CMS's CARE deregulation proposal reaches hospice inpatient units: the Life Safety Code update and the outside-window rule in CMS-3484-P

Short answer: CMS published proposed rule CMS-3484-P on Nov. 10, 2026, at 91 FR 72634. For hospices that provide inpatient care directly, it would move 42 CFR 418.110 to the 2024 Life Safety Code and Health Care Facilities Code and drop the outside-window requirement for patient sleeping rooms. Home health rules (part 484) aren't touched. Comments are due Jan. 11, 2027.

Key facts (as of Nov. 10, 2026, morning CT) - The document: CMS-3484-P, "Cutting Administrative Requirements for Excellence in Patient Care," FR Doc. 2026-22812, 91 FR 72634–72767, published Nov. 10. - Comments: due Jan. 11, 2027, under file code CMS-3484-P, at Regulations.gov docket CMS-2026-3631 or by mail. - Who it touches in our lane: hospices that run their own inpatient facilities (42 CFR 418.110). Home health (part 484) is not on the rule's list of amended parts. - The hospice change: 2024 editions of NFPA 101 and NFPA 99 replace the 2012 editions; the post-2016 outside-window and 36-inch sill rule would go. - Price tag: CMS estimates about $320 million a year in savings across all provider types and calls the effect on hospices "unquantifiable." - Status: proposed only. Nothing changes until CMS issues a final rule.

What is CMS-3484-P?

It is a deregulation package. CMS says it reviewed the conditions of participation for all 21 provider and supplier types and is proposing to remove or rewrite rules it now considers "obsolete or excessively burdensome." Most of the 134 pages are about hospitals, critical access hospitals, nursing homes, rural emergency hospitals and facilities for people with intellectual disabilities. Hospital groups such as HAP have summarized the hospital, critical access hospital and REH pieces, such as the dropped obstetric training and QAPI requirements. For nursing homes, the rule would end weekly respiratory-illness reporting outside a public health emergency.

CMS issued the proposal Nov. 5, Healthcare News Center reported, and it published in the Federal Register Nov. 10. The document says CMS Administrator Mehmet Oz approved it Oct. 15.

What would change for hospice inpatient facilities?

Only one hospice regulation is amended: 42 CFR 418.110, the condition of participation for hospices that provide inpatient care directly. The same proposal makes parallel Life Safety Code updates for hospitals and long-term care facilities.

From the proposed regulatory text and preamble:

• Newer fire code. Proposed 418.110(d)(1)(i) would require the 2024 edition of the Life Safety Code (NFPA 101) instead of the 2012 edition and its four tentative interim amendments.
• Newer building code. Proposed 418.110(e) would require the 2024 Health Care Facilities Code (NFPA 99) with TIAs 24-1 and 24-2. Chapters 7, 8, 12 and 13 of that code still would not apply to hospices.
• The window rule goes. CMS would delete current 418.110(d)(6). That paragraph requires an outside window or outside door in every patient sleeping room, and a sill no higher than 36 inches, in buildings constructed after July 5, 2016. CMS says the 2024 Life Safety Code doesn't treat this as an essential life-safety feature. It says hospices would still have to provide a "home-like atmosphere" under 418.110(f).
• Door latches. Proposed 418.110(d)(1)(ii) keeps the ban on roller latches for corridor doors and widens it to any device that keeps a door closed at a 5 pound-force at the latch edge.
• An FSES option. Proposed 418.110(d)(1)(iii) points facilities that use the Fire Safety Evaluation System to the 2025 edition of NFPA 101A.
• A new waiver path. Under proposed 418.110(d)(4) and (e)(3), if CMS decides that an updated code provision gives "an equal or superior means of ensuring patient safety," it would announce a voluntary waiver in subregulatory guidance. A facility that wants it must formally elect it and document that choice.
• Waiver and state-code wording. The existing hardship-waiver and state-code-exemption paragraphs would be reworded to say CMS acts after a recommendation from the state survey agency or accrediting organization, at the Secretary's discretion.

What stays the same?

The proposed text keeps the sprinkler-outage rule. If a sprinkler system is shut down for more than 10 hours, the hospice must evacuate the affected area or set up a fire watch until it is back in service. The alcohol-based hand rub provision also stays. Both are carried in the proposed text as 418.110(d)(5) and (d)(6); the window rule CMS would delete is the current (d)(6).

The rule also proposes to incorporate by reference the 2022 NFPA 110 (emergency and standby power), the 2022 NFPA 13 (sprinkler installation) and the 2023 NFPA 25 (inspection, testing and maintenance of water-based fire protection systems). CMS describes these as supporting standards referenced by the 2024 codes.

Does it change anything for home health agencies?

Not directly. Part 484, the home health conditions of participation, is not among the parts the rule amends. Home health shows up in the preamble mainly as background. The 2019 burden-reduction rule eased home health aide competency evaluations, and the CY 2025 home health payment rule is where CMS first finalized the nursing-home respiratory reporting this proposal would drop.

Home health payment and enrollment for 2027 were set in the separate CY 2027 final rule, CMS-1844-F. Our CY 2027 explainer and moratorium-rules story cover it.

What does CMS say it would cost or save?

CMS estimates average annual savings of about $320 million across the whole rule. HAP reports CMS also expects 3.26 million hours of staff time returned. For hospices, the regulatory impact analysis gives no dollar figure. It says the rule would have "unquantifiable effects" on hospices, PACE, REHs, ASCs and dialysis facilities. CMS says the effect of the code updates will vary by which NFPA edition a state or local authority already enforces, and it asks commenters for data on that.

How do you comment, and by when?

Comments must be received by Jan. 11, 2027. CMS asks commenters to cite file code CMS-3484-P and use one method only: Regulations.gov docket CMS-2026-3631, regular mail, or express or overnight mail, at the addresses printed in the Federal Register notice. Comments are posted publicly, including any personal information they contain.

What this page is not

Not clinically reviewed. Not legal, billing, survey or construction advice. Not a prediction of what CMS will finalize or when. Hospices with inpatient units should check the proposed text, their state's adopted codes and their accrediting organization or state survey agency.

Sources

• Federal Register, CMS-3484-P, FR Doc. 2026-22812, 91 FR 72634, Nov. 10, 2026
• GovInfo, official PDF of FR Doc. 2026-22812
• Regulations.gov, docket CMS-2026-3631
• HAP, CMS proposal seeks to cut hospital regulatory burden
• Healthcare News Center, CMS CARE proposed rule

Photo: Tony Webster, via Wikimedia Commons, CC BY-SA 4.0 (cropped). A ceiling-mounted fire sprinkler head. Stock photo; not taken at any hospice.

Not clinically reviewed. Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards. Read how we use AI, our editorial policy and our corrections policy.