The Centers for Medicare & Medicaid Services released a proposed rule Dec. 27 that would establish national emergency preparedness requirements for 17 different types of Medicare- and Medicaid-participating providers and suppliers, including end-stage renal disease facilities. The main focus of the rule is on increasing staff education on how to respond to man-made disasters, and require that dialysis clinics coordinate their disaster plans with federal, state, tribal, regional and local emergency systems.

If adopted, the rule would add additional requirements to the Conditions for Coverage for ESRD facilities. Comments are due to CMS by Feb. 25.

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Here are some of the basic requirements within the rule, as summarized by a Legal Alert released by the law firm McGuireWoods. More details are available at

  • Emergency Plan. ESRD facilities must develop and maintain an emergency preparedness plan based on a facility-based and community-based risk assessment utilizing an “all-hazards approach.” The plan must include strategies for addressing emergency events identified in the risk assessment, the needs of the patient population and the process for ensuring cooperation and collaboration with all levels of government emergency response agencies. The plan must be reviewed annually.
  • Policies and procedures.The proposed rule requires ESRD facilities to, at a minimum, develop policies and procedures addressing the following emergency preparedness topics:
  1. Patient and staff tracking during and after an emergency
  2. Safe evacuation from the dialysis facility
  3. Shelter-in-place requirements
  4. Medical records documentation, availability and confidentiality
  5. The use of volunteers in an emergency
  6. Backup arrangements with other dialysis facilities and providers to receive patients
  7. Processes for ensuring that emergency medical system assistance and emergency equipment can be obtained when needed.
  • Communication plan. The proposed rule requires dialysis facilities to develop and maintain an emergency preparedness communication plan that includes contact information for staff, patients, and other facilities and emergency response groups. The communication plan must also describe how protected health information will be shared in a HIPAA-compliant manner during and after the emergency.
  • Training, testing and patient orientation. The proposed rule requires dialysis facilities to perform and document annual employee training on emergency procedures and requires annual mock disaster drills. Patients must receive orientation and training on emergency procedures, including: what to do in case of an emergency, where to go to evacuate during an emergency or to receive emergency dialysis, whom to contact in case of an emergency, and how to disconnect themselves from their dialysis machines in case of an emergency.