In 2017, the Centers for Medicare & Medicaid Services (CMS) took steps to bolster nursing home emergency preparedness and response through enhanced Requirements for Participation (RfPs). Nursing homes must meet these RfPs to begin or continue participating in the Medicare and Medicaid programs. CMS contracts with and oversees 52 State Survey Agencies (SAs) to conduct oversight of nursing homes’ compliance with the RfPs.
CMS provides SAs with guidance on the procedures to use when conducting surveys for all RfPs, including the 26 emergency preparedness requirements. For all CMS-certified health care facilities (including nursing homes), the guidance for the emergency preparedness requirements is found in Appendix Z of CMS’s State Operations Manual. For other nursing home-related RfPs, the guidance is generally found in Appendix PP of CMS’s State Operations Manual.
In March 2025, the U.S. Department of Health and Human Services Office of Inspector General Office of Evaluation and Inspections issued a report entitled “State Survey Agencies Need Additional Guidance to Assess Nursing Home Emergency Preparedness Programs” that stated: “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 CMS, are responsible for determining whether nursing homes comply with Medicare and Medicaid Requirements for Participation, including rules regarding emergency preparedness.”
“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.”
The OIG recommended: “To improve the survey process and support survey staff with limited expertise in the area, OIG recommends that CMS:
Issue guidance that encourages State survey agencies to collaborate and share information
Provide surveyors with instructions for how to assess the contents of nursing home emergency preparedness documentation as a part of the survey process.”
If you or a loved one may have been injured (or worse) as a result of malpractice in a nursing home in the United States due to nursing home staff shortage, nursing home understaffing, nursing home pressure ulcer (nursing home bedsore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.
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