In January 2018 Medicare made multiple changes to the language of the condition regarding Emergency Preparedness §484.102. Medicare also created an exception to emergency preparedness testing and drills: if the HHA experiences an emergency - that requires activation of the emergency plan (i.e. COVID-19), the HHA is exempt from testing and drills for a year following the emergency:

§484.102(d)(2) Testing.

The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do 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 HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA 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.

§484.102: Emergency Preparedness

§484.102 Condition of participation: Emergency preparedness. The HHA must comply with all applicable Federal, State, and local emergency preparedness requirements. The following are the requirements which need to be in your Policy and Procedures for Emergency Preparedness. Surveyors will want to see documentation of staff training as applicable:

•    The Emergency Plan (“Plan”) must be reviewed and updated at least annually.
•   The Plan must be based on a facility- and community-based risk assessment utilizing an all-hazards approach.
•   The Plan must include strategies for addressing emergency events as indicated in the risk assessment.
•   The plan must address patient populations that include what services the HHA can provide in an emergency and continuity of operations during an emergency.
•   The Plan must include a process for cooperation and collaboration with all emergency preparedness officials in order to maintain an integrated response during an emergency situation.
•   The HHA must have a procedure for informing state and local officials who would need to be evacuated from their homes due to an emergency.
•   The HHA must have a procedure for determining how services will be provided when there is an interruption in services due to an emergency. This includes a requirement that the HHA notify state and local officials of any on-duty staff or patients they are unable to contact.
•   The HHA must have a system for protecting patient information and the confidentiality of such information in the event of an emergency.
•   The HHA is required to have a process on the use of volunteers or other staffing to address surge needs during an emergency
•   The HHA must develop and maintain an emergency preparedness communication plan that must be reviewed and updated at least annually.
•   The communication plan must have contact information for staff, contracted entities providing services to the HHA, patients’ physicians, volunteers, emergency preparedness staff at all levels of government and other sources of assistance.
•   The HHA must have a primary and alternative means of communication for contacting staff and emergency preparedness agencies.
•   The HHA must implement a method for sharing patient information with other health care providers to ensure continuity of care.
•   Develop and maintain an emergency training and testing program taking into account the Emergency Plan, Risk Assessment, Policies and Procedures and Communication Plan. The training and testing program must be updated at least annually. The HHA must maintain documentation of the training.
•   The HHA must participate in a full-scale and community-based exercise on the emergency preparedness plan.
•   A second community or facility-based exercise must also be conducted. This exercise must include a tabletop exercise, which includes a group discussion led by a facilitator.
•    If the HHA participates in the system-wide emergency preparedness plan, it must ensure the HHA’s patient population and services offered are taken into account.