DEPARTMENT OF HEALTH & HUMAN SERVICES 
 
Health Care Financing Administration 
 
Center for Medicaid and State Operations 
7500 Security Boulevard Baltimore, MD 21244-185C 
 
September 30, 1999 
 
Dear State Survey Agency Director: 
 
This letter informs you of the Health Care Financing Administrations (HCFA) plans for Day One 
activities for the new millennim and to solicit the States cooperation in supporting our 
information needs regarding the status of State Survey Agency (SA) monitoring of the health and 
safety of individuals in Medicare/Medicaid approved facilities. 
 
For SAs, HCFA defines Day One as the period beginning January 1, 2000, until the period in 
which all immediate and serious health and safety issues related to the millennium have been 
resolved. HCFAs primary objective regarding Day One is for us and our partners to maintain 
communication regarding the status of the health and safety of our beneficiaries across the 
millennium threshold and on into the Year 2000 (Y2K). 
 
Our own Day One plan (DOP) under the Department of Health and Human Services (DHHS) 
guidelines requires us to be aware of the status of SA monitoring of immediate and serious health 
and safety problems so that we can provide this information upon request. We need the assistance 
of you and your staff. We attach Day One Guidelines, including reporting requirements, to enable 
us to gather this information from your Agency and provide it to DHHS, if requested. 
 
HCFAs Requirements for States 
 
HCFA requires that the SA identify staff who will provide full coverage on the millennium 
weekend, to implement the DOP reporting schedule described in Attachment I. Each contact 
person will be responsible for responding to inquiries from HCFA with the information required 
by Attachment II (checklist) to enable HCFA to monitor the health and safety of beneficiaries in 
facilities. 
 
HCFA requires each SA to share its Day One schedule and plans with its provider community. 
SAs must also furnish contact information (who will be available, how to make contact, and what 
to report) to the provider community, well in advance of the Day One period. 
 
HCFAs Recommendations to States 
 
HCFA strongly recommends that all SAs develop a complete DOP. A DOP will help ensure 
transition through the millennium.  Page 2 - State Survey Agency Director 
 
HCFA will not formally review your DOP. However, we have requested SA contingency plans 
and will review the ones we have received to assess the States ability to respond to provider 
failures due to Y2K. We recommend that SAs share their DOPs with their HCFA regional office 
(RO) contact. (See attached list for your RO contact.) We may be able to provide some technical 
assistance to the SAs if requested. 
 
HCFA recommends that you coodinate all information regarding Day One activities with your RO 
contacts. The RO contacts will be reporting frequently to HCFA central office (CO) on the status 
of State operations. The RO staff will develop a list of SA contacts and maintain this list through 
the millennium period. Please report any contact changes to the RO if they occur. 
 
As part of their Y2K provider outreach activities, HCFA expects SAs to keep their provider 
communities informed about their schedule, plans, and ability to respond to provider inquiries 
during the day one period. 
 
HCFA recommends that States develop DOP templates/checklists that track key information. The 
checklist that we are planning to use to monitor health and safety issues at Medicare approved 
facilities is attached and will be the basis for Day One dialog between the RO staff and State staff 
to assess providers ability to care for patients. We suggest that your template/checklist be modeled 
after the attached checklist to facilitate status reporting between HCFA and the State. We also 
suggest that you incorporate the checklist in your DOP. 
 
HCFA also recommends that States establish a Day One Team whose function is to evaluate key 
business operations and to provide status information. The team could include personnel such as 
the Y2K Project Manager, coordinators, functional area managers, business analysts, technical 
support staff, etc. The areas of responsibilities and the functions of each Day One Team member 
should be defined in the DOP. A precise timetable of activities to be performed, the personnel 
required, documentation, and reporting requirements should also be included in the DOP. 
 
