The Unprepared Beware
Last year a High Alert, LLC white paper had raised the specter of NRP/NIMS compliance being linked to CMS (Medicare, Medicaid and Tricare) billing, the discussion had been strictly theoretical. Several federally funded training programs have now brought to the table a new and ominous implication of the NIMS Integration Center Implementation Plan for Hospitals and Healthcare. Additionally, hospitals have reported being informed that disaster preparedness will be linked to CMS reimbursement (Medicare, Medicaid and Tricare payments).
Almost immediately, a National Incident Management System (NIMS) update alert from the NIMS Implementation Center, included obscure reference to a frequently asked question (FAQ) document on the FEMA website. This document, posted on April 20, 2007, like many documents before it was deeply buried within the FEMA website, accessible only to those who knew where to find it.
The last two questions on this FAQ document dealt with a raging debate regarding the repercussions of failing to be NIMS compliant before the looming September 30, 2007 deadline.
The first answered the question of whether the Joint Commission required NIMS compliance for accreditation. The answers stated “Not at this time.”
The second question similarly was a response to inquiries regarding whether CMS required NIMS compliance for Medicare and Medicaid benefits and reimbursements. Again the answer was “Not at this time.”
Times have changed.
On October 18, 2007, President George W. Bush signed Homeland Security Presidential Directive 21 (HSPD-21) into law establishing the new specialty of Disaster Healthcare and fulfilling many of the predictions of the original High Alert, LLC white paper. HSPD-21 is available for download here:
High Alert, LLC published a new white paper on the implications of HDPS-21, Sarbanes-Oxley (SAR-OX) and Federal False Claims (FFC) legislation for healthcare law and disaster healthcare. The new High Alert, LLC white paper is available for download here:
Download preparedness_and_the_force_of_lawrevised_20oct07.pdf
Each of the critical infrastructure industries identified in the National Response Plan (NRP) and the National Incident Management System (NIMS) have similar HSPD’s. The correlations made regarding healthcare law can easily be extrapolated to each of these critical infrastructure industries as well.
Although the federal government has not acted on these possibilities, they are very aware of the potential. FEMA even issued a series of statements directed to hospitals indicating that FEMA has no plan to pursue SAR-OX or FFC’s action under HSPD-21. The problem is that it is the Department of Justice (DOJ), not FEMA who pursues such claims and FEMA does not speak for DOJ.
This white paper has been vetted through contacts in D.C. and while not confirmed as an active plan, no part has been refuted except in the afore mentioned FEMA statements. However, the observations in this white paper is bolstered by the recent alignment of Joint Commission guidelines with NIMS guidelines. These Joint Commission changes occurred after the publication of the white paper, but were predicted despite the insistence of FEMA that such Joint Commission changes would not occur. It is now anticipated that Emergency and Disaster Preparedness will become a Core Performance Benchmark for Joint Commission in 2009. Given that Joint Commission is now provides de facto the Medicare and Medicaid compliance inspection, these 2009 changes will complete the alignments described in the white paper.
The Unprepared Beware!
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