[Federal Register Volume 71, Number 208 (Friday, October 27, 2006)]
[Proposed Rules]
[Pages 62957-62971]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-17911]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 483
[CMS-3191-P]
RIN 0938-AN79
Medicare and Medicaid Programs; Fire Safety Requirements for Long
Term Care Facilities, Automatic Sprinkler Systems
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would require all long term care facilities
to be equipped with sprinkler systems. This proposed rule especially
requests public comments on the duration of a phase-in period to allow
long term care facilities to install such systems.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on December 26,
2006.
[[Page 62958]]
ADDRESSES: In commenting, please refer to file code CMS-3191-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (fax) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. You may submit electronic comments on specific issues in this
regulation to http://www.cms.hhs.gov/eRulemaking. Click on the link
``Submit electronic comments on CMS regulations with an open comment
period.'' (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-3191-P, P.O. Box 8012, Baltimore, MD 21244-8012.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address only:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-3191-P, Mail Stop C4-26-05, 7500
Security Boulevard, Baltimore, MD 1244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-9994 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Danielle Shearer, (410) 786-6617;
James Merrill, (410) 786-6998; Jeannie Miller, (410) 786-3164; or
Rachael Weinstein, (410) 786-6775.
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-3191-P and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on
CMS Regulations'' on that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
[If you choose to comment on issues in this section, please
indicate the caption ``Background'' at the beginning of your comment.]
The Life Safety Code (LSC), published by the National Fire
Protection Association (NFPA), a private, nonprofit organization
dedicated to reducing loss of life due to fire, is a compilation of
fire safety requirements. The LSC contains fire safety requirements for
both new and existing buildings. It is updated through a consensus
process and generally published every 3 years. Sections 1819(d)(2) and
1919(d)(2) of the Social Security Act (the Act) require that long term
care facilities participating in the Medicare and Medicaid programs
meet the provisions of the edition of the LSC that is adopted by the
Secretary.
Beginning with the adoption of the 1967 edition of the LSC in 1971,
Medicare and Medicaid regulations have historically incorporated the
LSC requirements by reference for all long term care facilities as well
as other providers, while providing the opportunity for a Secretarial
waiver of a requirement under certain circumstances. The statutory
basis for incorporating NFPA's LSC for our other providers is under the
Secretary's general rulemaking authority at sections 1102 and 1871 of
the Act, and under provider-specific provisions of title XVIII that
permit us to issue regulations to protect the health and safety of
participants in Medicare and Medicaid. We adopted the LSC to ensure
that patients and residents are consistently protected from fire,
regardless of the location in which they receive care. Since adopting
and enforcing the 1967 and subsequent editions of the LSC, there has
been a significant decline in the number of multiple death fires,
indicating that the LSC has been effective in improving fire safety in
health care facilities.
On October 26, 2001, we published a proposed rule (66 FR 54179),
and on January 10, 2003, we published a final rule in the Federal
Register, entitled ``Fire Safety Requirements for Certain Health Care
Facilities'' (68 FR 1374). In that final rule, we adopted the 2000
edition of the LSC provisions as the standard governing Medicare and
Medicaid health care facilities, including long term care facilities.
The final rule required all existing long term care facilities to
comply with the 2000 edition of the LSC.
The 2000 edition of the LSC required all newly constructed
buildings containing health care facilities to have an automatic
sprinkler system installed throughout the building. However, like all
previous editions, the LSC did not require existing buildings to
install automatic sprinkler systems throughout if they met certain
construction standards, ranging from the size of the buildings to the
types of material used in their construction.
In accordance with the 2000 edition of the LSC, an existing
building that meets the above-mentioned construction standards must
install sprinklers if it undergoes a major renovation. However, in such
cases, it is only required to install sprinklers in the renovated
section(s). Therefore, a building may only be sprinklered on one floor
or one
[[Page 62959]]
wing. We did not receive any timely public comments in response to the
October 2001 proposed rule that addressed the issue of installing
automatic sprinkler systems in buildings not undergoing major
renovations. That is to say, no public comments supported, questioned
or challenged our proposal to incorporate this LSC provision by
reference.
[If you choose to comment on issues in this section, please include
the caption ``GAO Report'' at the beginning of your comments.]
A recent Government Accountability Office (GAO) report entitled
``Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in
Federal Standards and Oversight'' (GAO-04-660, July 16, 2004, http://www.gao.gov/new.items/d04660.pdf) examined two long term care facility
fires (Hartford and Nashville) in 2003 that resulted in 31 total
resident deaths. The report examined Federal fire safety standards and
enforcement procedures, as well as results from the fire investigations
of these two incidents. The report recommended that fire safety
standards for unsprinklered facilities be strengthened and cited
sprinklers as the single most effective fire protection feature for
long term care facilities.
In response to a recommendation made in the GAO report, on March
25, 2005, we published an interim final rule with comment period in the
Federal Register entitled, ``Fire Safety Requirements for Certain
Health Care Facilities; Amendment'' (70 FR 15229). This interim final
rule added paragraph (a)(7) to Sec. 483.70, to require long term care
facilities, at minimum, to install battery-operated smoke detectors in
resident sleeping rooms and public areas, unless they have a hard-wired
smoke detector system in resident rooms and public areas or a sprinkler
system installed throughout the facility. Numerous public comments
regarding this regulation indicated that the proper term for the fire
safety device we described is ``smoke alarms'' rather than ``smoke
detectors.'' Therefore, we will refer to these fire safety devices as
``smoke alarms.'' The final rule ``Fire Safety Requirements for Certain
Health Care Facilities; Amendment'' also will reflect this terminology
change.
Paragraph (a)(7) would be rendered moot by this proposed rule
because all facilities would be required to have sprinklers throughout
their buildings and would thus fall under one of the two exceptions
noted above. For this reason, we are proposing to add a sunset
provision to paragraph (a)(7). The sunset date for proposed paragraph
(a)(7)(iv) in Sec. 483.70 would correspond to the phase-in date of the
sprinkler requirement. For example, if all facilities were required to
have sprinklers installed throughout their buildings by March 25, 2016,
then the sunset date of the smoke alarms requirement in paragraph
(a)(7)(iv) would be March 25, 2016. We believe this would reduce burden
and confusion for long term care providers.
[If you choose to comment on issues in this section, please include
the caption ``Current Fire Safety Status'' at the beginning of your
comments.]
Structural fires in long term care facilities are relatively common
events. From 1994 to 1999, an average of 2,300 long term care
facilities reported a structural fire each year (2004 GAO Report).
Although there were approximately 2,300 fires in long term care
facilities per year, those fires only resulted in an average of 5
fatalities nationwide per year (2004 GAO Report). The likelihood of a
fatality occurring due to a long term care facility fire was quite low.
The likelihood of a high number of fatalities occurring due to a
long term care facility fire was even lower. From 1990 to 2002, there
were no major long term care facility fires that resulted in a high
number of fatalities. The long term care facility fires that did occur
during this time period either did not result in fatalities or resulted
in one or two fatalities. For 12 years, there simply were no major
fires in long term care facilities that could begin to compare to the
loss of life caused by the Hartford and Nashville fires.
We believe that the low number of fire-related fatalities each year
is attributable to the increasing use of automatic sprinkler systems in
long term care facilities as a fire protection method. State and local
jurisdictions often adopt new editions of the LSC when they are
published. Therefore, a building constructed in 1991 likely met the
requirements of the 1991 edition of the LSC. Beginning with the 1991
edition of the LSC, all newly built facilities were required to have
automatic sprinkler systems. In addition, beginning with the 1991
edition of the LSC, all facilities undergoing major renovations were
also required by the LSC to install automatic sprinkler systems at
least in those renovated areas. Therefore, as new facilities have
replaced old facilities, and as facilities have been renovated, the
number of residents protected by automatic sprinkler systems has
increased. The increase in the number of automatic sprinkler systems
and the number of residents residing in sprinklered buildings
significantly has decreased the likelihood of a fatality occurring due
to fire.
According to NFPA data cited in the 2004 GAO report, there is an 82
percent reduction in the chance of death occurring in a sprinklered
building when compared to the chance of death occurring in an
unsprinklered building. In addition, we note that there has never been
a multiple death fire in a long term care facility that had an
automatic sprinkler system installed throughout the facility.
Automatic sprinkler systems are effective in reducing the risk of
fatalities due to fire because they limit the size of a developing fire
and prevent the fire from growing and spreading beyond the area where
the fire ignited. Limiting the size of a fire and preventing it from
growing and spreading results in a smaller number of individuals who
are threatened by the fire. In addition, impeding the fire's growth
gives the facility staff and residents and the local fire department
more time to respond to the situation.
Automatic fire suppression through sprinklers also alleviates some
of the current heavy reliance on facility staff to implement the
facility's emergency plan. Fires often occur at night, as both the
Hartford and Tennessee fires did, when staffing levels are lowest.
Investigators of the Hartford fire determined that the facility's staff
did not fully implement the facility's emergency plan, and that may
have contributed to the number of fatalities in that fire. The 2004 GAO
report concluded that, ``reliance on staff response as a key component
of fire protection may not always be realistic, particularly in an
unsprinklered facility.'' Limiting the area of a building affected by a
fire may result in less of a need to evacuate or relocate residents,
thus eliminating some of the heavy reliance on facility staff response.
