Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 62957 

Protection of Children 

We have analyzed this proposed rule 

under Executive Order 13045, 

Protection of Children from 

Environmental Health Risks and Safety 

Risks. This rule is not an economically 

significant rule and would not create an 

environmental risk to health or risk to 

safety that might disproportionately 

affect children. 

Indian Tribal Governments 

This proposed rule does not have 

tribal implications under Executive 

Order 13175, Consultation and 

Coordination with Indian Tribal 

Governments, because it would not have 

a substantial direct effect on one or 

more Indian tribes, on the relationship 

between the Federal Government and 

Indian tribes, or on the distribution of 

power and responsibilities between the 

Federal Government and Indian tribes. 

Energy Effects 

We have analyzed this proposed rule 

under Executive Order 13211, Actions 

Concerning Regulations That 

Significantly Affect Energy Supply, 

Distribution, or Use. We have 

determined that it is not a ‘‘significant 

energy action’’ under that order because 

it is not a ‘‘significant regulatory action’’

under Executive Order 12866 and is not 

likely to have a significant adverse effect 

on the supply, distribution, or use of 

energy. The Administrator of the 

Information and Regulatory Affairs has 

not designated it as a significant energy 

action. Therefore, it does not require a 

Statement of Energy Effects under 

Executive Order 13211. 

Technical Standards 

The National Technology Transfer 

and Advancement Act (NTTAA) (15 

U.S.C. 272 note) directs agencies to use 

voluntary consensus standards in their 

regulatory activities unless the agency 

provides Congress, through the Office of 

Management and Budget, with an 

explanation of why using these 

standards would be inconsistent with 

applicable law or otherwise impractical. 

Voluntary consensus standards are 

technical standards (e.g., specifications 

of materials, performance, design, or 

operation; test methods; sampling 

procedures; and related management 

systems practices) that are developed or 

adopted by voluntary consensus 

standards bodies. 

This proposed rule does not use 

technical standards. Therefore, we did 

not consider the use of voluntary 

consensus standards. 

Environment 

We have analyzed this proposed rule 

under Commandant Instruction 

M16475.lD and Department of 

Homeland Security Management 

Directive 5100.1, which guide the Coast 

Guard in complying with the National 

Environmental Policy Act of 1969 

(NEPA) (42 U.S.C. 4321–4370f), and 

have concluded that there are no factors 

in this case that would limit the use of 

a categorical exclusion under section 

2.B.2 of the Instruction. Therefore, we 

believe this proposed rule should be 

categorically excluded, under figure 2–

1, paragraph (32)(e) of the Instruction, 

from further environmental 

documentation. Under figure 2–1, 

paragraph 32(e) of the Instruction, an 

‘‘Environmental Analysis Checklist’’

and a ‘‘Categorical Exclusion 

Determination’’ are not required for this 

rule. However, comments on this 

section will be considered before the 

final rule. 

List of Subjects in 33 CFR Part 117 

Bridges. 

Regulations 

For the reasons discussed in the 

preamble, the Coast Guard proposes to 

amend 33 CFR part 117 as follows: 

PART 117—DRAWBRIDGE 

OPERATION REGULATIONS 

1. The authority citation for part 117 

continues to read as follows: 

Authority: 33 U.S.C. 499; 33 CFR 1.05–

1(g); Department of Homeland Security 

Delegation No. 0170.1; section 117.255 also 

issued under the authority of Pub. L. 102–

587, 106 Stat. 5039. 

2. Revise § 177.899 to read as follows: 

§ 117.899 Youngs Bay and Lewis and 

Clark River. 

(a) The draw of the US101 (New 

Youngs Bay) highway bridge, mile 0.7 

across Youngs Bay at Smith Point shall 

open on signal for the passage of vessels 

if notice is given at least one half-hour 

in advance to the drawtender at the 

Lewis and Clark River Bridge by marine 

radio, telephone, or other suitable 

means from 7 a.m. to 5 p.m. Monday 

through Friday and from 8 a.m. to 4 

p.m. on Saturday and Sunday. At all 

other times, including all federal 

holidays except Columbus Day, notice is 

required by telephone at least two hours 

in advance. The opening signal shall be 

two prolonged blasts followed by one 

short blast. 

