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Revisions to CMS Emergency Preparedness Rule Could Hinder Developing Collaboration

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
December 7, 2018

In November 2017, the Centers for Medicare and Medicaid Services (CMS) instituted an emergency preparedness rule (the rule) issuing specific preparedness requirements for which 17 different types of health care providers would be responsible. Standards included in the rule cover areas including risk assessment, policies and procedures, communication plans and training and testing. The development of the rule began in the wake of Hurricane Katrina, during which many hospitals struggled to provide adequate care for their patients amid all the devastation. The need for health facilities to be able to meet standards of care under crisis conditions has certainly not diminished, as evidenced by stories emerging from hurricanes in Florida and Texas as well as wild fires in California. However, CMS did recently issue a proposed rule to change some of the requirements under the preparedness rule, among other proposed revisions.

This discussion will focus on the revision which would no longer require facilities to document efforts to contact preparedness officials at any level of government or collaborative and cooperative planning efforts with other facilities. According to the proposed change, such work would still be required, but without full documentation. The CEO of the National Association of County and City Health Officials, Lori Tremmel Freeman, makes a convincing argument in her written response  that it has had an important and positive effect in terms of encouraging collaboration:

Since inception of the final rule, local health departments have noted increased engagement and breadth of participation by healthcare entities, such as long-term care and dialysis centers, who previously were not involved in local or regional healthcare coalitions and other joint-planning efforts.

 It should be noted NACCHO represents publicly-funded local health departments. The American Hospital Association, which represents hospitals that are primarily privately funded, expressed support for changes to the emergency preparedness rule due to concerns about cost and administrative burdens, although it does not address documenting coordination specifically. The American Medical Association did not take an official position on the documentation issue in their comment regarding the proposed rule.

NACCHO expresses concern that the proposed change “would reduce accountability and transparency in whether and how the collaboration is occurring.” Based on my experience talking with those in the health emergency preparedness field, the facilities that became involved in health care coalitions after the enactment of the CMS rule would reduce that participation unless they are required to document that activity. With limited resources and time, people will focus on those tasks in health care for which they know they will be held accountable. If you remove the accountability check on engaging in collaboration, it will get lost amidst all the other responsibilities facilities have.

While it may be true that healthcare practitioners and staff are very busy, preparedness can no longer be treated as a second or third-tier priority in the health care system, as we face stronger and more frequent hurricanes, larger and more dangerous wild fires, as well as infectious disease emergencies involving influenza and measles. Recent failures within the healthcare system where patients were not evacuated in a timely manner during a heat wave or allegedly abandoned in a wildfire show the terrible consequences when preparedness is not emphasized. It also shows that collaboration and coordination between facilities is desperately required.

I have seen the benefits of the rule in terms of bringing together health care constituencies from long-term care, ambulatory surgery centers, and hospice organizations to discuss preparedness and consider their important role in the system. These trainings and discussions would not have happened without the rule’s requirements for facilities to coordinate and collaborate. The activities surrounding the implementation of the rule have led to new, important conversations that promote better preparedness in the community. This work happened because of leadership from the Centers for Medicare and Medicaid Services which sent the message that this was important for our country. Revising the rule at this point in time will send the message that the federal government places less value on partnership at the local, state, and tribal levels. It will also reinforce the dangerous perception by some that they can just “wait out” regulations like the CMS emergency preparedness rule.

The CMS emergency preparedness rule should be given more time to be evaluated before changes are made, as noted by the AARP in their comment. Particularly in rural areas where health care resources are limited, it is important to do everything possible to incentivize the building of relationships in advance of an emergency. More data should be collected to determine the influence that the rule has had on preparedness and relationships within the health sector before revisions are made. As suggested by the AARP, it is possible that the requirements of the emergency preparedness rule “could become smoother and less burdensome over time as facilities gain more experience with their emergency preparedness programs.” Careful consideration should also be given to how the change will affect the quality of hospital emergency plans and training used to prepare for disasters, which are also addressed in the proposed revision.


Author: Nathan Myers is an associate professor of Political Science at Indiana State University. He primarily teaches courses in the Master of Public Administration program. Myers is also a member of the Indiana State University Center for Genomic Advocacy. His teaching and research interests include organizational behavior, public health policy, and biotechnology policy associated with genomic research. He can be reached at [email protected] 

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