ters strike; in fact, their needs often increase in the immediate aftermath of a disaster.”

Despite the good intentions behind

it, the rule raises certain implementa- tion concerns in the ASC community. One of the key areas of concern is its training and testing requirements. The rule requires that Medicare- and Med- icaid-participating providers provide annual trainings, conduct drills and exercises and participate in an actual incident that tests the health care pro- viders’ emergency plans.

The annual training requirement consists of two drills, an annual com- munity-based

mock disaster drill

and another mock disaster drill, or a table top exercise. ASCA objected to the community-based requirement because many communities have dem- onstrated in the past that they are not interested in including ASCs in their emergency preparedness and response planning. In response, CMS still final- ized the requirement of the two exer- cises but allowed for an exception: ASCs must document that they tried to coordinate and collaborate with the community to participate in a mock disaster drill. Once that communica- tion is documented, ASCs must then do an individual facility-based com- munity mock disaster drill. It is noteworthy that although CMS does not require a local or state gov- ernment official to approve or sign off on the ASC’s emergency plan, the ASC must still comply with state laws. Since state approval is not required, the ASC, rather than the state, is responsible for ensuring that its plan complies with both federal and state requirements. The community-based mock drill also raises concerns for ASCs because of the word community. CMS did not define the word in the final rule and refused to do so in subsequent inter- pretative guidelines. It did explain, however, that this was intended to afford flexibility to providers so they

can develop drills that are “realis- tic and reflect their risk assessment.” Given that explanation, the term could mean entities within a state or multi- state region, depending on the size, location, capacity and type of entity. Many ASCs already practice emer-

gency preparedness as a requirement through their respective accrediting organizations. In this final rule, CMS indicated that accrediting organiza- tions with deeming authority now need to submit their new emergency preparedness standards to CMS for review. Once CMS confirms that the accrediting organizations’ new stan- dards meet or exceed the new require-

Track the Latest Regulatory and Legislative News for ASCs

Visit ASCA’s web site every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs. GovtAffairsUpdate

ments, accredited ASCs will need to meet those standards to remain accred- ited and Medicare-certified. Lynne

Bergero, project


for the Division of Healthcare Qual- ity Evaluation for The Joint Commis- sion explains how the new rule affects her organization. “For most areas,” she says, “Joint Commission standards were in direct alignment with CMS EM [emergency management] final rule requirements. For example, the final rule requires two annual emer- gency exercises, a requirement that has been in Joint Commission stan- dards for ambulatory care for years at standard EM.03.01.03 in the Emer- gency Management chapter. For other areas, specific differences were iden- tified, and The Joint Commission will develop new elements of performance for these issues to support organization implementation.”

ASCs should be preparing now to ensure that they comply with the Emergency

Preparedness Rule by

November 16, 2017. This prepara- tion should include, but is not limited to, reviewing current emergency pre- paredness policies, modifying these policies, if needed, and obtaining and documenting the approval of these policies by the center’s various com- mittees and/or Governing Board. CMS has explicitly stated that there will be no exceptions for the requirements and the CMS response to noncompliance will follow the same process it follows with any other Conditions of Participa- tion (CoPs) or Conditions for Cover- age (CfCs) that apply to the facility at hand. To stay informed on developing interpretative guidelines, visit CMS’ web site and ASCA’s Emergency Pre- paredness Resource page or consult your accrediting organization.

Nawa Arsala is ASCA’s assistant regulatory counsel. Write her at narsala@


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