Schedule of HCFA Activities 
 
Our Command and Control Center in CO will be staffed over the holiday weekend so that CO staff 
can receive reports of any State operational problems. Our RO staff will be your primary point of 
contact to report status information. From January 1 through January 7, 2000, the ROs will report 
the status of your operations to HCFA CO staff who in turn will notify DHHS. HCFAs reporting 
schedule will be coordinated with the RO staff, who in turn will coordinate time frames with 
States. 
 
o     Friday, December 31, 1999 is a Federal holiday and, as such, there will be no expectations   of the SAs to provide Page 3 - State Survey Agency Director 
 
o     Monday, January 3, 2000, is not a Federal holiday. HCFA will be open for business as   usual and all normal 
 
o     From Saturday, January 1, 2000, thru Friday, January 7, 2000, HCFA CO will receive   daily updates from H
  provide monitoring if problems are encountered in a particular State. These additional   calls will receive stat
 
o     If problems are reported and remain unresolved, HCFA/CMSO will continue to actively   monitor the situation
 
It is critical that we set up a process to rapidly detect and address potential immediate and serious 
situations that may impact the health and safety of our beneficiaries who depend on us. This can 
only be accomplished through our joint eforts and commitment. Thank you for your continued 
cooperation and commitment. If you have particular questions regarding Day One activities please 
call your RO contact person or call Mavis Connolly (410-786-6707) or James Merrill (410-786-
6998) in the HCFA CO. 
 
Sincerely, 
 
/s/ 
 
Rachel Block Deputy Director 
 
Attachments cc: 
 
All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations  Attachment I 
 
DAY ONE PLAN GUIDELINES 
 
for State Survey Agency Directors 
 
DAY ONE PLAN--DEFINITON 
 
The Day One Plan (DOP) is a plan of activities to ensure business continuity and ensure that 
systems and operations function without disruption as we move into the new millennium. Good 
business practice recommends that organizations develop a plan of their activities for the Day One 
period. The goal of this activity and other Year 2000 (Y2K) readiness activities is simple: 
thorough preparedness and accurate knowledge of operational status ofMedicare/Medicaid health 
care providers generate beneficiary confidence that they will continue to have access to quality 
care throughout the millennium. For the purposes of these guidelines Day One will cover the 
period from Thursday, December 30, 1999, through Friday, January 7, 2000. There are some 
additional activities that will occur outside of Day One that need to be considered related to that 
period; e.g., staff training, additional staff needed to assess provider ability to care for patients, 
sufficient paper supplies to document problems manually, planning for and securing additional 
backup lines of communication (FAX machines, phone lines, phones, cellular phones.) 
 
DOP DEVELOPMENT 
 
HCFA suggests that all SAs develop a thorough and complete DOP based on the schedule and 
activities discussed below. The DOP should establish a Day One Team that would include 
personnel such as the Y2K Project Manager, coordinators, survey and certification managers, 
business analysts, surveyors, etc. The areas of responsibilities and the functions of each Day One 
Team member should be defined in the DOP. A precise timetable of activities to be performed, the 
personnel required, a contractor point of contact (if necessary), a communication plan for 
providers, documentation, and reporting requirements should also be included. 
 
State agency personnel responsible for survey and certification activities should establish central 
command centers to monitor key DOP activities, receive information reports, assess business 
functions, and direct problem resolution or implement contingency plans. The State Survey 
Agency (SA) should identify specific contact people whom the regional office (RO) can 
communicate with during the DOP. States should notify their regional office (RO) contact 
person of the name(s) of the SA liaison staff by October 15,1999. 
 
As part of their Y2K provider outreach activities with all potential emergency processes, SAs 
MUST keep their provider communities informed about their schedule and plans for accepting 
complaints, provider inquiries, and assessing provider operating problems during the Day One 
period. Some State agencies have published this information in provider bulletins and letters.  Page -2- State Survey Agency Director 
 
DOP -ASSUMPTIONS/EXPECTATIONS 
 
The following assumptions/requirements should be used in developing DOPs: 
 
o     Friday, December 31, 1999, is a Federal/State holiday and, as such, beneficiaries, 
providers, and the general public will not expect the SA to be open or that business will   be conducted in anyt
 
o     Staff will be on duty at all HCFA ROs and central office throughout the millennium 
  weekend. HCFA staff will be regularly reporting the status of the State agencies 
  operations to HCFAs Command and Control Center in Central Office (CO) during this   period so that summa
DOP. 
 
