Why OIG Did This Review

• Nursing home failures, such as resident deaths during Hurricane Ida, demonstrate continued challenges in nursing home emergency preparedness. These failures raise questions about how effective the survey process is in overseeing nursing home emergency preparedness.
• State survey agencies, contracted and overseen by the Centers for Medicare and Medicaid Services (CMS), are responsible for determining whether nursing homes comply with Medicare and Medicaid Requirements for Participation, including rules regarding emergency preparedness.
• Though CMS leads the oversight of nursing homes’ compliance with Medicare and Medicaid program 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 that support the emergency preparedness of health care facilities and health care systems, including nursing homes.

What OIG Found

A quarter of State survey agencies reported that surveyors typically lack emergency preparedness expertise when hired, and building and retaining this expertise is challenging.

CMS program guidance is more focused on documents to collect to demonstrate compliance with emergency preparedness rules than on assessing the content of those documents.

Nearly one-half of State survey agencies reported successes that go beyond CMS guidance, including (1) information sharing with emergency preparedness partners and (2) additional tools and resources to enhance CMS guidance.

What OIG Recommends

To improve the survey process and support survey staff with limited expertise in the area, OIG recommends that CMS:

1. Provide surveyors with instructions for how to assess the contents of nursing home emergency preparedness documentation as a part of the survey process.
2. Issue guidance that encourages State survey agencies to collaborate and share information.

CMS concurred with both recommendations.