Source: http://watchcoalition.org/Long-Term-Care-Center-Requirements-Under-The-CMS-Emergency-Preparedness-Rule
Timestamp: 2019-05-25 07:53:50
Document Index: 526079529

Matched Legal Cases: ['§1861', '§1866', '§1861', '§1866', 'art 483', '§483', '§483']

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Healthcare / Inpatient Providers / Skilled Nursing/Long-Term Care
cms long-term care center definition
Skilled Nursing Facility: An institution (or a distinct part of an institution) which: is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; has in effect a transfer agreement (meeting the requirements of §1861(1)) with one or more hospitals having agreements in effect under §1866; and meets the requirements for a SNF described in subsections (b), (c), and (d) of this section.
Nursing Facility: An institution (or a distinct part of an institution) which is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, rehabilitation services for injured, disabled, or sick persons, or on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; has in effect a transfer agreement (meeting the requirements of §1861(1)) with one or more hospitals having agreements in effect under §1866; and meets the requirements for a NF described in subsections (b), (c), and (d) of this section.
part 483 — requirements for states and long-term care facilities, Page: 172 (64030)
20. Add §483.73 to read as follows:
§483.73 Emergency Preparedness
The LTC center must comply with all applicable Federal, State, and local emergency preparedness requirements. The LTC center must establish and maintain an emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the elements below:
(a) The LTC center must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do all of the following:
(1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents.
(3) Address resident population, including, but not limited to, persons at-risk; the type of services the LTC center has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.
(4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the LTC center's efforts to contact such officials and, when applicable, its participation in collaborative and cooperative planning efforts.
(b) The LTC center must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:
(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:
(i) Food, water, medical, and pharmaceutical supplies.
(ii) Alternate sources of energy to maintain:
(A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;
(B) Emergency lighting;
(C) Fire detection, extinguishing, and alarm systems; and
(D) Sewage and waste disposal.
(2) A system to track the location of on-duty staff and sheltered residents in the LTC center's care during and after an emergency. If on-duty staff and sheltered residents are relocated during the emergency, the LTC center must document the specific name and location of the receiving facility or other location.
(3) Safe evacuation from the LTC center, which includes consideration of care and treatment needs of evacuees; staff responsibilities; transportation; identification of evacuation location(s); and primary and alternate means of communication with external sources of assistance.
(4) A means to shelter in place for residents, staff, and volunteers who remain in the LTC center.
(5) A system of medical documentation that preserves resident information, protects confidentiality of resident information, and secures and maintains the availability of records.
(6) The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.
(7) The development of arrangements with other LTC centers and other providers to receive residents in the event of limitations or cessation of operations to maintain the continuity of services to LTC residents.
(8) The role of the LTC center under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials.
(c) The LTC center must develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be reviewed and updated at least annually. The communication plan must include all of the following:
(iii) Residents' physicians.
(iv) Other LTC centers.
(ii) The State Licensing and Certification Agency.
(iii) The Office of the State Long-Term Care Ombudsman.
(iv) Other sources of assistance.
(i) LTC center's staff.
(4) A method for sharing information and medical documentation for residents under the LTC center's care, as necessary, with other health care providers to maintain the continuity of care.
(5) A means, in the event of an evacuation, to release resident information as permitted under 45 CFR 164.510(b)(1)(ii).
(6) A means of providing information about the general condition and location of residents under the facility’s care as permitted under 45 CFR 164.510(b)(4).
(7) A means of providing information about the LTC center's occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee.
(8) A method of sharing information from the emergency plan that the facility has determined is appropriate with residents and their families or representatives.
(d) The LTC center must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually.
(1) Training program. The LTC center must do all of the following:
(i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role.
(2) Testing. The LTC center must conduct exercises to test the emergency plan at least annually, including unannounced staff drills using the emergency procedures. The LTC center must do all of the following:
(i) Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. If the LTC center experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC center is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event.
(iii) Analyze the LTC center's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the LTC center's emergency plan, as needed.
emergency standby and power systems
(e) The LTC center must implement emergency and standby power systems based on the emergency plan set forth in paragraph (a) of this section.
(1) Emergency generator location. The generator must be located in accordance with the location requirements found in the Health Care Facilities Code (NFPA 99 and Tentative Interim Amendments TIA 12–2, TIA 12–3, TIA 12–4, TIA 12– 5, and TIA 12–6), Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12–1, TIA 12–2, TIA 12–3, and TIA 12–4), and NFPA 110, when a new structure is built or when an existing structure or building is renovated.
(2) Emergency generator inspection and testing. The LTC center must implement the emergency power system inspection, testing, and maintenance requirements found in the Health Care Facilities Code, NFPA 110, and Life Safety Code.
(3) Emergency generator fuel. LTC centers that maintain an onsite fuel source to power emergency generators must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.
(f) If a LTC center is part of a healthcare system consisting of multiple separately certified healthcare facilities that elects to have a unified and integrated emergency preparedness program, the LTC center may choose to participate in the healthcare system’s coordinated emergency preparedness program. If elected, the unified and integrated emergency preparedness program must do all of the following:
(g) The standards incorporated by reference in this section are approved for incorporation by the Director of the Office of the Federal Register. Copies may be obtained at no cost from the National Fire Protection Association with registration.
NFPA 99, Health Care Facilities Code, 2012 edition, issued August 11, 2011.
Technical interim amendment (TIA) 12–2 to NFPA 99, issued August 11, 2011.
TIA 12–3 to NFPA 99, issued August 9, 2012.
TIA 12–4 to NFPA 99, issued March 7, 2013.
TIA 12–5 to NFPA 99, issued August 1, 2013.
TIA 12–6 to NFPA 99, issued March 3, 2014.
NFPA 101, Life Safety Code, 2012 edition, issued August 11, 2011.
TIA 12–1 to NFPA 101, issued August 11, 2011.
TIA 12–2 to NFPA 101, issued October 30, 2012.
TIA 12–3 to NFPA 101, issued October 22, 2013.
TIA 12–4 to NFPA 101, issued October 22, 2013.
NFPA 110, Standard for Emergency and Standby Power Systems, 2010 edition, including TIAs to chapter 7, issued August 6, 2009.
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