o     State agencies should provide adequate staff and coverage to answer telephone calls from   facilities for the entir
 
1. As with any potential emergency conditions, SA staff must be able to respond to reports of   Y2K failures that hav
 
2. SA staff should provide a designated contact person to the HCFA RO. 
 
3. SA should contact known facilities affected by power and water failures to assess their ability   to continue operation
 
o     State agencies should plan to provide adequate staffing to respond to a possible increase in   beneficiary inquiries 
 
PRE-DAY ONE ACTIVITIES 09/01/99 -12/01/99 
 
Develop a DOP for survey and certification activities. 
 
As suggested to you in our March 10, 1999 letter, please take steps to raise provider awareness 
about the Y2K system problems in all facilities under your jurisdiction, with special emphasis on 
those facilities (SNFs, hospitals) that care for the frail, elderly and/or acutely ill patients, those 
facilities that are reliant on computer driven equipment (laboratories), and those facilities that are 
heavily dependent on outside suppliers of essential water and electrical services (ESRD).  Page -3- State Survey Agency Director 
 
Remind facilities to pay particular attention to critical areas such as, water, electricity, life support 
systes, biomedical equipment with embedded chips (defibrillator, ventilators, infusion pumps,) 
elevators, fire control systems, medical devices, monitoring equipment, HVAC systems and 
communication systems. Facilities should have contingency plans to respond to a failure of one or 
more of these critical areas. 
 
Notify providers of the SA phone numbers and contacts for the Day One period and request that 
they report Y2K failures that could potentially result in serious injury, harm, impairment or death. 
Plan for adequate staff for the Day One period to monitor calls or reports of Y2K failures that 
could potentially result in serious injury, harm, impairment, or death. 
 
Plan for adequate staff for the Day One period for possible on site monitoring for troubled 
facilities and for possible assistance with transfer and relocation of residents. 
 
DOP SCHEDULE 
 
All States should have plans in place for dealing with disasters. Such plans should be adapted as 
necessary and activated when normal monitoring identifies potential serious care problems as a 
result of Y2K. There should be a heightened awareness and particular attention paid to any known 
area affected by power and water supply failure. In the event that the SA becomes aware of those 
types of critical failures, it should make calls to the providers in the affected area. Particular 
attention should be paid to the impact of the water supply on ESRD facilities. 
 
Activities to be Completed on Saturday. Janary 1. 2000 
 
1:00 A.M. (Local time) 
 
Shortly after midnight local time, SAs should be available to receive any reports of known 
immediate and serious health and safety problems in the Medicare/Medicaid approved facilities 
within their jurisdiction. 
 
7:30 A.M. EST 
 
RO staff in regions 1-4 will contact a designated SA contact person at this time. SA will report to 
the RO the status of any known immediate and serious health and safety problems in the 
Medicare/Medicaid approved facilities within their jurisdiction. See Attachment II for a checklist 
of information needed for RO report. 
 
8:30 A.M. EST 
 
RO staff in regions 5-7 will contact a designated SA contact person at this time as above.  Page -4- State Survey Agency Director 
 
10:00 A.M. EST 
 
ROs 1-4 will call the CO Commad and Control Center (C2C) contact and relay the initial SA 
report. 
10:30 A.M. EST 
 
ROs 8-10 will contact a designated SA contact person at this time as above (7:30 AM EST Report) 
 
11:00 A.M. EST 
 
ROs 5-7 will call the CO C2C contact and relay the initial SA report. 
 
1:00 P.M. EST 
 
ROs 8-10 will call the CO C2C contact and relay the initial SA report. 
 
ROs 1-4 will call the CO C2C and relay the follow-up SA report. 
 
2:00 P.M. EST 
 
ROs 5-7 will call the CO C2C and relay the follow-up SA report. 
 
