Countdown to Compliance: What the CMS Sprinkler Requirement Means for Your High-Rise Healthcare Facility

CMS Sprinkler Deadline 

The clock is ticking toward a critical compliance deadline – July 5, 2028. That’s when the Centers for Medicare & Medicaid Services (CMS) sprinkler requirement officially takes effect for existing high-rise healthcare facilities. The requirement is outlined in the 2012 edition of the NFPA Life Safety Code, which was adopted by CMS in 2016.

While July 5, 2028 may seem far off, we at Jensen Hughes understand that a project of this undertaking requires a significant investment of time, budget and personnel, and can take months or even years to complete. And CMS has suggested that given the twelve (12) year lead-time given to be compliant, there will be no extensions or exceptions expected, so most Accrediting Organizations (e.g, The Joint Commission and DNV) are asking during their survey process what the plan is for full compliance. .

Who’s Affected by the CMS Sprinkler Requirement?

If your healthcare facility qualifies as a high-rise – defined by the Life Safety Code as any building with an occupiable floor more than 75 feet above the lowest level of fire department access – then the requirement applies to you. Any building containing a healthcare occupancy rising to that category will want to look closely at Chapter 19 of the Life Safety Code. This chapter references NFPA 13, the Standard for the Installation of Sprinkler Systems, and outlines both implementation requirements and requirements for integration with existing fire alarm system.

Why This Isn’t a "Later" Problem

Compliance involves more than just installing a few sprinklers. Many facilities will need:

• Full system installations
• Upgrades to existing systems
• Fire alarm integration
• Ceiling access in older buildings, which can reveal unexpected challenges
• Permit reviews, which can take up to nine months in some states

The lead time for acquiring infrastructure – piping, sprinkler heads and fittings – can be significant. And phasing work to minimize disruption in occupied healthcare spaces requires careful planning and coordination, including:

• Phased shutdowns
• Infection Control Risk Assessments
• Interim life safety measures

Don’t Wait – Start Your Compliance Journey Now

If your facility falls under this CMS sprinkler requirement and isn’t yet compliant, now is the time to act. Start with an expert-led facility assessment. At Jensen Hughes, we help healthcare organizations:

• Determine high-rise status and applicability of these requirements
• Evaluate current infrastructure and identify need improvements
• Build a custom roadmap toward full compliance
• Full suite of engineering and design services including sprinkler design

Don’t let the 2028 deadline catch you off guard. Contact Jensen Hughes today to start your compliance plan and protect your facility, patients and staff with confidence.