accrediting bodies currently still require an H&P to be current within 30 days or less in some cases.

Emergency Preparedness Background In response to Hurricane Katrina in 2005, CMS implemented disaster pre- paredness requirements for ASCs back in 2009. These requirements were sep- arated out and expanded upon in a sep- arate Emergency Preparedness Con- dition for Coverage (CfC), §416.54, which became effective November 2017. While it is critical for ASCs to be prepared in case of an emergency, the burden associated with the rule that went into effect in 2017 has been viewed by ASCA and many of its mem- bers as overly burdensome for outpa- tient, primarily elective, facilities. In response to concerns raised by several stakeholder groups, CMS adopted sev- eral changes to these requirements in its final Burden Reduction Rule. Many

depend on healthcare provider and supplier type.

Final Rule: The following changes, applicable to ASCs, are now effective: ■

■ elimination

review of the facility’s emergency plan (EP) now required every two years, instead of annually, as before; of

the requirement

that facilities document efforts to contact local, tribal, regional, state and federal EP officials; ASCs still need to try to coordinate with them, but facilities no longer need to document their efforts;

training of staff now required every two years or when EP is significantly updated, instead of every year;

testing exercise of outpatient providers now required once a year instead of twice. Of those two exercises: ●

functional exercise every other year; and

in the opposite years, providers may conduct a testing exercise of their choice, which may include: a community-based full-scale exercise, if available, an individ- ual facility-based functional exer- cise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator.

exempting providers from the next required exercise after an event requir- ing activation of EP plan (i.e., if your facility must deal with an emergency). This rule became effective on Friday,

providers must either participate in a community-based full-scale exercise, if available, or conduct an individual facility-based

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November 29, 2019. ASCA members can access a spreadsheet that breaks down all the Conditions for Coverage (CfC) changes effective November 29 here. CMS will be updating Appen- dix L to provide more clarity on these changes, but it is unclear how long that will take. The current version of Appen- dix L is from 2015, meaning it has not even been updated since the emergency preparedness changes went into effect. If your state law or accrediting body requirements are more restric- tive than CMS’ new CfCs, those other requirements take precedence. Before you consider changing your policies and procedures to reflect the new CMS requirements, please make sure you are fully aware of your state and accredit- ing organization requirements. ASCA Members can access resources breaking down the burden reduction rule at rule-analysis. This includes a spread- sheet showing changes to ASC CfCs, as well as one-pagers breaking down states with existing requirements for H&Ps and transfer agreements.

Kara Newbury is ASCA’s director of Government Affairs and regulatory counsel. Write her at

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