Cooperative Agreement AND CMS Emergency Preparedness Rules Related to Pediatric Care May 23 rd 2017 Teresa Ehnert ChiefBureau of Public Health Emergency Preparedness AGENDA Review of Pediatric Care Requirements for the Hospital ID: 591591
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Slide1
Pediatric Care Requirements and Hospital Preparedness Program: New 2017
Cooperative Agreement
AND
CMS Emergency Preparedness Rules Related to
Pediatric Care
May 23
rd
, 2017
Teresa Ehnert
|
Chief-Bureau of Public Health Emergency PreparednessSlide2
AGENDA
Review of Pediatric Care Requirements for the Hospital
Preparedness
Program (HPP) in New 2017 Cooperative Agreement
Review of CMS Rules Related to Children/Pediatric Care
Discussion on collaboration between HPP and Emergency Medical Services for Children (EMSC)
OPEN
DISCUSSIONSlide3
Pediatric
Care Requirements
HPP-2017
Cooperative
Agreement and CMS Requirements
GoalThe goal is to understand 2017 Cooperative Agreement and HPP Requirements related to Health Care Coalition (HCC), Pediatric Care and Emergency Medical Services for Children (EMSC)Slide4
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 1 Strategy:
Strengthen Community
Resilience
Activity 1:
Partner with Stakeholders by Developing and Maturing Health Care Coalitions
HPP Requirements:
Identify
HCC Members
Awardees and HCCs
should
expand HCC membership to include additional types of members
……..
HCCs
also should
include specialty patient referral centers such as
pediatric
, burn, trauma, and psychiatric centers, as HCC members within its geographic boundaries. They may also serve as referral centers to other HCCs where that specialty care does not exist
.Slide5
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 1 Strategy:
Strengthen Community
Resilience
Activity 2:
Characterize the Probable Risks to the Jurisdiction and the HCC Joint
Requirements-Jurisdictional
Risk Assessments
HPP Requirements:
Assess
Hazard Vulnerabilities and Risks
Each awardee-funded HCC
must
complete an annual hazard vulnerability analysis (HVA) to identify and plan for risks, in collaboration with the
awardee.
The
assessment components
should
address population characteristics, including demographics, and consider those
individuals who might require additional help
in an emergency including
children
, pregnant women, seniors, and individuals with access and functional needs, including people with disabilities and others with unique needs.Slide6
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 1 Strategy: Strengthen Community
Resilience
Activity
3:
Characterize Populations at Risk
HPP
Requirements :
HPP
awardees and HCCs
must
obtain de-identified data from the U.S. Department of Health and Human Services emPOWER map
every six months
to identify populations with unique health care needs …
As
part of inclusive planning for populations at risk conducted by HPP awardees, HPP-funded HCCs
must
:
Support
public health agencies with situational awareness and information technology (IT) tools already in use that can help identify
children
, seniors, pregnant women, people with disabilities, and others with unique
needs
PHEP
Requirements :
To address the needs of infants and children, awardees
should
collaborate with child-serving institutions such as schools and daycare centers to assure crisis preparedness plans are in place
.Slide7
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 2 Strategy:
Strengthen
Incident
Management
Activity 4:
Ensure HCC Integration and Collaboration with Emergency Support Function-8 (ESF-8
)-
HCC
Response
Plan
Each HCC funded by the awardee
must
develop a
response plan
that is informed by its members’ individual emergency operations plans and
submit
the plan to ASPR by the
end of Budget Period 2
with annual progress reports.
Each
HCC’s response plan
must
clearly outline:
Activation
and notification processes for initiating and implementing medical surge response coordination among HCC members and other topics related to medical surge, including:
Strategies
to implement if the emergency overwhelms regional capacity or specialty care including trauma, burn, and
pediatric
capability
.Slide8
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 3 Strategy: Strengthen Information Management
Activity 2.
Share Emergency Information and Warnings across Disciplines, Jurisdictions, and HCCs and their
Members
Joint
Requirements:
Coordinate
Emergency Information Sharing between Public Health and Health
Care.
The
following are factors that HCCs, in coordination with HPP and PHEP awardees and other public health agency members,
should
consider when developing processes and procedures to rapidly acquire and share clinical knowledge.
Processes
and procedures should address a variety of emergencies such as chemical, biological, radiological, nuclear, or explosive (CBRNE), trauma, burn,
pediatrics
, or highly infectious disease
outbreaksSlide9
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 5 Strategy: Strengthen Surge
Management
Activity 2: Address Surge Needs
Joint
Requirements:
Family Reunification
During
a public health incident or crisis, families are at risk for becoming disconnected. HPP awardees and HCCs
must
serve as planning resources and
SMEs to
PHEP awardees and public health agencies as they develop or augment existing response plans for affected populations, including mechanisms for family reunification. These plans should give consideration to:
• Reunification considerations for
childrenSlide10
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 5 Strategy: Strengthen Surge
Management
Activity 4:
Address Specialty Surge
HPP
Requirements:
Pediatric Care
HPP awardees
must
collaborate
with the EMSC
program within its jurisdiction to better meet the needs of children receiving emergency medical care. Following are specific areas of collaboration:
The
HRSA
administer the EMSC program at the federal level, and
this
program works to ensure that
critically ill and injured children
receive optimal pediatric emergency care. Slide11
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
Domain 5 Strategy: Strengthen Surge
Management
Activity
4:
Address Specialty Surge
HPP
Requirements:
Pediatric Care
(Contd.)
Following are specific areas of collaboration.
HPP and
the EMSC program awardees within their jurisdictions
must
provide a
joint letter of support indicating
that EMSC and HPP are linked at the awardee level.