The effectiveness of automatic sprinkler systems has prompted some
States, including Virginia, Connecticut, and Tennessee, to require that
all long term care facilities have sprinklers. The NFPA also requires
all long term care facilities to have automatic sprinkler systems as
part of the 2006 edition of the LSC. The American Health Care
Association (AHCA), one of the largest long term care facility provider
organizations, supports installing sprinkler systems in all long term
care facilities, and worked with the NFPA on the provisions of the 2006
LSC.
[If you choose to comment on issues in this section, please include
the caption ``CMS Action'' at the beginning of your comments.]
[[Page 62960]]
We support the NFPA in its decision to include an automatic
sprinkler system requirement for all long term care facilities in the
2006 edition of the LSC. We have decided to proceed with this rule,
without adopting the NFPA 2006 edition of the LSC, because we want to
avoid further delay in requiring an automatic sprinkler system in long
term care facilities. As the 2003 fires demonstrated, there is a
significant need to improve fire safety in long term care facilities in
a timely manner. To adopt the 2006 edition of the LSC, we are required
to go through notice and comment rulemaking. In addition to the time
that it takes to carefully analyze the LSC in its entirety, the
rulemaking process itself is a time-consuming process that, even in the
best case scenario, takes 18 months to complete. Given the large scope
of the LSC, it is probable that it would take even longer to complete
the full rulemaking process. Therefore, it is probable that we would
not be able to adopt and enforce compliance with the 2006 edition of
the LSC until 2008 or 2009. In addition, the 2008 or 2009 publication
date of a final rule would simply begin a probable phase-in period,
which could be anywhere from 3 to 10 additional years. We believe that
delaying the rulemaking process would be a disservice to all long term
care facility residents who reside in buildings that do not have
sprinklers. Therefore, we have decided at this time to proceed with
rulemaking that does not include adoption of the NFPA 2006 LSC.
We will continue to work with the NFPA to revise and refine each
edition of the LSC. We are currently examining the 2006 edition of the
LSC in its entirety and exploring the possibility of adopting it for
all Medicare and Medicaid participating health care facilities. We are
soliciting public comment about our decision to proceed with rulemaking
separate from the 2006 LSC. In addition, we may make changes to this
sprinkler rule according to public comments that we receive that are
related to the sprinkler requirements in the NFPA 2006 edition of the
LSC.
We are also soliciting public comment regarding our decision to
regulate the installation of automatic sprinkler systems through
Federal rulemaking rather than deferring to State and local
jurisdictions. There has been discussion within the larger long term
care community about the advantages and disadvantages of Federal, State
and local regulation in this area. In particular, we would like public
comments regarding the necessity, advantages, and disadvantages of this
Federal regulation requiring sprinklers. We would also like public
comments regarding the necessity, advantages, and disadvantages of
deferring to State and local jurisdictions.
II. Provisions of the Proposed Regulations
For the reasons described in section I of this preamble, we are
proposing a rule with three main components. First, the regulation
proposes to add a sunset provision to paragraph (a)(7) in Sec. 484.70
that would correspond to the phase-in date of the sprinkler
requirement. This sunset provision would provide that, as of the phase-
in date, we would no longer enforce the requirement that facilities
have and maintain at least battery-operated smoke alarms. Second, this
regulation proposes to require every long term care facility to install
an approved, supervised automatic sprinkler system in accordance with
the 1999 edition of NFPA 13, Standard for the Installation of Sprinkler
Systems, throughout the facility if it does not have such a system
already. Third, the regulation proposes to require every long term care
facility to test, inspect, and maintain an approved, supervised
automatic sprinkler system in accordance with the 1998 edition of NFPA
25, Standard for the Inspection, Testing and Maintenance of Water-Based
Fire Protection Systems.
The proposed requirements of this regulation include three
technical terms: ``approved,'' ``automatic,'' and ``supervised.'' These
terms are terms of art in the fire safety community and are included in
NFPA 101, Life Safety Code, with which long term care facilities must
already comply. There may be, however, individuals who are not familiar
with the terms. Their definitions are as follows:
Approved means acceptable to the authority having
jurisdiction.
Automatic means that which provides a function without the
necessity of human intervention.
Supervised means that the system and particular components
of the system are monitored by a device with auditory and visual
signals that are capable of alerting facility staff should the system
or one of its components become inoperable for any reason.
The following section describes each of the main components.
A. Sunset Provision
[If you choose to comment on issues in this section, please include
the caption ``Sunset Provision'' at the beginning of your comments.]
We are proposing in Sec. 483.70(a)(7)(iv) to add a sunset
provision for smoke alarms that would correspond to the phase-in date
of the sprinkler installation requirement. We are proposing to add this
provision because otherwise paragraph (a)(7) would be rendered moot by
this proposed rule. Paragraph (a)(7) requires long term care facilities
to have at least battery-operated smoke alarms in resident rooms and
common areas. Facilities that are fully sprinklered in accordance with
NFPA 13 are exempt from the smoke alarm requirement. Once all
facilities install sprinkler systems in accordance with the 1999
edition of NFPA 13, as we are proposing to require, all facilities
would be exempt from the requirements of paragraph (a)(7). We believe
that it is proper to state, in regulation, that the smoke alarm
requirement would cease to be effective upon the phase-in date of the
sprinkler requirement. Therefore, we propose to add a sunset provision
to the smoke alarm requirement.
B. Installation
[If you choose to comment on issues in this section, please include
the caption ``Installation'' at the beginning of your comments.]
We are proposing in Sec. 483.70(a)(8)(i) to require long term care
facilities to install approved, supervised automatic sprinkler systems
throughout their facilities in accordance with NFPA 13, Standard for
the Installation of Sprinkler Systems (which we would incorporate by
reference). If a long term care facility was part of another building,
such as a hospital, then the building would be required only to have
sprinklers in the long term care facility section. The NFPA 13
specifies how to properly design and install sprinkler systems using
the proper components. The standards of NFPA 13 cover a wide variety of
factors that are involved in designing and installing sprinkler
systems. The NFPA 13 is divided into 10 main chapters governing the
design and installation phases of automatic sprinkler systems. They are
as follows:
General Information.
Classification of Occupancies and Commodities.
System Components and Hardware.
System Requirements.
Installation Requirements.
Hanging, Bracing, and Restraint of System Piping.
Design Approaches.
Plans and Calculations.
Water Supplies.
System Acceptance.
The NFPA 13 is a very detailed document, with a wide variety of
standards and exceptions to those standards. The document provides many
options for the design and installation of sprinkler systems so that
[[Page 62961]]
each system may be tailored to the building in which it is installed.
It is not practical to discuss each and every standard of NFPA 13 in
this proposed rule. The technical standards of NFPA 13, along with
helpful background and explanatory text, are in the Automatic Sprinkler
System Handbook, published by the National Fire Protection Association
(8th edition. Puchovsky, Milosh T., Ed.; 1999, Quincy, MA). The
Automatic Sprinkler System Handbook contains more than 1,000 pages of
information and provides far more information than this proposed rule.
Therefore, the following section will only briefly discuss the general
content of each design and installation-related chapter of NFPA 13, to
provide an overview of the factors that facilities would be required to
address when designing and installing an automatic sprinkler system.
Chapter 1, General Information, discusses four separate areas.
First, it describes the scope of NFPA 13. According to the Automatic
Sprinkler System Handbook, NFPA 13 provides the minimum requirements
for sprinkler systems to operate during a fire. These requirements
focus on the design and installation of sprinkler systems that use
automatic or open sprinklers that discharge water to suppress or
control a fire.
Second, chapter 1 describes the purpose of NFPA 13. The NFPA 13
focuses on the technical aspects of the design and installation of
sprinkler systems in order to standardize these areas ``based on sound
engineering principles, test data, and field experience.'' The purpose
of NFPA 13 is to ensure through standardization that sprinkler systems,
when designed and installed in buildings, are designed, assembled, and
installed in a safe and effective manner using the correct materials
(for instance, pipes) and information (for instance, system diagrams).
Third, chapter 1 defines important terms that are used throughout
the document. Frequently, the terms used in NFPA 13 are specific to
sprinkler systems, and their definitions may not be available in other
resources. To avoid any possible confusion, NFPA 13 provides an
inclusive list of terms and their definitions as they apply to
sprinkler systems. This list is one way in which NFPA 13 standardizes
sprinkler system requirements.
Finally, chapter 1 addresses the level of protection that sprinkler
systems are expected to provide. Chapter 1-6.1 states that, ``[a]
building, where protected by an automatic sprinkler system
installation, shall be provided with sprinklers in all areas.'' The
success of a sprinkler system depends, in large part, on how large a
fire is when it first begins and the initial sprinklers are activated.
If a fire begins in a sprinklered area, then the sprinklers would
quickly be activated, spraying water on the fire and surrounding areas.
