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Survey & Certification Group: Emergency Preparedness Rule
"On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation goes into effect on November 16, 2016." The purpose of this rule is "To establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems. This page provides additional information, such as the background and overview of the final rule and related resources.
Centers for Medicare & Medicaid Services (U.S.)
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Healthcare Payer Strategies to Reduce the Harms of Opioids
"Prescription opioid misuse and opioid use disorder (OUD) are significant and growing public health problems in the United States (U.S.) that impact stakeholders across the healthcare sector, including private, employer-sponsored, and public health plans.(1-4)[1] Healthcare payers (herein, payers), employer organizations, and law enforcement all have strong motivations to combat the inappropriate prescribing of opioids to improve patient health and reduce expenditures for medically unnecessary services and therapies. These are largescale problems for which payers play a critical role in reducing fraud, waste, and abuse while ensuring access to medically necessary therapies. Payers can help to combat the opioid crisis by identifying and sharing strategies, such as reimbursement and coverage policies, conditions for provider plan participation, and dissemination of information to a variety of audiences, to address the large-ranging issues that lead to fraud, waste, and abuse in the healthcare system. Such interventions are particularly suited to payers due to their relationships with providers of healthcare services, pharmacies, insured patients, employers, and law enforcement (in cases where potential fraud is identified). Payers collect and administer a large amount of healthcare information that can be used to identify and intervene on behalf of patients at risk of opioid-related harm, as well as to target fraud, waste, and abuse in opioid prescribing."
Centers for Medicare & Medicaid Services (U.S.)
2017-01
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Centers for Medicare & Medicaid Services (CMS) Opioid Misuse Strategy 2016
"Many Medicare and Medicaid beneficiaries and their families have experienced opioid use disorder, commonly referred to as addiction. Given the growing body of evidence on the risks of misuse, highlighted by the recently published guidance from the Centers for Disease Control (CDC), and the Administration's commitment to combatting the opioid epidemic, CMS [Centers for Medicare & Medicaid Services] is outlining our agency's strategy and the array of actions underway to address the national opioid misuse epidemic. Strategies outlined in this paper do not include CMS's vision for the treatment of cancer and hospice patients. Treatment of patients in these situations requires careful medical supervision based on therapeutic goals, ethical considerations, and the balance of risks and benefits of opioid therapy. Opioid drugs can treat both acute and chronic pain. While these types of drugs, including fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone, can have benefits for many patients with serious pain-related conditions, these drugs cause serious and substantial harm when used improperly. Even when used as directed, they contribute to overdose or lead to development of substance use disorder in some individuals. The high potential for misuse of opioids have led to alarming trends across the United States, including record numbers of people developing opioid use disorders, overdosing on opioids, and dying from overdoses. Opioid misuse places Americans at an elevated risk for heroin use, overdose, and death. Use by injection places them at risk for exposure to blood borne diseases, including HIV and Hepatitis C."
Centers for Medicare & Medicaid Services (U.S.)
2017-01-05
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Disaster Preparedness Toolkit for State Medicaid Agencies
"Medicaid has played a critical role in helping states and Territories respond to public health crises and natural and human-made disasters such as hurricanes (e.g., Hurricanes Katrina, Maria, Harvey and Irma), wildfires (e.g., California wildfires), flooding (e.g., Hurricane Harvey floods in Texas), and public health crises (e.g., Flint, Michigan lead contamination crises). To help Medicaid agencies prepare for such disasters in the future, the Centers for Medicare and Medicaid Services (CMS) Coverage Learning Collaborative developed a set of tools on the strategies available to support Medicaid operations and enrollees in times of crisis. Those tools are: (1) This memorandum which provides a high-level summary of the types of Medicaid and CHIP strategies that can be deployed by states and Territories. It is organized by operational area--eligibility and enrollment, benefits and cost sharing and provider workforce--and provides examples of how the strategies were used by other states and Territories. The memorandum also provides a review of the legal authorities that are available to effectuate various strategies, ranging from changes to State Plan Amendments to obtaining an 1135 Waiver. Finally, Appendix A provides a snapshot summary of the strategies, legal authorities and state examples. (2) A companion inventory of the various strategies available to states and the action needed to effectuate them. Based on interviews with federal officials and a review of federal statute, regulation and approved 1135 and 1115 demonstrations, the CMS Coverage Learning Collaborative team compiled a detailed list of all available strategies, some of which are available without needing approval from CMS. The inventory provides significantly more detail on available options than the memorandum."
