Bill Mangieri CBCP, CHEP Region VI Field Project Officer ASPR/OEM/NHPP

1. National Healthcare Preparedness Program Proposed CMS Rule & FEMA Recovery Policy Bill Mangieri CBCP, CHEP Region VI Field Project Officer ASPR/OEM/NHPP

2. CMS Proposed Emergency Preparedness Rule Overview: The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to establish consistent emergency preparedness requirements, increase patient safety during emergencies for persons served by Medicare-and Medicaid-participating facilities, and establish a more coordinated response to natural and man-made disasters.

3. Proposed Requirements CMS has identified four specific areas that are central to an effective system. The proposed rule would require the participating providers and suppliers to meet these requirements, which include four standards: • Emergency plan--Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities. • Policies and procedures—Develop and implement policies and procedures based on the plan and risk assessment. • Communication plan—Develop and maintain a 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. • Training and testing program—Develop and maintain training and testing programs, including initial and annual trainings, conducting drills and exercises or participate in an actual incident that tests the plan.

4. Customized by Provider Types The proposed requirements are adjusted to reflect the characteristics of each type of provider and supplier. For example: • Outpatient providers and suppliers will not be required to have policies and procedures for provision of subsistence needs • Each Organ Procurement Organization (OPO) must have an agreement with another OPO to provide procurement services in the event that the OPO cannot provide such services due to an emergency • Hospitals, Critical Access Hospitals and Long Term Care facilities will be required to implement emergency and standby power systems based on their emergency plan • Religious Nonmedical Health Care Institutions and OPOs will only be required to conduct annual tabletop exercises.

5. CMS Proposed Rule Public Review View the Proposed Rule & Submit Comments by March 31st, 2014 https://www.federalregister.gov/articles/2013/12/27/2013-30724/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid

6. FEMA Recovery Policy 9525.4 Emergency Medical Care & Medical Evacuations Purpose: identifies the extraordinary emergency medical care and medical evacuation expenses that are eligible for reimbursement under the Category B, Emergency Protective Measures provision of FEMA’s Public Assistance Program following an emergency or major disaster declaration. Authority: Robert T. Stafford Disaster Relief and Emergency Assistance Act. Objective: The objective of this policy is to provide Federal assistance to eligible applicants to address immediate threats to life and property resulting from a major disaster or emergency.

7. Circumstances for Policy Implementation When the emergency medical delivery system within the designated disaster area is destroyed or severely compromised by the disaster event. When the State and local governments lack the capability to perform or contract for eligible emergency medical care or medical evacuation work, the State may request direct Federal assistance from FEMA.

8. Eligible Applicants State & local governments Private non-profit hospitals & nursing homes Note: Private for-profit hospitals are not eligible for reimbursement from FEMA, however, some costs that private for-profit providers incur under contract with an eligible applicant may be eligible for Public assistance funding, which FEMA will reimburse to the eligible applicant.

9. Eligible Emergency Medical Care Costs Overtime costs for regular permanent employees who perform eligible work. Transport of disaster survivors who require emergency medical care to medical facilities. Treatment and monitoring of disaster survivors who require emergency medical care. Vaccinations for disaster survivors and emergency workers. Temporary tents or portable buildings for treatment of disaster survivors. Security for temporary facilities.

10. Ineligible Costs • Medical care costs incurred once a disaster survivor is admitted to a medical care facility on an impatient basis. • Costs associated with follow-up treatment of disaster survivors beyond 30 days of the emergency or major disaster declaration. • Administration costs associated with the treatment of disaster survivors. • Loss of revenue.

11. Eligible Medical Evacuation Costs Overtime for permanent employees to evacuate and assist in the transport of patients from the original facility. Equipment costs incurred in the transport of patients from the original facility. Labor and equipment costs incurred during transport while returning the patient to the original medical or custodial care facility. Costs incurred from activation of contracts, mutual aid agreements, or force account resources in advance of an emergency or major disaster event necessary to prepare for medical evacuations in threatened areas.

12. Duplication of Benefits FEMA is prohibited from approving funds for reimbursement that are covered by any other source of funding. Applicants must first exhaust all existing sources of funding such as: • Private insurance coverage • Medicaid/Medicare • Any other pre-existing sources of funding

13. FEMA Reimbursement Resources • A Quick Guide for FEMA Reimbursement to Acute Care Hospitals http://www.ynhhs.org/emergency/pdfs/FEMA-ACH_ReimbursementGuide.pdf • FEMA Recovery Policy 9525.4 http://www.fema.gov/9500-series-policy-publications/95254-emergency-medical-care-medical-evacuations • FEMA IS 634 Intro to Public Assistance Program http://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=is-634

14. Thank You! Bill Mangieri CBCP,CHEP Region VI Field Project Officer National Healthcare Preparedness Program Office of Emergency Management Assistant Secretary for Preparedness & Response William.Mangieri@hhs.gov