ANNEX I JOINT REGION MUTUAL AID PLAN (MAP) MEMORANDUM OF UNDERSTANDING 1. I. Introduction and Background

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1 ANNEX I JOINT REGION MUTUAL AID PLAN (MAP) MEMORANDUM OF UNDERSTANDING 1 I. Introduction and Background As in other parts of the nation, members of the Mutual Aid Plans (MAP) are susceptible to disasters that could exceed the resources of any single Regional MAP. A disaster could result in the need to evacuate residents out of the facility or even the region. It is also possible for the disaster to result in the need for transportation and supplies from healthcare facilities and vendors in or out of the region. II. Purpose of Mutual Aid Memorandum of Understanding The mutual aid support concept is well established and is considered standard of care in most emergency response disciplines. The purpose of this mutual aid support agreement is to aid facilities in their emergency management by authorizing the assistance of transportation or supplies. This support may also include accepting and caring for evacuated residents from the disaster-struck facility. This Mutual Aid Memorandum of Understanding (MOU) is a voluntary agreement among the individual Long Term Care (nursing facilities), Assisted Living and Rest Home organizations for the purpose of providing mutual aid at the time of a disaster. For purposes of this MOU, a disaster is defined as an overwhelming incident that exceeds the effective response capability of the impacted health care facility or facilities and/or a particular Regional MAP. The following plan is designed for those disasters where an unpredictable event requires the immediate, short term evacuation of residents or the need of supplies to continue operations. It is NOT designed as part of a contingency plan for long term resident evacuation due to employee strike or closure of a health care facility. An incident of this magnitude will almost always involve the Local Emergency Management Office, the Massachusetts Department of Public Health (DPH) and/or the Executive Office of Elder Affairs and activation of the MAP Regional Coordinating Center (titled differently based on the unique complexities of Region 1 5.) The disaster may be an external or internal event for facilities within a Regional MAP and assumes that each affected facility s internal emergency management plans have been fully implemented. It also assumes the MAP of the disaster area has been activated as far as possible. 2 The Joint Region Mutual Aid Plan is grateful to the American Hospital Association and the District of Columbia Hospital Association who developed the original MOU from which this is adapted. Annex 4.1

2 By signing this Memorandum of Understanding (MOU) all facilities are evidencing their intent to abide by the terms of the MOU in the event of a disaster as described above. The terms of this MOU are to be incorporated into the facility s Emergency Management Plans and Emergency Operations Plans. Should any changes occur during the plan year that would preclude a facility in a particular Regional MAP from participating, or if changes in contact persons or phone numbers should become necessary, you must notify the Steering Committee of your Regional MAP. III. Definition of Terms Command Center (facility command post) Community Emergency Response Teams (CERT) Dept. of Public Health Reportable Incidents (require notification of DPH) A location from which Facility Incident Command oversees all incident operations. It will be established in a facility during an emergency and will be the facility s primary point of administrative authority and decision-making. is a group of volunteer emergency workers who have received basic training in disaster preparedness, disaster fire suppression, basic disaster medical operations, light search and rescue, and team operations. They are designed to act as an auxiliary to existing emergency responders in the event of a major disaster. 1. All incidents seriously affecting the health or safety of patients or residents 2. Occurrence of epidemic disease, including food poisoning 3. All fires 4. All deaths resulting from incidents within a facility 5. Other emergencies (Note: This item is in the section under Disaster). See 105 cmr or for more information. The Executive Office of Elder Affairs has Reportable Incidents and should be reviewed directly with Elder Affairs. Disaster (within a facility) Disaster (community-wide) An incident that exceeds a facility s effective response capability or cannot appropriately be resolved solely by using its own resources. Such disasters will very likely involve the local emergency management agency, first responders, Massachusetts DPH, and may involve loan of transportation or supplies from another facility, or the emergent evacuation of residents. An incident that is more wide spread and affects several health care facilities at or about the same time. Since the community is also affected, local vendors could be caught in the same disaster incident. This disaster could overwhelm the Regional MAP in its ability to place numerous evacuated residents or provide needed supplies and transportation. In addition to the Disaster (within a Annex 4.2

