Medicare and Medicaid Programs: Emergency Preparedness Requirements for Private Duty/Personal Care A

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Dear friends,



The following article is describes the Centers for Medicare & Medicaid
Services (CMS) final rules regarding emergency preparedness. Feel free to
share this information. If you decide to use this material, please include
our copyright designation that is shown at the end of the article and send
us a copy of any publication in which the material appears.



Please do not hesitate to contact us with comments, questions, or requests
for additional information.



Elizabeth



Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Fax: (877) 871-9739

Twitter: @HogueHomecare

ElizabethHogue@ElizabethHogue.net





Medicare and Medicaid Programs: Emergency Preparedness Requirements for
Private Duty/Personal Care Agencies



The Centers for Medicare & Medicaid Services (CMS) has issued final rules
regarding emergency preparedness. The final rule was published in the
Federal Register on September 16, 2016, and is effective on November 15,
2016. Agencies are, however, not required to comply until November 15,
2017.



In a Summary of Major Provisions published along with the final regulations,
CMS states: "We are issuing emergency preparedness requirements that will be
consistent and enforceable for all affected Medicare and Medicaid providers
and suppliers."



CMS also states in the commentary to the final rule that the rules apply to
providers who care for patients who are homebound or receiving services at
home. In other words, the requirements do not apply only to Medicare
certified home health agencies who provide services to homebound patients.



In fact, it seems reasonable to apply the requirements to private duty home
care agencies, since services by these types of agencies are often at a
greater frequency than intermittent services provided by Medicare certified
agencies. Unlike services provided under the home health benefit of the
Medicare Program, such services may be provided 24 hours per day, 7 days per
week.



Based upon the above, all Medicaid providers may be required to comply with
the final rule. Consequently, private duty home care agencies that are not
Medicare certified, but receive payments from Medicaid Programs, including
Medicaid waiver programs and managed Medicaid plans, may be subject to these
requirements.



The final rule includes specific requirements for "home health agencies,"
which, according to the rule, is not limited to Medicare certified home
health agencies.



Here are the key requirements:



Agencies must comply with all applicable Federal, State and
local emergency preparedness requirements.



Agencies must establish and maintain emergency preparedness programs that
must be reviewed and updated at least annually. Agencies' emergency
preparedness plans must be based on and include a documented provider and
community-based risk assessment using an "all-hazards" approach and must:



- Include strategies to address emergent events identified by risk
assessments



- Address the types of services agencies can provide in emergencies
and continuity of operations, including delegations of authority and
succession plans



- Include processes for cooperation and collaboration with local,
tribal, regional, State, or Federal officials in emergency situations,
including documentation of agencies' efforts to contact such officials and,
if applicable, participation in collaborative and cooperative planning
activities



Agencies must develop and implement policies and procedures governing
emergency preparedness based on emergency plans that are reviewed and
updated at least annually. At a minimum, policies and procedures must
address the following:



- Plans for agencies' patients during a natural or man-made disaster,
including individual plans for each patient that must be included as part of
comprehensive assessments



- Procedures to inform State and local emergency preparedness
officials about agency patients in need of evacuation from their residences
at any time due to emergency situations based on patients' medical and
psychiatric conditions and home environments



- Procedures to use to follow up with on-duty staff and patients to
determine needed services if there are interruptions in service during or
due to emergencies. Agencies must inform State and local officials of any
on-duty staff or patients that they are unable to contact.



- Establishment of a system of medical documentation that preserves
patients' information, protects confidentiality of patients' information and
secures and maintains availability of records



- Use of volunteers in emergencies or other emergency staffing
strategies, including a process for integration of state and Federally
designated health care professionals to address surge needs during
emergencies



Agencies must develop and maintain emergency preparedness
communication plans that comply with Federal, State and local laws that are
updated annually and include:



- Names and contact information for staff, entities that provide
services under arrangement, patients' physicians, and volunteers



- Contact information for Federal, State, tribal, regional and local
emergency preparedness staff



- Other sources of assistance, including primary and alternate means
of communication with agencies' employees and Federal, State, tribal,
regional and local emergency management agencies



- Methods for sharing information and medical documentation for
patients under agencies' care, as necessary, with other health care
providers in order to maintain continuity of care



- Processes to release patients' information during evacuations and
to provide information about the general condition and location of patients
under agencies' care consistent with all applicable requirements