Centers for Medicare & Medicaid Services (U.S.)
2018-08-20
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Medicaid and CHIP Coverage Learning Collaborative: Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Disaster
"Medicaid has played a critical role in helping states and Territories respond to public health crises and natural and human-made disasters such as hurricanes (e.g., Hurricanes Katrina, Maria, Harvey and Irma), wildfires (e.g., California wildfires), flooding (e.g., Hurricane Harvey floods in Texas), and public health crises (e.g., Flint, Michigan lead contamination crises). To help Medicaid agencies prepare for such disasters in the future, the Centers for Medicare and Medicaid Services (CMS) Coverage Learning Collaborative developed a set of tools to prepare states on the strategies available to support Medicaid operations and enrollees in times of crisis."
Centers for Medicare & Medicaid Services (U.S.)
2018-08-20
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Role of Medicaid and CHIP in Responding to Public Health Crises and Disasters [presentation]
These presentation slides address the role of Medicaid/CHIP [Children's Health Insurance Program] in responding to emergencies and/or disasters that involve a public health crisis.
Centers for Medicare & Medicaid Services (U.S.)
2018-08-13
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Information to Assist Providers and Suppliers in Meeting the New Training and Testing Requirements of the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule
"The Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule became effective on November 15, 2016 with an implementation date of November 15, 2017 (a correction notice was published on November 15, 2016 (81 FR 80594) correcting technical, typographical errors and did not alter the effective date). This means that as of November 15, 2017, all affected providers and suppliers must meet all of the applicable requirements of the rule. For additional background information, providers and suppliers may reference policy memorandum SC-17-05 'Information on the Implementation Plans for the Emergency Preparedness Regulation' published, on October 28, 2016."
Centers for Medicare & Medicaid Services (U.S.); United States. Department of Health and Human Services
2017-03-24
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Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (SOM)
"The Emergency Preparedness Final Rule (81 Fed. Reg. 63860, September 16, 2016) sets out requirements for all providers and suppliers in regards to planning, preparing and training for emergency situations. The rule includes requirements for emergency plans, policies and procedures, communications and staff training. While there are minor variations based on the specific provider type, the rule is applicable to all providers and suppliers. The emergency preparedness requirement is a Condition of Participation/Condition for Coverage which covers the requirement for facilities to have an emergency preparedness program."
United States. Department of Health and Human Services; Centers for Medicare & Medicaid Services (U.S.)
2019-02-01
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Tribal Nursing Home Best Practices: Emergency Preparedness
From the Document: "Across Indian Country, tribal nursing homes provide culturally sensitive long-term care environments where American Indian and Alaska Native elders can age with dignity and remain connected to their communities. Emergency planning is a crucial aspect of ensuring elders' comfort and safety. Many tribal nursing homes developed emergency preparedness plans to protect their residents in case of a natural disaster or other emergency. [...] A comprehensive, well-rehearsed emergency plan helps ensure that nursing home staff conduct evacuations and other emergency protocols efficiently to protect the safety of everyone involved. Having a plan in place reassures nursing home residents and their loved ones that they will remain safe in the event of an emergency. Many tribal nursing home emergency plans provide examples of culturally sensitive planning measures that other tribal facilities can emulate. This report describes the emergency preparedness approaches of five tribal nursing homes. It compiles emergency preparedness recommendations from nursing homes that have successfully created emergency plans and shares what has worked for these facilities, including leveraging partnerships, securing funding, and implementing staff training."
Centers for Medicare & Medicaid Services (U.S.); United States. Department of Health and Human Services
2017-12-01
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Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures, Appendix Z
From the Document: "On September 16, 2016, the final rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers was published (Federal Register Vol. 81, No. 180). This rule affects all 17 provider and supplier types eligible for participation in Medicare. The rule became effective on November 15, 2016 and will be implemented on November 15, 2017. [...] An advanced copy of the interpretive guidelines and survey procedures is available and will be incorporated into the SOM [State Operations Manual] under Appendix Z and applies to all 17 provider and supplier types. Since the Conditions of Participation (CoPs), Conditions for Coverage (CfCs) and requirements apply across providers and suppliers and only vary slightly, CMS [Centers for Medicare & Medicaid Services] has compiled the requirements under one appendix."
United States. Department of Health and Human Services; Centers for Medicare & Medicaid Services (U.S.)
2017-06-02
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