Home Health & Hospice Week

Plus: OIG is going to examine EP CoP compliance.

Home health and hospice agencies have been flexing their emergency preparedness muscles since day 1 of the COVID-19 pandemic. But that doesn’t mean they’ll ace the newest federal requirements for EP — and a federal watchdog agency has its eyes on the issue.

Reminder: In a final rule published in the Sept. 30, 2019 Federal Register, the Centers for Medicare & Medicaid Services streamlined a number of duties under emergency preparedness requirements (see HCW by AAPC, Vol. XXIX, No. 5). That included how often facilities and providers have to conduct EP testing — for inpatient hospices, two training exercises a year; for HHAs and freestanding hospices, “one community-based full-scale exercise, if available, or an individual facility-based functional exercise, every other year and in the opposite years, these providers may choose the testing exercise of their choice” — including a drill, tabletop exercise, or workshop.

Plus: “Facilities that activate their emergency plans are exempt from the next required full-scale community-based or individual, facility-based functional exercise,” CMS said in a Sept. 28, 2020 memo to state surveyors, six months into the COVID-19 public health emergency.

Now CMS has issued a new memo to state surveyors with guidance regarding EP plan testing exemptions as the PHE wears on. “CMS recognizes many facilities are still operating under disaster/emergency conditions during the PHE, i.e., under an activated emergency plan. We are therefore providing additional guidance for inpatient providers/suppliers, consistent with the exemption authorized by the EP regulations,” says memo QSO-20-41-ALL revised on June 24.

Latest: The PHE is still in full force. Effective July 20, HHS Secretary Xavier Becerra renewed the PHE again. This renewal will last 90 days, and the Department of Health and Human Services has previously indicated it will keep the PHE going at least through the end of this year.

“The updated guidance” — i.e. the exemption from the full-scale exercise — “only applies if a facility is still currently operating under its activated emergency plan. Facilities which have resumed normal operating status (not under their activated emergency plans) and were exempted from a full-scale exercise for its 2020 cycle, must conduct a full-scale exercise or an individual facility-based exercise for its next cycle,” CMS instructs in the memo.

The key is whether your agency has resumed normal operations, the National Association for Home Care & Hospice notes in its member newsletter. “If the facility is still operating under its currently activated emergency plan, any currently activated emergency plan will be recognized by surveyors as having met the full-scale exercise requirement for 2021 (even if it claimed the exemption for the 2020 full-scale exercise),” NAHC explains.

In other words, the revised memo clarifies “that providers that continue to operate under the emergency plan and have not returned to normal operations may utilize the actual emergency exemption, even if the exemption was used during the last exercise cycle,” relates Visiting Nurse Associations of America affiliate LeadingAge on its website.

Don’t expect to get any sympathy from surveyors on the matter, since the HHS Office of Inspector General says it’s keeping an eye on a related EP topic. The OIG has added “Home Health Agencies’ Emergency Communication Plans: Strengths and Challenges Ensuring Continuity of Care During Disasters” to its Work Plan agenda.

“The COVID-19 pandemic highlighted the importance of emerging infectious disease (EID) preparedness in health care facilities, including home health agencies,” the OIG says in its Active Work Plan entry for the topic. Yet “natural disasters such as hurricanes, floods, and fires continue to threaten operations, even as HHAs continue to address the impact of COVID-19. In 2020, the United States experienced a record number of natural disasters, and Federal scientists predict a greater number of hurricanes and storms in 2021.”

Past natural disasters “highlighted vulnerabilities in HHAs’ preparedness for disasters, specifically with regards to communication and continuity of care,” the OIG claims. As part of agencies’ EP conditions of participation, “CMS requires HHAs to develop communication plans that must include information necessary to ensure continuity of care during any emergency. This evaluation will determine selected HHAs’ compliance with EP CoPs and will report factors these HHAs identify as hindering and/or supporting continuity of care during a disaster.”

The OIG plans to issue its report on the topic in 2023.

Note: The 11-page updated survey memo is at www.cms.gov/files/document/qso-20-41-all-revised-06212021.pdf. The OIG Work Plan entry is at https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp.