Emergency Preparedness

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​AHCA/NCAL provides information and resources to help members respond to an emergency in a timely, organized, and effective manner. ​​​


What You Need to Know​​​ ​

In August 2022, the United States declared the ongoing monkeypox outbreak a public health emergency. Learn more about the disease and the warning​ signs you need to watch out for in LTC.​  

COVID-19 Updates​
​​Find the latest information on COVID-19 for long term care providers. This includes infection control practices, regulatory requirements and resources on COVID-19 vaccinations for long term care staff and residents. 

To meet Emergency Preparedness requirements, providers must be able to demonstrate their experience activating their emergency plans through written documentation. This is most commonly accomplished through ​an After-Action Report (AAR) and Improvement Plan. AHCA has developed a COVID-19 AAR Template that members can utilize to document their response and recovery efforts during the pandemic. 
Long term care facilities should prepare to manage potential flu outbreaks and double efforts to encourage residents and staff to take the influenza vaccine. Individuals 65 years or older are one of the high risk groups who can experience serious complications, even death, from influenza infection. Learn more on how to minimize the flu for residents.​ ​
Active Shooter Preparedness​
HealthCap® offers a free webinar that focuses on key aspects of active shooter events and what to do if your long term care community experiences a threat or real-life active shooter.




PHE Ending Impact on Emergency Preparedness Regulations https://www.ahcancal.org/News-and-Communications/Blog/Pages/PHE-Ending-Impact-on-Emergency-Preparedness-Regulations-.aspxPHE Ending Impact on Emergency Preparedness Regulations 5/2/2023 4:00:00 AM<p></p><p>The Centers for Medicare & Medicaid Services (CMS) released a new regulatory memo on May 1st, <a href="https://www.cms.gov/files/document/qso-23-13-all.pdf" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">QSO-23-13-ALL </a> entitled “Guidance for Expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023." The memo outlines each waiver CMS put into place during COVID-19 and how the end of the PHE will affect those waivers. AHCA's full summary is <a href="/News-and-Communications/Blog/Pages/CMS-Announces-Ending-of-COVID-Staff-Vaccine-Requirement,-Other-Protocols.aspx" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">here. </a><br> <br>There is a section in the memo related to Emergency Preparedness starting on page 2, stating that the following information supersedes the previously issued <a href="https://www.cms.gov/files/document/qso-20-41-all-revised-05262022.pdf" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">QSO-20-41-ALL-REVISED</a> memo for all certified providers/suppliers. CMS regulations for Emergency Preparedness (EP) require the provider/supplier to conduct exercises to test their EP plan to ensure that it works, and that staff are trained appropriately about their roles and the provider/supplier's processes. During or after an actual emergency, the EP regulations allow for a one-year exemption from the requirement that the provider/supplier perform testing exercises. The exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the 12-month exercise cycle. The cycle is determined by the provider/supplier (e.g., calendar, fiscal or another 12-month timeframe). The exemption only applies when a provider/supplier activates its emergency preparedness program for an emergency event.</p><p><span style="font-size:11pt;">Providers are expected to return to normal operating status and comply with regulatory requirements for emergency preparedness with the conclusion of the PHE, including conducting a full-scale exercise within its annual cycle for 2023 and an exercise of choice. The cycle is determined by the provider (e.g., calendar, fiscal, or another 12-month time).</span></p><p>​</p>
CMS Announces Ending of COVID Staff Vaccine Requirement, Other Protocolshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Announces-Ending-of-COVID-Staff-Vaccine-Requirement,-Other-Protocols.aspxCMS Announces Ending of COVID Staff Vaccine Requirement, Other Protocols5/1/2023 4:00:00 AM<p>​<br></p><div>Today, t​he Centers for Medicare & Medicaid Services (CMS) released a new regulatory memo <a href="https://www.cms.gov/files/document/qso-23-13-all.pdf" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">QSO-23-13-ALL​</a> entitled “Guidance for Expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023.” The memo outlines each waiver CMS put into place during COVID-19 and how the end of the PHE will affect those waivers. Additionally, the memo outlined timelines for certain regulatory requirements issued through the PHE. This memo applies to Long Term Care (LTC), Intermediate Care Facilities (ICF), and other provider types. </div><div><br></div><div><strong>Reporting to Residents, Representatives and Families on COVID-19</strong></div><div><br></div><div>CMS will exercise enforcement discretion for the requirement to report to residents, their representatives and families and not expect providers to meet this requirement at this time. This pertains to the requirement associated with F885. AHCA has advocated for this relief and has confirmed that this change is effective May 1, 2023.​</div><div><br></div><div><strong>Staff COVID-19 Vaccine Requirements</strong></div><div><br></div><div>Related to the <a href="https://www.govinfo.gov/content/pkg/FR-2021-11-05/pdf/2021-23831.pdf" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">interim final rule</a> issued November 5, 2021, CMS will soon end the interim final rule requiring all healthcare staff to be fully vaccinated for COVID-19. CMS will provide more information on this at the anticipated end of the PHE. CMS does continue to urge everyone to stay up to date on their COVID-19 vaccine.</div><div><br></div><div><strong>Requirements for Educating about and Offering Residents and Staff the COVID-19 Vaccine</strong></div><div><br></div><div>Facilities will need to continue to educate and offer residents and staff the COVID-19 vaccine until the interim final rule expires, 3 years after issuance, which would be May 21, 2024. </div><div><br></div><div><strong>Requirements for Reporting Related to COVID-19</strong></div><div><br></div><div>The requirement to report via NHSN is set to terminate December 31, 2024. This will continue until that time as a requirement to support national efforts to control the spread of COVID-19.  </div><div><br></div><div>CMS does note that some reporting, such as COVID-19 vaccine status of residents and staff through NHSN, is permanent and will continue indefinitely unless additional regulatory action is taken. </div><div><br></div><div>Providers should also be aware that the SNF Quality Reporting Program (QRP) will require reporting of two COVID-19 vaccine related measures: </div><div><br></div><div><ul><li>​COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date (FY24)</li><li>COVID-19 Vaccination Coverage among Healthcare Personnel </li></ul></div><div><br></div><div><strong>Emergency Preparedness</strong></div><div><br></div><div>During the PHE, facilities were not required to complete full-scale Emergency Drills. This allowance will expire at the end of the PHE.</div><div><br></div><div><strong>3-Day Prior Hospitalization</strong></div><div><br></div><div>As previously reported, the 3-Day waiver will terminate immediately with the expiration of the COVID-19 PHE. Meaning, beginning May 12, 2023, SNF stays will require a qualifying hospital stay before Medicare coverage. Additionally, residents will be required to have a 60-day wellness break to begin a new benefit period.</div><div><br></div><div><strong>Nurse Aide Training Competency and Evaluation Programs (NATCEP)</strong></div><div><br></div><div>All individual waivers granted to States and individual facilities will terminate at the conclusion of the PHE, unless a facility or State has been granted a waiver that expires prior to the end of PHE. Uncertified nurse aides working in a LTC​ facility covered by a waiver granted to a State or individual facility will have 4 months from the date the PHE ends (or from the termination date of the facility’s or state’s waiver, if earlier) to complete a state approved NATCEP program. This includes those LTC care facilities, or facilities in states that were granted an extension of the waiver after October 6, 2022.</div><div><br></div><div><strong>Preadmission Screening and Annual Resident Review (PASARR)</strong></div><div><br></div><div>As previously reported, CMS will begin requiring residents to have a PASARR prior to admitting to facilities when the PHE expires. This will affect all admissions taking place after May 11, 2023.</div><div><br></div><div><strong>Resident Roommates and Grouping</strong></div><div><br></div><div>CMS waived the requirements in 42 CFR 483.10(e)(5) and (7) solely for the purposes of grouping or cohorting residents with respiratory illnesses. The requirements of this waiver will end with the conclusion of the PHE.</div><div><br></div><div><strong>Requirements for COVID-19 Testing</strong></div><div><br></div><div>The COVID-19 testing requirements will expire with the end of the PHE. However, COVID-19 testing remains important and is a nationally recognized standard to help identify and prevent the spread of COVID-19. Facilities should continue to follow CDC guidelines for when to test residents and staff.</div><div><br></div><div><strong>Focused Infection Control (FIC) Surveys</strong></div><div><br></div><div>Beginning in Fiscal Year 24, states will no longer be required to conduct additional FIC surveys in their states. For Fiscal Year 23, states are still required to survey 20% of their nursing homes utilizing FIC surveys.</div><div><br></div><div><strong>Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)</strong></div><div><br></div><div>CMS previously waived the requirement for clients to have the opportunity to participate in social, religious, and community group activities. The waiver of this requirement ends upon the conclusion of the PHE.</div><div><br></div><div>Additionally, requirements for routine training, that was waived for ICF/IIDs, during the pandemic, will resume when the PHE expires.</div><div><br></div><div>CMS waived the requirement that each client must receive a continuous active treatment program. This requirement will resume when the PHE expires. </div><div><br></div><div>CMS also waived the requirements for the facility to provide sufficient Direct Support Staff (DSS) so that Direct Care Staff could provide direct client care. AHCA is seeking more information on the impact to ICF/IID providers and will be in touch with more information.<br></div>Today, CMS released a new regulatory memo QSO-23-13-ALL entitled “Guidance for Expiration of the COVID-19 Public Health Emergency on May 11, 2023.
