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A Good Reversal on Liquid Oxygen

Doug BeardsleyBy Doug Beardsley, Vice President of Members Services, Care Providers of Minnesota
June 15, 2018  |  All members

Good news was shared with the American Health Care Association’s (AHCA) Life Safety Code Committee during their meeting on Sunday June 10, 2018, at the National Fire Protection Association (NFPA) conference in Las Vegas, Nevada.

At the meeting, Jim Merrill, Life Safety Engineer from the central office of the Centers for Medicare & Medicaid Services (CMS) responded to a series of questions submitted to CMS by AHCA. Doug Beardsley had provided a series of questions regarding the recent CMS Region V interpretation of liquid oxygen limits in skilled nursing facilities and nursing facilities (SNFs/NFs) for CMS response.

Mr. Merrill agreed with the logic provided by Beardsley, and surprisingly stated he would be issuing something in writing, within a “week or two” that will apply the liquid oxygen limits ONLY TO NEW CONSTRUCTION (new would be considered built or MDH plan approval July 5, 2016, or later). In other words, if your facility was built or new building plans were approved July 4, 2016, or earlier, the new liquid oxygen (LOX) restrictions will not apply to your SNF/NF. Mr. Merrill repeated his commitment to this new interpretation during an NFPA presentation on June 12, 2018. As a result, CMS is not expected to accept or adopt the recent TIA adopted by NFPA (which would have provided limited relief at best).

Watch for additional information once the CMS written communication is released. Arguments made by Beardsley and the AHCA Life Safety Code committee to CMS central office included the following: 
  • Nursing facilities are required to provide individualized person-centered care and services. Most (not all) residents prefer liquid oxygen for the ease of use, portability, and lower cost (realize that Medicare does not pay for oxygen in a nursing facility for residents who are not currently covered under Medicare Part A). This change will increase the cost of care to private pay residents, residents not covered by Medicare Part A, and state Medicaid programs.
  • Some physician oxygen orders require liquid oxygen or “piggybacked” oxygen concentrators to meet the high-flow ordered. Piggybacked O2 concentrators essentially create an anchor for the resident, restricting movement to within the room and dining to in-room only.
  • Some residents on ventilators require high-flow levels of O2, something the generally requires liquid oxygen to deliver.
  • Oxygen concentrators use a lot of electricity, are noisy, produce heat, are ergonomically challenging to move by both residents and staff, and create significant tripping hazards for both staff and residents (both the electrical cord and the extensive tubing residents want for mobility).
  • Compressed oxygen tanks also carry unique downsides pertaining to safety, transport, storage, and ergonomics. It is really a step-backward to revert to K and H tanks.
  • Many, many nursing facility residents are admitted for transitional care—a bridge between the hospital and home (home may be a house, apartment, or assisted living community). Almost always, if oxygen is needed, LOX is used at home. Residents should not need to use an alternative oxygen delivery system during their rehab and will also need oxygen while participating in therapy (where it will be prohibited).
  • In 2004-2005 CMS required that nursing facilities all invested in compliant oxygen transfill rooms so that oxygen could be safely transfilled for use in resident rooms. What is the purpose of these transfill rooms if the use of LOX is going to be so limited?
  • Was this really the intent of NFPA 99 11.7.4, to essentially eliminate the use of LOX in resident sleeping rooms, despite these rooms being fully sprinkled?
  • Is there data to suggest the use of LOX in nursing facility resident sleeping rooms and patient care areas has been dangerous to the safety of persons or the integrity of property to support this change?
  • Facilities are permitted to store substantially larger quantities of oxygen in the corridor, which makes this new requirement somewhat absurd in terms of perceived safety and risk.

Doug Beardsley – 952-851-2489 – 


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