For the complete document, please visit the Centers for Medicare and Medicaid Services (CMS) at http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp
Emergency and disaster-related Conditions for Coverage are outlined in the paragaphs §494.60 Condition: Physical environment.
§494.60 Condition: Physical environment
(d) Standard: Emergency preparedness. The dialysis facility must implement processes and procedures to manage medical and nonmedical emergencies that are likely to threaten the health or safety of the patients, the staff, or the public. These emergencies include, but are not limited to, fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters likely to occur in the facility’s geographic area.
(1) Emergency preparedness of staff. The dialysis facility must provide appropriate training and orientation in emergency preparedness to the staff. Staff training must be provided and evaluated at least annually and include the following:
(i) Ensuring that staff can demonstrate a knowledge of emergency procedures, including informing patients of--
(A) What to do;
(B) Where to go, including instructions for occasions when the geographic area of the dialysis facility must be evacuated;
(C) Whom to contact if an emergency occurs while the patient is not in the dialysis facility. This contact information must include an alternate emergency phone number for the facility for instances when the dialysis facility is unable to receive phone calls due to an emergency situation (unless the facility has the ability to forward calls to a working phone number under such
emergency conditions); and
(D) How to disconnect themselves from the dialysis machine if an emergency occurs.
(ii) Ensuring that, at a minimum, patient care staff maintain current CPR certification; and
(iii) Ensuring that nursing staff are properly trained in the use of emergency equipment and emergency drugs.
(2) Emergency preparedness patient training. The facility must provide appropriate orientation and training to patients, including the areas specified in paragraph (d)(1)(i) of this section.
(3) Emergency equipment. Emergency equipment, including, but not limited to, oxygen, airways, suction, defibrillator or automated external defibrillator, artificial resuscitator, and emergency drugs, must be on the premises at all times and immediately available.
(4) Emergency plans. The facility must--
(i) Have a plan to obtain emergency medical system assistance when needed;
(ii) Evaluate at least annually the effectiveness of emergency and disaster plans and update them as necessary; and
(iii) Contact its local disaster management agency at least annually to ensure that such agency is aware of dialysis facility needs in the event of an emergency.
(e) Standard: Fire safety.
(1) Except as provided in paragraph (e)(2) of this section, by [OFR - insert 300 days after publication in the Federal Register], the dialysis facility must comply with applicable provisions of the 2000 edition of the Life Safety Code of the National Fire Protection Association (which is incorporated by reference at §403.744(a)(1)(i) of this chapter).
(2) Notwithstanding paragraph (e)(1) of this section, dialysis facilities participating in Medicare as of [OFR - insert 180 days after publication in the Federal Register] utilizing non-sprinklered buildings on such date may continue to use such facilities if such buildings were constructed before January 1, 2008 and State law so permits.
(3) If CMS finds that a fire and safety code imposed by the facility’s State law adequately protects a dialysis facility’s patients, CMS may allow the State survey agency to apply the State’s fire and safety code instead of the Life Safety Code.
(4) After consideration of State survey agency recommendations, CMS may waive, for individual dialysis facilities and for appropriate periods, specific provisions of the Life Safety Code, if the following requirements are met:
(i) The waiver would not adversely affect the health and safety of the dialysis facility’s patients; and
(ii) Rigid application of specific provisions of the Life Safety Code would result in an unreasonable hardship for the dialysis facility.
