Administration officials cited a pressing need for regulatory consistency for health care facilities, which are governed by a patchwork of federal, state and local rules. Some institutions are not required to plan extensively for emergencies. Others may already be meeting most goals.

After the attacks of Sept. 11, 2001, and the subsequent anthrax mailings, the federal government offered preparedness grants to state and local health departments, which paid for health care organizations to stockpile equipment and improve readiness for a surge of patients. But that funding has faced deep cuts.

Now officials are trying a different tack: making emergency preparedness a condition for many institutions to participate in the Medicare and Medicaid programs.

The current proposal is unusual because it applies to 17 types of providers at once, which together serve an estimated nine million fee-for-service patients each month, as well as other patients covered by Medicare Advantage and Medicaid. Federal officials said this broad approach was needed to ensure that the health care system pulls together and that poorly prepared institutions do not stress others during a crisis.

Government officials will have three years to finalize the rule. Their calculations suggest a relatively modest financial impact: $8,000 on average for hospitals the year the rule takes effect and about $1,262 each year for skilled nursing facilities. But some facilities would be required to spend much more. Upgrading emergency power systems to run air-conditioning, if necessary to meet patient safety requirements, alone could cost from tens of thousands to millions of dollars, according to hospital engineering specialists.

Plans for a nationwide regulation on emergency preparedness for health care institutions date from the Bush administration, after an estimated 215 deaths occurred in hospitals and nursing homes in Louisiana following Hurricane Katrina in 2005. “In New Orleans it seems very likely that dozens of lives could have been saved by competent emergency planning and execution,” the proposed rule said.