CMS Rule Changes: What Health Centers Need to Know

Dec 04, 2019

Guest Author: Tina Wright, Director, Emergency Management, Massachusetts League of Community Health Centers

Healthcare is a highly regulated industry on not only the federal and state levels, but also by accreditation and safety standards. After reviewing the severe damage following disasters (including severe weather such as Hurricanes Katrina and Sandy and human-made disasters such as utility accidents), the Centers for Medicare and Medicaid Services (CMS) established minimum emergency preparedness requirements which went into effect in 2016. These requirements mandate that healthcare providers and facilities focus on continuity of care for patients during emergencies.

The minimum requirements established by the original CMS emergency preparedness rule include creating and maintaining an Emergency Management (EM) program, which consists of conducting an all-hazards risk assessment, creating an emergency plan, as well as policies and procedures related to the plans, creating an emergency communications plan, and training staff on an annual basis and testing program elements through two (2) annual exercises. Since this was the first time for many healthcare providers to do any kind of emergency preparedness activities beyond standard fire evacuation drills, health centers and other facilities struggled to meet the minimum set forth and enforced by CMS and advised that the rule exacerbated healthcare providers’ already excessive administrative burden.

According to CMS

In an “effort to balance patient safety and quality of care while limiting unnecessary procedural burdens on providers, and in accordance with the January 30, 2017 Executive Order ‘Reducing Regulation and Controlling Regulatory Costs’ (Executive Order 13771), CMS has conducted a comprehensive review of the regulatory health and safety standards for applicable provider and supplier types. CMS issued this final rule to revise the applicable regulations as a continuation of our efforts to reduce regulatory burden in accordance with the aforementioned Executive Order…. These finalized revisions balance patient safety and quality, while also providing broad regulatory relief for providers and suppliers.”

Changes specific to federally qualified health centers (FQHCs) include changing annual maintenance of emergency management programs to every other year. Other changes include:

  • Review and maintenance of plans (emergency operations and communications plans), policies, and procedures frequency requirements changed from annual to biennial (once every 2 years)
  • Elimination of requirement to document cooperation and collaboration with local officials. (Although facilities no longer required to document partnership, they should be able to describe the process)
  • Training and testing program must be reviewed and updated at least every 2 years
  • Provide emergency preparedness training to staff at least every 2 years
  • Added: "if the emergency preparedness policies and procedures are significantly updated, the FQHC must conduct training on the updated policies and procedures”
  • Testing requirement changed from 2 exercises per year to 1, and exercises are to alternate in complexity
  • Additional changes included aligning the definition of exercises with those set forth in the Homeland Security Exercise and Evaluation Program (HSEEP), as well as adding new definitions for what qualifies for testing and training:
    • Functional Exercise (FE): “FEs are designed to validate and evaluate capabilities, multiple functions and/or sub-functions, or interdependent groups of functions. FEs are typically focused on exercising plans, policies, procedures, and staff members involved in management, direction, command, and control functions” as defined by HSEEP.
    • Mock Disaster Drill: A drill is a coordinated, supervised activity usually employed to validate a specific function or capability in a single agency or organization. Drills are commonly used to provide training on new equipment, validate procedures, or practice and maintain current skills.
    • Workshop: A workshop, for the purposes of this guidance, is a planning meeting/ workshop which establishes the strategy and structure for an exercise program.
    • Click here for additional details.

What do these changes mean to health centers today?

Ideally, the changes will result in staff relief, a reduction of the burden of proof, and flexibility to allow more time to update the various elements throughout the health center’s EM Programs. EM leads at health centers are now able to alter timelines of their activities, which offers more opportunities for improving processes, including the ability to continually onboard and train staff on components of the EM Program and focus on cultivating a culture of preparedness throughout their health center. However, there is concern that the burden reduction will lead to a drop in support and buy-in from facility leadership, and an assumed decline in participation with local and regional healthcare preparedness coalitions and other emergency management activities. An additional concern is that these changes will cause added confusion, and may conflict with other EM requirements set forth by individual states and accreditation agencies (such as the Joint Commission).

As the CMS rule for burden reduction changes went into effect on November 27, 2019, the Health Resources and Services Administration (HRSA) is now tasking Primary Care Associations (PCAs) nationally to take up targeted EM activities in the 2020-2023 project cycle. HRSA’s overarching goals for the enhancement of FQHC emergency preparedness includes increasing formal agreements between health centers and PCAs for the purposes of operational status reporting, as well as increasing the amount of EM training and technical assistance to health centers while leveraging the CMS rule and alignment with HRSA resources. Many PCAs across the country have participated in the PCA Emergency Management Advisory Coalition (click here to visit EMAC), a high-functioning peer group of professionals devoted to emergency management and serving the needs of FQHCs and Look-alikes. Through EMAC, training, education, and various tools on the CMS rule have been shared since 2013, and while HRSA is now making EM for health centers a priority across the country, health centers have seen the value and return on investment for their facilities and patients to continue to enhance their abilities to prepare for, respond to, and recover from emergencies and disasters.

What does the future hold for health centers in EM?

Through the CMS requirement for planning for continuity of care of patients, and with the HRSA overarching EM goal, health centers will be provided targeted support from both PCAs and other National Training and Technical Assistance Partners (NTTAPs) collaborating on EM Programs with the intent to improve operations and restore continuity of services for their patients. Because health centers are rooted in responding to the emerging needs of their communities, it is not surprising that most identify their role in EM to be similar to what they do every day, and are well-positioned to continue to enhance their operational readiness to be community responders.

Want to learn more about the CMS rule and recent changes to its requirements? Take a look at NNCC’s CMS Rule Checklist, now updated to reflect the CMS burden reduction changes.

Stay Connected to Nurse-Led Care