New Medicare Regulation Requires Long Term Care Facilities to Have Sprinkler Systems by August 13, 2013

August 18, 2008

On August 13, 2008, the Centers for Medicare and Medicaid Services published in the Federal Register a Final Rule that requires all long term care facilities receiving Medicare or Medicaid funding to “install an approved, supervised automatic sprinkler system…throughout the building by August 13, 2013” and to “test, inspect, and maintain” such a sprinkler system in accordance with specified standards. This represents a change to existing physical environment requirements under the Conditions of Participation for Long Term Care Facilities.

The Final Rule discusses the rationale for requiring sprinkler systems, the safety benefits involved, and potential cost savings and includes a number of comments and responses by CMS that are helpful in further interpreting the new regulation at 42 C.F.R. § 483.70(a)(8)(i)-(ii). The text of the Final Rule can be found online at

Here are some key points for providers to consider:

  • The words “approved, “automatic,” and “supervised” used in the regulation are all terms of art defined by the National Fire Protection Association (NFPA) 101, Life Safety Code with which long term care facilities are already required to comply.
  • The regulation applies to all long term care facilities receiving Medicare or Medicaid funding regardless of their size or stage of construction (i.e., new or renovation).
  • Long term care facilities that are based in other health care facilities, such as hospitals, are required by the Final Rule only to have sprinklers in the long term care facility section of the building. Facilities other than long term care facilities such as intermediate care facilities, adult day care facilities, or critical access hospitals are not subject to the regulation.
  • The regulation does not preempt existing or more stringent State or local requirements for sprinkler systems. States including Virginia, Connecticut, and Tennessee already require long term care facilities to have sprinkler systems.
  • The Final Rule contains cost estimates for both unsprinklered and partially sprinklered facilities that may provide a useful starting point for providers attempting to determine the financial impact of the regulation.

The costs associated with installation of a sprinkler system and compliance with the new regulation could present significant concerns for long term care providers. If you have any questions about the new regulation or how it might impact you or your facility, please contact: