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.




HHS Extends Public Health Emergency Through January 12https://www.ahcancal.org/News-and-Communications/Blog/Pages/HHS-Extends-Public-Health-Emergency-Through-January-12.aspxHHS Extends Public Health Emergency Through January 1210/13/2022 4:00:00 AM<p></p><div>U.S. Health and Human Services Secretary Xavier Becerra renewed the declaration that a public health emergency exists. This is effective October 13, 2022, and will continue for 90 days pursuant to federal law. </div><div><br></div><div>The Public Health Emergency renewal through mid-January is welcome news. It provides for the uninterrupted continuation of several flexibilities that have protected beneficiary access to important services in as safe and effective manner as possible.</div><div><br></div><div>Please email <a href="mailto:COVID19@ahca.org" data-feathr-click-track="true">COVID19@ahca.org</a> for additional questions.<br></div><p>​</p>U.S. Health and Human Services Secretary Xavier Becerra renewed the declaration that a public health emergency exists.
Reduce COVID-19 Hospitalizations and Deaths with Paxlovid for Eligible Residents https://www.ahcancal.org/News-and-Communications/Blog/Pages/Reduce-COVID-19-Hospitalizations-and-Deaths-with-Paxlovid-for-Eligible-Residents-.aspxReduce COVID-19 Hospitalizations and Deaths with Paxlovid for Eligible Residents 10/4/2022 4:00:00 AM<div><span style="font-size:14.6667px;display:none;"></span>As we head into the fall and winter months, there will likely be an increase in the number of COVID-19 cases around the country. While vaccination continues to provide the best protection, COVID-19 therapies are widely available to help treat eligible people who do get sick and are at risk of developing severe disease. Antiviral treatments for patients at risk for COVID-19 reduces their risk of hospitalization and death.   </div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">The antiviral Paxlovid (ritonavir-boosted nirmatrelvir) along with Veklury (remdesivir) are they preferred treatments for eligible adult and pediatric patients with positive COVID-19 test results and who are at risk for progression to severe COVID-19. COVID-19 therapeutics should be considered for any COVID-19 patient who meets the eligibility criteria.   </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">This <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/Documents/COVID19/ASPR%20Info%20Sheet_Paxlovid_Aug%202022_FINAL.pdf" data-feathr-click-track="true" target="_blank">information sheet</a> summarizes current information about Paxlovid and offers resources about other COVID-19 therapeutics. In addition, a study was done to identify the efficacy of Paxlovid among elderly patients with co-morbidities. The <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/Documents/COVID19/Paxlovid-Signifcantly-Reduces-COVID-19-Hospitalizations-and-Deaths.pdf" data-feathr-click-track="true" target="_blank">study</a> identified that Paxlovid significantly reduced COVID-19 hospitalizations and deaths.   </span></div><p>​</p>
CDC Releases Updates to COVID-19 Infection Prevention and Control Guidance https://www.ahcancal.org/News-and-Communications/Blog/Pages/CDC-Releases-Updates-to-COVID-19-Infection-Prevention-and-Control-Guidance-.aspxCDC Releases Updates to COVID-19 Infection Prevention and Control Guidance 9/23/2022 4:00:00 AM<p><strong>​CDC Releases Updates to COVID-19 Infection Prevention and Control Guidance Bringing Relief</strong></p>The CDC today released updates to three guidance documents now available on its website. AHCA has provided a high-level summary of the changes and linked to each guidance for additional information. Many of these changes reflect the tireless work that AHCA members have devoted to advocating for CDC to update. ​<br><br><p>The agency notes that these updates have been made to <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e1.htm?s_cid=mm7133e1_w" data-feathr-click-track="true" target="_blank">reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools</a>. </p><p>The key changes outlined in the <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html" data-feathr-click-track="true" target="_blank">guidance for COVID-19 infection prevention and control</a> update include:</p><ul><li>Vaccination status no longer is used to inform source control, screening testing, or post-exposure (e.g., work restriction, quarantine) recommendations.</li><li>Standalone guidance for nursing homes is being archived and any setting-specific recommendations has been added to Section 3 of the main guidance.</li></ul><p>The following are changes to S<span style="text-decoration:underline;">ource Control</span>:</p><ul><li>When community transmission levels <strong>are high,</strong> source control is recommended for everyone in areas where they could encounter patients.  Health care personnel could choose not to wear source control when in areas restricted from patient access (if Community Levels aren't also high and don't meet criteria below).</li><li>When community transmission levels <strong>are not high</strong>, source control is recommended for individuals who: </li><ul><li>Have suspected or confirmed respiratory infection.</li><li>Had close contact with someone with COVID-19 for 10 days after contact.</li><li>Reside or work in an area of the facility experiencing COVID-19 outbreak.</li><li>Have otherwise had source control recommended by public health.</li></ul><li>Even if not otherwise required by the facility, individuals should always be allowed to wear source control based on personal preference.</li></ul><p>The following are changes to U<span style="text-decoration:underline;">niversal PPE</span>:</p><ul><li>Consider implementing PPE when Community Transmission levels <strong>are high.