Final CMS Emergency Prep Rule Hits Home Health

Under a new final rule, home health agencies and other Medicare-certified providers will be required to meet emergency preparedness standards—or face the risk of losing national payor reimbursements.

The Centers for Medicare & Medicaid Services (CMS) issued its long-awaited rule on emergency preparedness at a time when numerous natural disasters over the last few years have put people’s health and safety in jeopardy. In wake of the recent devastating flooding in Louisiana that claimed the life of the founder and former CEO of Amedisys Inc. (Nasdaq: AMED) and more than a dozen others, emergency plans and procedures are all the more prominent.

Baton Rouge-based Amedisys was significantly impacted by the flooding surge. As one of the nation’s largest providers of home health care, the company makes its emergency preparedness a priority.

“With more than 420 care centers across the country, Amedisys deals with tornadoes, hurricanes and other natural disasters every year,” Kate Jones, RN, Amedisys senior vice president of public policy and research, told Home Health Care News. “Our Disaster Response Team followed its emergency preparedness and recovery plan to the letter during the unprecedented flooding in Baton Rouge, Louisiana, last month.”

More than 100 Amedisys employees were affected by the flooding in Louisiana, and the company had to help both its patients and employees.

“Because of our extensive disaster response efforts, Amedisys home health continued to not only see our current patients, but also continued to accept new referrals from the local hospitals,” Jones said. “All of these are the results of having a very strong emergency preparedness plan in place.”

The Louisiana floods specifically were invoked by CMS in its announcement of the new emergency preparedness standards.

“Situations like the recent flooding in Baton Rouge, Louisiana, remind us that in the event of an emergency, the first priority of health care providers and suppliers is to protect the health and safety of their patients,” CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., said in a press release. “Preparation, planning and one comprehensive approach for emergency preparedness is key. One life lost is one too many.”

While the importance of emergency preparedness cannot be understated, the new rule will certainly have some administrative and regulatory burdens on home health agencies and other health care providers.

In fact, the burdens could be heavier for home health care agencies, hospice providers and other long-term care services providers, as these care settings have not typically had emergency preparedness plans in place, according to Emily Lord, executive director at Healthcare Ready, an organization that works to ensure patient access to health care through public/private collaboration.

“Frankly, those three are the groups that will have the biggest burden,” Lord told Home Health Care News. “A lot of the other health care groups, like hospitals, have been doing this stuff for a while. It’s nowhere near as robust as CMS is saying they will have to do.”

Planning and Preparing

Mandating emergency preparedness and creating some standards across health care on this issue has been in the works for some time. In the case of an emergency, such as a natural disaster, access to health care can be critical. For example, Hurricane Sandy represented a real test of health care preparedness, where limitations on access to medication for chronic conditions resulted in avoidable emergency room visits. The new rule would help continued access to care with new, coordinated emergency plans and procedures in place.

The final rule mandates that heath care providers across 17 settings, including home health care, meet four industry best practices standards:

1. Emergency plan—Providers must develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies and disasters.

2. Policies and procedures—Develop and implement policies and procedures based on the emergency plan and risk assessment.

3. Communication plan—Develop and maintain a communication plan that complies with both federal and state law. Patient care must be well-coordinated within the facility, across health care providers and with state and local public health departments and emergency systems.

4. Training and testing program—Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.

CMS has noted that the standards will vary depending on the type of health care provider and care setting, though all health care groups must have their new procedures and plans in place by November 2017.

What’s at Stake

While the proposed rule for emergency preparedness was first introduced in 2013, an influx of new regulations for the home health industry over the last several years means this particualr mandate may not have been a priority, according to Lord. With a little more than a year to go, home health companies will have to ramp up to meet new compliance benchmarks and participate in training and testing their plan.

“There’s not a lot of time to do this,” Lord said. “[The rule] is not as stringent on home health care as hospitals, but home health still has to cover a lot of preparedness and planning, even just understanding their risk. They will have to look at what will impact the community and the people, like being ready if the power goes out, if there is flooding, and have special planning for the elderly.”

For larger health care providers, like Amedisys, and institutional systems, getting the emergency plan and procedures in place many also be easier than for smaller providers, like many home health care agencies.

“Any time that mandatory annual training is added as a regulatory requirement, it increases burden on the provider to some degree,” Jones said. “We already include emergency preparedness in our annual training, and already have comprehensive plans in place because of our geographic footprint.”

Amedisys plans to review the final regulations and will make revisions to its existing emergency plans. Hospital systems, for example, may have the resources to hire a consultant to come up with an emergency plan, while independent businesses may not.

“CMS doesn’t think [home health] will need to hire folks [to comply],” Lord said. “They assume it will be affordable to do the four phases of the plan. I don’t know that I agree with that—a lot of agencies don’t have business continuity, and they might have to hire someone. It’s going to take effort. …For smaller chains and independents, it’s going to be hard and a real burden.”

CMS has also outlined that it intends to tie reimbursements to compliance of emergency preparedness, though the immediate requirements are not yet explicit. For now, the issued rule may cause some immediate burdens for home health care companies, but the overall goals of emergency preparedness will likely result in stronger care settings and better patient outcomes.

“My guess is that there will be growing pains for a bit, but overall, patients will be protected,” Lord said. “I think it’s going to lead to much healthier communities.”

Written by Amy Baxter