These procedures would prevent the fire from expanding and would
therefore protect the occupants of the building. Conversely, if a fire
begins in one part of a building where there are no sprinklers, then it
would be allowed to grow due to the lack of sprinklers. Once the fire
reached an area with sprinklers, the fire would likely be too large for
the sprinklers to control. Sprinkler systems are not intended to
prevent a fire in an unsprinklered area from spreading to a sprinklered
area. Therefore, NFPA 13 requires that sprinklers be installed
throughout a building. If there is a 2-hour fire wall separating the
section of a building that contains a long term care facility from the
rest of the building, then the long term care facility section is
considered to be its own building. This means that we require only the
long term care facility section to have sprinklers installed
throughout. If there is no 2-hour fire wall separating the long term
care facility from the rest of the building, then the long term care
facility could choose to install a 2-hour fire wall separation or
sprinkler the entire building.
Chapter 2, Classification of Occupancies and Commodities, is
divided into two sections, one for occupancies and the other for
commodities. Sprinkler systems are designed using a variety of methods
and components within the requirements of NFPA 13. The choice of design
method and components is based on how the building is used. Chapter 2
identifies the general occupancies and their fire risk levels. It also
identifies the many different types of items that are stored in
buildings. These broad classifications of occupancies and commodities
enable sprinkler system designers to tailor the systems to the
particular fire safety needs of each building. The classifications also
help ensure that all buildings, regardless of their differences, are
fully protected by appropriate sprinkler systems.
Chapter 3, System Components and Hardware, contains the general
requirements for the pieces that are used to create a sprinkler system.
First and foremost, NFPA 13 requires that the system components be
listed. This provision requires that the components used to build a
sprinkler system be on a list published by an organization that
periodically inspects the products on the list. The list states that
the component meets appropriate designated standards or has been tested
and found suitable for a specific purpose. Using listed components
helps ensure that the components, and thus the system, are effective
and reliable in the event of a fire.
This chapter also covers the basic requirements for sprinkler
system components. It requires that sprinklers have certain specified
discharge and temperature characteristics. The chapter also requires
that facilities maintain a sufficient number of replacement sprinklers
for each type of sprinkler used in the facility. In addition to being
properly maintained, sprinklers may need to be replaced. It is
important that a facility have enough sprinklers in its possession in
order to replace any sprinklers immediately, so as not to compromise
the effectiveness and reliability of the entire system in the event of
a fire.
Chapter 3 also contains requirements for escutcheon plates, guards,
shields, aboveground pipes and tubes, underground pipes, fittings,
joinings, hangers, valves, fire department connections, waterflow
alarms, and any coatings that are on system components. All of the
requirements included in chapter 3 of NFPA 13 exist to ensure that the
components used to construct sprinkler systems will operate as needed
in the event of a fire. Some of the above listed components, such as
pipes, are also addressed in other chapters of NFPA 13.
Chapter 4, System Requirements, is divided into requirements for
the different types of sprinkler systems that may be used in a
facility. The two main categories of sprinkler systems are wet and dry
pipe systems. Wet pipe systems are, in the most general terms, systems
in which the pipes contain water. When the heat from a fire triggers
the sprinklers, the water is immediately discharged. Dry pipe systems
are filled with air or nitrogen, rather than water. When the air or
nitrogen is released, the water flows into the pipes and out through
the sprinklers. Within these two broad sprinkler system categories,
each of which provides an equal level of fire protection, NFPA 13
addressed many variations that sprinkler system designers may use to
address the needs of a particular building. The NFPA 13 leaves the
choice of which system type and variation to use for each building to
the sprinkler system designer. This flexibility helps ensure that the
sprinkler system fully addresses the unique needs of the building and
its occupants, thereby ensuring that the
[[Page 62962]]
building is optimally protected by its sprinkler system.
Chapter 5, Installation Requirements, contains the requirements for
the normal arrangement of sprinkler system components. The actual
layout of a specific sprinkler system may differ from the normal layout
described in this chapter of NFPA 13 based on the available water
supply, type of sprinkler, building construction features, and other
considerations. However, the basic layout principles of this chapter,
such as the position and location of sprinklers and valves, would still
apply. Chapter 5 helps ensure that facilities are adequately protected
by providing the minimum and maximum limits for sprinkler system
components. Within this minimum-maximum range, system designers have
the flexibility to address the fire-safety needs of each facility.
This chapter includes the specific requirements for the many
different types of sprinklers. It covers sprinklers ranging from
standard pendent and upright spray sprinklers to early suppression
fast-response sprinklers. Each sprinkler type has advantages and
disadvantages depending on the circumstances under which it is used.
The sprinkler type that may be appropriate for one facility may not be
appropriate for another. Therefore, NFPA 13 includes requirements for
all sprinkler types so that sprinkler system designers have the
flexibility to properly utilize the right sprinkler type for the job.
This chapter also includes requirements for specialized facilities,
such as those that store flammable and combustible materials. These
requirements would not pertain to long term care facilities because
health care occupancies are considered to be light hazards. As
described in chapter 5, light hazard buildings are not included in the
specialized facilities.
Chapter 6, Hanging, Bracing, and Restraint of System Piping,
contains the requirements for the structural issues that are related to
installing sprinkler piping systems. It identifies acceptable types of
hangers, how those hangers are installed, how fire main joints are
restrained, and how pipes are protected in areas where earthquakes
occur. It is important to ensure that sprinkler system components are
properly hung. If they are improperly hung, then they may randomly fall
down and injure someone. In addition, improperly hung components may
fall under the pressure of water flowing through them during a fire
situation, thus disabling the sprinkler system and allowing the fire to
grow.
Chapter 7, Design Approaches, addresses the minimum amount of water
necessary to effectively control or suppress a fire. This chapter
requires that water demands will be determined using the occupancy
hazard fire control approach and permits special design approaches to
allow for the use of non-standard components such as early suppression
fast-response sprinklers. Facilities are required to ensure that there
is a sufficient amount of water to control or suppress a fire.
Chapter 8, Plans and Calculations, is an extension of chapter 7
that focuses on the specific methodologies that can be used to
calculate and verify a sprinkler system's hydraulic demand and its
available water supply. Properly calculating these values is a crucial
step in ensuring that the system has adequate pressure and water to
control or suppress a fire. If a value is not properly calculated and,
for example, there is not enough water available for a sprinkler system
to fully control a fire, then the fire would be allowed to grow and
spread to other areas. The growth of the fire would jeopardize the
safety of the building's occupants.
This chapter also requires that preliminary sprinkler system plans
be submitted for review to the authority having jurisdiction for
several reasons. First, submitting the plans before construction begins
would help ensure that the plans meet all requirements, thus avoiding
changes at a later date. Also, submitting the plans for review may help
ensure that there are no errors. A person who is not familiar with the
plan brings a fresh perspective and may be able to more easily spot
errors. Finally, submitting plans early helps to avoid
misunderstandings. It is often difficult to verbally describe how a
system would be constructed and how it would function. A visual layout,
which is already required by most authorities having jurisdiction,
would aid in communication and understanding between all parties,
including the designer, the authority having jurisdiction, and the
construction personnel.
Chapter 9, Water Supplies, further expands on the areas that are
related to ensuring that a sprinkler system has adequate water to
control or suppress a fire. It addresses situations where a facility
may not have an adequate municipal water supply. Facilities may need to
install a pump to increase water pressure and a tank to store extra
water to compensate for an inadequate municipal supply. This chapter
includes the requirements that these additional components would need
to meet and addresses their proper use in a sprinkler system.
Chapter 10, Systems Acceptance, requires that sprinkler systems,
once constructed, be tested. System testing is done in order to verify
that the basic requirements of all of the previous chapters of NFPA 13
are satisfied, that the construction of the system is satisfactory, and
that the system performs as intended. During a system test, facilities
are required to examine pipes, pipe joints, alarms, and other
components to ensure that they are properly installed and that they are
in working order.
We would require that all long term care facilities that do not
already have an automatic sprinkler system installed throughout the
building install such a system in accordance with all of the
requirements NFPA 13, including but not exclusive to those described
above.
C. Phase-In
[If you choose to comment on issues in this section, please include
the caption ``Phase-in'' at the beginning of your comments.]
We are soliciting public comment regarding an appropriate phase-in
timeframe for the installation of an automatic sprinkler system. Such a
timeframe should provide for this additional fire protection feature as
quickly as possible without undue burden on long term care facilities.
We are soliciting public comment regarding a phase-in period for
this requirement because we believe that it would require a substantial
amount of time for a facility to plan and install an automatic
sprinkler system. A facility would likely decide to use the services of
a fire safety consultant to design a system that met its needs. Simply
securing these services could be a time-consuming process. In addition,
a facility would probably need to reallocate its resources and possibly
secure additional capital resources to implement this requirement. This
part of the preparation would also take a substantial amount of time to
complete. After preparing for the installation, a facility would
actually have to install the system. Installation may require removing
ceilings, cutting walls, and numerous other construction tasks.
Installation may also require temporarily relocating residents, either
within the facility or to another facility, while the sprinkler system
was being installed. We believe that most facilities would choose to
install sprinklers in their existing facility, and would therefore go
through this preparation and implementation process.
[[Page 62963]]
However, there may be some facilities that choose to relocate to a
building that already has a sprinkler system installed throughout the
building. These facilities may have planned to relocate to another
building for reasons unrelated to the proposed sprinkler requirement.
