Agency for Health Care Administration Emergency Preparedness and Response Molly McKinstry, Deputy Secretary Health Quality Assurance May 16, 2018 1
Program Components Health Care Facility Emergency Preparedness Licensure Requirements Federal Requirements AHCA Role in Emergency Response Hurricane Irma Experience New Emergency Power Regulations Emergency Management Resources Local Collaboration 2
Partnerships Strong and Effective Partnerships are Critical to Emergency Preparedness and Response 3
Health Care Facility Licensure AHCA Regulation of Health Care Providers State Licensure Federal Certification for Medicare and Medicaid Inspections Consumer Complaints Concerns/Monitor Visits Licensees are legally responsible for all aspects of the provider operation. A license issued is a public trust and a privilege and is not an entitlement. The maintenance and operation of a provider must ensure safe, adequate, and appropriate care and treatment, and health of persons treated. 4
Regulated Health Care Facilities and Providers Abortion Clinics Adult Day Care Centers Adult Family Care Homes Ambulatory Surgery Centers Assisted Living Facilities Birth Centers Clinical Laboratories Crisis Stabilization Units Health Care Service Pools Health Care Clinics Home Health Agencies Home Medical Equipment Providers Homemaker Companion Agencies Homes for Special Services Hospices Hospitals Intermediate Care Facilities for Developmentally Disabled Nurse Registries Nursing Homes (Skilled Nursing) Prescribed Pediatric Extended Care Centers Residential Treatment Facilities Short Term Residential Treatment Facilities Transitional Living Facilities Federal Certification Programs Underlined Emergency Planning Review and Approval Required Italics Emergency Plan No External Approval 5
Health Care Facility Emergency Preparedness Comprehensive Emergency Management Plans Required for hospitals, nursing homes, assisted living facilities, home health agencies and other health care providers Enable self-sufficiency during an emergency Licensure rules developed by AHCA and Dept of Elder Affairs (DOEA) Federal regulations developed by HHS Centers for Medicare and Medicaid Services (CMS) 6
State Comprehensive Emergency Plan Components Risk Assessment and Planning Policies and Procedures Communication Plan Training and Testing Management Plans Hazard Analysis Resident Characteristics Dementia, Oxygen, Dialysis Facility Flood Zone Proximity to Transportation Emergency Activation Key Staff / Chain of Command Continuous Staffing and Staff Families Food, Water, Sleeping Arrangements Emergency Power Plan, Fuel, Capacity Transportation Evacuation and Re-Entry Sheltering Others Notification and Reporting 7
Plan Review and Approval State comprehensive emergency management plan is subject to review and approval by either the local emergency management agency or Department of Health. Plan review must be completed within 60 days and either approve the plan or advise the facility of necessary revisions. Frequency of subsequent reviews vary by provider type e.g. nursing homes CEMPs submission is annual, ALF when substantial changes are made. 8
State Licensure Emergency Preparedness Regulations Apply to state licensed providers Condition of licensure renewal AHCA can respond to reports of non-compliance at any time Regulatory citations issued Providers may correct compliance is the goal Sanctions if appropriate See AHCA Website for Regulations and Approval Authority 9
http://www.ahca.myflorida.com/mchq/emergency_ Activities/index.shtml 10
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New Federal Emergency Preparedness Requirements Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Published September 16, 2016 Applies to all 17 federally certified provider and supplier types Implemented date November 15, 2017 Compliance required for participation in Medicare and Medicaid First Year of Implementation 12
Providers/Suppliers Impacted by the Federal Regulation Hospitals Ambulatory Surgical Centers Hospices Long Term Care (LTC) Facilities Nursing Homes/ Skilled Nursing Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Home Health Agencies Transplant Centers (Hospital-based) Psychiatric Residential Treatment Facilities (PRTF s) All-Inclusive Care for the Elderly (PACE) 13
Providers/Suppliers Impacted by the Federal Regulation Comprehensive Outpatient Rehabilitation Facilities (CORF s) Critical Access Hospitals Rehabilitation Agencies, Outpatient Physical Therapy and Speech Language Community Mental Health Centers Organ Procurement Organizations End-Stage Renal Disease Facilities Rural Health Clinics and Federally Qualified Health Centers (Federally Qualified Health Care Centers) Religious Nonmedical Health Care institutions (RNHCI s) 14
Four Provisions for All Provider Types Risk Assessment and Planning Policies and Procedures Emergency Preparedness Program Communication Plan Training and Testing 15
