In December 2013, with the deadly lessons of Hurricane Katrina still a fresh memory, and the more recent failures of six hospital emergency power systems triggered by Super Storm Sandy, the Centers for Medicare and Medicaid Services (CMS) published its proposed Emergency Preparedness Rule (EP).
The sweeping new federal regulation established base standards for generator performance, inspection, testing and maintenance (ITM) in hospitals and nursing homes to protect patients, residents, staff and visitors during power outages. The EP Rule designated the 2012 edition of NFPA 99, Health Care Facilities Code and the 2010 edition of NFPA 110, Standard for Emergency and Standby Power Systems as its requirements for emergency power systems in hospitals and nursing homes, as well as other facilities governed by the EP Rule. CMS’s proposed rule went a step beyond NFPA 110 by requiring that generators undergo a four-hour test annually, instead of once every three years as dictated by NFPA 110.
The reasoning behind the enhanced testing was to help ferret out generators more likely to fail during before they were put to the test during an extended outage. The American Society for Healthcare Engineering (ASHE), a personal membership group of the American Hospital Association, strongly objected to the proposal, arguing in public comments that the requirement would collectively cost hospitals millions more in testing. ASHE also argued that more frequent testing wasn’t the best way to identify generators more likely to fail during an extended outage. When CMS published its final rule nearly three years later, the more stringent testing requirement had been dropped and the four-hour test remained a requirement every three years.
Today, the discovery of seriously outdated generators in LA County hospitals has prompted renewed discussion about whether CMS missed an opportunity to address this risk when it proposed its EP rule. In 2019, the Los Angeles County Emergency Medical Services (EMS) Agency launched a multi-year emergency power resilience initiative and hired Powered for Patients as the project consultant. P4P Project Director Eric Cote led the work, including a census of the emergency power systems in 80 LA County hospitals.
Cote discovered seriously outdated generators in a number of hospitals, including some in excess of 40, 50 and even 60 years of age, some of which were in single generator hospitals. EMS Agency officials were shocked by the findings and responded swiftly, enlisting P4P’s help to develop groundbreaking new protocols to accelerate emergency power status reporting during outages. The EMS Agency also adopted the nation’s first confidential risk rating of hospital emergency power systems conducted by a county health agency.
P4P recently teamed up with the California Society of Healthcare Engineering (CSHE) to convene an Expert’s Panel to discuss the LA County findings, the risks associated with outdated healthcare facility generators and potential mitigation strategies. Panelists included experts on federal and state generator performance and testing requirements for hospitals and nursing homes, hospital facility directors and generator service providers.
One panelist, Robert Solomon, P.E., currently serves as the Chief Development Officer in the Boston office for SOCOTEC, a global construction and infrastructure consulting firm. Solomon was previously a Director at the NFPA and led the team responsible for development of several of the fire protection and life safety codes referenced in the CMS Emergency Preparedness Rule.
Given the discovery of aging generators in LA County, Solomon is suggesting that it may be time to consider different or enhanced testing of aging emergency power system components. “When CMS first published its proposed Emergency Preparedness Rule, generator age wasn’t a consideration, and at the time as well as now, neither NFPA 99 or NFPA 110 had any limits on the life span of the generator components,” said Solomon. “The inspection, testing and maintenance requirements embodied in NFPA 110 have been seen as the best way to safeguard against generator failures. In retrospect, given the discovery of older generators in LA County, generator component age is something that I believe should be evaluated for future code changes and state or federal regulation.”
The LA County findings have already spurred a proposed change to NFPA 110. During the August 2025 meeting of the NFPA 110 Technical Committee, a committee member, Skip Gregory, AIA, reported on the discovery of outdated generators in LA County which prompted a proposed new annex section (Annex D) for the next edition of NFPA 110. The Annex language, as proposed, would, among other things, call attention to the need to provide additional scrutiny to older components of an emergency power supply system that may be approaching or even past their expected life cycle.
“I don’t think CMS officials were aware that hospitals were relying on such outdated generators when they developed the Emergency Preparedness Rule,” said Cote. “Had they realized this, I believe they would have addressed it, most likely with enhanced testing requirements, especially for single generator hospitals.”
Cote said recommendations emerging from the recent Expert’s Panel with CSHE would be worth consideration by CMS. These included requiring single generator hospitals to install quick connect devices that would allow a rapid connection of a temporary generator. Panelists also discussed requiring single generator hospitals to install commonly available monitoring equipment that would provide an automated, real-time alert to designated individuals anytime the generator experiences a problem while operating. Such a warning could accelerate response to a stricken facility, minimizing the risk of an emergency evacuation.