3 facility), Massachusetts Emergency Management Agency (MEMA) would also be activated for a Community-wide incident. Disaster Medical Assistance Team (DMAT) Disaster Struck Facility Donor Facility Facility Emergency Support Function (ESF 8) Health & Homeland Alert Network (HHAN) Joint Region Mutual Aid Plan (MAP) A DMAT is a volunteer group of medical and nonmedical individuals, usually from the same State or region of a State, who have formed a response team under the guidance of the National Disaster Medical System, or under similar State or local auspices. Facility where the disaster occurred (for internal or external disasters). Transportation or supplies may be requested, or the evacuation of residents may be required. Facility that provides transportation, pharmaceuticals or supplies to another. Long Term Care (skilled nursing), Assisted Living and Rest Homes. This is the health and medical support function at the state government (or federal level) that facilitates communication, cooperation and coordination with local municipalities and supporting agencies concerning regional health and medical service issues and activities in a regional or state-wide disaster. Primary form of alert notification for all Regions of the plan. This is the agreement that joins the six (6) Regional Mutual Aid Plans so they can help each other when a regional plan is overwhelmed. Levels of Care: Assisted Living Residences ALRs offer a combination of housing, meals and personal care services to adults on a rental basis. Assisted living residences are not the same as licensed nursing facilities; ALRs do not provide medical or nursing services. They are not designed for people who need serious medical care. Instead, assisted living is intended for adults who may need some help with activities such as housekeeping, meals, bathing, dressing and/or medication reminders and who would like the security of having assistance available on a 24 hour basis in a residential and noninstitutional environment. The underlying philosophy of assisted living is based on providing needed services to residents in a way that enhances their autonomy, privacy and individuality. Residents have the right to make choices in all aspects of their lives. Level I Intensive Nursing and Rehabilitative Care A facility or units thereof that provide continuous skilled nursing care and an organized program of restorative services in addition to the minimum, basic care and services required. Level II Skilled Nursing Care A facility or units thereof that provide continuous skilled nursing care and meaningful availability of restorative services and other therapeutic services in addition to the minimum, basic care and services required. This can also include care facilities for children. Annex 4.3

4 Level III Supportive Nursing Care A facility or units thereof that provide routine nursing services and periodic availability of skilled nursing, restorative and other therapeutic services, as indicated, in addition to the minimum, basic care and services required. For patients whose condition is stabilized to the point that they need only supportive nursing care, supervision and observation. Level IV Resident Care Facilities A facility or units thereof that provides or arranges to provide, in addition to the minimum basic care and services required, a supervised supportive and protective living environment and support services incident to old age for residents having difficulty in caring for themselves and who do not require Level II or III nursing care or other medically related services on a routine basis. The facility s services and programs seek to foster personal well-being, independence, and optimal level of psychosocial functioning, and integration of residents into community living. Community Support Facility (technically part of Level IV) A resident care facility in which the Department of Public Health determines that 50% or more of the facility s residents are Community Support Residents. The Community Support Facility is the only Level IV facility allowed to routinely admit Community Support Residents and will be expected to maintain 50% or more of these residents. The central purpose of a CSF shall be to provide its current Community Support Residents, and new Community Support Resident admissions, with mental health and support services. These services will be provided in order to assure resident security and the provision of appropriate care, as well as to maximize resident independence, prevent reinstitutionalization and, wherever possible, provide rehabilitation and integration into the community. Liaison Officer MAP Regional Coordinating Center Massachusetts System for Advance Registration of Volunteer Health Professionals (MSAR) Medical Reserve Corp (MRC) Regional Mutual Aid Plan (MAP) A healthcare staff member that knows the facility, its Administration & Incident Command System. Primary facility contact position when the Regional or Joint Region Mutual Aid Plan is activated. These Centers operate out of each of the six (6) regions (1-3, 4A/B, 4C, 5) and provide coordinating support for the Regional or Joint Region Mutual Aid Plan with regards to supplies, equipment, communications, transportation and distribution of residents to other care facilities. These facilities may have different names in each Region. The Massachusetts Department of Public Health (MDPH) has launched MSAR, a statewide, secure database of pre-credentialed health care professionals who have agreed to volunteer their services in the event of a public health emergency. The mission of the Medical Reserve Corps (MRC) is to improve the health and safety of communities across the country by organizing and utilizing public health, medical and other volunteers. Agreements among health care facilities in a particular geographical region to help each other during a disaster with supplies, transportation or accepting evacuated residents. Annex 4.4

