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The Centers for Medicare & Medicaid Services will explore broadening some of its life safety and emergency preparedness requirements after a federal audit found widespread noncompliance with the regulations. 

The report was released Friday by the Office of the Inspector General. The federal watchdog investigated new life safety and emergency preparedness requirements implemented by CMS in 2016. The changes included updates to sprinkler systems and smoke detector coverage and expanding emergency preparedness planning requirements.  

In its sample size of eight states, OIG investigators found a total of 2,233 areas of noncompliance with life safety and emergency preparedness requirements occurring at 150 out of 154 nursing homes that were visited. 

The OIG specifically found 1,094 areas of noncompliance with life safety requirements. They included problems with building exits, fire barriers, carbon monoxide detectors, smoking policies and fire drills. 

The watchdog also found 1,139 areas of noncompliance with emergency preparedness requirements, which ranged from issues with emergency plans, emergency supplies and power and emergency plan training and testing. 

“These deficiencies occurred because of several factors, including inadequate oversight by management, staff turnover, inadequate oversight by State survey agencies, and a lack of any requirement for mandatory participation in standardized life safety training programs,” the OIG report said. “As a result, residents, visitors, and staff at the nursing homes were at increased risk of injury or death during a fire or other emergency.”

The federal watchdog said it also identified several opportunities for CMS to expand on its life safety requirements for nursing homes. 

It specifically recommended CMS propose regulations requiring nursing homes and inspection contractors to notify state survey agencies when fire alarm and sprinkler systems aren’t working or at risk of not working, and carbon monoxide detectors to be installed for all nursing homes that use fuel-burning appliances or have an attached garage. 

CMS agreed with those two recommendations, as well as the suggestion that CMS work with state survey agencies to require mandatory participation in standardized life safety training for nursing home staff. 

The agency, however, did not agree with a fourth recommendation: that CMS develop a plan in conjunction with state survey agencies to address issues preventing more frequent surveys at facilities with a history of high-risk deficiencies. 

CMS said it will consider the suggestions when proposing new regulations. It also noted that it’s already begun working on corrective steps with a limited number of providers with repeat serious deficiencies.