- Processes to provide information about agencies' needs and
abilities to provide assistance to authorities having jurisdiction, Incident
Command Centers or designees



Agencies must develop and maintain emergency preparedness training and
testing programs that are based on emergency plans, risk assessments,
policies and procedures and communication plans required by the final
regulations that are reviewed at least annually, including the following:



- Initial training in emergency preparedness policies and procedures
for all new and existing agency employees, individuals providing services
under arrangement and volunteers, consistent with expected roles



- Demonstrations of staff knowledge of emergency procedures



- Provision of emergency preparedness training at least annually and
maintenance of documentation of the training



- Conduct of exercises to test emergency plans at least annually,
including participation in full-scale exercises that are at least provider
based and preferably community based



- Conduct of additional exercises that may include, but are not
limited to, a second full-scale exercise that is community or provider
based, a tabletop exercise that includes group discussions led by
facilitators using narrated, clinically-relevant emergency scenarios and
sets of problem statements, directed messages or prepared questions designed
to challenge emergency plans



- Analysis and documentation of agencies' response to all drills,
tabletop exercises and emergency events, including revisions to agencies'
emergency plans as needed



Based upon the final rule it is unclear how private duty agencies'
compliance with these requirements will be monitored and enforced. These
activities are likely to vary from state-to-state.



Private duty agencies have become accustomed to operating in a relatively
unregulated industry, especially when compared to Medicare certified home
health agencies. The future is likely to bring more regulation of this
industry, including with regard to emergency preparedness.





C2016 Elizabeth E. Hogue, Esq. All rights reserved.



No portion of this material may be reproduced in any form without the
advance written permission of the author.


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Content-Type: text/html;
charset="us-ascii"
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Dear =
friends,

 

The following article is describes the Centers for =
Medicare & Medicaid Services (CMS) final rules regarding emergency =
preparedness.  Feel free to share this information.  If you =
decide to use this material, please include our copyright designation =
that is shown at the end of the article and send us a copy of any =
publication in which the material appears. 

 

Please do =
not hesitate to contact us with comments, questions, or requests =
for additional information.

 

Elizabeth

 

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Fax: (877) 871-9739

Twitter: @HogueHomecare

ElizabethHogue@Elizabet=
hHogue.net

 

 

Medicare and Medicaid Programs: Emergency =
Preparedness Requirements for Private Duty/Personal Care =
Agencies

 

The Centers =
for Medicare & Medicaid Services (CMS) has issued final rules =
regarding emergency preparedness.  The final rule was published in =
the Federal Register on September 16, 2016, and is effective on November =
15, 2016.  Agencies are, however, not required to comply until =
November 15, 2017. 

 

In a Summary =
of Major Provisions published along with the final regulations, CMS =
states: “We are issuing emergency preparedness requirements that =
will be consistent and enforceable for all affected Medicare and =
Medicaid providers and suppliers…”

 

CMS also =
states in the commentary to the final rule that the rules apply to =
providers who care for patients who are homebound or receiving =
services at home.  In other words, the requirements do not =
apply only to Medicare certified home health agencies who provide =
services to homebound patients.

 

In fact, it =
seems reasonable to apply the requirements to private duty home care =
agencies, since services by these types of agencies are often at a =
greater frequency than intermittent services provided by Medicare =
certified agencies.  Unlike services provided under the home health =
benefit of the Medicare Program, such services may be provided 24 hours =
per day, 7 days per week.

 

Based upon =
the above, all Medicaid providers may be required to comply with the =
final rule.  Consequently, private duty home care agencies that are =
not Medicare certified, but receive payments from Medicaid Programs, =
including Medicaid waiver programs and managed Medicaid plans, may be =
subject to these requirements.

 

The final =
rule includes specific requirements for “home health =
agencies,” which, according to the rule, is not limited to =
Medicare certified home health agencies.

 

Here are the =
key requirements:

 =

 &nbsp=
;            =
  Agencies must comply with all applicable Federal, State and =
local emergency preparedness requirements.

