The discussion below is an update to our more comprehensive previous analysis entitled CMS Emergency Preparedness Final Rule Could Require More Equipment on Generators. 

The Emergency and Standby Power Systems portion of the CMS Emergency Preparedness Final Rule (CMS EPFR) discussed “specific compliance with NFPA 99, NFPA 101 and NFPA 110 for generator design, location, installation and ongoing ITM.” [Note: ITM means Inspection, Testing and Maintenance.] It also discussed the CMS-required all hazards approach that includes planning for both internal and external utility failures in addition to other types of emergencies.  Among the CMS EPFR’s mandate for dealing with utility failures is the requirement stating, “Hospitals that maintain an onsite fuel source to power emergency generators must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.”

“Subsistence requirement” and “… alternate sources of energy …”

Another broader requirement can be found starting on Federal Register page 64010, bottom of column one).  Under the (b) Policies & procedures requirements pertaining to all inpatient providers, can be found the following: “1. Subsistence Requirement.  This final rule will require all inpatient providers to meet the subsistence needs of staff and patients, whether they evacuate or shelter in place, including, but not limited to, food, water, and supplies, alternate sources of energy to maintain temperatures to protect patient health and safety and for the safe and sanitary storage of such provisions. ….”

The Subsistence Requirement is also discussed within the 7/2/2017 CMS Survey & Certification Letter S&C 17-29-ALL entitled “Advanced Copy- Appendix Z, Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures”.  That document includes “Facilities must establish policies and procedures that determine how required heating and cooling of their facility will be maintained during an emergency situation, as necessary, if there were a loss of the primary power source.”

Besides dealing with just the more traditional emergency power loads, the CMS S&C 17-29-ALL Interpretive Guidelines suggest that state agency surveyors conducting CMS EPFR compliance reviews verify that there are adequate policies and procedures to ensure adequate alternate energy sources necessary to maintain “Temperatures to protect patient health and safety and for the safe and sanitary storage of provisions.”

Within the second round of CMS FAQs/responses [CMS S&C 17-21-ALL (FAQ-2) dated 3/2/17], are the following general inquiry questions and clarification:

“Q: Does the requirement to maintain temperatures via alternate power (Generators) apply to areas where pharmaceuticals and other temperature limited storage criteria is specified by the manufacturer?

A: Under 482.15 (b)(1)(ii)(A) temperatures to protect patient health and safety and for the safety and sanitary storage of provisions. Refer also to (i) provisions which refers to pharmaceutical supplies as provisions. So yes they need to maintain temperatures of storage areas.”

The CMS EPFR Webpage includes numerous FAQs and responses related to these and other issues.  The earlier analysis includes several FAQ responses for clarity on these topics.  If the above topics apply to your facility we suggest that you review the entire analysis.

NFPA Disclaimer: Although the writer is a voting member of (and was the 10-year Chairman of) the NFPA Technical Committee on Emergency Power Supplies, which is responsible for NFPA 110 and 111, the views and opinions expressed in this article are purely those of the writer and shall not be considered the official position of NFPA or any of its Technical Committees and shall not be considered to be, nor be relied upon as, a Formal Interpretation. Readers are encouraged to refer to the entire text of all referenced documents.  NFPA members can obtain NFPA staff interpretations at www.nfpa.org.