HPP
awardees
must
provide the initial letter of support with their funding applications
at the beginning of each budget period throughout the five-year project
period.
HPP
awardees
must
work with HCCs and EMSC to ensure that all hospitals are prepared to receive, stabilize, and manage
pediatric
patients.
At
the end of each budget period
, HRSA will provide HPP with data regarding each hospital’s capability to manage
pediatric medical emergencies
to assist with this work
.Slide12
Pediatric
Care Requirements for HCC
HIGHLIGHTS
-2017
Cooperative Agreement
HPP Evaluation and Performance Measurement StrategyTo measure and evaluate HPP performance, a variety of measures were developed at the input-, activity-, output-, or outcome-level. The 2017-2022 HPP performance measures target output and outcome measures to address the information needs of various stakeholders
.
One
of the 22 HPP performance measures and the six measures (23-28) for select U.S. territories and freely associated states is:
Percent
of hospitals with an Emergency Department (ED) recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage
pediatric medical emergencies
.Slide13
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Comments on CMS EP Rules for Pediatric Care and
CMS Response:
Comment-1:
Joint
Guidelines for Care of
Children
in the Emergency Department, developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association,
as a resource
for the final rule.
Response to Comment 1:
…
We
also want to thank commenters for their recommendations for
additional resources
on emergency preparedness. We provided an extensive list of resources in the proposed and have included links to various resources in this final rule that facilities can use as resources during the development of their emergency preparedness plans. However, we note that these lists are not comprehensive
,…… since we intend to allow facilities flexibility as they implement the emergency preparedness requirements….
Omissions
from the list of resources set out in the proposed rule do not indicate any intention on our part to exclude other resources from use by facilities.Slide14
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-2
:
A commenter recommended that emergency preparedness plans should account for children's special needs during an emergency. The commenter stated that emergency preparedness plans should include
children's medication
and
medical device
needs, challenges regarding
patient transfer
for neonatal and pediatric intensive care patients, and issues involving behavioral health and family reunification
.
Comment-3:
A commenter recommended that
CMS collaborate
closely with the Emergency Medical Services for Children (EMSC) program administered by the Health Resources and Services Administration (HRSA). The commenter noted that this program focuses on improving the
pediatric
components of the EMS system
.Slide15
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Response to Comment 2 & 3:
We appreciate the commenter's concerns. As required in § 482.15(a)(1), (2), and (3), when a provider or supplier develops an emergency preparedness plan, we will expect that the provider/supplier will use a facility-based and community-based risk assessment to develop a plan that addresses that facility's patient population, including at-risk populations.
If the provider serves children, or if the majority of its patient population is children, as is the case for children's hospitals,
we will expect the provider
to take into account children's access and functional needs during an emergency or disaster in its emergency preparedness plan.Slide16
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-4:
A commenter recommended that we include the
Joint Guidelines for Care of Children in the Emergency Department, developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association, as a resource for the final rule.
Response to Comment 4:
At § 482.15(a)(3), we proposed that a hospital's emergency plan address its patient population, including, but not limited to, persons at-risk. We also discussed in the preamble of the proposed rule that “at-risk populations” are individuals who may need additional response assistance, including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency or are non-English speaking, lack transportation, have chronic medical disorders, or have Start Printed Page 63875pharmacological dependency
.
According
to the section 2802 of the PHS Act (42 U.S.C. 300hh-1) as added by Pandemic and All-Hazards Preparedness Act (PAHPA) in 2006, in “
at-risk individuals” means
children
, pregnant women, senior citizens and other individuals who have special needs in the event of a public health emergency as determined by the Secretary. Slide17
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-5:
A commenter stated that it could be difficult for
children's hospitals to maintain a comprehensive list of people and entities, as required for a hospital's communication plan. The commenter gave an example of a hospital that maintains a listing for most managers Start Printed Page 63884and above, but not for all general staff and volunteers.
Response to Comment 5:
…We
disagree
with the commenters who suggested that it would be overly burdensome for hospitals to maintain a current contact list.
As a best practice
, most hospitals maintain an up-to-date list of their current staff for staffing directories and human resource management. In addition, most hospitals have procedures or systems in place to handle their roster of volunteers.
We believe that a hospital would have a comprehensive list
of their staff, given that these lists are necessary to maintain operations and formulate a
payroll.....
Furthermore,
we clarify
that we are not requiring hospitals to include in their
communication plan
contact information for the families of staff, or the families of patients who are not directly involved in the patient's care, or contractors not currently providing services under arrangement. Slide18
Pediatric
Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-6:
A commenter recommended that CMS consider including non-healthcare facilities in the communication plan, such as
child care programs and schools, where children with disabilities and other access and functional needs may be sheltering in place.
Response to Comment 6:
We do not believe
that it is appropriate to require hospitals to include other providers of services, such as child care programs and schools, in their communication plan in these conditions of participation. However, we have allowed facilities the flexibility and the discretion to include such providers in their communication plans if deemed appropriate for that facility and patient population.Slide19
CMS EMERGENCY PREPAREDNESS NEW
RULE:
RESOURCES AND ADHS-BPHEP TECHNICAL ASSISTANCE
IMPORTANT LINK
2017 Performance Measures:
2017-2022 HPP Performance Measures Implementation
Guidance
ASPR-TRACIE:
https://asprtracie.hhs.gov
/
Medicare
and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and
Suppliers
https
://
www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaidSlide20
THANK YOU
Teresa Ehnert
| Chief-Bureau of Public Health Emergency Preparedness
teresa.ehnert@azdhs.gov
|
602-364-3571
azhealth.gov
@
azdhs
facebook.com
/
azdhs