CMS Issues Emergency Declaration Blanket Waivers for Health Care Providers
by Brad Keyes, CHSP, on May 7, 2020 1:00:32 AM
In a formal communication issued April 29, 2020, CMS granted 1135 blanket waivers on Physical Environment items for Inspection, Testing & Maintenance (ITM). Refer to page 23 of the following linked CMS document:
CMS is waiving certain physical environment requirements for Hospitals, CAHs, inpatient hospice, ICF/IIDs, and SNFs/NFs to reduce the disruption of patient care and potential exposure/transmission of the COVID-19 virus. The physical environment regulations require that facilities and equipment be maintained to ensure an acceptable level of safety and quality. CMS will permit facilities to adjust scheduled inspection, testing, and maintenance (ITM) frequencies and activities for the facility and medical equipment.
Specific Physical Environment Waiver Information:
42 CFR §482.41(d) for hospitals, §485.623(b) for CAH, §418.110(c)(2)(iv) for inpatient hospice, §483.470(j) for ICF/IID; and §483.90 for SNFs/NFs all require these facilities and their equipment to be maintained to ensure an acceptable level of safety and quality. CMS is temporarily modifying these requirements to the extent necessary to permit these facilities to adjust scheduled inspection, testing, and maintenance (ITM) frequencies and activities for the facility and medical equipment.
42 CFR §482.41(b)(1)(i) and (c) for hospitals, §485.623(c)(1)(i) and (d) for CAHs, §482.41(d)(1)(i) and (e) for inpatient hospices, §483.470(j)(1)(i) and (5)(v) for ICF/IIDs, and §483.90(a)(1)(i) and (b) for SNFs/NFs require these facilities to be in compliance with the NFPA 101-2012 Life Safety Code (LSC) and the NFPA 99-2012 Health Care Facilities Code (HCFC). CMS is temporarily modifying these provisions to the extent necessary to permit these facilities to adjust scheduled ITM frequencies and activities required by the LSC and HCFC. The following LSC and HCFC ITM are considered critical and are not included in this waiver:
- Sprinkler system monthly electric motor-driven and weekly diesel engine-driven fire pump testing.
- Portable fire extinguisher monthly inspection.
- Elevators with firefighters’ emergency operations monthly testing.
- Emergency generator 30 continuous minutes of monthly testing and associated transfer switch monthly testing.
- Means of egress daily inspection in areas that have undergone construction, repair, alterations, or additions to ensure its ability to be used instantly in case of emergency.
42 CFR §482.41(b)(9) for hospitals, §485.623(c)(7) for CAHs, §418.110(d)(6) for inpatient hospices, §483.470(e)(1)(i) for ICF/IIDs, and §483.90(a)(7) for SNFs/NFs require these facilities to have an outside window or outside the door in every sleeping room. CMS will permit a waiver of these outside windows and outside door requirements to permit these providers to utilize facility and non-facility space that is not normally used for patient care to be utilized for temporary patient care or quarantine.
The American Society for Healthcare Engineering (ASHE) had previously reported on possible 1135 waivers and provided a template for health care facilities to request such waivers from CMS. Since the above are blanket waivers, a request does NOT need to be submitted to CMS to use the above-mentioned waivers. The waivers have an effective date of March 1, 2020, and continue until the declaration of emergency is lifted. Visit the ASHE web site for more information. There they have recommended time frame details on specific ITM items in their waiver table.
ASHE also recommends that each organization evaluate the approved waivers and determine the appropriateness for their application at the organization. Be aware that federal waivers such as these may not be applicable to state and/or local Authorities Having Jurisdiction (AHJs) or accreditation organizations.
It is important to understand that these 1135 blanket waivers issued by CMS allow you to make an adjustment in the ITM schedule… not to cancel or delete any required ITM. Therefore, make sure you re-schedule any test or inspection after it has been postponed. You still need to conduct the required test or inspection but at a later date. Contact your state and local AHJs and your accreditation organization to determine if they also recognize these CMS 1135 waivers.