committee staff.
The E-tags that have additional guidance in Appendix Z are E-004, E-0015, E-0041, E-0018, E-0037 and E-0039. Providers should review the QSO memo and the revised Appendix Z and then review and revise Emergency Plan as needed.