5 Regional Steering Committee Resident Accepting Facility Stop-over Site/Point Task Force / Steering Committee Group of people who oversee the Regional Mutual Aid Plan. Facility that receives evacuated residents. Nearby building where residents can be held pending return to original healthcare facility or distribution into Mutual Aid Plan. This building should be reviewed for its ability to handle the entire resident population or multiple facilities should be chosen to accomplish this. Additionally, the facility should be reviewed from a vulnerability standpoint to ensure that movement to the facility will not endanger evacuated residents or staff (i.e. flood area.) Group of people who oversee the overall Mutual Aid Plan (combination of all Regions). These individuals will also be tasked to participate in the MAP Regional Coordinating Centers as necessary. Annex 4.5

6 IV. General Principles of Understanding 1. Regional Mutual Aid Plan (MAP): Every facility will commit to: Participating annually in two (2) drills and one educational meeting as set up by the Regional Steering Committee or Statewide Task Force / Steering Committee. Accepting a stated number (10% of licensed beds) and type of resident the facility is qualified to care for. This number and type are pre-agreed by each facility. Using the Resident Evacuation Tag (Disaster Tag) and wrist bands or another acceptable level of marking for tracking and identifying residents. The Active Resident Record/Chart (Current Service Plan and Med List for Assisted Living residents) will be sent with the resident with the only exception being the need for a fast evacuation from the healthcare facility with the inability to gather the resident information Resident Evacuation Tags will still be used in a fast out evacuation (completed either in the parking lot or appropriate Stop Over Site/Point.) Notification of their status and updating key information on website. Payment to vendors and other healthcare facilities signed onto this plan for reimbursement for the care of a Disaster Struck Facilities residents, supplies, equipment and staff that may be loaned or provided to the Disaster Struck Facility. Also, the Resident / Medical Record & Equipment Tracking Sheet will be used. Payment of annual dues to the MAP to pay for drills, educational meetings, plan updates, website and administrative costs incurred in the regions. 2. Joint Region Mutual Aid Plan (MAP): Each Regional MAP group designates representatives to attend the Joint Region MAP meetings and coordinate the Joint Region MAP initiatives with the particular Regional MAP. Individual health care facilities also commit to participating in exercises and drills to test their Regional MAP and, upon agreement, the Joint Region MAP. 3. Implementation of Joint Region MAP Memorandum of Understanding: A health care facility and Regional MAP becomes a participating member when an authorized administrator and representative of the Regional MAP signs the MOU. During a disaster, only the authorized administrator (or designee), Command Center at each facility, or the MAP Regional Coordinating Center has the authority to request or offer assistance through the Regional (or Joint Region) MAP. Representatives from the Local or State Emergency/Licensing Agencies (Office of Emergency Management, Mass Emergency Management Agency, Emergency Medical Services, Massachusetts DPH, EOEA, etc.) may also make this request. If the disaster is widespread and the Regional MAP is no longer effective, the authorized Administrator should communicate with the MAP Regional Coordinating Center to call the MAP Regional Coordinating Center of another Regional MAP or directly to facilities or vendors in another Regional MAP. If the MAP Regional Coordinating Center is unavailable and the resources of the DPH, EOEA or State ESF 8 are overtaxed, the authorized Administrator my call directly to facilities or vendors in another Regional MAP. NOTE: In this situation, it is required that Resident Accepting Facilities notify their respective MAP Regional Coordinating Center to assist with coordinating the request. Annex 4.6