3:00 P.M. EST 
 
ROs 8-10 will call the CO C2C and relay the foow-up SA report. 
 
6:00 P.M. EST 
 
ROs 8-10 will contact the SA and follow-up on an initial problems as necessary. 
 
6:30 P.M. EST 
 
All components will report to the CO C2C contact any outstanding problems raised during the day. 
 
Activities to be Completed January 2, 2000 
 
9:00 A.M. EST 
 
ROs 1-4 will contact a designated SA contact person at this time. SA will report any known 
immediate and serious health and safety problems in the Medicare/Medicaid approved facilities 
within their jurisdiction.  Page -5- State Survey Agency Director 
 
10:00 A.M. EST 
 
ROs 1-4 will contact the CO contact and relay the follow-up SA report. 
 
ROs 5-7 will contact the SA and follow-up on initial problems as necessary 
 
11:00 A.M. EST 
 
ROs 5-7 will contact the CO contact and relay the follow-up SA reports. 
 
12:00 Noon. EST 
 
ROs 8-10 will contact the SA and follow-up on any initial probles as necessary. 
 
1:00 P.M. EST 
 
ROs 1-4 will call the CO C2C contact and report on the follow-up assessments. 
 
ROs 8-10 will call the CO C2C contact and report on the follow-up assessments. 
 
2:00 P.M. EST 
 
ROs 5-7 will call the CO C2C contact and report on the follow-up assessments. 
 
4:00 P.M. EST 
 
ROs 8-10 will call the CO C2C contact and report on the follow-up assessments. 
 
5:00 P.M. EST 
 
ROs 1-4 will call the CO C2C contact and report on the follow-up assessments. 
 
6:00 P.M. EST 
 
ROs 5-7 will call the CO C2C contact and report on the follow up assessments. 
 
6:30 P.M. EST 
 
All components will report to the CO C2C contact any outstanding problems raised during the day.  Page -6- State Survey Agency Director 
 
Activities to Be Completed January 3. 2000 
 
Each SA will continue to monitor and investigate any reports of known immediate and serious 
health and safety problems in the Medicare/Medicaid approved facilities within their jurisdiction. 
In the event that immediate and serious problems related to Y2K failures are multiple, the SA will 
suspend all routine certification activities until the problems/complaints received return to normal 
operating levels. 
 
7:30 A.M. EST 
 
RO staff in regions 1-4 will contact a designated SA contact person at this time. SA will report to 
the RO any known immediate and serious health and safety problems in the Medicare/Medicaid 
approved facilities within their jurisdiction. 
 
8:30 A.M. EST 
 
RO staff in regions 5-7 will contact a designated SA contact person at this time and follow-up on 
initial problems as necessary. 
 
10:00 A.M. EST 
 
ROs 1-4 will call the CO Command and Control Center (C2C) contact and relay the follow-up SA 
report. 
 
10:30 A.M. EST 
 
ROs 8-10 will contact a designated SA contact person at this time as and follow-up on any initial 
problems as above (7:30 AM EST Report) 
 
11:00 A.M. EST 
 
ROs 5-7 will call the CO C2C contact and relay the follow-up SA report. 
 
12:00 Noon EST 
 
ROs 8-10 will call the CO C2C contact and relay the follow-up SA report. 
 
1:00 P.M. EST 
 
ROs 1-4 will call the CO C2C and relay the follow-up SA report. 
 
2:00 P.M. EST 
 
ROs 5-7 will call the CO C2C and relay the follow-up SA report.  Page -7- State Survey Agency Director 
 
3:00 P.M. EST 
 
ROs 8-10 will call the CO C2C and relay the follow-up SA report. 
 
5:00 P.M. EST 
 
ROs 1-4 will call the CO C2C contact and relay the follow-up SA report. 
 
6:00 P.M. EST 
 
ROs 5-7 will call the CO C2C contact and relay the follow-up SA report. 
 
6:30 P.M. EST 
 
All components will report to the CO C2C contact any outstanding probles raised during the day. 
 