Protect Residents and Staff with the Emergency Preparedness Program Best Practice Guidebookhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Protect-Residents-and-Staff-with-the-Emergency-Preparedness-Program-Best-Practice-Guidebook.aspxProtect Residents and Staff with the Emergency Preparedness Program Best Practice Guidebook4/11/2023 4:00:00 AM<p><span style="font-size:11pt;">​Disasters and emergencies, whether natural or man-made, can strike at any time, and it is essential that long term care facilities are prepared to respond effectively. To maintain compliance with F838-Facility Assessment regulation, long term care providers must conduct and document a <em>facility-based and community-based risk assessment </em>utilizing an all-hazard approach to determine what resources are necessary to care for residents during emergency situations.  </span></p><div> <br></div><div>The recently updated, <strong>downloadable</strong> <a href="https://ahcapublications.org/products/emergency-preparedness-program" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">Emergency Preparedness Program Best Practice Guidebook for Long Term Care</a> offers a comprehensive facility and community-based approach to emergency preparedness, with a focus on best practices and compliance management. <img src="/News-and-Communications/Blog/PublishingImages/Pages/Protect-Residents-and-Staff-with-the-Emergency-Preparedness-Program-Best-Practice-Guidebook/8587%20Emergency%20Preparedness%20Plan%20Cover_2022%20(1).jpg?RenditionID=1" alt="8587 Emergency Preparedness Plan Cover_2022 (1).jpg" class="ms-rtePosition-2 ms-rteImage-4" style="margin:5px;" /><br><br></div><div> </div><div>Every facility is unique and preparedness must be tailored to fit the specific needs and circumstances of each organization. One of the key features of this <strong>customizable</strong> resource is its function as a best practice template. </div><div> </div><div>Effective emergency preparedness at the facility level requires a coordinated effort from <strong>all levels of staff</strong>; decisions made by the executive director, facilities managers, and other staff members are crucial to maintaining continuity of operations and ensuring resident safety during a disaster. Staff must be equipped to guide emergency responders, provide logistical support, and plan for short-term needs and long-term recovery as a team. In addition to internal coordination, staff must also be familiar with the resources available to them <strong>outside of their organization</strong>, including local, state, federal, and nongovernmental agencies. Understanding how to work within these frameworks is essential to providing safety and continuity of care. </div><div> </div><div>The <em>Emergency Preparedness Program Best Practice Guidebook for Long Term Care</em> provides a framework for facilities to assess their readiness and develop a <strong>comprehensive plan</strong> to mitigate emergencies. With proper preparation and coordination, providers can maintain CMS compliance and safeguard the health and well-being of their residents and staff even in the most challenging circumstances. <br></div><p>​</p>Disasters and emergencies, whether natural or man-made, can strike at any time, and it is essential that long term care facilities are prepared to respond effectively.
CMS Releases Categorical Waiver on Health Care Microgrid Systemshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Releases-Categorical-Waiver-on-Health-Care-Microgrid-Systems.aspxCMS Releases Categorical Waiver on Health Care Microgrid Systems4/11/2023 4:00:00 AM<p>​<br></p><div>Recently, CMS released <a href="https://www.cms.gov/files/document/qso-23-11-lsc.pdf" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]">QSO-23-11-LSC</a> regarding a Categorical Waiver – Health Care Microgrid Systems (HCMSs) for all skilled nursing facilities (SNFs), with the exception of SNFs providing life support. This memo is effective immediately. </div><div> </div><div>Various CMS regulations governing certain providers require compliance with the 2012 edition of the National Fire Protection Association (NFPA) Health Care Facilities Code (NFPA 99). The 2012 edition of NFPA 99 requires emergency power for an essential electric system (EES) to be supplied by a generator or battery system; however, the 2021 edition of NFPA 99 permits emergency power for an EES to be supplied by sources other than a generator or battery system, including a health care microgrid system (HCMS).  </div><div> </div><div>Health care microgrid systems (HCMSs) are small-scale electrical grids where the sources of electricity can be provided by clean energy technologies (e.g., fuel cells, solar, wind, energy storage, etc.). According to NFPA 99 (2021), 3.3.76, Health Care Microgrid Control System is defined as a system including health care microgrid control functions that can manage itself, operate autonomously, and connect to and disconnect from the utility for the exchange of power and the supply of ancillary services.  </div><div><br></div><div>An HCMS can be more reliable, efficient, and reduces environmental and health issues associated with generator emissions through the use of clean energy technologies.  </div><div><br></div><div>In addition to sustainability, an HCMS can provide additional redundancy and resiliency beyond the traditional use of generators.  </div><div><br></div><div>CMS is issuing a categorical waiver permitting new and existing health care facilities subject to CMS requirements to utilize alternate sources of power other than a generator set or battery system only if in accordance with the 2021 edition of NFPA 99, 2023 edition of the National Electric Code (NFPA 70), and associated references. CMS regulations allow for the waiver of specific provisions of the 2012 edition of NFPA 99 where the application would result in unreasonable hardship upon a provider or supplier, but only if the waiver does not adversely affect the health and safety of patients or residents. CMS has determined that limiting the ability to utilize an HCMS as a power source in place of a traditional generator or battery systems is an unreasonable hardship. As such, CMS is providing the opportunity to utilize HCMS through a categorical waiver.   </div><div> </div><div><strong>Exclusions </strong></div><div> </div><div>The categorical waiver excludes long term care (LTC) facilities that provide life support as the LTC requirements at 42 CFR 483.90(c)(2) requires these facilities to have an emergency generator without exception. </div><div><br></div><div><strong>Categorical Waiver Process </strong> </div><div> </div><div>Providers that choose to utilize this categorical waiver must formally elect and document their decision. </div><div> </div><div>At the survey entrance conference, a provider or supplier that has elected to use the categorical waiver must provide the survey team with their documented decision and verification of compliance with all applicable requirements in the 2021 edition of NFPA 99. If a provider or supplier has not elected to use this categorical waiver, the facility emergency power supply system will be surveyed for compliance to the 2012 edition of NFPA 99, the 2023 edition of NFPA 70, and associated references. It is not acceptable for a facility to notify surveyors of the election to use a categorical waiver after the survey team has issued a citation. The survey team will review the documented decision to use the categorical waiver and confirm the facility is compliant with the applicable requirements.  </div><div> </div><div>If a provider or supplier has not elected to use this categorical waiver, the facility emergency power supply system will be surveyed for compliance with the 2012 edition of the NFPA 99. </div><div> </div><div>If a provider or supplier has elected to use the categorical waiver for an HCMS and is in compliance with the 2021 edition of NFPA 99, 2023 edition of the NFPA70, and associated references, the facility will not be cited for non-compliance with the 2012 edition of NFPA 99 and will not be required to request a separate waiver as part of the survey plan of correction. The survey team will describe the facility-specific categorical waiver use under K900 – Health Care Facilities Code-Other and mark the facility as “The Facility Meets the Standard, Based Upon, 3. Recommended Waivers.”  </div><div> </div><div>If a provider or supplier has elected to use the categorical waiver for an HCMS and is not in compliance with the 2021 edition of NFPA 99, 2023 edition of the NFPA 70, and associated references, the facility will be cited for non-compliance with the 2012 edition of NFPA 99. The survey team will describe the facility-specific categorical waiver use under K900 – Health Care Facilities Code-Other and cite the facility referencing applicable sections of the 2012 NFPA 99. In order for the facility to continue to use the categorical waiver for an HCMS, it will need to provide an acceptable plan of correction to reestablish compliance with the 2021 edition of NFPA 99, 2023 edition of NFPA 70, and associated references. </div><div> </div><div>For questions or concerns relating to this memorandum, please contact <a href="mailto:QSOG_LifeSafetyCode@cms.hhs.gov" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]">QSOG_LifeSafetyCode@cms.hhs.gov</a>.<br></div>CMS released QSO-23-11-LSC regarding a Categorical Waiver – Health Care Microgrid Systems for all skilled nursing facilities, except for SNFs providing life support.

