CMS Proposes “Program Efficiencies” Affecting Emergency Preparedness, Hospice and Home Health

Regulation | September 27, 2018 | by Barbara Gay

On September 17, CMS released proposed regulations to promote efficiency and transparency as well as reduce burden. Nursing home regulations were notably not included in the proposed rule, however its emergency preparedness provisions affect all Medicare and Medicaid providers (including nursing homes). Additional aspects of the proposed rule address changes in the Hospice and Home Health programs. CMS has also posted a fact sheet.

Emergency Preparedness

The proposed rule, when finalized, would revise CMS’s September 2016 final rule on Emergency Preparedness and the related implementation provisions published in November 2017. The focus of this new proposal is to reduce the burden and associated costs related to complying with the existing emergency preparedness requirements. proposed changes will affect all Medicare and Medicaid participating healthcare providers including nursing homes.

Specific proposals include:

  • Amending the requirement to review and update the Emergency Preparedness Program (EPP) annually. The proposal would permit review every two years or potentially longer at the provider’s own discretion.
  • Amending the annual training requirement to allow training to occur every two years after initial education in the EPP has occurred.
  • Amending the testing requirements to permit one of the required testing exercises to be in the form of a simulation or workshop. Currently, two exercises are required annually with one of the exercises being a full scale/community-based exercise. This proposal would permit more flexibility for the second exercise which currently must minimally be a paper-based table-top exercise.


For the Hospice program, the proposed rule would:

  • Streamline the hiring process for hospices, allowing hospices to defer to state licensure requirements for their aides regardless of the state content or format, and allow states to set forth training and competency requirements that meet the needs of their populations.
  • Encourage seamless integration of information provided by the hospice’s drug management expert into routine interdisciplinary group meetings rather than having to use the more cumbersome “check box” approach that hospices currently implement in order to demonstrate compliance with the regulation.
  • Remove the requirement that the hospice have on staff an individual with specialty knowledge of hospice medications.
  • Replace a requirement that hospices provide a physical paper copy of policies and procedures with a requirement that hospices provide information regarding the use, storage and disposal of controlled drugs to the patient or patient representative, and family.
  • Require hospices that provide hospice care to residents of a skilled nursing facility/nursing facility or Intermediate Care Facilities for Individuals with Intellectual Disabilities to provide facility staff orientation in a way that avoids duplication of efforts of other hospices serving residents of the facility.

Home Health

For the Medicare Home Health Program, the proposed rule would:

  • Revise the requirement related to completing a full competency evaluation when an aide is found to be deficient in one or more skills. Instead of completing a full competency evaluation, an aide would only be required to complete retraining and a competency evaluation directly related to the deficient skills
  • Remove the requirement that Home Health Agencies (HHAs) provide a copy of the clinical record to a patient, upon request, by the next home visit, but retain the requirement that it be provided upon request, within 4 business days.

CMS seeks comments on the proposed rule by November 20, 2018. They note that they are soliciting comments on additional regulatory reforms for burden reduction in future rulemaking. In addition, CMS suggests that comments on the rule may include or expand upon comments submitted in response to Requests for Information on previously released Prospective Payment Systems. LeadingAge staff will be analyzing the rule and submitting comments.

Read the proposed rule.

Read the Fact Sheet.