7 4. Communications: The impacted facility is responsible for informing emergency authorities and the Massachusetts DPH or Executive Office of Elder Affairs of its situation and defining needs that cannot be accommodated by the facility itself. The senior Administrator (or designee) in the Disaster Struck Facility Command Center is responsible for requesting supplies or authorizing the evacuation of residents in conjunction with Emergency Agencies. Communications between facilities for formally requesting and volunteering assistance should therefore occur among the senior Administrators (or designees) with coordination support from DPH or EOEA as well as the MAP Regional Coordinating Center. This communication often begins through the Liaison Officer of the disaster struck facilities Command Center. 5. Responsibility to Care for the Residents: Once admitted the resident shall be under the care of the accepting facility until discharge, transfer or reassigned. At end of disaster, residents should be returned and accepted back at original facility unless agreement is reached between administrators or based on the decision by the family/resident. (The Resident Accepting Facility is to make every effort to facilitate a smooth transition back to the original facility.) NOTE: From an ethical standpoint, it is expected that no marketing efforts will be made by the Resident Accepting Facility. 6. Loans of Equipment and Supplies: Use of equipment, such as vehicles, tools, and reusable materials and supplies, are subject to the following conditions: a. Loaned equipment may be loaned with an operator and this would follow Supervision and Financial and Legal Liability elements of this Agreement. b. Loaned equipment shall be returned to the lender Donor Facility upon release by the Disaster Struck Facility or immediately upon the Disaster Struck Facilities receipt of an oral or written notice from the Lender for the return of the equipment or reusable materials and supplies. The intent would be to have everything returned to the Donor Facility within 24 hours. c. Disaster Struck Facility shall, at its own expense, supply all maintenance, fuel and other needs for the equipment and supplies. All equipment and supplies are provided as is, with no representation or warranties as to its fitness for particular purpose. d. The Donor Facilities costs related to the transportation, handling, unloading/loading of equipment, supplies and materials shall be chargeable to the Disaster Struck Facility. Copies of invoices should be provided for such charges or hourly accounting of charges for the Donor Facilities employees who perform such services. e. If the equipment, supplies or materials are damaged in transit or while at the Disaster Struck Facility, the Donor will be reimbursed by the Disaster Struck Facility for reasonable costs of repairing such equipment or reusable supplies/materials or, if replacement is the only option, reimburse the Donor for equipment, supplies or materials of equal condition and capability. Any determinations of what constitutes equal condition and capability shall be at the discretion of the Donor. 7. Loans of Staff and Staff Supervision: Annex 4.7

8 When in need of staff, supplies, equipment or pharmaceuticals: The Disaster Struck Facility will have supervisory direction over the donor facility s staff and/or borrowed supplies, equipment or pharmaceuticals once they are received by the Disaster Struck Facility. After Evacuation from a Disaster Struck Facility: If the Disaster Struck Facility s staff and supplies have gone to a Resident Accepting Facility with their evacuated residents, the Resident Accepting Facility will have supervisory direction. 8. Financial and Legal Liability: When in need of staff, supplies, equipment or pharmaceuticals: The Disaster Struck Facility will: assume legal responsibility for the staff, supplies, equipment and pharmaceuticals from the Donor facility during the time the staff and supplies are at the Disaster Struck Facility. reimburse the Donor Facility for all of that facility s costs determined by the facilities involved (see also Loans of Equipment/Supplies and Loans of Staff/Staff Supervision in the Agreement). Although staff are under the supervisory direction and are the legal responsibility of the Disaster Struck Facility where they may be working during a disaster, if they are paid for this time it will be by the Donor Facility. Workers Compensation and other insurances will also be paid for by the Donor Facility (if loaning staff) or the Disaster Struck Facility (if sending staff to the Resident Accepting Facility.) The Donor Facility or the Resident Accepting Facility may request reimbursement from the Disaster Struck Facility. After evacuation from a Disaster Struck Facility: Resident Accepting Facility assumes the legal and financial responsibility for transferred residents upon arrival into the Resident Accepting Facility. Any staff working at the Resident Accepting Facility from the Disaster Struck Facility will have workers compensations and payment for staff time covered by the Disaster Struck Facility. Summation: Staff wages, benefits, taxes, or other compensation is always paid by their home facility (employer). Annex 4.8

