Section 485.544 - Condition of participation: Physical environmentThe REH must be constructed, arranged, and maintained to ensure the safety of the patient, and to provide facilities for diagnosis and treatment and for special services appropriate to the needs of the community.
(a)Standard: Buildings. The condition of the physical plant and the overall REH environment must be developed and maintained in such a manner that the safety and well-being of patients are ensured.(1) There must be emergency power and lighting in at least the operating, recovery, and emergency rooms, and stairwells. In all other areas not serviced by the emergency supply source, battery lamps and flashlights must be available.(2) There must be facilities for emergency gas and water supply.(3) The REH must have a safe and sanitary environment, properly constructed, equipped, and maintained to protect the health and safety of patients.(b)Standard: Facilities. The REH must maintain adequate facilities for its services. (1) Diagnostic and therapeutic facilities must be located for the safety of patients.(2) Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality.(3) The extent and complexity of facilities must be determined by the services offered.(4) There must be proper ventilation, light, and temperature controls in patient care, pharmaceutical, food preparation, and other appropriate areas.(c)Standard: Safety from fire.(1) Except as otherwise provided in this section, the REH must meet the provisions applicable to Ambulatory Health Care Occupancies, regardless of the number of patients served, and must proceed in accordance with the Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4).(2) In consideration of a recommendation by the state survey agency or accrediting organization or at the discretion of the Secretary, CMS may waive, for periods deemed appropriate, specific provisions of the Life Safety Code, which would result in unreasonable hardship upon an REH, but only if the waiver will not adversely affect the health and safety of the patients.(3) The provisions of the Life Safety Code do not apply in a state if CMS finds that a fire and safety code imposed by state law adequately protects patients in an REH.(4) An REH may place alcohol-based hand rub dispensers in its facility if the dispensers are installed in a manner that adequately protects against inappropriate access.(5) When a sprinkler system is shut down for more than 10 hours, the REH must:(i) Evacuate the building or portion of the building affected by the system outage until the system is back in service, or(ii) Establish a fire watch until the system is back in service.(d)Standard: Building safety. Except as otherwise provided in this section, the REH must meet the applicable provisions and must proceed in accordance with the 2012 edition of the Health Care Facilities Code (NFPA 99, and Tentative Interim Amendments TIA 12-2, TIA 12-3, TIA 12-4, TIA 12-5 and TIA 12-6).(1) Chapters 7, 8, 12, and 13 of the adopted Health Care Facilities Code do not apply to an REH.(2) If application of the Health Care Facilities Code required under paragraph (d) of this section would result in unreasonable hardship for the REH, CMS may waive specific provisions of the Health Care Facilities Code, but only if the waiver does not adversely affect the health and safety of patients.(e)Incorporation by reference. The material listed in this paragraph (e) is incorporated by reference into this section with the approval the Director of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51 . To enforce any edition other than that specified in this section, CMS must publish a document in the FEDERAL REGISTER and the material must be available to the public. All approved material is available for inspection at CMS and the National Archives and Records Administration (NARA). Contact CMS at: CMS Information Resource Center, 7500 Security Boulevard, Baltimore, MD, email scott.cooper@cms.hhs.gov or call (410) 786-9465. For information on the availability of this material at NARA, email fr.inspection@nara.gov or go to: www.archives.gov/federal-register/cfr/ibr-locations.html. The material may be obtained from the following source(s) in this paragraph (e).(1) National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169, www.nfpa.org, 1.617.770.3000. (i) NFPA 99, Health Care Facilities Code, 2012 edition, issued August 11, 2011.(ii) Technical interim amendment (TIA) 12-2 to NFPA 99, issued August 11, 2011.(iii) TIA 12-3 to NFPA 99, issued August 9, 2012.(iv) TIA 12-4 to NFPA 99, issued March 7, 2013.(v) TIA 12-5 to NFPA 99, issued August 1, 2013.(vi) TIA 12-6 to NFPA 99, issued March 3, 2014.(vii) NFPA 101, Life Safety Code, 2012 edition, issued August 11, 2011;(viii) TIA 12-1 to NFPA 101, issued August 11, 2011.(ix) TIA 12-2 to NFPA 101, issued October 30, 2012.(x) TIA 12-3 to NFPA 101, issued October 22, 2013.(xi) TIA 12-4 to NFPA 101, issued October 22, 2013.