Emergency Preparedness: New CMS Rules for ICFs/IID OHCA / OCID August 24, 2017 Dustin M. Ellinger BSN, MHA, RN Rolf Consulting LLC
So What s New? 2012 Life Safety Code Published: May 4, 2016 (S&C 16-22-LSC) Effective: July 5, 2016 Implementation: November 1, 2016 Emergency Preparedness Rule Published: September 16, 2016 Effective: November 15, 2016 Implementation: November 15, 2017
2012 LSC References
2012 LSC Key References NFPA 101 (2012 ed.) Life Safety Code Handbook Core Chapters (18/19 Health Care) Other chapters address means of egress, fire protection, etc. NFPA 99 (2012 ed.) Health Care Facilities Code Handbook (for Health Care Occupancies) Key Areas Addressed Gas and Vacuum Systems, Electrical System, HVAC, Medical Gases, Fire Protection New Requirement for Risk Assessment **Other References NFPA 10, NFPA 13, NFPA 25, NFPA 70, NFPA 72, NFPA 80, NFPA 96, NFPA 110, NFPA 220
The Form CMS-2786V
The Form CMS-2786R
Procedural Changes Fire Safety Evaluation System (FSES) Equivalency concept used in lieu of waivers Grandfathered buildings no-longer performed by ODH Approximately 40-50 buildings affected FSES required with annual LSC survey (qualified consultant) The Short Form Used for Health Care Occupancy Not used as of September 1, 2016 New process under consideration
Emergency Preparedness Existing Health Requirements W438 W439(CFR 483.70[h]) Standard: Emergency Plan and Procedures (1) The facility must develop and implement detailed written plans and procedures to meet all potential emergencies and disasters such as fire, severe weather, and missing clients. (2) Must communicate, periodically review, make the plan available, and provide training to the staff
Emergency Preparedness Existing Health Requirements W440 W451(CFR 483.70[i]) Standard: Evacuation Drills (1) The facility must hold evacuation drills at least quarterly for each shift of personnel and under varied conditions to ensure all personnel on all shifts are trained to perform assigned tasks and ensure that all personnel on all shifts are familiar with the use of the facility s fire protection features and evaluate the effectiveness of emergency and disaster plans and procedures
Emergency Preparedness Existing Health Requirements (CFR 483.70[i], continued) (2) The facility must actually evacuate clients during at least one drill each year on each shift make special provisions for the evacuation of clients with physical disabilities file a report and evaluation of each evacuation drill investigate all problems with evacuation drills, including accidents and take corrective action during fire drills, clients may be evacuated to a safe area in facilities certifed under health care occupancy chapter (18/19) of the Life Safety Code. (3) Live-in relief staff must meet quarterly drill requirement
Emergency Preparedness Existing Health Requirements W451-439(CFR 483.70[j]) Standard: Fire Protection (1) The facility must meet Life Safety Code (NFPA 101) health care occupancy (18/19) or Residential Board and Care (32/33) (2) The survey agency may apply one or both occupancy chapters (3) Board and Care occupancies must have evacuation capability evaluated (4) applicability of state fire code (5) Must comply with battery lighting (90 min) *
New Preparedness Rules
Emergency Preparedness Rule Published in Federal Register on September 8, 2016 Effective November 15, 2016 Compliance Expected by November 15, 2017 Advanced Guidelines Published by CMS on June 2, 2017 CFR 483.475 Condition of Participation: Emergency Preparedness (a)emergency Plan based on risk assessment, all-hazards approach (b)policies and Procedures based on plan and risk assessment (c)communication Plan coordination of patient care internally and externally, and communications with emergency officials (d)training and Testing initial and annual training, drills and exercises and/or participate in actual incident that tests plan
Advanced Guidance (App. Z) S&C 17-29-ALL Published June 2, 2017 Interpretive Guidelines will be incorporated into the State Operations Manual under Appendix Z All 17 provider types listed in App. Z Citations will be cited as E Tags (e.g., E0001 to E0044) State agencies will decide whether evaluated by Health or Life Safety Code surveyors Questions about Emergency Preparedness Rule can be sent to SCGEmergencyPrep@cms.hhs.gov
(a) Emergency Plan Reviewed and Updated Annually Community-based, all-hazards approach, including missing residents Based on risk assessment (slides to follow) Population-specific *Includes: continuity of operations delegations of authority succession plans cooperation with state & local leaders *Templates available online
