Home Health & Hospice Week

Clarifications may keep you out of hot water with surveyors.

With the COVID-19 public health emergency fully into its third year, providers have been wondering about their ongoing responsibilities for Emergency Preparedness testing. Now they have an answer.

Background: In a final rule published in the Sept. 30, 2019 Federal Register, the Centers for Medicare & Medicaid Services streamlined a number of duties under EP requirements (see HCW by AAPC, Vol. XXIX, No. 5). That included how often facilities and providers have to conduct EP testing.

One of the changes in the rule was to allow inpatient providers — including inpatient hospices — to conduct two training exercises a year. “One of the two annually required testing exercises could be an exercise of their choice, which could include one community-based full-scale exercise (if available), an individual facility-based functional exercise, a drill, or a tabletop exercise or workshop that included a group discussion led by a facilitator,” CMS explained in the final rule. The other test must be a community-based full-scale exercise, if available, or an individual facility-based functional exercise.

For home health agencies and freestanding hospices, Medicare requires them to conduct “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.

However: Another new rule provision came into sharp focus under the COVID PHE. “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 released on Oct. 2 of that year. To access this exemption, “facilities must be able to demonstrate, through written documentation, that they activated their program due to the emergency,” CMS told surveyors in QSO-20-41-ALL.

In the updated memo, CMS adds some qualifiers to that exemption for providers that are still operating under their emergency plans, or that have reactivated them. “While facilities may claim the exemption if operating under an activated emergency plan, CMS encourages facilities to conduct full-scale or individual facility-based exercises in order to ensure facilities are fully prepared to respond to all emergencies, should they arise,” the memo says.

“We also note that some facilities may be operating under an activated emergency plan for the COVID-19 PHE and are required to activate additional plans or procedures based on another disaster or emergency such as inclement weather,” CMS adds. “Full-scale exemptions due to an actual disaster are based on any activation of the emergency plan during the facility’s 12-month cycle. Exemptions do not accumulate or carry over to following full-scale exercises,” the memo instructs.

The memo adds a few new scenarios to explain its updated guidance. The National Association for Home Care & Hospice highlights this example from the memo as helpful to hospice and home health agencies:

Question: “Facility Z conducted a table-top exercise in June 2019 (based on its annual cycle). It is scheduled to conduct a full-scale exercise in June 2020. In March 2020, Facility Z activates its emergency preparedness program due to the COVID-19 PHE. The facility conducts its required exercise of choice in June 2021. As of March 2022, the facility continued to operate under an activated emergency plan.

“When must the facility conduct its next required full-scale exercise? What is the exemption based on the requirements?”

Answer: “The facility is exempt from the June 2020 scheduled full-scale exercise for that ‘annual year’ and is required to complete an exercise of choice in June 2021, and a following full-scale exercise in June 2022. It is exempt from its next required full-scale or individual facility-based exercise which would have been in June 2020. However, since the facility is continuing to operate under its activated emergency plan in early 2022, the facility is exempt from the full-scale exercise in June 2022,” the updated memo clarifies. 

Note: The revised memo is at www.cms.gov/files/document/ qso-20-41-all-revised-05262022.pdf.