The decision to move, however, may be prompted by the proposed
requirements. For some facilities it may be easier to move rather than
to install such a system in their current location. Locating,
purchasing or constructing, and moving a facility would be a lengthy
process. A phase-in period, we believe, would allow facilities that
choose to relocate to a sprinklered building the chance to do so
instead of installing sprinklers in an existing building.
Given these considerations, we believe that requiring a long term
care facility to install an automatic sprinkler system throughout its
building requires a phase-in period. We would encourage facilities that
were able to install an automatic sprinkler system to do so as soon as
possible, rather than delay the project until the effective date of a
phase-in period drew near.
D. Maintenance
[If you choose to comment on issues in this section, please include
the caption ``Maintenance'' at the beginning of your comments.]
We are proposing in Sec. 483.70(a)(8)(ii) to require that all long
term care facilities test, inspect, and maintain an approved,
supervised automatic sprinkler system in accordance with the 1998
edition of NFPA 25, Standard for the Inspection, Testing, and
Maintenance of Water-Based Fire Protection Systems, which we propose to
incorporate by reference. Proper inspections, tests, and maintenance of
sprinkler systems are critical to ensuring that sprinkler systems
function properly on a continuous basis. Fires are, by nature,
unpredictable, and sprinkler systems must be operable at all times to
ensure that buildings are protected whenever and wherever fires occur.
National Fire Protection Association 25 covers a wide variety of
testing, inspection, and maintenance requirements for the numerous
types of sprinkler systems that facilities may install and the
auxiliary equipment that may be necessary for some facilities. The
general contents of the chapters of NFPA 25 are as follows: Chapter 1,
General Information, describes the scope of the document; describes and
defines key ideas and terms; requires that facilities maintain records
of inspections, tests, and maintenance activities; establishes who is
responsible for ensuring that all inspection, testing, and maintenance
duties are performed; and requires that all inspection, testing, and
maintenance activities be conducted in a safe manner.
Chapters 2, Sprinkler Systems; 3, Standpipe and Hose
Systems; 7, Water Spray Fixed Systems; and 8, Foam-Water Sprinkler
Systems, address the specific inspection, testing, and maintenance
requirements for the different types of sprinkler systems that
facilities may use, based upon their needs and circumstances.
Chapter 9, Valves, Valve Components, and Trim, focuses on
the inspection, testing, and maintenance of the valves, valve
components, and trim that are used to construct these systems.
Chapters 4, Private Fire Service Mains; 5, Fire Pumps, and
6, Water Storage Tanks, address the inspection, testing, and
maintenance requirements for auxiliary equipment that may be necessary
for a particular facility.
Chapter 10, Obstruction Investigation, provides the
minimum requirements for conducting investigations of possible sources
of materials that can block pipes and prevent them from operating
properly.
Chapter 11, Impairments, assures that adequate measures
are taken when a sprinkler system is wholly or partially shutdown,
either on an emergency or preplanned basis, to ensure that increased
fire safety risks are minimized and that the shutdown is as short in
duration as possible.
Chapter 12, Referenced Publications, provides a list of
other NFPA publications that are referred to within NFPA 25.
Facilities would be required by this proposed rule to comply with
all applicable chapters of NFPA 25 once they had installed their
sprinkler systems in accordance with the requirements of NFPA 13.
III. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to
provide 60-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether an information collection should be
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act
of 1995 requires that we solicit comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
We are soliciting public comment on each of these issues for the
following sections of this document that contain information collection
requirements:
In summary, Sec. 483.70(a)(8)(ii) requires that all long term care
facilities test, inspect, and maintain an approved, supervised
automatic sprinkler system in accordance with the 1998 edition of NFPA
25, Standard for the Inspection, Testing, and Maintenance of Water-
Based Fire Protection Systems. This section states that facilities
would be required by this proposed rule to comply with all applicable
chapters of NFPA 25 once they have installed their sprinkler systems in
accordance with the requirements of NFPA 13.
We believe that facilities would utilize the services of a
contractor for all inspection, testing, and maintenance activities,
including documentation of those activities. Therefore, no burden would
be associated with the development of the documentation. There would,
however, be a burden associated with the time and effort required by
facilities to maintain documentation of inspections, tests, and
maintenance activities in accordance with the standards outlined in the
NFPA 25. This burden would be the time it takes to file the
documentation.
The burden associated with these requirements is estimated to be 1
hour per long term care facility. Therefore, we estimate it would take
2,462 total annual hours (1 hour x 2,462 estimated affected long term
care facilities) to satisfy this burden.
If you comment on these information collection and recordkeeping
requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic
Operations and Regulatory Affairs, Regulations Development Group, Attn:
Bill Parham, CMS-3191-P, Room C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850; and Office of Information and Regulatory
Affairs, Office of Management and Budget, Room 10235, New Executive
Office Building, Washington, DC 20503, Attn: Carolyn Lovett, CMS Desk
Officer, CMS-3191-P, [email protected] fax (202) 395-6974.
[[Page 62964]]
IV. Regulatory Impact Statement
[If you choose to comment on issues in this section, please
indicate the caption ``Regulatory Impact Statement'' at the beginning
of your comment.]
A. Overall Impact
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more in any 1 year).
We have examined the impact of this proposed rule, and we have
determined that this rule would not meet the criteria to be considered
economically significant, and it would not meet the criteria for a
major rule.
This determination is based on a variety of cost factors and phase-
in lengths. As a brief summary, we estimate that this proposed rule
would cost $47.8 to $69.9 million, $73.5 to $107.5 million, and $107.7
to $157.6 million annually, based on phase-in periods of 10 years, 7
years, and 5 years, respectively.
The estimated cost range for installing a sprinkler system
throughout an existing building for an average size unsprinklered
facility (50,000 square feet) would be $205,000 to $307,500, depending
on the cost per square foot. The projected installation cost of this
proposed requirement would account for approximately 0.4 to 0.6 percent
of an average facility's actual revenue over a 10-year period, 0.6 to
0.9 percent over a 7-year period, and 0.8 to 1.2 percent over a 5-year
period.
The estimated cost range for installing a sprinkler system
throughout an existing building for an average size partially
sprinklered facility (37,500 square feet) would be $153,750 to
$230,625, depending on the cost per square foot. The projected
installation cost of this proposed requirement would account for
approximately 0.3 to 0.5 percent of an average facility's actual
revenue over a 10-year period, 0.4 to 0.7 percent over a 7-year period,
and 0.6 to 0.9 percent over a 5-year period.
The basis for these estimates is fully described in section IV.B.2
of this proposed rule. In that section, we estimate that 1,947
partially sprinklered facilities would, over a 10 year phase-in period,
install sprinklers throughout their buildings in accordance with this
proposed rule, at a cost of $75,338 to $416,250 per facility, based on
size and installation cost variables. The average yearly installation
cost for all partially sprinklered facilities would be $37.2 million to
$54.1 million. This determination is further based on the estimate that
515 unsprinklered facilities would install sprinklers, at a cost of
$100,450 to $615,000 per facility. The average yearly installation cost
for all unsprinklered facilities would be $10.5 million to $15.8
million. The average yearly installation cost estimates are based on an
example of a 10-year phase-in period.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small government
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
$6 million to $29 million in any 1 year. For purposes of the RFA, most
entities affected by this proposed rule are considered small businesses
according to the Small Business Administration's size standards, with
total revenues of $29 million or less in any 1 year (for detail, see 65
FR 69432). Individuals and States are not included in the definition of
a small entity.
According to our statistics, long term care facilities, all of
which would be required to have sprinkler systems throughout their
buildings, earned a total of $89.6 billion in 1999 (http://www.cms.hhs.gov/statistics/nhe/historical/t7.asp). According to the
National Nursing Home Survey: 1999 Summary (http://www.cdc.gov/nchs/data/series/sr_13/sr13_152.pdf), there were 18,000 nursing facilities
in operation at that time.
(Note:
In the following paragraph the terms ``average facility'' and
``small facility'' are strictly based on a revenue metric. That is,
the terms only describe the amount of revenue that facilities would
have.)
Long term care facilities vary in a number of ways, ranging from
the number of residents to the predominant source of payment for those
residences. For the purposes of our general analysis, we chose to
assess the financial impact of this proposed rule on an average
(median) facility and a much smaller facility (50 percent below the
median). An average facility had approximately $4,977,778 in revenue in
1999. A facility with revenue 50 percent below this average earned
$2,488,889. For example, over a 5-year, 7-year, and 10-year period, an
average facility would earn $24,888,890, $34,844,446, and $49,777,780,
respectively. The small facility would earn $12,444,445, $17,422,223,
and $24,888,890 over those same time periods.
The projected cost of this proposed requirement would account for
0.8 to 1.2 percent of a typical small facility's actual revenue over
the 5-year example period, 0.5 to 0.9 percent of such facility's actual
revenue over the 7-year example period, or 0.4 to 0.7 percent of such
facility's actual revenue over the 10-year example period. We are
assuming that a small facility's square footage was 50 percent less
than an average facility's square footage because there is a strong
correlation between the size of a facility, as reflected by the number
of resident beds it has, and the facility's revenue level. We believe
that, given these estimates, this proposed rule would not have a
significant impact on a substantial number of small entities.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 603 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds.
