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Intelligent Solutions in Pharmacy Benefits
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The Centers for Medicare & Medicaid Services (CMS) recently finalized a new rule to be implemented by November 15, 2017 to create consistent emergency preparedness requirements for participating Medicare and Medicaid health care providers, as well as a better coordinated response to both man-made and natural disasters in an effort to increase patient safety during times of emergency.
Before we dive into some of the specifics, let us answer the question: Why was this new rule proposed and officially finalized in September 2016?
CMS explains that over the past few years, there have been several man-made and natural catastrophes that have resulted in the health and safety of Medicare and Medicaid beneficiaries being put at great risk. As a result, the purpose of the new emergency preparedness requirements is to have participating providers and suppliers be more prepared to cater to patients during any future disaster or other emergency. Ultimately, these providers and suppliers will need to work with state, tribal, regional, local and federal emergency preparedness systems in an effort to make sure that their facilities are ready to care for patients.
After an in-depth review of current emergency preparedness rules and regulations, CMS hopes to bridge any gaps that were originally present by requiring providers and suppliers, who participate in Medicare or Medicaid, to take the following actions:
- Create an emergency plan. Participating providers must come up with an emergency plan using an all-hazards approach that focuses on “capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier”.
- Establish policies and procedures. Participating providers must create, and then implement, policies and procedures based upon their risk assessment and emergency plan.
- Have a communication plan. Participating providers will need to come up with a communication plan that is aligned with Federal and State law. CMS explains that within this plan, “patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems”.
- Develop a training and testing program. Participating providers are expected to create and maintain strong training and testing programs – both initial and annual trainings are to be included. They must also take part in drills and exercises OR take part in an incident that tests the success of the plan.
For additional specifics about the CMS’ new emergency preparedness requirements, check out this chart, where the requirements are outlined based on provider type.
PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal health care outcomes while minimizing overall health care costs. For more information, please visit www.pbirx.com or call (888) 797-2479.
