On November 5, 2026, the Centers for Medicare & Medicaid Services (CMS) issued its proposed Cutting Administrative Requirements for Excellence in Patient Care (CARE) rule. Among a broad range of proposed changes intended to reduce regulatory burdens for licensed healthcare providers, CMS is proposing a significant update to its physical environment (PE) requirements, including adoption of the 2024 editions of NFPA 101, Life Safety Code, and NFPA 99, Health Care Facilities Code, along with updated emergency and standby power system standards.
Unlike most code changes, this proposal is not about adding new requirements. It is about design flexibility and deregulation. For hospitals and other healthcare facilities, adopting these newer editions represents a substantial update from the editions currently referenced by CMS and could provide increased flexibility in the planning, design, construction, and ongoing operation of healthcare facilities, helping institutions and their design teams better meet the demands healthcare organizations face today.
CMS is now accepting public comments, and the voices of healthcare institutions matter. Comments from hospitals, health systems, and other healthcare providers help show CMS that the proposed flexibility is practical, needed, and supported by those who plan, build, and operate healthcare facilities every day. Comments are due by January 11, 2027.
What Is CMS Proposing?
As part of the proposed rule, CMS would adopt the 2024 editions of NFPA 101 and NFPA 99, as well as various updated NFPA standards referenced by these newer editions. CMS is also proposing to formally codify its authority to permit facilities to comply with specific provisions of newer editions of NFPA 101 or NFPA 99.
What Could the 2024 Life Safety Code Mean for Healthcare Facilities?
Adoption of the 2024 edition of NFPA 101 would introduce a number of changes with the potential to affect healthcare facility design, construction costs, operational flexibility, and ongoing maintenance. Several notable examples include:
- Larger Smoke Compartments
The 2024 Life Safety Code permits healthcare smoke compartments up to a maximum of 40,000 square feet, an increase from the traditional 22,500-square-foot limitation. - Reduced Smoke Compartmentation Below Healthcare Occupancies
The 2024 edition removes the requirement to provide smoke barriers on a story below healthcare occupancies. - Larger Healthcare Suites
The 2024 Life Safety Code increases the maximum allowable area of certain healthcare suites to 15,000 square feet. - Private Mode Fire Alarm Notification
The 2024 edition more explicitly addresses private operating mode notification in healthcare occupancies. - Alternate Care Sites
The 2024 Life Safety Code includes new provisions addressing Alternate Care Sites, reflecting lessons learned from emergency conditions and the need for healthcare systems to establish temporary patient care capabilities outside traditional healthcare environments. - Reduced Exit Sign Testing
Another notable operational change is the elimination of the traditional requirement to test exit signs monthly under the applicable 2024 provisions.
Design, Cost, and Operational Impacts
Taken together, these changes demonstrate that adopting a newer edition of NFPA 101 is more than an administrative code update. Unlike most code changes, which tend to add requirements, this proposal is intended to give healthcare institutions and designers more options for meeting the operational, financial, and clinical demands healthcare facilities face.
For design teams, provisions such as larger smoke compartments and suites may offer greater planning flexibility and facilitate clinical layouts that would be more difficult under earlier editions.
For owners and project teams, fewer required smoke barriers and related components may potentially reduce construction costs, particularly on large healthcare projects where smoke compartmentation affects walls, doors, dampers, penetrations, and building systems across multiple disciplines.
For facility managers, changes to inspection and testing requirements may reduce recurring maintenance activities, while other new provisions may require updates to policies, procedures, fire response plans, or emergency preparedness programs.
The impact will vary considerably by project. Rather than treating the change as simply a transition from one edition of NFPA 101 to another, project teams should evaluate the requirements in the context of each project’s specific design, cost, operational, and long-term facility goals. Doing so can help identify opportunities for practical, constructible, and compliant solutions while recognizing new obligations introduced by the 2024 edition.
Why Healthcare Institutions Should Comment
The proposed rule is part of a broader CMS effort to reduce regulatory burden. The agency’s stated goals are to reduce costs, increase transparency, enhance flexibility for providers to deliver innovative patient care, and streamline existing regulations, while maintaining patient safety and quality care. CMS estimates the proposals would save $320 million and return more than 3.26 million hours of staff time to providers.
Proposed rules are shaped by the comments CMS receives. Healthcare institutions are best positioned to explain how the proposed physical environment updates would affect their facilities, and CMS needs to hear that perspective before the rule is finalized. Institutions and design teams are encouraged to submit comments that:
- Support adoption of the 2024 editions of NFPA 101 and NFPA 99 and the updated emergency and standby power standards, so that facilities are no longer limited by older editions.
- Describe the practical benefits of added design flexibility, such as larger smoke compartments and suites, that can support better clinical layouts and patient flow.
- Share the potential cost and operational impacts, including construction savings, reduced maintenance and testing burdens, and staff time that can be redirected to patient care.
- Support CMS’s proposal to codify its authority to permit facilities to comply with specific provisions of newer editions of NFPA 101 or NFPA 99.
Comments may be submitted electronically, by regular mail, or by express or overnight mail, and should reference file code CMS-3484-P. Healthcare institutions that want to see this flexibility finalized should consider submitting comments before the January 11, 2027 deadline.
What Project Teams Should Know
Importantly, this CMS update is currently a proposed change, rather than a final adoption of these standards. Project teams should continue to confirm applicable CMS requirements, state licensing requirements, locally adopted building and fire codes, and project-specific requirements before relying on provisions of the 2024 editions.
Nevertheless, the proposed transition is worth evaluating now, particularly for healthcare projects that are early in planning or expected to remain in design and construction for several years. Understanding how the 2024 provisions differ from existing requirements can help identify opportunities affecting project design, construction costs, operational flexibility, and ongoing facility maintenance.
Evaluating these impacts early can also help project teams determine how the proposed requirements align with an owner’s specific priorities and definition of project success.
How Code Red Consultants Can Help
Code Red Consultants works with healthcare owners, architects, engineers, and contractors to evaluate Life Safety Code requirements and develop practical code strategies that respond to regulatory requirements and project-specific goals.
As CMS moves through the rulemaking process, Code Red Consultants can help project teams evaluate how the proposed adoption of the 2024 editions of NFPA 101 and NFPA 99 may affect active projects, future capital projects, existing facility conditions, and long-term compliance strategies. Evaluating these changes early can help identify opportunities for greater design flexibility, potential construction and operational efficiencies, and creative, constructible solutions that align fire protection and life safety requirements with each client’s definition of success.
Codes, regulations, and enforcement practices continue to evolve, and requirements may vary by jurisdiction and authority having jurisdiction. This article highlights selected changes associated with the proposed CMS adoption and is not intended to represent an exhaustive review of the changes contained in the 2024 editions. Project teams should confirm applicable requirements for their specific facility and scope of work.