We know that 8.41 percent of long term care facilities, 1,514
nationwide, are located in hospitals, but we do not know how many of
those hospitals are small rural hospitals. As described in section
IV.B.2 of this proposed rule, 75.89 percent of long term care
facilities nationwide report that they are fully sprinklered. An
additional 15.2 percent report that they are partially sprinklered,
4.14 percent report that they are not sprinklered, and 4.77 percent did
not report any information about sprinklers. From this information, we
estimate that, of the 1,514 long term care facilities located in
hospitals, 1,204 are fully sprinklered, 241 are partially sprinklered,
and 69 are not sprinklered. We assume that long term care facilities
that are located in small rural hospitals are small as well.
For a small unsprinklered facility with less than 50 resident beds,
we
[[Page 62965]]
estimate that purchasing and installing sprinklers would cost $100,450
(at $4.10 per square foot), $134,750 (at $5.50 per square foot), or
$150,675 (at $6.15 per square foot). If the small unsprinklered
facility met the revenue criteria for a smaller facility as described
above, then the projected cost of this proposed requirement would
account for 0.8 to 1.2 percent of the facility's revenue over the 5-
year example period, 0.5 to 0.9 percent of the facility's revenue over
the 7-year example period, or 0.4 to 0.7 percent of the facility's
revenue over the 10-year example period.
For a small partially sprinklered facility with less than 50
resident beds, we estimate that purchasing and installing sprinklers
would cost $75,338 (at $4.10 per square foot), $101,063 (at $5.50 per
square foot), or $113,006 (at $6.15 per square foot). If the small
partially sprinklered facility met the revenue criteria for a smaller
facility as described above, then the projected cost of this proposed
requirement would account for 0.7 to 0.9 percent of the facility's
revenue over the 5-year example period, 0.4 to 0.6 percent of the
facility's revenue over the 7-year example period, or 0.3 to 0.5
percent of the facility's revenue over the 10-year example period.
Therefore, we believe that this proposed rule would not have a
significant impact on the operations of a substantial number of small
rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. This proposed rule would not have an effect on
State, local, or tribal governments because we do not propose to
require State, local, or tribal governments to take any action. Based
on our example of a 10-year phase-in period, we estimate that the
private sector costs of this proposed regulation would be $47.8 million
to $69.9 million in any 1 year for installation and an additional
$1,019 per facility for maintenance. After the initial installation
period, we estimate that the private sector costs of this proposed
regulation would $2,508,778 annually for maintenance. This estimate
would not approach the $110 million threshold; therefore, this section
does not assess the anticipated costs and benefits as required by
section 202 of the Unfunded Mandates Reform Act of 1995.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. This proposed regulation would not have any Federalism
implications.
B. Anticipated Effects
1. Benefits
Decreasing Loss of Life
We believe that installing an approved, supervised automatic
sprinkler system in accordance with NFPA 13, Standard for the
Installation of Sprinkler Systems, throughout a long term care facility
would have a positive impact on resident safety. According to the July
2004 GAO report discussed above, installing sprinklers decreases the
chances of fire-related deaths by 82 percent. In unsprinklered
facilities, there are 10.8 deaths per 1,000 fires. In sprinklered
facilities, there are 1.9 deaths per 1,000 fires.
The 2003 fires in Hartford and Nashville resulted in more fire
related deaths (31) than there were for several previous years
combined. Both of these fires occurred in unsprinklered buildings. If
sprinklers had been installed in these facilities, and if they were
properly maintained, we estimate that 82 percent of those fire-related
deaths may have been prevented, based on an 82 percent reduction in the
chances of death occurring in a sprinklered facility. We estimate that,
based on this reduction, 25 (82 percent of 31 deaths = 25) lives could
have been saved by sprinklers in these two fires, or 13 lives in the
Hartford fire and 12 lives in the Nashville fire.
In 1997, the average age at admission for long term care facility
residents was 82.6 years, and 51 percent of long term care facility
residents were 85 years of age or older (The Changing Profile of
Nursing Home Residents: 1985-1997. Sahyoun NR, Pratt LA, Lentzner H,
Dey A, Robinson KN. Aging Trends; No. 4. National Center for Health
Statistics. Hyattsville, MD; 2001). These numbers reflect the overall
demographic trend in long term care facilities toward an older patient
population. For the purposes of our analysis, we assume that the
average age of long term care facility residents is 85. Also in 1997,
the life expectancy for an individual at age 85 was 6.3 years (Older
Americans 2000: Key Indicators of Well-Being. Federal Interagency Forum
on Aging-Related Statistics. http://www.agingstats.gov/chartbook2000/tables-healthstatus.html). This means that an 85-year-old long term
care facility resident could expect to live an average of 6.3 more
years.
Based on the assumption that the average age of long term care
facility residents is 85 with a life expectancy at age 85 of 6.3 years,
we estimate that sprinklers in these two fires would have added 157.5
life years (25 lives saved x 6.3 life years per life saved).
While the number of deaths in these two fires is not typical of the
number of fire-related deaths in long term care facilities as a whole,
we believe that they should still be taken into consideration when
discussing the impact on the general long term care facility resident
population.
In a typical year from 1994 through 1999, about 2,300 long term
care facilities report structural fires (July 2004 GAO report). For the
purposes of our analysis, we estimate that 3,688 long term care
facilities currently do not have sprinklers installed throughout the
buildings. (See section IV.B.2. of this proposed rule).
We estimate that 25 percent (575) of the 2,300 facilities that
reported fires did not have sprinklers installed throughout their
buildings. This estimate is based on the results of the 2004 GAO report
and a nationwide survey of long term care facilities as described in
section IV.B.2 of this proposed rule.
Based on the rate of 10.8 deaths per 1,000 unsprinklered facility
fires, we estimate that 6 deaths occurred in 575 fires in unsprinklered
facilities annually. (575 facilities = 57.5 percent of 1,000
facilities; 57.5 percent of 10.8 deaths = 6 deaths). This estimate
differs slightly from the average number of deaths (5) that occurred
due to long term care facility fires, as presented in the July 2004 GAO
report, because this estimate predicts the number of deaths that should
statistically occur, based on established percentages, rather than the
average number of deaths that occurred annually in the past. This
estimate is prospective, whereas the 2004 GAO figure is retrospective.
If these unsprinklered or partially sprinklered facilities install
sprinklers throughout their buildings and those sprinklers are properly
maintained, then we estimate that there would be 1 death (57.5 percent
x 1.9 deaths per 1,000 sprinklered facility fires = 1) in those same
575 facilities. Installing sprinklers in unsprinklered buildings would,
based on these estimates, save 5 lives annually.
[[Page 62966]]
Table 1.--Estimated Annual Fire Deaths
------------------------------------------------------------------------
Number of estimated Number of estimated
annual fire-related annual fire-related Number of estimated
deaths in unsprinklered deaths if those annual lives saved by
long term care facilities were sprinklers
facilities sprinklered
------------------------------------------------------------------------
6 1 5
------------------------------------------------------------------------
Given the estimate described above that installing and maintaining
sprinkler systems in existing long term care facilities would save 5
lives annually, we estimate that sprinklers would save 31.5 life years
annually (5 lives saved x 6.3 years gained per life).
Table 2.--Life Years
------------------------------------------------------------------------
Number of life years gained per Number of life years gained
life saved annually
------------------------------------------------------------------------
6.3 31.5
------------------------------------------------------------------------
There are a wide variety of estimates regarding the statistical
value of a quality-adjusted life year. That is, there are numerous
studies that attempt to quantify how much individuals and society are
willing to pay to gain a single, quality year of life, known as a
quality-adjusted life year. These studies, using one or more of four
different methodologies, have estimated that individuals and society
are willing to pay between $50,000 and $450,000 for a quality-adjusted
life year. Due to the fact that there is no widely accepted standard
value, we have refrained from estimating the statistical value of each
life year that would be gained as a result of a final rule requiring
sprinklers in all long term care facilities.
Decreasing Loss of Property
As a result of installing and properly maintaining sprinklers, we
anticipate that facilities that experience fires would lose less
property. While the amount of property damage and loss that would be
prevented by installing and maintaining sprinklers is not readily
quantifiable, we believe that the amount of damage prevented would be
substantial and that this prevention would benefit affected long term
care facilities.
Decreasing Fire Recovery Disruption and Time
In addition to losing less property due to fire, we anticipate that
long term care facilities that experience fires would be able to
recover more quickly with fewer disturbances to residents. Because
sprinkler heads generally activate only in the area immediately near
the fire source, the area that would be damaged by a fire would likely
be much smaller in a sprinklered building than it would be in a
building without sprinklers, thus reducing recovery costs. In addition,
by limiting the area affected by the fire, there would be fewer
disturbances to residents during the recovery time. While we cannot
quantify these benefits to long term care facilities and their
residents, we believe that they are substantial and worth considering.
2. Costs
This proposed rule would require a long term care facility to
install an approved, supervised automatic sprinkler system in
accordance with NFPA 13, Standard for the Installation of Sprinkler
Systems, throughout the building. This proposed rule would also allow
long term care facilities to install automatic sprinkler systems within
a phase-in period to be determined based on public comments. As
described in section IV.B.2 of this proposed rule, we set forth the
various contingencies, assumptions, and data sources that we used to
develop our estimates. In addition, in section IV.B.2, we present our
final estimates based on those contingencies, assumptions, and data
sources.
