1. NSHE Annual Trade Show & Conference Brad Taylor, CHFM ASHE Region 8 Board Representative May 2, 2014

2. Publication of the proposed rule:April 16, 2014 Comments due: June 16, 2014 www.regulations.gov Search: “Fire”

3. CMS Proposed Rule §482.41 CMS: 2012 Life Safety Code Adoption 5.02.2014

4. Support 2012 Adoption On the whole, ASHE supports the adoption of current codes. The new codes:  Incorporate lessons learned  Reduce conflicts  Are consistent with other codes  Recognize changes in heath care delivery  Provide greater flexibly  Incorporate categorical waivers

5. Support 2012 Adoption ASHE Strategic Imperative - Unified Codes While regulations are a critical part of keeping patients, staff, and visitors safe, current codes and standards still have much room for improvement. ASHE is working to improve outdated codes, conflicting codes, codes not based on science, and inappropriate code interpretations.

6. Why do we use consensus codes? OMB Circular A-119 (1998) intended to: 1.Encourage federal agencies to benefit from the expertise of the private sector 2.Promote federal agency participation in such bodies to ensure creation of standards that federal agencies can use 3.Reduce reliance on government-unique standards where an existing voluntary standard would suffice

7. PROPOSED RULE Overview

8. §482.41 (b)(2)(i) Adoption, change in definition  Changes definition of “health care occupancy” from applying to “4 or more patients” to “regardless of the number of patients served”  Would apply to hospital outpatient depts. o Based on billing of hospital-based provider services in outpatient buildings o Do your buildings comply with “health care occupancy” requirements?

9. §482.41 (b)(2)(ii) Roller Latches  Does not allow the exception in the LSC that permits use of roller latches  CMS standards have permitted use of roller latches for more than 20 years  Roller latches have become common in behavioral health

10. §482.41 (b)(7) ABHR  2012 LSC allows ABHRs  Accepts 2012 LSC requirements but adds “if installed to prohibit inappropriate access” o Interpretive guidance is needed to determine what this means.

11. §482.41 (b)(8) Sprinkler 4-hour rule  NFPA 25 formerly required evacuation or fire watch of facilities if a sprinkler system was out of service for more than 4 hours in a 24-hour period.  This has been changed in NFPA 25 to 10 hours to accommodate a “work day.”  CMS proposes going back to the 4-hour period.

12. §482.41 (b)(9) OR Smoke Vents  Required when flammable anesthetics were used  Removed as operating room ACH increased, sprinkler requirements were added, severity of fire risk and extent decreased  ECRI data suggests 250 fires annually o Surgical fires are extremely rare:.00092% o Potential cost nationwide: ?

13. §482.41 (b)(10) 36" Sill Height  Okay for new construction  As written will apply to existing construction o How many existing facilities will this affect? o What is the cost to fix this condition?  Is it worth it? o Staff should not break out windows during a fire o Patients should not be evacuated through windows

14. §482.41 (c)(1) Adoption of NFPA 99, 2012 edition Directly adopts NFPA 99: Health Care Facilities Code Except chapters: o Chapter 7 = IT and Nurse Call o Chapter 8 = Plumbing o Chapter 12=Emergency Preparedness o Chapter 13=Security

15. §482.41 (c)(2) Waivers for NFPA 99  Gives CMS authority to grant waivers to NFPA 99 requirements  Same requirement as for NFPA 101

16. Making Comments The comment process is not a vote – one well-supported comment is often more influential than a thousand form letters.  This is not a “Me Too!” vote  Duplicating comments by others lessens the value of both comments

19. Next Steps  Communicate with your members  Start the discussion  Provide guidance for commenting  Share the ASHE Issue Brief on the subject with hospital leadership  Encourage members to comment on the proposed rules

20. Provide Feedback to ASHE Share your feedback Share your evidence Share your comments Suggest other resources To: firesafetyfeedback@aha.org

21. Comments Due: June 16, 2014 www.regulations.gov Search: “Fire”

22. Greater efficiency supports patient care A national energy efficiency movement brought to you by ASHE

23. The Reality Hospitals must make cost cuts to survive & thrive in new healthcare reality Facilities Management will be expected to contribute to cost-cutting efforts

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