[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR488.54]



[Page 668-669]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 488_SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES--Table of 

 

                     Subpart B_Special Requirements

 

Sec.  488.54  Temporary waivers applicable to hospitals.



    (a) General provisions. If a hospital is found to be out of 

compliance with one or more conditions of participation for hospitals, 

as specified in part 482 of this chapter, a temporary waiver may be 

granted by CMS. CMS may extend a temporary waiver only if such a waiver



[[Page 669]]



would not jeopardize or adversely affect the health and safety of 

patients. The waiver may be issued for any one year period or less under 

certain circumstances. The waiver may be withdrawn earlier if CMS 

determines this action is necessary to protect the health and safety of 

patients. A waiver may be granted only if:

    (1) The hospital is located in a rural area. This includes all areas 

not delineated as ``urban'' by the Bureau of the Census, based on the 

most recent census;

    (2) The hospital has 50 or fewer inpatient hospital beds;

    (3) The character and seriousness of the deficiencies do not 

adversely affect the health and safety of patients; and

    (4) The hospital has made and continues to make a good faith effort 

to comply with personnel requirements consistent with any waiver.

    (b) Minimum compliance requirements. Each case will have to be 

decided on its individual merits, and while the degree and extent of 

compliance will vary, the institution must, as a minimum, meet all of 

the statutory conditions in section 1861(e)(1)-(8), in addition to 

meeting such other requirements as the Secretary finds necessary under 

section 1861(e)(9). (For further information relating to the exception 

in section 1861(e)(5) of the Act, see paragraph (c) of this section.)

    (c) Temporary waiver of 24-hour nursing requirement of 24-hour 

registered nurse requirement. CMS may waive the requirement contained in 

section 1861(e)(5) that a hospital must provide 24-hour nursing service 

furnished or supervised by a registered nurse. Such a waiver may be 

granted when the following criteria are met:

    (1) The hospital's failure to comply fully with the 24-hour nursing 

requirement is attributable to a temporary shortage of qualified nursing 

personnel in the area in which the hospital is located.

    (2) A registered nurse is present on the premises to furnish or 

supervise the nursing services during at least the daytime shift, 7 days 

a week.

    (3) The hospital has in charge, on all tours of duty not covered by 

a registered nurse, a licensed practical (vocational) nurse.

    (4) The hospital complies with all requirements specified in 

paragraph (a) of this section.

    (d) Temporary waiver for technical personnel. CMS may waive 

technical personnel requirements, issued under section 1861(e)(9) of the 

Act, contained in the Conditions of Participation; Hospitals (part 482 

of this chapter). Such a waiver must take into account the availability 

of technical personnel and the educational opportunities for technical 

personnel in the area in which the hospital is located. CMS may also 

limit the scope of services furnished by a hospital in conjunction with 

the waiver in order not to adversely affect the health and safety of the 

patients. In addition, the hospital must also comply with all 

requirements specified in paragraph (a) of this section.



[39 FR 2251, Jan. 17, 1974. Redesignated at 39 FR 11419, Mar. 28, 1974, 

and amended at 41 FR 27962, July 8, 1976. Further redesignated at 42 FR 

52826, Sept. 30, 1977, and amended at 47 FR 31531, July 20, 1982; 51 FR 

22041, June 17, 1986. Redesignated at 53 FR 23100, June 17, 1988]