Activities to Be Completed Janary 4 thru 7. 2000 
 
Each SA will continue to monitor and investigate any reports of known immediate and serious 
health and safety problems in the Medicare/Medicaid approved facilities within their jurisdiction. 
In the event that immediate and serious problems related to Y2K failures are multiple and affect 
the quality of patient care, the SA should ensure that these Y2K problems are dealt with as quietly 
as possible. The SA may need to suspend all routine certification activities until the 
problems/complaints received return to normal operating levels. 
 
8:30 A.M. EST 
 
RO staff in regions 1 -4 will contact a designated SA contact person at this time. SA will report to 
the RO the status of any known immediate and serious health and safety problems in the 
Medicare/Medicaid approved facilities within their jurisdiction. 
 
9:30 A.M. EST 
 
ROs 5-7 will contact a designated SA contact person at this time and follow-up on initial problems 
as necessary. 
 
10:00 A.M. EST 
 
ROs 1-4 will call the CO C2C contact and relay the follow-up SA report.  Page -8- State Survey Agency Director 
 
10:30 A.M. EST 
 
ROs 8-10 will contact a designated SA contact person at this time as and follow-up on any initial 
probles as above (7:30 AM EST Report) 
 
11:00 A.M. EST 
 
ROs 5-7 will call the CO C2C contact and relay the follow-up SA report. 
 
12:00 Noon EST 
 
ROs 8-10 will call the CO C2C contact and relay the follow-up SA report. 
 
1:00 P.M. EST 
 
ROs 1-4 will call the CO C2C and relay the follow-up SA report. 
 
2:00 P.M. EST 
 
ROs 5-7 will call the CO C2C and relay the foUow-up SA report. 
 
2:30 P.M. EST 
 
All components will report to the CO C2C contact any outstanding problems raised during the day.  ATTACHMENT II  
Checklist 
 
Information Collection Necessary for State Agency Monitoring CP-007 
 
Section One 
 
Affected Facility information: 
 
The SA will report on facilities affected by power andor water failures. 
 
1. Number and Type of Facilities contacted 
 
2. Status of the affected facilities 
 
A. No identified problems affecting serious and immediate health and safety. 
 
B. Serious and immediate problems which could affect health and safety. 
Complete Section Two for this provider. 
 
Section Two 
 
The RO will collect the following information from the SA on any reports of Y2K failures that 
have caused health and safety problems for beneficiaries receiving care from a Medicare/Medicaid 
approved facility: 
 
Provider Specific Information: 
 
1.   Date RO received complaint 
 
2.   Provider or Supplier Type 
 
3.   Provider Name 
 
4.   Type of Problem(s) that are causing or likely to cause serious injury, harm or death. 
 
5.   Number of patients affected by problem 
 
6.   SA plan of action 
 
Status Reports 
 
7.   Resolution of problem date 
 
8    OSCAR System: Is the SA telephone access to OSCAR operational? List any problems. 
 
9    MDS System:    Is MDS operational? List any problems. 
 
10  ASPEN         Is ASPEN operational? List any problems.  Attachment IIl 
 
Regional Office Contacts 
 
     
Region I  Charlie Reynolds  617-565-9156 
     
Region II  Sue Kelly  212-264-2058 
Joel Truman  212-264-3926 
     
Region III  Mike Gregory  215-861-4296 
Timothy Hock  215-861-4311 
     
Region IV  Brenda Nimmons  404-562-7405 
     
Region V  Chuck Bennett  312-886-5561 
     
Region VI  Mitchell Chunn  214-767-4446 
     
Region VII  James Scott  816-426-3406 x3204 
Demetria Wills  816-426-2408 x3205 
     
Region VIII  Helen Jewell  303-844-7048 
Nancy Walker  303-844-7037 
Annette Brauchler  303-844-7053 
Dr. Paul Long  303-844-1978 
     
Region IX  Stan Marcisz  415-744-3746 
Richard Shirasawa  415-744-3712 
     
Region X  Mary (Fran) Lassiter  206-615-2313 
Mo Lynch  206-615-2340 
Ed Prichard  206-615-2313