(b) Policies and Procedures Subsistence needs for staff and clients, whether evacuating or shelter food, water, medical, and pharmaceutical needs Alternate sources of energy to maintain safe temperature, emergency lighting, fire suppression, sewage/waste System to track location of staff and residents Evacuation (not just locations but how to ) & transfer agreements Means to shelter in place for those remaining Medical records documentation Use of volunteers 1135 Waiver
(c) Communication Plan Names and contact information for: Staff Entities providing services under arrangement Clients physicians Other ICFs/IID Volunteers Federal, state, regional emergency preparedness staff Licensing and certification agencies State protection and advocacy agencies Primary and alternate means to contact staff / EMA entities Method for sharing info with other care providers for continuity Means to release information Means of providing general condition and location info Means of communicating with incident command center Sharing info with residents / families
(d) Training & Testing Initial and Annual Training (with documentation) Unannounced staff drills Full-scale community-based exercise (unless actual event activates plan) Second full-scale exercise or tabletop exercise, with after action review Integrated healthcare systems May participate in integrated program However, each certified facility must participate in development Must take into account each facility s unique circumstances, population, services
Training and Testing Memo CMS S&C 17-21 ALL, published March 24, 2017 Training and Testing requirements expected to be fully met by November 15, 2017 Includes both full-scale, community-based exercise and tabletop exercise. Note: CMS says they understand that a full-scale community-based exercise may not always be possible for some providers and suppliers and outlines provisions for completing an individual facility-based eoercise with documentation of why the community-based exercise couldn t be completed. Follow CMS S&C Policy and Memos to States
Emergency Rule FAQ Continuity of Operations, Delegation of Authority, Succession Planning No specific format or order required but plan must include these elements Resource provided below http://www.phe.gov/preparedness/planning/hpp/reports/documents/hccoop2-recovery.pdf (See FAQ #1) Must be coordinated with local EMA officials no sign off Community involvement Check ODH website for list of existing coalitions What does training encompass? Initial and Annual Exercises and Drills All Staff, but responsibilities may be delineated
Emergency Rule FAQ Hazard Vulnerability Assessment (HVA) All Hazard Approach No specific form recommended Good example: Kaiser Permanente HVA http://www.calhospitalprepare.org/hazard-vulnerability-analysis Typical HVA Components Natural Hazards Technological Hazards Human Hazards Hazardous Materials
Emergency Rule FAQ Generator for Hospitals, CAH, LTC may be necessary to power HVAC system (not explicit in other provider types) Mandatory Generator vs. Mandatory Alternate Source of Energy to Maintain Temperatures Alt energy source required to maintain temperatures to protect individuals and storage of provisions Must be able to maintain temperatures in emergency Could involve heating and cooling in loss of power Need to evaluate during risk assessment ***NEW GUIDANCE PROVIDED IN APPENDIX Z***
Generator Clarification This specific standard does not require facilities to have or install generators or any other specific type of energy source Facilities must establish policies and procedures that determine how required heating and cooling of their facility will be maintained during an emergency situation, as necessary, if there were a loss of the primary power source If portable generators used, should be operated, tested, and maintained in accordance with manufacturer, local and/or State requirements. If permanent generator used, must meet NFPA standards.
Emergency Rule FAQ Safe storage of provisions means food, water, pharmaceuticals or medications and medical supplies No specific quantities of medical supplies (e.g. xx days) are specified. Examples of facility or community-based exercises: Earthquake, Hurricane, Tornado, Flood Blizzard* Fire Cyber Attack Infectious Disease Outbreak Medical Surge Active Shooter
New Surveyor Tool (E-tags)
Other Resources OHCA Website / Training Opportunities CMS Emergency Preparedness Rule / Google for website Frequently Asked Questions Table of Requirements Hazard-specific guidance Templates and Checklists Hazard Vulnerability Analysis Tools Provider / trade associations (e.g., AHCA) Many websites (e.g., Kaiser Permanente, OSHA, FEMA, etc.) Incident Command System FEMA.gov ICS Resource Center Technical Resources, Assistance Center and Information Exchange ASPR TRACIE www.asprtracie.hhs.gov
Questions?