(b) The draw of the Oregon State (Old 

Youngs Bay) highway bridge, mile 2.4, 

across Youngs Bay at the foot of Fifth 

Street, shall open on signal for the 

passage of vessels if notice is given at 

least one half-hour in advance to the 

drawtender at the Lewis and Clark River 

Bridge by marine radio, telephone, or 

other suitable means from 7 a.m. to 5 

p.m. Monday through Friday and from 

8 a.m. to 4 p.m. Saturday and Sunday. 

At all other times, including all federal 

holidays except Columbus Day, notice is 

required by telephone at least two hours 

in advance. The opening signal is two 

prolonged blasts followed by one short 

blast. 

(c) The draw of the Oregon State 

(Lewis and Clark River) highway bridge, 

mile 1.0, across the Lewis and Clark 

River, shall open on signal for the 

passage of vessels if notice is given at 

least one half-hour in advance by 

marine radio, telephone, or other 

suitable means from 7 a.m. to 5 p.m. 

Monday through Friday and from 8 a.m. 

to 4 p.m. on Saturday and Sunday. At 

all other times, including all federal 

holidays except Columbus Day, notice is 

required by telephone at least two hours 

in advance. The opening signal is one 

prolonged blast followed by four short 

blasts. 

Dated: October 13, 2006. 

R.R. Houck, 

Rear Admiral, U.S. Coast Guard, District 

Commander,Thirteenth Coast Guard District. 

[FR Doc. E6–17971 Filed 10–26–06; 8:45 am] 

BILLING CODE 4910–15–P 

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. 

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. 


rmajette on PROD1PC67 with PROPOSALS1
62958 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

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 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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 § 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 

§ 483.70 would correspond to the phasein 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.] 


rmajette on PROD1PC67 with PROPOSALS1
62960 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

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 § 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 WaterBased 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 § 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 batteryoperated 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 § 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 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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 


rmajette on PROD1PC67 with PROPOSALS1
62962 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

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 nonstandard 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 timeconsuming 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. 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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 § 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, FoamWater 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, § 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 WaterBased 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 × 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, 

Carolyn_Lovett@omb.eop.gov fax (202) 

395–6974. 


rmajette on PROD1PC67 with PROPOSALS1
62964 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

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 phasein 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 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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/tableshealthstatus.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 × 

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 × 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. 


rmajette on PROD1PC67 with PROPOSALS1
62966 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

TABLE 1.—ESTIMATED ANNUAL FIRE DEATHS

Number of estimated annual fire-related 

deaths in unsprinklered long term care 

facilities 

Number of estimated annual fire-related 

deaths if those facilities were sprinklered 

Number of estimated annual lives saved by 

sprinklers 

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 × 

6.3 years gained per life). 

TABLE 2.—LIFE YEARS

Number of life years 

gained per life saved 

Number of life years 

gained 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 nonsprinklered. 

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 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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 

beds (less 

than 24,500 

sq. ft) 

50–99 beds 

(24,501–

49,500 sq. ft) 

100–199 beds 

(49,501–

99,500 sq. ft) 

200 or more 

beds (99,501 

or more sq. ft) 

Total number 

of affected 

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. 


rmajette on PROD1PC67 with PROPOSALS1
62968 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

TABLE 4.—NUMBER OF PARTIALLY SPRINKLERED FACILITIES AFFECTED

Less than 50 

beds (less 

than 24,500 

sq. ft) 

50–99 beds 

(24,501–

49,500 sq. ft) 

100–199 beds 

(49,501–

99,500 sq. ft) 

200 or more 

beds (99,501 

or more sq. ft) 

Total number 

of affected 

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 facilityspecific 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) 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 62969 

TABLE 5.—TOTAL INSTALLATION COST PER UNSPRINKLERED FACILITY

$4.10 per 

square foot 

$5.50 per 

square foot 

$6.15 per 

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 

square foot 

$5.50 per 

square foot 

$6.15 per 

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 

square foot 

$5.50 per 

square foot 

$6.15 per 

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 

square foot 

$5.50 per 

square foot 

$6.15 per 

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 


rmajette on PROD1PC67 with PROPOSALS1
62970 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 

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 × 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 × 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 × 1 hour). The total annual cost 

of this proposed documentation 

requirement would be $46,778 ($19 per 

facility × 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, § 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 


rmajette on PROD1PC67 with PROPOSALS1
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 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 LongTerm Care Facilities 

2. In § 483.70, add new paragraph 

(a)(7)(iv) and new paragraph (a)(8) to 

read as follows: 

§ 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 


rmajette on PROD1PC67 with PROPOSALS1