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Have you rested easy in terms of your building expenses due to a grandfather clause that allows you to comply with the 1981 edition of the National Fire Protection Association’s Life Safety Code? That has all changed with a Oct. 26 draft rule from Medicare that proposes to do away with the grandfather clause and require surgery centers, hospitals, and other providers to comply with the 2000 edition of the Life Safety Code.
"We are not proposing to grandfather any facility under these new provisions because we believe the provisions will not impose an undue burden," the Centers for Medicare & Medicaid Services (CMS) says in the draft rule. However, some outpatient surgery experts disagree and say the expenses could be significant.
The final rule could be adopted with the grandfather clause, according to a CMS official who, under department policy, spoke on condition of anonymity. Comments are due by Dec. 26. The various editions of the code address building requirements, hallway widths, door sizes, emergency power, and electrical requirements. The Joint Commission on the Accreditation of Healthcare Organizations has adopted the 1997 edition. Individual states have adopted various editions. The change made between the 1985 and 2000 Life Safety Codes is where a generator is required, according to the CMS official. A waiver can be requested for the generator, he says.
The Federated Ambulatory Surgery Association (FASA) in Alexandria, VA, surveyed its members, and 10% of 390 respondents are using batteries for emergency power. For the facilities, the change would be costly, she says. One architect estimated a cost of $50,000 for the generator alone and noted that the higher expense would be the necessary rewiring and lost revenue for the days the facility would need to be closed for that work.
Of particular significance to FASA is that facilities with generators still may not be in compliance. According to Kathy Bryant, executive director, only 15% of ambulatory surgery centers (ASCs) responding to the survey could confirm that they have a Type I electrical system, the system required by the 2000 Life Safety Code. This means that up to 85% of ASCs may need to complete significant electrical work to comply with the new requirements. "At this time, it would appear unreasonable to insist that all ASCs comply with these new standards given the extensive and costly nature of changes required, particularly in the absence of any documented harm to patients that have resulted from the current standards," Bryant says.
In a memo to members of the San Diego-based American Association of Ambulatory Surgery Centers, Michael Romansky, JD, partner in the health law practice at McDermott, Will, and Emery in Washington, DC, says the new requirements include the following additional requirements:
• Facilities would be required to install emergency lighting that illuminates escape routes for 1.5 hours. "We are phasing in this requirement over a three-year period, to allow for the normal replacement cycle of batteries used in emergency lighting systems," CMS says. The cost to install this equipment is estimated to be $600 per light.
• Facilities would be required to protect vertical openings (for example, stairwells) so that fire and toxic gases cannot spread from one level to another. The estimated cost of compliance with this requirement is $2,938 per vertical opening, according to CMS.
• Facilities would be required to install fire alarm systems that notify local fire and emergency forces. The cost is estimated at $900 per facility.
• Facilities in nonsprinkler buildings would be required to separate all areas from the corridor by corridor walls that are fire-rated. "This change is only a proposal at this point, but if finalized, could require significant retrofitting expenditures from ASCs and other providers," Romansky says.
The cost to upgrade a facility to meet this requirement is estimated to be approximately $7,124 for buildings that currently meet the 1967 Life Safety Code and approximately $5,735 for buildings meeting the 1973 code. The estimated cost of installing sprinkler systems in buildings that don’t have them is $2.50 per square foot, or approximately $125,000 for a 50,000-square-foot building, according to CMS. "This requirement is not imposed on facilities not undergoing renovations," the agency says.
The proposed rule, published in the Oct. 26 Federal Register, replaces a rule proposed on the same subject in 1990. That rule would have required providers to meet the 1981 or 1985 edition of the code, which did not encourage use of sprinklers. The Medicare official says, "What we are trying to do is force you to sprinkler the building."
For facilities that already are in compliance with the 1985 edition of the Life Safety Code, "The 2000 codes are slightly less stringent than 1985 for new facilities, and there’s little difference for facilities undergoing renovation," according to Liz Dudek, deputy secretary for managed care and health quality in the Agency for Health Care Administration in Tallahassee, FL.
There’s one item in the 2000 edition that CMS proposes not to adopt. The 2000 edition allows roller latches in some situations. A roller latch is a type of mechanism that keeps a door closed. "Roller latches have proven to be an unreliable door-latching mechanism requiring extensive maintenance to operate properly," CMS says. "Many roller latches in fire situations failed to provide adequate protection to residents in their rooms during an emergency." The estimated cost to replace a roller latch is $190 per door.
CMS may grant a waiver for a specific code requirement if the waiver would not adversely affect patient/staff health and safety and the requirement would impose an unreasonable hardship on the facility. Generally, a provider may request a waiver from its state agency. A state may request that the state life safety code be applicable to all facilities rather than the 2000 Life Safety Code.
The life safety code is developed by the National Fire Protection Association in Quincy, MA. To purchase the 2000 Life Safety Code, contact the association at (800) 344-3555 or visit www.nfpa.org. Search for "NFPA 101." You can pay by credit card to download a pdf file. The cost of the code (101-00) for nonmembers is $50.50 plus $6.95 for shipping. The cost for the Life Safety Code Handbook (101 HB 00), which includes the code plus interpretation, for nonmembers is $96.75 plus $6.95 for shipping.
For more information on the draft rule, contact the following at the Centers for Medicare & Medicaid Services: