CMS Waives Hospice Physical Environment/Life Safety Rules During COVID-19

The U.S. Centers for Medicare & Medicaid Services (CMS) continues to issue 1135 waivers to relax certain Conditions of Participation during the coronavirus pandemic national emergency. The agency has released new waivers pertaining to physical environment and Life Safety Code rules for inpatient hospices.

The waived requirements include those related to the frequency and activities for facility and medical equipment, scheduled inspections, testing and maintenance for their facilities and medical equipment, as well as positioning and storage of alcohol-based hand rubs and fire drill requirements.

“CMS is waiving certain physical environment requirements for inpatient hospice to reduce disruption of patient care and potential exposure/transmission of COVID-19,” the agency indicated in a statement. “The physical environment regulations require that facilities and equipment be maintained to ensure an acceptable level of safety and quality. CMS will permit facilities to adjust scheduled inspection, testing and maintenance (ITM) frequencies and activities for facility and medical equipment.”

CMS requires inpatient facilities to comply with the National Fire Protection Association’s Life Safety Code as well as the Health Care Facilities Code for fire protection and prevention. The agency continues to require hospices to comply with certain aspects of the code. These include:

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  • Sprinkler system monthly electric motor-driven and weekly diesel engine-driven fire pump testing
  • Elevators with firefighters’ emergency operations monthly testing
  • Emergency generator 30 continuous minute monthly testing and associated transfer switch monthly testing
  • Portable fire extinguisher monthly inspection
  • Elevators with firefighters’ emergency operations monthly testing
  • Emergency generator 30 continuous minute monthly testing and associated transfer switch monthly testing
  • Means of egress daily inspection in areas that have undergone construction, repair, alterations, or additions to ensure its ability to be used instantly in case of emergency

The waivers do allow hospices to temporarily house or quarantine patients in facility and non-facility space that is not normally used for patient care. These areas will not be required to have an outside window or outside door for the duration of the national emergency. The agency typically requires patient care areas to have those features.

CMS is permitting hospices to use a documented fire safety orientation training program in lieu of fire drills, due the infection risks associated with moving and massing staff together.

The agency is also waiving prescriptive requirements for the placement of alcohol-based hand rub dispensers due to the need for increased vigilance in infection control. However, hospices must still comply with safe storage requirements for those products.

“Alcohol-based hand rubs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers,” CMS indicated. “This includes restricting access by certain patient/resident populations to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area.”