 

Agencies =
must establish and maintain emergency preparedness programs that must be =
reviewed and updated at least annually.  =
Agencies’ emergency preparedness plans must be based on and =
include a documented provider and community-based risk assessment using =
an “all-hazards” approach and must:

 

-        =
Include =
strategies to address emergent events identified by risk =
assessments

 =

-        =
Address =
the types of services agencies can provide in emergencies and continuity =
of operations, including delegations of authority and succession =
plans

 =

-        =
Include =
processes for cooperation and collaboration with local, tribal, =
regional, State, or Federal officials in emergency situations, including =
documentation of agencies’ efforts to contact such officials and, =
if applicable, participation in collaborative and cooperative planning =
activities

 =

Agencies =
must develop and implement policies and procedures governing emergency =
preparedness based on emergency plans that are reviewed and updated at =
least annually.  At a minimum, policies and procedures must address =
the following:

 

-        =
Plans for =
agencies’ patients during a natural or man-made disaster, =
including individual plans for each patient that must be included as =
part of comprehensive assessments

 =

-        =
Procedures =
to inform State and local emergency preparedness officials about agency =
patients in need of evacuation from their residences at any time due to =
emergency situations based on patients’ medical and psychiatric =
conditions and home environments

 =

-        =
Procedures =
to use to follow up with on-duty staff and patients to determine needed =
services if there are interruptions in service during or due to =
emergencies. Agencies must inform State and local officials of any =
on-duty staff or patients that they are unable to =
contact.

 =

-        =
Establishme=
nt of a system of medical documentation that preserves patients’ =
information, protects confidentiality of patients’ information and =
secures and maintains availability of records

 =

-        =
Use of =
volunteers in emergencies or other emergency staffing strategies, =
including a process for integration of state and Federally designated =
health care professionals to address surge needs during =
emergencies

 

 &nbsp=
;            =
  Agencies must develop and maintain emergency preparedness =
communication plans that comply with Federal, State and local laws that =
are updated annually and include:

 

-        =
Names and =
contact information for staff, entities that provide services under =
arrangement, patients’ physicians, and =
volunteers

 =

-        =
Contact =
information for Federal, State, tribal, regional and local emergency =
preparedness staff

 =

-        =
Other =
sources of assistance, including primary and alternate means of =
communication with agencies’ employees and Federal, State, tribal, =
regional and local emergency management agencies

 =

-        =
Methods =
for sharing information and medical documentation for patients under =
agencies’ care, as necessary, with other health care providers in =
order to maintain continuity of care

 =

-        =
Processes =
to release patients’ information during evacuations and to provide =
information about the general condition and location of patients under =
agencies’ care consistent with all applicable =
requirements

 =

-        =
Processes =
to provide information about agencies’ needs and abilities to =
provide assistance to authorities having jurisdiction, Incident Command =
Centers or designees

 =

Agencies =
must develop and maintain emergency preparedness training and testing =
programs that are based on emergency plans, risk assessments, policies =
and procedures and communication plans required by the final regulations =
that are reviewed at least annually, including the =
following:

 =

-        =
Initial =
training in emergency preparedness policies and procedures for all new =
and existing agency employees, individuals providing services under =
arrangement and volunteers, consistent with expected =
roles

 =

-        =
Demonstrati=
ons of staff knowledge of emergency procedures

 =

-        =
Provision =
of emergency preparedness training at least annually and maintenance of =
documentation of the training

 =

-        =
Conduct of =
exercises to test emergency plans at least annually, including =
participation in full-scale exercises that are at least provider based =
and preferably community based

 =

-        =
Conduct of =
additional exercises that may include, but are not limited to, a second =
full-scale exercise that is community or provider based, a tabletop =
exercise that includes group discussions led by facilitators using =
narrated, clinically-relevant emergency scenarios and sets of problem =
statements, directed messages or prepared questions designed to =
challenge emergency plans

 =

-        =
Analysis =
and documentation of agencies’ response to all drills, tabletop =
exercises and emergency events, including revisions to agencies’ =
emergency plans as needed

 

Based upon =
the final rule it is unclear how private duty agencies’ compliance =
with these requirements will be monitored and enforced.  These =
activities are likely to vary from state-to-state.

 

Private duty =
agencies have become accustomed to operating in a relatively unregulated =
industry, especially when compared to Medicare certified home health =
agencies.  The future is likely to bring more regulation of this =
industry, including with regard to emergency =
preparedness.

 

 

©2016 Elizabeth E. Hogue, Esq.  All =
rights reserved.

 

No portion of this =
material may be reproduced in any form without the advance written =
permission of the author.

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