CMS Updates Emergency Preparedness Guidance (SNF)

Last week, the Centers for Medicare & Medicaid Services (CMS) released revisions to QSO-20-41-ALL Guidance Related to Emergency Preparedness-Exercise Exemption. These revisions provide guidance and clarification regarding emergency preparedness exercise requirements during the ongoing COVID-19 public health emergency (PHE).

For Inpatient Providers, which includes long term care and skilled nursing settings, the updated guidance only applies if a facility is still currently operating under its activated emergency plan or has reactivated its emergency plan for COVID-19 in 2021 or 2022. Facilities which have resumed normal operating status (not under their activated emergency plans) are required to conduct their testing exercises based on the regulatory requirements for their specific provider or supplier type. This guidance provides clarifications on testing exemptions for those providers/suppliers who continue to operate under their activated emergency plan and those which may have reactivated their emergency plans for COVID-19.

This guidance will also apply for any subsequent 12-month cycles in the future, in the event facilities continue to operate under their activated emergency plans for COVID-19 response activities. If the facility is still operating under its currently activated emergency plan during its specified 12-month cycle of testing exercises, any currently-activated emergency plan will be recognized by surveyors as having met the full-scale exercise requirement for that 12-month cycle.

If the facility claimed the full-scale exercise exemption in 2020 and 2021 based on its activated emergency plan for COVID-19 response and has since resumed normal operating status, the inpatient provider/supplier is expected to complete its required full-scale exercise, unless it has reactivated its emergency plan for an actual emergency during its 12-month cycle for 2022.

To determine compliance, surveyors will:

• Identify the facility’s annual cycle.
• Ensure the facility has conducted two required exercises within the 12-month period, dependent on the scenarios above. Since the COVID-19 PHE is ongoing (over a 12-month period), CMS is clarifying that the inpatient provider/supplier is exempt from the 2021 and 2022 full-scale exercises so long as it is still currently operating under an activated emergency plan or has reactivated its plan at the onset of its 12-month cycle period (exercise cycle).
• Ask the facility to describe the exemption to ensure understanding that exemption is based on the scheduled next-required full-scale exercise, not the exercise of choice.
• Verify documentation evidence that the facility activated its emergency plan in order to determine whether the testing exemption is acceptable for use. Documentation may include, but is not limited to, the following:
  Notice of activation to staff via electronic systems (alerts);
  Proof of patient transfers and changes in daily operations based on the emergency;
  Initiation of additional safety protocols, for example, mandate for use of personal protective equipment (PPE) for staff, visitors and patients as applicable;
  Coordination with state and local emergency officials;
  Minutes of board/facility meetings;
  1135 Waiver (individual or use of blanket flexibilities); or,
  Incident command system related reports, such as situation reports or incident action plans.
• Determine based on the above examples, whether the facility is compliant with the exemption clause and has conducted the appropriate required exercises.