The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report on March 11, 2025, stating that state survey agencies need clearer guidance to assess nursing home emergency preparedness programs.
The report, posted on March 14, states that nursing home failures, such as resident deaths during Hurricane Ida, demonstrate continued challenges in emergency preparedness. These failures raise questions about the effectiveness of the survey process in overseeing nursing home preparedness.
State survey agencies, which are contracted and overseen by the Centers for Medicare and Medicaid Services (CMS), are responsible for ensuring nursing homes comply with Medicare and Medicaid Requirements for Participation, including emergency preparedness rules. While CMS oversees nursing home compliance with these rules, the Administration for Strategic Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) fund efforts at state and local levels to support healthcare facility emergency preparedness, including for nursing homes.
The OIG report found that a quarter of state survey agencies reported that surveyors typically lack emergency preparedness expertise when hired, and building and retaining this expertise is challenging. The report also pointed out that CMS program guidance is more focused on the documentation required for compliance rather than assessing the content of that documentation. Additionally, nearly half of state survey agencies reported successes beyond CMS guidance, such as enhanced information sharing with emergency preparedness partners and additional tools to improve compliance.
To strengthen the survey process and support survey staff with limited expertise in emergency preparedness, the OIG recommends that CMS: 1) provide surveyors with clear instructions on how to assess the contents of nursing home emergency preparedness documentation as part of the survey process, and 2) issue guidance encouraging state survey agencies to collaborate and share information. CMS has concurred with both recommendations.
Access the full report here.
Compliance Perspective
Issue
CMS requires nursing homes that participate in the Medicare and Medicaid programs to meet a broad range of emergency preparedness requirements. These include (1) having and maintaining an all-hazards emergency preparedness plan that incorporates a facility- and community-based risk assessment, as well as plans for continuity of operations; (2) establishing policies and procedures to be followed in the event of an emergency; (3) maintaining a communication plan to ensure that affected individuals and oversight groups receive needed information; and (4) having a program for training staff and conducting exercises to ensure that the plans will be effective in the event of an emergency.
Discussion Points
- Review your Emergency Preparedness Plan and update as necessary. Review the most current Life Safety codes and ensure that your building meets those requirements. Make sure the Plan is available to staff so they can easily access the guidelines for the various components should an emergency occur.
- Train all staff on your Emergency Preparedness Plan. Conduct drills for the various disaster response plans to ensure staff competency with each. Ensure that the facility maintenance director is aware of current Life Safety codes and provide training as needed. An educational program titled Emergency Preparedness Requirements for Nursing Homes is available in the Safety Category of Med-Net Academy Compliance for access by all clients.
- Periodically conduct environmental audits to ensure that Life Safety codes are being followed. Audit staff understanding to ensure that they are aware of their roles during each category of emergency per your Emergency Preparedness Plan. Audit to ensure that thorough documentation of each drill is on file and available for surveyor access when requested, to include participation in an annual area-wide drill with your local emergency response teams.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
