A Medicare-certified home health agency must keep an emergency preparedness program with four parts: an emergency plan based on an all-hazards risk assessment, policies and procedures that include an individual emergency plan for every patient, a communication plan, and a training and testing program (42 CFR §484.102). Each part is reviewed and updated at least every 2 years. Many states add emergency rules of their own, and some of them apply to every licensed agency, certified or not.
1. The emergency plan
- A documented risk assessment of the agency's offices and the community it serves, using an all-hazards approach, with strategies for each emergency it identifies.
- The patient population the agency serves, the services it can provide in an emergency, and continuity of operations, including delegations of authority and succession plans.
- How the agency cooperates with local, tribal, regional, state and federal emergency preparedness officials (42 CFR §484.102(a)).
2. Policies and procedures
- An individual emergency plan for each patient, made as part of the comprehensive assessment (§484.102(b)(1)).
- How the agency tells state and local emergency officials about patients who would need help to evacuate their homes, based on their medical and psychiatric condition and home environment (§484.102(b)(2)).
- How the agency follows up with on-duty staff and patients if services are interrupted, and tells officials about anyone it cannot reach (§484.102(b)(3)).
- A system of medical documentation that keeps patient information confidential, secure and available (§484.102(b)(4)).
- The use of volunteers and other emergency staffing strategies (§484.102(b)(5)).
3. The communication plan
- Names and contact information for staff, contractors, patients' physicians and volunteers.
- Contact information for emergency preparedness officials and other sources of help.
- Primary and alternate ways to reach staff and emergency management agencies.
- A way to share patient information and medical documentation with other providers, and to share a patient's general condition and location with officials as HIPAA allows (45 CFR §164.510(b)(4)).
- A way to tell the authority in charge what the agency needs and what help it can give (42 CFR §484.102(c)).
4. Training and testing
| What | How often | Rule |
|---|---|---|
| Training on the emergency policies and procedures for staff, contractors and volunteers, as fits their roles, with records kept and staff showing they know the procedures | At the start, at least every 2 years after that, and after any significant update | 42 CFR §484.102(d)(1) |
| Exercises to test the emergency plan | At least once a year | §484.102(d)(2) |
| A full-scale community-based exercise or, if none is available, an individual facility-based functional exercise. An actual emergency that activates the plan counts for the next one. | Every 2 years | §484.102(d)(2)(i) |
| A second exercise: another full-scale or functional exercise, a mock disaster drill, or a tabletop exercise or workshop led by a facilitator | Every 2 years, in the other year | §484.102(d)(2)(ii) |
| A review of the response to each drill, exercise and real emergency, with the plan revised as needed | After each one | §484.102(d)(2)(iii) |
An agency that is part of a health care system may take part in the system's unified emergency preparedness program if that program meets §484.102(e), including a risk assessment for the agency itself.
Who has to follow §484.102
The rule binds every Medicare-certified home health agency. Missouri also applies the federal Conditions of Participation to every licensed home health agency (19 CSR 30-26.010(1)(A)). Michigan does not license home health agencies, so a Michigan agency follows the federal rule through its Medicare certification. An agency that is licensed but not certified follows its state's emergency rules, below. Hospices have a similar rule of their own, 42 CFR §418.113: see what policies are required for hospice.
What state rules add
| State | What the rule adds | Rule |
|---|---|---|
| Texas | A written emergency preparedness and response plan based on a risk assessment; a disaster coordinator and an alternate named by title; a triage category for each patient; help for patients who may need evacuation assistance to register with the state's STEAR registry; a review of the plan every year and after each emergency; and a yearly drill if the plan was not tested in a real emergency | 26 TAC §558.256 |
| Florida | A comprehensive emergency management plan in AHCA's format, updated and submitted every year for review by the county emergency management agency, county health department or Department of Health; every patient is told about the county special needs registry on admission | s. 400.492 and s. 408.821, F.S.; Rule 59A-8.027, F.A.C. |
| Louisiana | A plan that follows the state's model home health emergency preparedness plan and covers evacuation, care in shelters, staffing, transportation, and telling the family when a patient is evacuated; the plan is activated at least once a year by a real event or a drill, and updates go to the parish Office of Emergency Preparedness | LAC 48:I §9121 |
| California | A written plan designed to provide continuing care if an emergency interrupts patient care services | 22 CCR §74721(c)(8) |
| Georgia | The group of professional personnel sets the agency's policy on emergency care and reviews it every year | Rule 111-8-31-.07(3)(a) |
| North Carolina | A written policy on managing emergency care situations in the home, and emergency backup for equipment or power failure where the agency supplies the equipment | 10A NCAC 13J .1001(a)(5) and .1112(4) |
| District of Columbia | Each plan of care names the employees in charge of managing emergencies and the emergency protocols for that patient | 22-B DCMR §3914.3(l) and (m) |
Where a state rule is stricter than the federal one, such as a yearly review, follow the stricter rule. Each state's home health manual sets out its emergency rules alongside the federal program: see all home health manuals.
Questions a surveyor may ask
- Show me your risk assessment and emergency plan. When were they last reviewed?
- Pick a patient: where is the individual emergency plan in the record, and what does it say?
- How would you tell local emergency officials which patients need help to evacuate?
- Show me your communication plan and your last two exercises with the after-action reports.
- Who is in charge if the Administrator cannot be reached during a disaster?
Staff need training on the plan, not only a copy of it. See how read-and-sign works alongside training.
Next step
Every Cura Core home health manual includes an emergency preparedness policy written to §484.102 and your state's rules. Pick your state on the home health manuals page and read three of its policies free.