Facility Risk Assessment, Planning, and Communication Develop and annually update an emergency plan based on a risk assessment using an all-hazards approach, focusing on capacities and capabilities: Care-related emergencies Equipment and power failures Interruptions in communications, including cyber-attacks, Loss of a portion or all of a facility Interruptions in the normal supply of essentials such as water and food Develop and annually update policies and procedures to implement the plan Develop and annually update a communication plan to address communication: Within the facility Across health care providers With state and local public health departments and emergency management systems 16
Training & Testing Requirements Develop and maintain training and testing programs, including initial training in policies and procedures Participation in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based exercise Conduct an additional exercise that may include, but is not limited to the following: A second full-scale exercise that is individual, facilitybased A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan 17
There are Requirements Which Vary by Provider Type Outpatient providers are not required to have policies and procedures for the provision of subsistence needs. Home health agencies and hospices required to inform officials of patients in need of evacuation. (Note: Florida licensure regulations require continuity of care planning) Long-term care and psychiatric residential treatment facilities must share information from the emergency plan with residents and family members or representatives. 18
Temperature Controls and Emergency and Standby Power Systems Under the Policies and Procedures, Standard- there are requirements for subsistence needs and temperature controls. Additional requirements for hospitals, critical access hospitals, and long-term care facilities for Emergency Power and Stand-by Systems. 19
CMS 1135 Wavier Guidance Must specifically address the facility s role in emergencies where the President declares a major disaster or emergency under the Stafford Act or an emergency under the National Emergencies Act, and the HHS Secretary declares a public health emergency. Facilities policies and procedures should address what coordination efforts are required during a declared emergency in which a waiver of federal requirements under section 1135 of the Act has been granted by the Secretary. Facilities should also have in place policies and procedures which address emergency situations in which a declaration was not made and where an 1135 waiver may not be applicable. 20
Resources Providers and Suppliers should refer to the resources on the CMS website for assistance in developing emergency preparedness plans. The website also provides important links to additional resources and organizations who can assist. https://www.cms.gov/medicare/provider- Enrollment-and- Certification/SurveyCertEmergPrep/index.html 21
Blending State Federal Emergency Preparedness Federal emergency rules are separate from Comprehensive Emergency Management Plans (CEMP) CEMP is approved by county but remember to have federal plan approved by the facility s governing body Regulatory Agency reviews federal regulations for compliance 22
State Comprehensive Emergency Management Plans Next Steps CEMP Rules being revised for all AHCA Programs Align where possible with Federal Requirements Previous workshop comments will be considered Provide input on areas where guidance is needed, such as enforcement Unique plans for each provider versus uniformity for residential/ non-residential 23
State Emergency Operations All Emergencies are Local Local/County Emergency Management Agencies Lead Responsibility for Emergency Activities State Emergency Operations Center Emergency Special Function Branches ESF- 8: Health and Medical Department of Health - Lead Agency for Health Care Administration Support 24
Agency Roles & Responsibilities During an Emergency Track Provider Status and Impact Assist in Prioritization of Response Facilitate Updates to State and Federal Agencies and Partners Regarding Provider Status Provider Contact and Data Collection Surrounding Events Site Visits Post-Impact Assessments AHCA, DOH, Other Partner Agencies Carry out Regulatory Duties as Necessary 25
Solutions to Problems Policy Matters Reasonable in Circumstances with Safety Focus Over Capacity Admission Requirements Evacuation Location Options Regulatory Waivers Out of State Practitioners Medicaid Policy Seek Federal Waivers 26
Emergency Event Database Facilities use FLHealthStat, an online database, to report emergency information during the emergency Anticipated Emergency Event Monitor Pre-Impact Actions Evacuation/ Transportation Available Beds Reports Twice a Day Emergency Response Determine Impact to Address Power Outages Damage or Impact Evacuation/ Transportation Limited View of Activities as Reported 27
Transition to New Online System Emergency Status System Provider Registration Access for Emergency Management Officials Series of Releases Improve Information Available Improve Flexibility Ongoing Improvements Florida Health Stat is used until transition 28
Challenges Execution of Emergency Plans Home Health and Hospice Continuity of Care Transportation Gas Shortages Evacuation Plans Original Plans Not Feasible Expedited Re-Entry After Storm Post-Storm Evacuations Extensive Power Outages Heat, Generators, Fuel 29
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Irma Experience Power Restoration 6.7 million homes and businesses lost power at the height of storm (September 11 th ) 75% restored by September 15th (1.5 million) Logistics generators and fuel Post-impact evacuation 31