</strong></li><ul><li>N95 in select situations (e.g., aerosol-generating procedures such as nebulizer treatments).</li><li>Eye protection during patient care encounters.</li></ul></ul><p>The following are changes to <span style="text-decoration:underline;">Testing</span>:</p><ul><li>Series of 3 tests recommended for asymptomatic individuals following exposure to someone with COVID-19 infection. </li><ul><li>Testing is recommended immediately (but generally not earlier than 24 hours after the exposure) <strong>and,</strong> if negative, again 48 hours after the first negative test, <strong>and</strong>, if negative, again 48 hours after the second negative test.  This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.</li></ul><li>Testing is generally <strong>not</strong> recommended for asymptomatic individuals who have recovered in the prior 30 days.</li><ul><li>If testing, antigen test is recommended.</li><li>Antigen test is also recommended for those within 31-90 days of infection.</li></ul></ul><p>The following are changes to <span style="text-decoration:underline;">Screening Testing</span>:</p><ul><li><strong>No longer recommending asymptomatic screening testing </strong>of nursing home personnel who have <strong>not</strong> had a recognized exposure.</li><li>Screening testing remains recommended for new admissions to nursing homes when community transmission levels <strong>are high</strong>.</li></ul><p>The following are changes to <span style="text-decoration:underline;">Quarantine and Work Restrictions</span>:</p><ul><li><strong>No longer routinely recommending quarantine</strong> (for patients) or work restriction (for healthcare personnel) for asymptomatic individuals following COVID-19 exposures.</li><li>Continue to emphasize:</li><ul><li>Monitoring for symptoms.</li><li>Series of 3 tests.</li><li>Continued use of source control for 10 days following the exposure.</li><li>Prompt isolation or work restriction if symptoms develop or testing is positive for COVID-19 infection.</li></ul></ul><p>The following are updates related to settings such as <strong>assisted living communities</strong> and group homes:</p><ul><li>Long term care settings (excluding nursing homes) whose staff provide “non-skilled personal care" like that provided by family members in the home (e.g., many assisted living communities, group homes), should follow guidance for high-risk congregate care settings.</li><li>Visiting or shared health care personnel who enter the setting to provide health care to one or more residents (e.g., physical therapy, wound care, intravenous injections, or catheter care provided by home health agency nurses) should follow the health care IPC recommendations in the guidance.</li></ul><p>The following <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html" data-feathr-click-track="true" target="_blank">Interim Guidance for Managing Healthcare Personnel with COVID-19 Infection or Exposure to COVID-19</a>, include:</p><ul><li><strong>In most circumstance, asymptomatic HCP with higher-risk exposures do not require work restriction.</strong></li><li>Updated recommendations for testing frequency to detect potential for variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms.</li></ul><p>In addition, the following key points were noted in the updated <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html" data-feathr-click-track="true" target="_blank">Strategies to Mitigate Healthcare Personnel Staffing Shortages | CDC</a>. </p><ul><li><a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html" data-feathr-click-track="true" target="_blank">Conventional strategies</a> were updated to advise that, in most circumstances, asymptomatic health care personnel (HCP) with higher-risk exposures do not require work restriction, regardless of their vaccination status; therefore, the contingency and crisis strategies about earlier return to work for these HCP was removed.</li></ul><strong>CMS also updated QSO on testing consistent with CDC guidance. Testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility. Also, CMS </strong><a href="https://www.cms.gov/files/document/qso-20-38-nh-revised.pdf" data-feathr-click-track="true" target="_blank"><strong>updated recommendations</strong></a><strong> for testing individuals who have recovered from COVID-19.</strong><br><br><span style="font-size:14.6667px;">Note, while the CDC and CMS have changed their guidance, the guidance from local and state health departments may be more restrictive. Please check your local or state guidance. </span><br><p> <br></p><p>​<br></p><p> <br></p><p>​</p>
PRF Reporting Period 3 Due September 30https://www.ahcancal.org/News-and-Communications/Blog/Pages/PRF-Reporting-Period-3-Due-September-30.aspxPRF Reporting Period 3 Due September 309/22/2022 4:00:00 AM<p>​</p><div>Providers who received Provider Relief Fund (PRF) payments exceeding $10,000, in the aggregate, between January 1, 2021- June 30, 2021, are required to report in Reporting Period 3 (RP3). There will be no extension. <strong>You must submit a report on use of funds by September 30, 2022, at 11:59 p.m. ET.</strong></div><div><br></div><div>On September 8, 2022, providers received a notification, based on their status in the reporting process, reminding them of their reporting requirement. The RP3 reminder email for <strong>providers registered but who have not yet reported</strong> may be viewed <a href="/Reimbursement/Documents/PRF/RP3%20-%20Reporting%20Reminder%20Email%20-%20Registered,%20Not%20Started.pdf" data-feathr-click-track="true" target="_blank">here</a>. The RP3 reminder email for <strong>providers registered and in progress</strong> may be viewed <a href="/Reimbursement/Documents/PRF/RP3%20Reporting%20Reminder%20Email%20-%20Registered,%20In%20Progress.pdf" data-feathr-click-track="true" target="_blank">here</a>. <br></div><div><br></div><div><strong>Request to Report Late Due to Extenuating Circumstances</strong></div><div><br></div><div>Providers who experienced one or more extenuating circumstances that prevented them from submitting a completed PRF Report in Reporting Periods 1 and/or 2 (RP1 and RP2) by the deadline had the opportunity to submit a Request to Report Late Due to Extenuating Circumstance. The opportunities to submit late reports for RP1 and RP2 have passed. While it’s anticipated that the Extenuating Circumstances option will be offered for RP3, providers are highly encouraged to complete the report by the September 30 deadline. It is a request process that will open and approved providers will be required to submit reports in a two-week window of time.</div><div><br></div><div>For more details about the Extenuating Circumstances process and what is considered in this category, please review the <a href="https://www.hrsa.gov/provider-relief/reporting-auditing/late-reporting-requests" data-feathr-click-track="true" target="_blank">Request to Report Late Due to Extenuating Circumstances webpage</a>. </div><div><br></div><div><strong>Upcoming reporting periods:</strong></div><div><br></div><div><ul><li>​Reporting Period 4 opens on January 1, 2023</li><li>Reporting Period 5 opens on July 1, 2023</li></ul></div><div><br></div><div><strong>Need Help with Reporting?<br><br></strong></div><div>HRSA has detailed answers to common questions related to reporting requirements and auditing. Read the <a href="https://www.hrsa.gov/provider-relief/faq/reporting" data-feathr-click-track="true" target="_blank">PRB Reporting and Auditing FAQ</a>.</div><div><br></div><div>For all other questions related to reporting, call the Provider Support Line at 866-569-3522; for TTY, dial 711. Hours of operation are 9 a.m. - 11 p.m. ET, Monday through Friday. Hours are subject to change.</div><div><br></div><div><strong>Providers Must Enroll in Optum Pay to Claim their Payments</strong></div><div><span style="font-size:11pt;">Deadline to Enroll: October 21, 2022, at </span><span style="font-size:11pt;">6</span><span style="font-size:11pt;"> p.m. E</span><span style="font-size:11pt;">T</span><br></div><div><br></div><div>There are PRF Phase 4 or American Rescue Plan (ARP) Rural payments available, but providers have not taken the required actions to receive their funds. HRSA has attempted to contact these providers through the point of contact listed on the application. </div><div><br></div><div><strong>A FINAL REMINDER was sent: to receive these funds, providers must fully complete an </strong><a href="https://myservices.optumhealthpaymentservices.com/beginEnrollment.do" data-feathr-click-track="true" target="_blank"><strong>Optum Pay account</strong></a><strong> </strong><strong>by October 21, 2022 at 6 p.m. ET. Fully enrolling in Optum Pay may take up to 10 business days. Enrollment MUST be completed before the deadline.</strong><br></div><div><br></div><div>HRSA’s program integrity safeguards require providers receiving payments over $100,000 to register for an Optum Pay account to retrieve their payment. An explanation of the requirement was included in the application guidance.</div><div><br></div><div>Depending on when providers have successfully enrolled in Optum Pay, it may take an additional two weeks for funds to be available in their accounts.</div><div><br></div><div>For more information on PRF Phase 4 and ARP Rural payments, visit <a href="https://www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">https://www.hrsa.gov/provider-relief/future-payments</a>.</div><div><br></div><div><strong>Instructions for Setting Up an Optum Pay Account</strong></div><div><br></div><div>Visit <a href="https://myservices.optumhealthpaymentservices.com/beginEnrollment.do" data-feathr-click-track="true" target="_blank">https://myservices.optumhealthpaymentservices.com/beginEnrollment.do</a> to begin the online enrollment process. Providers must use the TIN associated with their Phase 4 PRF application to enroll. This process will not involve credentialing or contracting with UnitedHealth Group. The information providers submit will only be used to administer PRF and ARP Rural payments. Required information:<br><br></div><div><ul><li>​Organization demographic information (name, phone number and email address)</li><li>Contact information for one or two individuals from the organization to support administration and oversight of the account, including editing bank account deposit information for any future payments</li><li>The organization's banking information (routing number, account number, and account type)</li><li>Clear, legible, and unaltered voided check and/or a bank letter signed and dated from a bank officer</li><li>Clear and legible IRS Form W-9 signed and dated within 1 year</li></ul></div><div><br></div><div>To date, HRSA has released approximately $15.4 billion to more than 90,000 providers. Almost all (99 percent) applications have been processed. If a facility is anticipating a payment and it hasn’t been received, check the status of its Optum Pay account. </div><div><br></div><div><strong>For additional support with the Optum Pay set-up, please call the Provider Support Line at 866-569-3522 or the Optum Support line at 877-620-6194.</strong><br></div>Providers who received Provider Relief Fund payments exceeding $10,000, in the aggregate, between Jan. 1- Jun. 30, 2021, are required to report in Reporting Period 3.

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 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.