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State of California—Health and Human Services Agency
California Department of Public Health

AFL 18-38
September 14, 2018

Intermediate Care Facilities (ICF)/Developmentally Disabled (DD)
ICF/DD – Habilitative
ICF/DD – Nursing
ICF/DD – Continuous Nursing

Implementation of the Federal Emergency Preparedness Regulation

AUTHORITY:     Code of Federal Regulations (CFR) section 483.475

​All Facilities Letter (AFL) Summary

This AFL reminds certified Intermediate Care Facilities (ICF)/ Developmentally Disabled (DD), ICF/DD - Habilitative, ICF/DD – Nursing, and ICF/DD – Continuous Nursing of the new emergency preparedness regulation and to provide resources to assist facilities in complying with these requirements.

​On September 16, 2016, Title 42 CFR section 483.475 (Conditions of participation: Emergency preparedness) for Medicare and Medicaid participating providers and suppliers was published. The rule took effect on November 15, 2016; however, facilities had until November 15, 2017, to implement the new requirements.

The new emergency preparedness regulation requires all health care providers participating in Medicare and Medicaid to increase patient safety during emergencies and establish a more coordinated response to natural and human disasters.

Facilities are required to meet four core elements:

  1. Develop an emergency plan.
  2. Develop policies and procedures that are reviewed and updated at least annually.
  3. Develop and maintain a communication plan that complies with federal, state,
    and local laws.
  4. Develop a training and testing program. Facility staff must demonstrate knowledge of emergency procedures and the facility must provide staff training at least annually.

CDPH encourages facilities to sign-up with their respective county emergency medical services agency and/or local department of public health emergency communication system.


Emergency Preparedness Resources

CDPH has compiled resources that provide guidance for the new emergency preparedness requirements.


Stay Informed

CDPH publishes All Facilities Letters (AFLs) on the CDPH website to keep facilities up-to-date with important information, guidance, and policies. CDPH sends email notifications for new AFL releases to those who sign-up. CDPH encourages facilities to sign-up for California Health Alert Network (CAHAN) and AFL email notifications.

  • Sign-up to receive CAHAN Alerts and AFL release notifications by going to the following link:
  • The Survey Monkey will prompt you to provide:
    • Contact information for a designated emergency contact and an alternate. The emergency contact should be reachable and able to respond 24 hours a day. 
    • A designated email address to receive AFLs and a possible alternate. The AFL recipient may be anyone designated by the facility as the primary recipient for departmental communications.

For more information on this new regulation, consult with your L&C district office. 



Original signed by Scott Vivona

Scott Vivona
Assistant Deputy Director

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