 Featured Video

 Top Resources

 Planning Ahead

​In order to effectively handle disasters and emergencies, it is important for centers to plan ahead and prepare in advance. Long term and post-acute care centers can use a targeted approach to addressing vulnerabilities and hazards to help them best respond to and recover from events. This site seeks to assist centers in creating a plan to address its greatest risks:
Hazard Vulnerability Assessment
The Hazard Vulnerability Assessment (HVA) is a tool designed to assist centers in evaluating vulnerability to specific hazards. The tool uses various categories, such as probability of experiencing a hazard, human impact, property and business impact and response, to create a numeric value based on various hazards.

 Incident Command System

The Incident Command System is part of the emergency management system in many levels (federal, state, and local). Every significant incident or event, whether large or small, and whether it is even defined as an emergency, requires certain management functions to be performed.

The Nursing Home Incident Command System (NHICS) and Assisted Living Incident Command System (ALICS) outline a management framework that empowers long-term care staff to improve the effectiveness and efficiency of their incident response -- no matter what shift, or what day of the week the event occurs. ​​



 ‭(Hidden)‬ CMS Emergency Preparedness Rule

The Emergency Preparedness Final Rule was released on Friday, September 16, 2016. AHCA, along with guest speakers, will hold a webinar series event​ this year on the new emergency preparedness final rule impacting Skilled Nursing Facilities (SNF), Nursing Facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This final rule is not applicable to Assisted Living Providers. 

Providers will need to be in compliance by November 15th 2017. The webinar series will include, special guest speakers, an overview of the key new requirements, a list of tools to assess if you are prepared for the rule, steps to take now to prepare.

On Friday, September 1st, CMS released a memorand​um to State Survey Agency Directors announcing that the Emergency Preparedness Training is now available. All surveyors are required to take the training prior to surveying the Emergency Preparedness requirements. Surveying for requirements begins November 15th, 2017. 

The online course is now available on the Surveyor Training Website On-Demand. Once in the course catalog for provider training, search “emergency” and the course information will appear. Providers will have continued (ongoing) access to the course, so they can review it anytime.

Members are strongly encouraged to review and complete the training as it includes quizzes and exercises to check understanding. The training states to surveyors that the requirements do not prescribe or mandate specific technology or tools nor detailed requirements for how facilities should write emergency plans. The training includes the questions surveyors will ask and how documentation will be reviewed and checked. Links to resources and glossary terms are also included.​

​Emergency Resources

In addition to planning for natural disasters, staff and facilities must be prepared for other emergencies, such as pandemics, influenza, active shooters and more. All emergency situations must be handled swiftly, diligently and with the utmost care for staff and patients.

 Active Shooter

​While many emergencies are caused by natural disasters and are, staff and facilities should also be prepared for other types of emergencies. One emergency for which facilities should have plans in place is an active shooter.
Please note: The policies below are models only and should be modified and tailored to meet the needs of individual communities. 

AHCA/NCAL's Active Shooter Resources
External Resources

 Assisted Living Resources

The Emergency Preparedness Guide for Assisted Living is a comprehensive resource that will assist members with developing emergency operations plan and includes the planning process. The guide includes templates and numerous resources for members to utilize.


Assisted Living Incident Command System (ALICS)

The Incident Command System (ICS) is one component of the National Incident Management System or (NIMS). The Assisted Living Incident Command System or “ALICS” is a simplified ICS and through its use, long-term care providers can become part of this standardized system of efficient response. ICS was modified by two consultants for assisted living and reviewed by AALNA board members and then reviewed by the NCAL Workgroup of the AHCA/NCAL Emergency Preparedness Committee.

ALICS offers long-term care providers a flexible framework for command and control that is based on the standardized system of ICS. It does this through a system that is designed to:
  • Manage all emergency, routine, or planned events, of any size or type, by establishing a clear chain of command and a process for communication, decision‐making and delegation.
  • Allow personnel from different agencies or departments to be integrated into a common structure that can effectively address issues and delegate responsibilities.
  • Provide needed logistical and administrative support to operational personnel.​

 Shelter In Place

Shelter In Place: Planning Resource Guide for Nursing Homes

For the purposes of this resource guide, shelter in place (SIP) is defined as: A protective action strategy taken to maintain resident care in the facility and to limit the movement of residents, staff and visitors in order to protect people and property from a hazard.

Shelter In Place Guidebook (PDF)

 State Resources


 Winter Weather

The Centers for Disease Control and Prevention published a comprehensive winter weather health and safety site. Owners and administrators can take tips to prepare for extreme cold conditions and winter storms.​

 In Case of An Emergency

AHCA/NCAL regularly publishes and distributes informative documents for members regarding emergency preparedness, response, and recovery.

During public health emergencies, CMS will post updates on waivers on their Emergency Response and Recovery page. Members should check this page for updates during an event.