Phase-In Period
We are soliciting public comment regarding the length of a phase-in
period to allow long term care facilities to install sprinklers. The
cost of installing sprinklers is substantial, and we do not expect long
term care facilities to have $75,000 to $615,000, depending on the size
of the area requiring sprinklers and the cost of installing sprinklers,
immediately available to purchase and install sprinklers. We believe
that a phase-in period would mitigate the cost of installing sprinklers
by allowing facilities time to reprioritize and redistribute resources.
At this time, we do not know what would be the exact length of the
phase-in period.
For illustrative purposes only, we have estimated the annual costs
of this proposed rule for 5-year, 7-year, and 10-year phase-in periods.
While we would encourage all facilities to immediately begin the
process of purchasing and installing sprinklers, we understand that
some facilities would choose to wait until the very end of a phase-in
period to begin this process. Therefore, we expect that the full cost
of this proposed rule would be distributed over a period of several
years as facilities nationwide would likely stagger their installation
schedules to meet their individual needs and circumstances.
Number and Size of Affected Facilities
We estimate that the installation provision of this proposed
regulation would, over a 10-year phase-in period, impact 1,947
partially sprinklered and 515 unsprinklered long term care facilities.
We based this estimate on several elements.
The July 2004 GAO report on long term care facility fire safety
estimated that 20 to 30 percent of long term care facilities do not
have sprinklers throughout the facility and would therefore be subject
to the provisions of this regulation.
We conducted a survey of all 18,005 long term care facilities.
Facilities in 46 States and the District of Columbia responded to the
survey. Results from the four States that did not respond have been
extrapolated based on the pattern of responses from other States. The
survey found that 75.89 percent of long term care facilities are fully
sprinklered. In addition, 15.2 percent of long term care facilities
were partially sprinklered, and 4.14 percent did not have any
sprinklers. An additional 4.77 percent of facilities is unknown. The
4.77 percent of unknown facilities has been distributed, based on the
previously cited percentages, into the categories for fully, partially,
and non-sprinklered.
Of the 18,005 long term care facilities, we estimate that 14,317
are fully sprinklered. In addition, we estimate that there are 2,867
partially sprinklered facilities and 782 non-sprinklered facilities
(results of survey + extrapolated results for non-responding States +
extrapolated unknown results).
Distributing numbers based on percentages requires rounding, and
can result in facilities not being fully accounted for. The above
results do not account for 39 facilities. For purposes of our analysis,
we assume that these 39 facilities are non-sprinklered, for a total of
821 non-sprinklered facilities.
Therefore, we estimate that 14,317 facilities would not be impacted
by this proposed rule because they already have sprinklers installed
throughout their
[[Page 62967]]
buildings. We estimate that 3,688 facilities could potentially be
impacted by this proposed rule because they do not have sprinklers
installed throughout their buildings.
We estimate that, of those 3,688 facilities without sprinklers
throughout, 435 partially sprinklered facilities, and 170 non-
sprinklered facilities are located either in States that have their own
long term care sprinkler requirements (3) or in States that would adopt
the 2006 edition of the NFPA 101, Life Safety Code (LSC) (12).
The NFPA included a requirement that all existing long term care
facilities install sprinklers throughout their buildings in the 2006
edition of the LSC. The NFPA already requires that sprinkler systems
that are installed in all buildings be maintained according to NFPA 25.
Although Federal regulations require the 2000 edition of the LSC,
12 States have independently updated their requirements to adopt the
2003 edition of the LSC. We assume that these States would continue to
adopt the most recent version of the LSC.
The 2006 edition has already been released to the public, ahead of
any final CMS rule requiring sprinklers in all long term care
facilities. In adopting the 2006 edition of the LSC, those States would
require the long term care facilities within their jurisdictions to
install and maintain sprinklers absent this proposed rule. Therefore,
facilities in those States would not be impacted by this proposed rule.
In addition, we assume that 2 percent of existing long term care
facilities would be replaced or fully renovated each year as part of
the natural cycle of facilities upgrading their accommodations.
Therefore, of the initial 2,867 partially sprinklered and 821
unsprinklered facilities, we assume that 57 partially sprinklered and
16 unsprinklered facilities would be replaced or fully renovated each
year. If there were to be a 10-year phase-in period, then 570 partially
sprinklered and 160 unsprinklered buildings would likely be replaced or
fully renovated before the phase-in period would expire.
Of these 570 and 160 facilities, we estimate that 15 percent are in
the States that have independent sprinkler requirements or would adopt
the 2006 edition of NFPA 101, and would therefore require sprinklers
absent Federal rulemaking. These 85 and 24 facilities (15 percent of
570 and 160 facilities) are captured in the 435 partially sprinklered
and 170 unsprinklered facilities already excluded from our impact
analysis, as described above. That leaves an estimated 485 existing
partially sprinklered and 136 unsprinklered facilities that would be
naturally replaced by new facilities with sprinklers or fully renovated
within, for example, a 10-year phase-in period (570 naturally replaced
or renovated facilities -85 in States that would require sprinklers
absent Federal rulemaking = 485 facilities; 160 naturally replaced
facilities - 24 in States that would require sprinklers absent Federal
rulemaking = 136 facilities). Likewise, if there were to be a 7-year
phase-in period, then 399 partially sprinklered and 112 unsprinklered
buildings would likely be replaced or fully renovated before the phase-
in period would expire. If there were to be a 5-year phase-in period,
then 285 partially sprinklered and 80 unsprinklered buildings would
likely be replaced or fully renovated before the phase-in period would
expire.
This brings the total number of estimated affected partially
sprinklered facilities to 1,947 (original 2,867 existing partially
sprinklered facilities - 435 facilities in States that would require
sprinklers absent Federal rulemaking - 485 existing facilities that
would be replaced or renovated naturally over a 10 year phase-in period
= 1,947 partially sprinklered facilities that would be affected by this
proposed rule). The total number of estimated affected unsprinklered
facilities is 515 (original 821 existing unsprinklered facilities - 170
facilities in States that would require sprinklers absent Federal
rulemaking - 136 existing facilities that would be replaced naturally
over a 10-year phase-in period = 515 unsprinklered facilities that
would be affected by this proposed rule).
The same methodology was used to identify the number of affected
unsprinklered and partially sprinklered long term care facilities over
7-year and 5-year phase-in periods. These estimates, displayed in table
3, are not the same as the estimates for a 10-year phase-in period
because fewer facilities would be naturally replaced or remodeled
during a 7-year or 5-year phase-in than during a 10-year phase-in.
Therefore, more facilities would be affected by this proposed rule.
Based on discussions with the American Health Care Association and
State survey agencies, an average size unsprinklered long term care
facility has 100 resident beds and is 50,000 square feet (50,000/100 or
500 square feet per bed). Much larger long term care facilities have
recently been constructed. However, as newly constructed facilities,
they are already required to have sprinklers installed throughout their
buildings. Using the methodology described above, table 3, based on
data from our sprinkler survey and our Certification and Survey
Provider Enhanced Reporting system, shows the size and number of
affected unsprinklered facilities over three different phase-in
periods.
Table 3.--Number of Unsprinklered Facilities Affected
----------------------------------------------------------------------------------------------------------------
Less than 50 200 or more
beds (less 50-99 beds 100-199 beds beds (99,501 Total number
than 24,500 (24,501-49,500 (49,501-99,500 or more sq. of affected
sq. ft) sq. ft) sq. ft) ft) facilities
----------------------------------------------------------------------------------------------------------------
10 year phase-in................ 102 220 168 25 515
7 year phase-in................. 110 238 181 27 556
5 year phase-in................. 116 249 190 28 583
----------------------------------------------------------------------------------------------------------------
An average partially sprinklered facility also has 100 beds and is
50,000 square feet. Table 4 shows the size and number of affected
partially sprinklered facilities over three different phase-in periods.
[[Page 62968]]
Table 4.--Number of Partially Sprinklered Facilities Affected
----------------------------------------------------------------------------------------------------------------
Less than 50 200 or more
beds (less 50-99 beds 100-199 beds beds (99,501 Total number
than 24,500 (24,501-49,500 (49,501-99,500 or more sq. of affected
sq. ft) sq. ft) sq. ft) ft) facilities
----------------------------------------------------------------------------------------------------------------
10 year phase-in................ 253 561 745 388 1,947
7 year phase-in................. 272 603 801 417 2,093
5 year phase-in................. 285 631 838 436 2,190
----------------------------------------------------------------------------------------------------------------
These buildings, however, would not require sprinklers to be
installed in all areas because the building is already partially
sprinklered. For purposes of this impact analysis, we assume that a
partially sprinklered building is 25 percent sprinklered, leaving 75
percent of the building to be sprinklered in accordance with this
proposed rule. Buildings in this category may have more or less
sprinkler coverage than this assumption.
For facilities with fewer than 50 resident beds, we estimate that
sprinklers would be installed for 18,375 square feet (75 percent of
maximum square footage in this size category). For facilities with 50
to 99 resident beds, we estimate that sprinklers would be installed for
27,750 square feet (75 percent of average square footage in this size
category). For facilities with 100 to 199 resident beds, we estimate
that sprinklers would be installed for 55,875 square feet (75 percent
of average square footage in this size category). For facilities with
more than 199 resident beds, we estimate that sprinklers would be
installed for 75,000 square feet (75 percent of minimum square footage
in this size category).