Health Care Facility Reported Impact Power Outage 350 Nursing Homes (683 licensed) 1,677 Assisted Living Facilities (3,109) Half of Long Term Care Providers had No Power in Excess of 2 Days Evacuations 88 Nursing Homes 635 Assisted Living Facilities 90 Long Term Care Providers Returned Postevacuation Before Full Power was Restored 32
Emergency Power Rules: Time Line Final Rules Ratified by the Legislature via Legislative Bills March 26, 2018 Rules Effective Upon Governor Scott s Signature of Bills April 25, 2018 Emergency Power Plans Due 30 Days after Effective Date of Rules June 1, 2018 Emergency Power Plans Implemented or Extension Submitted January 1, 2019 Implementation Extension Under Certain Conditions 33
Emergency Power Rule Requirements Emergency power plan is part of the Comprehensive Emergency Management Plans (CEMPs) Emergency power source maintained at the facility Must support internal temperatures of 81 degrees or less Safe temperatures at all times for residents Nursing homes - no less than 30 square feet per resident ALF no less than 20 square feet per resident, may use 80% of licensed capacity to calculate, resident choice/ facility monitors Facilities on same campus may share resources 34
Emergency Power Fuel Nursing Homes Support internal temperatures for 96 hours 72 hours onsite fuel or piped gas Bring additional 24 hours of fuel onsite (to achieve 96 hours) upon declaration of an emergency If fuel storage is restricted by regulations and piped gas is not available, must replenish 24 hours prior to depletion 35
Emergency Power Fuel Assisted Living Facilities Support internal temperatures for 96 hours 72 hours onsite fuel or piped gas for 17+ beds 48 hours onsite fuel or piped gas for 16 or less beds Bring additional fuel onsite (to achieve 96 hours) upon declaration of an emergency If fuel storage is restricted by regulations, must replenish 24 hours prior to depletion Carbon monoxide detectors are required 36
Emergence Power Implementation Deadlines Implement plans by June 1, 2018 Extend until January 1, 2019 for certain delays Must still arrange for safe temperatures Have an alternative power source onsite or contract for delivery within 24 hours of state of emergency May evacuate if in an evacuation zone Does not supersede evacuation orders Additional extensions by Rule Variance 37
Nursing Home Review Process AHCA Office of Plans and Construction reviews nursing home mechanical plans Local Emergency Management Agencies review EPP for compliance notify AHCA Facility must correct deficiencies in 10 days 38
Assisted Living Facility Review Process Local Authority Having Jurisdiction reviews ALF building/mechanical plans Local Emergency Management Agencies review EPP for compliance notify AHCA 39
Consumer Notice and Publication Facility notifies residents submission/approval Facility provides AHCA consumer friendly summary AHCA posts summaries online 40
Emergency Power Plan Rules and Resources Links to Emergency Power Plan rules on Website Plans and Construction: Nursing Home Generator Project Checklist Sample format for Emergency Power Plans Sample format for Consumer Summary Questions and Answers Published Plans, Cooled Space, Fuel, New Facility, Extension, more Sample format for Extensions beyond June 1, 2018 41
FloridaHealthFinder.gov 42
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Coming Soon - Florida Health Finder Emergency Power Status Enhancement to Facility Profile Page for Nursing Homes and Assisted Living Facilities May 2018 Release (Draft Demo Below) 45
Floridahealthfinder.gov Facility Locator enables Search for any AHCA Regulated Provider 46
Advance Search Options allow Search using Provider Specific Features 47
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Download any List in Excel 49
Excel Download Example Assisted Living Facilities in Broward County 50
Local Emergency Management Coordination Enhancing Partnerships Local Collaboration to Address Preparedness Concerns Facilities Comprehensive Emergency Management Plan Status Improve Self-Sufficiency Greater Collaboration with Local Emergency Management during Emergencies 51
AHCA Area Offices Escambia Santa Rosa Okaloosa Walton Holme s Bay Calhoun Jackson Washington Jefferson Suwanne e Columbia Nassau Gadsde Leon Hamilton n Madison Baker Liberty Wakulla Taylor Gulf Franklin Clay Lafayette Dixie Union Alachua Putnam Gilchrist Bradford Marion Levy Volusia St. Johns Flagler Sumter Citrus Lake Seminole Hernando Orange Eight Field Offices (Eleven Regions) Field Office Managers Contact Information online. http://www.ahca.myflorida.com/mchq/field _Ops/Field_Office_Info.shtml Pasco Pinellas Sarasota Charlotte Polk Manatee Hardee DeSot o Lee Collier Osceola Glades Hendr y Indian River St. Luci e Martin Palm Beach Broward Dade 52
AHCA.myflorida.com FloridaHealthFinder.gov Laura MacLafferty, ECO Health Facility Regulation Chief Kim Smoak Field Operations Chief Scott Waltz Plans and Construction Chief Nursing Homes: Bernard Hudson Manager Long Term Care Unit Assisted Living Facilities: Keisha Woods Manager Assisted Living Unit NH_Emergencyrule@ahca.myflorida.com ALF_Emergencyrule@ahca.myflorida.com 53