9 Reimbursement for Resident Care: The DPH will work with the appropriate payer (Medicare, Medicaid or Private Payer) to work through the payment of services for the care of residents. NOTE*: Reimbursement covers facility costs but not necessarily ambulance/ transportation costs. Please review your facility specific business interruption insurance and agreements with private Emergency Medical Services transportation firms or private bus contracts. NURSING FACILITIES (NF): Emergency Involving NF to NF Transfer Licensed Beds: In the event that the MassHealth residents will be able to return in 30 days, MassHealth would continue to reimburse the disaster-struck facility during this 30 day period. It will be the responsibility of the two Nursing Facilities (disaster-struck and resident accepting) to enter into an agreement regarding payment and the allocation of MassHealth member patient paid amounts. In the event the residents will NOT be able to return in 30 days, the disaster-struck facility should proceed with discharge documentation on day 16 (MassHealth does not pay for day of Discharge) and the resident accepting facility should commence with admission procedures on day 16 for these MassHealth members. (MassHealth does pay for day of Admission.) In effect, on day 16 these MassHealth members would be treated like any new admission. The resident accepting facility would follow all standard admission procedures and practices. NOTE*: Consistent with the Center for Medicare and Medicaid Services (CMS) guidelines, the discharge and admission process should be completed within the 30 day timeframe. It is understood that it would be impractical to completely discharge all residents from one disaster struck facility and admit all of the residents in other facilities in one day. The key from a billing and payment standpoint regarding discharges and admissions is to ensure the discharge forms and the Admissions forms are filled out on the same day by the disaster struck facility and the resident receiving facility. The day of discharge is not paid for, but the day of admissions is and would therefore limit the financial impact on both organizations. * This model should be reviewed by other payers for acceptance. This approach would be accepted by CMS and the federal payer program as the language above was modified from the CMS guidelines released on 9/30/2007 in the Provider Survey and Certification FAQ on Declared Public Health Emergencies All Hazards. Emergency Involving NF to NF Transfer Un-licensed Beds - overflow: Annex 4.9

10 The same provisions as above would apply provided Department of Public Health issues the necessary approvals (licensure and certification) to the resident accepting facility to commence with and continue in an overflow situation. The approvals would need to be effective from the first day of the emergency. NOTE: It is assumed private paying residents will follow the same guideline above. Patient Choice Clarification Regarding Discharge from Facility with Emergency Situation: In the event that a MassHealth member chooses, during the first 30 days of the emergency period to: a) become a full time resident of the resident accepting facility OR b) wishes to transfer to a new Nursing Facility. The Disaster Struck Facility should initiate standard discharge and transfer procedures while the receiving facility should initiate standard admission practices. NOTE: While MassHealth will continue to pay for a MassHealth member during this 30 day period, the process does not prohibit or preclude a MassHealth member from seeking a different nursing facility to care for their needs. In that event, standard operating procedures governing admissions and discharges would apply. * This model should be reviewed by other payers for acceptance. SENIOR CARE OPTIONS (SCO): SCO members receive a fixed amount per month to manage their medical needs. Monthly payments are made directly to the SCO and the SCO distributes the dollars to the health care providers that provide care. In the event of an emergency and a NF resident is transferred to another NF or to a Hospital, the SCO will handle the reimbursement on behalf of the members. So, from a payment standpoint, standard procedures regarding payment would apply and it is business as usual. ASSISTED LIVING RESIDENCES: Awaiting final comments. Annex 4.10