Installation Cost Per Square Foot
Purchasing and installing a sprinkler system according to the
requirements of NFPA 13 encompasses a wide variety of factors,
including those briefly described in section II of this proposed rule.
Within the requirements of NFPA 13, there are numerous variables that
can impact the purchase and installation costs for a facility. Each
facility has different needs that must be addressed when purchasing and
installing a sprinkler system, and this cost estimate cannot address
each particular need or combination of needs. Therefore, we are basing
our cost estimates not on the individual requirements of NFPA 13 for an
individual facility, but on a bundled purchase and installation
estimate for an average facility, as described below. Individual
facilities may have costs above or below those of this average facility
due to facility size and facility-specific sprinkler system needs. Long
term care facilities that are based in other health care facilities,
such as hospitals, would be required by this proposed rule only to have
sprinklers in the long term care facility section of the building.
Therefore, we do not believe that facility-based long term care
facilities would have different installation costs than freestanding
facilities with similar resident bed and square footage numbers.
We estimate that it would cost between $4.10 and $6.15 per square
foot to purchase and install a sprinkler in an existing facility, with
an average cost of $5.50 per square foot. According to the Architects,
Contractors, Engineers Guide to Construction Costs, 2004 Edition by
Design and Construction Resources, purchasing and installing sprinklers
in new long term care facilities costs $2.05 per square foot. This cost
estimate incorporates all contractor costs such as labor, materials,
and a 20 percent overhead fee; 35 percent taxes and insurance on labor,
equipment, and tools; and 5 percent sales tax.
Although we recognize that capital and interest costs may increase
the cost of purchasing and installing automatic sprinkler systems in
long term care facilities, these costs are not included in our
estimates. Due to the individual circumstances of each facility,
unknown future interest rates, and various other factors, we are unable
to accurately estimate the capital and interest costs of installing
sprinkler systems. Therefore, we have chosen to exclude these costs
from our estimates while acknowledging that they do exist and will play
a role to some degree in the decisions of long term care facilities
that would be affected by this proposed rule.
Renovation costs are typically two to three times higher than new
construction costs because installing the sprinkler system must be
completed in a piecemeal fashion while the building remains occupied.
This increases the length of the construction time and, thus, increases
its costs. In addition, renovations to add sprinkler systems often
require upgrading or adding related building components such as water
lines and fire pumps. The upgrades and additions require more capital
investment and construction time. Increased investment and construction
time also increases costs.
For purposes of this impact analysis, we assume that renovating a
typical facility to add sprinklers would cost approximately 2.5 times
more than purchasing and installing sprinklers in new long term care
facilities. We do not have a specific source for this assumption;
therefore, we have also included cost estimates for facilities that
would pay $4.10 per square foot (2 times the cost of installing
sprinklers in new construction) and $6.15 per square foot (3 times the
cost of installing sprinklers in new construction).
Cost Estimates
The cost estimates for both unsprinklered and partially sprinklered
facilities are presented in the following tables. They are based on all
of the above-described estimates about the number of facilities that
would be affected, the sizes of those facilities, and the installation
costs per square foot. We note again that the number of facilities that
would be affected by this rule changes based on the length of the
phase-in period because fewer facilities would be naturally replaced or
remodeled during a 7-year or 5-year phase-in than during a 10-year
phase-in. Therefore, as the phase-in time is shortened, more facilities
would be affected by this rule, increasing the estimated cost impact of
this proposed rule.
Based on the above-described estimates and figures, we estimate
that an unsprinklered facility meeting the following size
specifications would have the following costs to comply with the
installation requirements of this proposed regulation. (See table 5)
[[Page 62969]]
Table 5.--Total Installation Cost per Unsprinklered Facility
----------------------------------------------------------------------------------------------------------------
$4.10 per $5.50 per $6.15 per
square foot square foot square foot
----------------------------------------------------------------------------------------------------------------
> 50 beds (24,500 square feet).................................. $100,450 $134,750 $150,675
50-99 beds (37,000 square feet)................................. 151,700 203,500 227,550
100-199 beds (74,500 square feet)............................... 305,450 409,750 458,175
<199 beds (100,000 square feet)................................. 410,000 550,000 615,000
Total cost for 515 facilities (10 year phase-in)................ 105,185,500 141,102,500 157,778,250
Total cost for 556 facilities (7 year phase-in)................. 113,510,550 152,270,250 170,265,825
Total cost for 583 facilities (5 year phase-in)................. 118,941,000 159,555,000 178,411,500
----------------------------------------------------------------------------------------------------------------
We estimate that a partially sprinklered facility meeting the
following size specifications would have the following costs to comply
with the installation requirements of this proposed regulation. (See
table 6)
Table 6.--Total Installation Cost per Partially Sprinklered Facility
----------------------------------------------------------------------------------------------------------------
$4.10 per $5.50 per $6.15 per
square foot square foot square foot
----------------------------------------------------------------------------------------------------------------
> 50 beds (18,375 square feet).................................. $75,338 $101,063 $113,006
50-99 beds (27,750 square feet)................................. 113,775 152,625 170,663
100-199 beds (55,875 square feet)............................... 229,088 307,313 343,631
More than 199 beds (75,000 square feet)......................... 307,500 412,500 416,250
Total cost for 1,947 facilities (10 year phase-in).............. 372,868,849 500,189,749 541,842,556
Total cost for 2,093 facilities (7 year phase-in)............... 400,825,249 537,692,224 582,472,102
Total cost for 2,190 facilities (5 year phase-in)............... 419,309,099 562,487,624 609,342,841
----------------------------------------------------------------------------------------------------------------
Based on the different installation costs and phase-in lengths
presented in this section, we estimate that the combined installation
cost for all impacted long term care facilities (unsprinklered and
partially sprinklered) would range from $478,054,349 to $787,754,341.
(See table 7)
Table 7.--Total Installation Cost for All Facilities
----------------------------------------------------------------------------------------------------------------
$4.10 per $5.50 per $6.15 per
square foot square foot square foot
----------------------------------------------------------------------------------------------------------------
Total cost for 2,462 facilities (10 year phase-in).............. $478,054,349 $641,292,249 $699,890,806
Total cost for 2,649 facilities (7 year phase-in)............... 514,339,799 689,962,474 752,787,927
Total cost for 2,773 facilities (5 year phase-in)............... 538,250,099 722,042,624 787,754,341
----------------------------------------------------------------------------------------------------------------
As stated earlier, we do not expect long term care facilities to
have funds immediately available to purchase and install sprinklers.
Therefore, we propose to allow a phase-in period of undetermined length
to help mitigate the cost of installing sprinklers by allowing
facilities time to reprioritize and redistribute resources.
For illustrative purposes only, we have estimated the annual costs
of this proposed rule for 10, 7, and 5-year phase-in periods. While we
would encourage all facilities to immediately begin the process of
purchasing and installing sprinklers, we understand that some
facilities would choose to wait until the very end of a phase-in period
to begin this process. Therefore, we expect that the full cost of this
proposed rule would be distributed over a period of several years as
facilities nationwide would likely stagger their installation schedules
to meet their individual needs and circumstances.
The following tables show the estimated annual installation costs
for the phase-in periods based on the estimated total cost figures
shown in table 7. The annual installation cost estimates have been
discounted at 3 and 7 percent in order to compare the cost in today's
dollars to the cost in future dollars.
Table 8.--Annual Costs Over All Phase-in Periods
[In millions]
----------------------------------------------------------------------------------------------------------------
$4.10 per $5.50 per $6.15 per
square foot square foot square foot
----------------------------------------------------------------------------------------------------------------
10 year phase-in................................................ 47.81 64.1 69.96
7 year phase-in................................................. 73.48 98.6 107.53
5 year phase-in................................................. 107.65 144.4 157.55
----------------------------------------------------------------------------------------------------------------
[[Page 62970]]
Maintenance
After installing an approved, supervised automatic sprinkler system
in accordance with the 1999 edition of NFPA 13 throughout the building,
all long term care facilities would be required to test, inspect, and
maintain their sprinkler systems in accordance with the 1998 edition
NFPA 25. We estimate that long term care facilities would conduct
quarterly inspections of their sprinkler systems and annual trip tests.
We assume that each inspection will take 4 hours to complete, at a cost
of $150 per inspection. We also assume that each trip test would take 6
hours, at a cost of $250. Based on these assumptions, we estimate that
long term care facilities would spend $850 annually to test and inspect
their sprinkler systems. In addition, we assume that long term care
facilities will spend an additional $150 annually to perform any
necessary maintenance duties.
Individuals who perform these testing, inspection, and maintenance
duties would have to be properly trained and, in some States and local
jurisdictions, they would have to be licensed. Generally, long term
care facilities would not have enough sprinkler system work needs to
directly employ someone with the necessary skills, training, and
licensure. Therefore, we believe that long term care facilities would
likely contract with another company to meet their testing, inspection,
and maintenance needs. In addition to actually conducting the necessary
testing, inspection, and maintenance activities, we believe that the
contract would also include a provision that the contractor prepares
adequate documentation of the activities conducted. We estimate that
the total cost of meeting these requirements would be $1,000 ($150 x 4
quarterly inspections = $600 + $250 annual trip test + $150 general
maintenance costs = $1,000).
