The Centers for Medicare & Medicaid Services may soon intensify its reform agenda focus on emergency planning, one of many areas targeted in President Biden’s 21-point nursing home plan unveiled earlier this year.

That’s according to knowledgeable observers reflecting on this week’s CMS announcement that it will be using input from providers at an upcoming emergency preparedness listening session to consider regulation changes.

“That flashes out to me with blinking red lights. We know that emergency preparedness was highlighted in the White House reform plan. We also know it was highlighted in the report from the National Academies,” Jodi Eyigor, director of nursing home quality and policy for LeadingAge, said on a call with members Wednesday. 

I think that we all need to be prepared for a lot more focus on emergency preparedness. I have been a little surprised that we haven’t heard more yet,” she added. “I felt like it was conspicuously missing from that guidance that CMS released at the end of June.”

The Phase 3 Requirements of Participation guidance Eyigor referenced did provide some updates to physical environment and infection control rules, but nothing as sweeping as what could be ahead.

CMS said in July, following the publication of a highly critical Office of Inspector General report, that it would likely roll the watchdog’s suggestions into new regulations. That report found problems with life safety and emergency preparedness — including concerns about emergency plans, supplies, training and facilities’ ability to meet life safety requirements at 150 of 154 nursing homes audited.

The timeline of CMS’ possible response remains vague, but safety experts said nursing homes need to start preparing now.

“They’ve got to move away from just paper compliance because they see it as an unfunded mandate,” said Stan Szpytek, president of the consulting firm Fire and Life Safety and a national life safety/disaster planning consultant. “They’ve got to take it more seriously.”

More heat coming

Life safety and emergency planning requirements have ranked below the importance of clinical and operational requirements, both among some nursing homes and surveyors. Szpytek said it took them a while to fully understand and embrace the first emergency preparedness appendix implemented in 2017, but he has seen a recent uptick in the number of emergency preparedness E-tags given and the severity of violations.

Whether CMS adds new types of emergencies to consider — such as climate change or other prolonged crises — or simply toughens its stance on current provisions is “the big unknown,” Szpytek said.

“I’m thinking they’ll just dig in,” he added. “I think the enforcement is going to get more focused and more intense.”

Too often, he said, skilled nursing staff may not understand emergency plans and be able to explain the basics to a surveyor. CMS expanded its hazard vulnerability requirements to cover infectious disease, staffing shortages and other lessons from the pandemic. It is believed it may now push providers to adopt more robust practice and preparation standards.

Without better preparation, providers might not be truly proficient in the face of a weather or man-made crises “unless you’ve got the actual rubber meeting the road, where people can put these into practice,” Szpytek said.

CMS may have revealed insights into its thinking in the outline for its listening session, to which attendance was limited to 150 registrants.

“They want to know things like what were your experiences developing your emergency preparedness plans, do current requirements pose any unintended barriers to your work, what resources do you use to inform your plans, what resources do you need as you update your plans,” Eyigor explained. “And how do you stand down your plan and recover following an emergency.”

Strengthening pandemic and emergency preparedness were among the final elements listed on the White House’s lengthy reform fact sheet issued in February.

“Both the pandemic and the increase in natural disasters have demonstrated how critical proactive emergency preparedness is to keeping residents of nursing homes safe,” the administration said. “CMS is examining and considering changes to emergency preparedness requirements and is working to bolster the resiliency of the healthcare sector as part of an administration-wide effort to be ready for the next pandemic and the next weather-related emergencies.”