11 REST HOMES: Awaiting final comments. 9. Documentation: During a disaster, the Disaster Struck Facility will accept and honor the donor facility s standard requisition forms. Documentation should detail the items involved in the transaction, condition of the material prior to the loan (if applicable), and the party responsible for the material. Donor and Resident Accepting facilities will keep records relating to costs incurred. 10. Public Relations: Each facility is responsible for developing and coordinating with other health care facilities and relevant organizations the media response to the disaster in conjunction with emergency agencies through Public Information Officers (PIO). If a Joint Information Center (JIC) at the city/town/state level is operations and/or the MAP Regional Coordinating Center is activated, this should be a combined response from all parties. 11. Hold Harmless Condition: All Donor, Resident Accepting Facilities, and Disaster Struck Facilities will be held harmless for acts of negligence or omissions when acting in good faith response for assistance during a disaster. As applicable, individual facilities are responsible for appropriate Credentialing of staff which may have been loaned to them and an internal process for providing Privileges (see Disaster Credentialing and Privileging Guideline), and for the safety and integrity of the supplies and equipment provided for use at their facility. Signed MOU document will be kept at the Massachusetts Long-Term Care Mutual Aid Association, Inc. offices located at 865 Central Avenue Needham, MA Phone: Health Care Mutual Aid Evacuation and Supply Plan Task Force: Region 1 [SIGNATURE]: Region 2 [SIGNATURE]: Region 3 [SIGNATURE]: Region 4A/B [SIGNATURE]: Region 4C [SIGNATURE]: Region 5 [SIGNATURE]: Annex 4.11

12 DISASTER CREDENTIALING AND PRIVILEGING Emergency privileges may be granted to a volunteer practitioner when the facility s Emergency Management Plan has been activated and the organization is unable to meet the residents needs. Privileges are determined by the internal facility policy or procedure. The facility (Incident Commander / Administrative person-on-call, in consultation with Medical Director or designee) determines that it is unable to handle the immediate resident needs with their existing staff. This position will also assign disaster responsibilities. Disaster privileges may also be granted to someone who may come with his/her resident from an evacuated facility. The following will be done by the Resident Accepting Facility / Management to Credential the volunteer practitioner: The Resident Accepting Facility will manage the activities of individuals who receive disaster privileges. Medical staff with disaster privileges will be identified by 2. Managers of these individuals will be identified by 3. Managers will have staff with disaster privileges working under their observation. Managers will be responsible for clinical record review and sign-off, as applicable. Disaster privileges may be granted upon presentation of a valid government issued photo ID (ie, driver s license or passport), and any of the following: A current picture ID or other ID card from a Hospital / NH / AL / RH. A current license certification or registration to practice and a valid picture ID issued by a state, federal or regulatory agency. A primary source of verification must be given where applicable. Identification indicating that the individual is a member of a Disaster Medical Assistance team (DMAT) or Medical Reserve Corps (MRC). Identification indicating that the individual has been granted authority to render resident care in emergency circumstances. Such authority having been granted by a federal, state or municipal entity. (i.e. MSAR) Presentation by current organizational staff member(s) with personal knowledge of practitioner s identity. As soon as the immediate situation is under control, not to exceed 72 hours (unless communication is disrupted, and this must be documented), the verification process of credentials and privileges of individuals who have received disaster privileges must be completed. This privileging process is identical to the process established under the medical staff bylaws for granting temporary privileges to fulfill an important resident need. Within 72 hours, the organization will determine the need to continue this disaster privileging policy. *NOTE: Individual staff should consider Massachusetts System for Advance Registration (MSAR) register at This should supplement the existing credentialing process. 2 Form of identification to be filled in by your facility. 3 Identify the marking that will be used i.e. facility badge, etc. Annex 4.12

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