In addition, all long term care facilities that would be affected
by this proposed regulation would be required to maintain documentation
of all inspection, maintenance, and testing activities. The burden
associated with these requirements is estimated to be 1 hour per long
term care facility. Therefore, we estimate it would take 2,462 total
annual hours (1 hour x 2,462 estimated affected long term care
facilities) to meet this requirement. This documentation maintenance
requirement would cost an affected facility $19 a year, based on an
hourly rate of $19 for an office employee ($19 per hour x 1 hour). The
total annual cost of this proposed documentation requirement would be
$46,778 ($19 per facility x 2,462 facilities).
This estimated cost would be offset by the elimination of the cost
of maintaining smoke alarms. Section 483.70(a)(7)(ii) requires long
term care facilities that did not have sprinklers installed throughout
their building to have a program for testing, maintenance, and battery
replacement to ensure the reliability of smoke alarms in their
facilities.
However, Sec. 483.70(a)(7)(iii)(b) exempts long term care
facilities from this smoke alarm maintenance requirement if their
facilities have sprinkler systems throughout their building that are
installed, tested, and maintained in accordance with NFPA 13.
Therefore, long term care facilities that install and maintain
sprinkler systems in accordance with this proposed regulation would be
exempt from the existing requirement to maintain their smoke alarms.
Due to the fact that all long term care facilities would be exempt from
this smoke alarm requirement upon the phase-in date of a final
regulation, we plan to add a sunset date to the smoke alarm requirement
upon finalization of this sprinkler regulation. Based on the cost
estimates published in ``Fire Safety Requirements for Certain Health
Care Facilities; Amendment'' (70 FR 15229, March 25, 2005), we estimate
that this exemption would save an average long term care facility that
was affected by the smoke alarm requirement $2,800 annually. This
results in a net savings of $1,800 annually ($2,800 savings from not
maintaining smoke alarms -$1,019 cost of maintaining sprinklers =
$1,781 net savings).
C. Alternatives Considered
1. Maintain Current Fire Safety Requirements
We currently require long term care facilities to comply with the
fire safety requirements in the LSC. In addition, we currently require
long term care facilities that do not have sprinklers installed
throughout the building to have and maintain at least battery operated
smoke alarms in resident rooms and public areas. We believe that these
requirements are a solid foundation for ensuring that all long term
care facility residents are protected from the threat of fire.
We also believe that these current measures do not go far enough to
protect long term care facility residents. Both the Hartford and
Nashville facilities were in substantial compliance with the LSC, yet
both facilities experienced severe fires with large numbers of
fatalities.
The smoke alarm requirement that we published in the Federal
Register on March 25, 2005 (70 FR 15229) after these fires was a step
toward improving fire safety and avoiding another devastating fire.
Unfortunately, smoke alarms can only warn facility staff and residents
of the fire. They cannot suppress a fire or prevent it from spreading
to other areas.
Long term care facility residents often have multiple or severe
health problems that complicate the facility's ability to ensure their
safety in the event of a fire. For example, frail elderly residents may
rely on facility staff to assist them in transferring and otherwise
moving about the facility. These types of residents are unable to
independently protect themselves from the threat of fire by moving away
from the danger. They are dependent on facility staff, who are also
responsible for ensuring the safety of dozens of other residents. A
rapidly growing fire can overwhelm both the staff and residents,
leading to tragic consequences.
However, a properly designed, installed, and maintained sprinkler
system effectively prevents a fire from spreading to other areas and
overwhelming the staff and residents. Containing a fire reduces the
threat to residents in other portions of the building and allows
facility staff to focus their energy on the area that is most affected
by the fire, without worry about the fire spreading to other areas and
threatening other residents. Sprinkler systems have consistently served
this function for many years, and they are commonly recognized as the
single most effective fire safety device currently available.
Given the past success of sprinkler systems and their potential for
saving lives in the future, we believe that maintaining the existing
fire safety requirements without adding sprinkler requirements does not
ensure the safety of long term care facility residents to the greatest
extent possible.
In addition, maintaining the existing fire safety requirements
would have left decisions regarding more stringent fire safety measures
in the hands of State and local governments. State and local
governments have, in the past, made very different decisions about fire
safety requirements in long-term care facilities. For example, some
States, such as Tennessee and Virginia, already require all long-term
care facilities to have sprinklers throughout their buildings. In
contrast, other States, such as Arkansas and Nebraska, do not have such
requirements, resulting in 25 percent or
[[Page 62971]]
more of their long-term care facilities completely lacking sprinklers.
This level of variability is not acceptable because residents of long-
term care facilities should be assured the same minimum level of fire
safety regardless of what State or locality they reside in. Federal
regulation is the most efficient and expedient manner for achieving the
goal of uniform nationwide minimum fire safety standards; therefore, we
chose to pursue Federal regulation rather than depending on State and
local governments.
2. Exempt Small Facilities
The Medicare Conditions of Participation are the minimum
requirements that providers are required to meet in order to be
Medicare and Medicaid certified. Many other standards setting
organizations have requirements that go beyond what Medicare and
Medicaid require. Facilities may choose to strive for these higher
standards, although Medicare and Medicaid do not require them to do so.
Exempting any facility from this proposed minimum requirement would
be a disservice to the residents of that facility. Residents deserve to
be safe from the threat of fire, whether they reside in a large
facility or a smaller one. The proposed sprinkler requirement would
ensure that, regardless of the size or location of their residence, all
residents are protected by the same basic minimum fire safety
requirements.
We believe that a phase-in period would help to mitigate the costs
of installing sprinklers for small facilities while ensuring that all
residents are protected by the same minimum requirements. Therefore, we
are not proposing to exempt small facilities from this requirement.
3. Require Immediate Compliance
Requiring immediate compliance with the proposed condition would,
we believe, be a hardship for affected long term care facilities.
Designing a sprinkler system, purchasing it, installing it, and testing
it all require a significant amount of time. The typical 60-day delay
in the effective date of a regulation would not be sufficient time to
complete the entire sprinkler process. For this reason, we have chosen
not to require immediate compliance. Instead, we believe that it is
appropriate to propose a several-year phase-in period for this
regulation.
We are specifically requesting public comments and suggestions
regarding the length of a phase-in period in section II.B of this
proposed rule.
D. Conclusion
For these reasons, we are not preparing analyses for the RFA
because we have determined that this rule would not have a significant
economic impact on small entities because the estimated cost of the
proposed regulation would account for less than 1 percent of an
affected facility's revenue over, for example, a 7-year or 10-year
period.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects in 42 CFR Part 483
Grant programs--health, Health facilities, Health professions,
Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting
and recordkeeping requirements, Safety.
For the reasons set forth in the preamble, the Centers for Medicare
and Medicaid Services proposes to amend 42 CFR chapter IV as set forth
below:
PART 483--REQUIREMENTS FOR STATES AND LONG-TERM CARE FACILITIES
1. The authority citation for part 483 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart B--Requirements for Long-Term Care Facilities
2. In Sec. 483.70, add new paragraph (a)(7)(iv) and new paragraph
(a)(8) to read as follows:
Sec. 483.70 Physical environment.
(a) * * *
(7) * * *
(iv) The terms of paragraph (a)(7) of this section shall remain
effective through the date specified at paragraph (a)(8)(i) of this
section.
(8) A long term care facility must:
(i) Install an approved, supervised automatic sprinkler system in
accordance with the 1999 edition of NFPA 13, Standard for the
Installation of Sprinkler Systems, as incorporated by reference,
throughout the building by phase-in date to be determined. The Director
of the Office of the Federal Register has approved the NFPA 13 1999
edition of the Life Safety Code, issued July 22, 1999 for incorporation
by reference in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. A
copy of the Code is available for inspection at the CMS Information
Resource Center, 7500 Security Boulevard, Baltimore, MD or at the
National Archives and Records Administration (NARA). For information on
the availability of this material at NARA, call 202-741-6030, or go to:
http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html. Copies may be obtained from the
National Fire Protection Association, 1 Batterymarch Park, Quincy, MA
02269.
(ii) Test, inspect, and maintain an approved, supervised automatic
sprinkler system in accordance with the 1998 edition of NFPA 25,
Standard for the Inspection, Testing and Maintenance of Water-Based
Fire Protection Systems, as incorporated by reference. The Director of
the Office of the Federal Register has approved the NFPA 25 1998
edition of the Life Safety Code, issued January 16, 1998 for
incorporation by reference in accordance with 5 U.S.C. 552(a) and 1 CFR
part 51. A copy of the Code is available for inspection at the CMS
Information Resource Center, 7500 Security Boulevard, Baltimore, MD or
at the National Archives and Records Administration (NARA). For
information on the availability of this material at NARA, call 202-741-
6030, or go to: http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html. Copies may be obtained from
the National Fire Protection Association, 1 Batterymarch Park, Quincy,
MA 02269.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: September 23, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 3, 2006.
Michael O. Leavitt,
Secretary.
[FR Doc. E6-17911 Filed 10-26-06; 8:45 am]
BILLING CODE 4120-01-P