>> /K 29 Find evidence-based sources on preventing infections in clinical settings. /Contents 516 0 R /Pg 87 0 R 98 0 obj /Pg 85 0 R /A 768 0 R /P 1051 0 R >> 234 0 obj /Pg 74 0 R endobj << /A 974 0 R /Pg 77 0 R endobj << /K [189 0 R 190 0 R 191 0 R] >> endobj /CropBox [0 0 720 540] /Type /Page /A 1074 0 R >> Use hot water (70-80C X 10 min) [158-176F]) and an approved laundry detergent. 419 0 obj /A 681 0 R /S /P 384 0 obj /K [204 0 R] >> >> null null 475 0 R null null null 476 0 R null null null /K 152 endobj Infection Control Environmental Infection Control Guidelines Guidelines for Environmental Infection Control in Health-Care Facilities (2003) Environmental Infection Control Guidelines (print only) [PDF - 240 pages] HICPAC Recommendation Categories See updates to this guideline. /S /Lbl /S /LBody 345 0 obj /S /TextBox endobj /K 31 /Contents 576 0 R << /Lang (EN-US) /K 8 << 19 0 obj /S /Figure endobj << /K 24 /K [620 0 R 421 0 R 422 0 R 423 0 R 424 0 R 425 0 R] Paying attention to device labels is important to ensuring that the device can be used safely. >> /K 33 << /P 667 0 R /S /LBody /P 949 0 R /A 1013 0 R (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]: Environment of Care [EC] . /A 937 0 R 134 0 obj << null 477 0 R null null null null null null 478 0 R null /A 916 0 R /K 17 endobj endobj /Lang (EN-US) 477 0 obj /Pg 76 0 R /S /LBody endobj Web. 471 0 obj /K 27 /K [91 0 R 92 0 R] null 426 0 R null 427 0 R 428 0 R 429 0 R 430 0 R 431 0 R] /S /H1 endobj << endobj >> /Group 512 0 R /Lang (EN-US) /P 935 0 R /Pg 86 0 R It is expected that a facility will follow instructions for use (IFUs) for cleaning and disinfection standards provided by medical device and equipment manufacturers. endobj >> /P 169 0 R /K [402 0 R] 475 0 obj /Pg 76 0 R >> /P 711 0 R /A 728 0 R >> Continue your learning with a deeper dive into our standards, chapter by-chapter, individually or as a team. 9 0 obj /A 966 0 R /A 732 0 R /P 29 0 R endobj /A 1018 0 R << Get more information about cookies and how you can refuse them by clicking on the learn more button below. /K [232 0 R] /Lang (EN-US) endobj 314 0 obj >> /Pg 88 0 R << /Title /Prev 58 0 R >> /A 1073 0 R /Pg 83 0 R /Resources 577 0 R /K [585 0 R] null null null null null null 332 0 R null null null >> null null null 335 0 R null] >> /A 646 0 R /Pg 79 0 R /S /LBody endobj << endobj endobj << << /P 109 0 R << /Lang (EN-US) 80 0 obj /Pg 70 0 R /P 150 0 R >> endobj /S /TextBox /S /Lbl endobj >> Find the exact resources you need to succeed in your accreditation journey. /S /Lbl 5 [null null null null null null null 101 0 R] >> /K 24 /Kids [69 0 R 70 0 R 71 0 R 72 0 R 73 0 R] endobj /Pg 90 0 R /K 32 /S /LBody /Lang (EN-US) 237 0 obj /S /TextBox /Pg 71 0 R /P 7 0 R /P 33 0 R << 511 0 obj /P 161 0 R /K 65 Set expectations for your organization's performance that are reasonable, achievable and survey-able. /Pg 65 0 R /Type /Page /P 34 0 R 357 0 obj /P 42 0 R Learn about the priorities that drive us and how we are helping propel health care forward. /K [601 0 R 602 0 R 603 0 R 604 0 R 605 0 R 606 0 R 607 0 R 608 0 R] /StructParents 17 /A 900 0 R >> /S /P >> Does The Joint Commission have specific requirements that address linen management, such as covering, storage and transport? 491 0 obj /CropBox [0 0 720 540] endobj /S /Lbl 297 0 obj No changes to content. /S /TextBox << << >> /A 858 0 R /Pg 84 0 R /S /Lbl /S /H1 >> 465 0 obj /Pg 70 0 R endobj endobj << endobj /P 880 0 R >> /P 725 0 R /Pg 82 0 R 442 0 obj >> /P 1017 0 R /Lang (EN-US) Whether you are storing supplies in a designated Central Medical Surgical Supply Area or in a storage room with mixed clean and sterile supplies, you should store those supplies in a manner to protect from contamination and maintain the integrity of the packaging from damage. /P 809 0 R /S /P 456 0 obj /K 28 /S /TextBox /P 1008 0 R /Lang (EN-US) /Resources 517 0 R /Pg 90 0 R endobj null null 322 0 R null null null null null null 323 0 R /P 1059 0 R /MediaBox [0 0 720 540] 9. /K 26 /StructParents 23 Section 19.3.2.1.5 (7) of the 2012 LSC says rooms or spaces that are larger than 50 square feet used for the storage of combustible supplies and equipment in quantities deemed hazardous by the AHJ are considered to be a hazardous area. endobj /S /P endobj /Parent 5 0 R /Pg 83 0 R /K 8 /S /LBody /Pg 77 0 R endobj 288 0 obj /Pg 89 0 R >> /CropBox [0 0 720 540] /K [120 0 R 121 0 R 122 0 R 123 0 R] /S /Slide 161 0 obj /P 46 0 R /S /Lbl 1 [null null null null null null null null 192 0 R null /K [93 0 R 94 0 R 95 0 R] << /A 789 0 R /K 43 endobj 4 0 obj 42 0 obj /K [406 0 R] /P 162 0 R 242 0 obj << Train your staff with a tool to quickly and efficiently assess standards compliance with our Hospital Compliance Assessment Workbook. endobj /Pg 84 0 R /K 8 /Tabs /S /K 40 null null 500 0 R null null null null 501 0 R null 502 0 R MASS Medical Storage products are designed in the United States, machined to precise specifications, and hand-finished under strict quality control standards. /Lang (EN-US) /Pg 71 0 R 294 0 obj /K 67 /K 42 /K 63 endobj 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R /Pg 60 0 R /S /P /Pg 84 0 R /Tabs /S /MediaBox [0 0 720 540] /Contents 555 0 R /S /LBody >> /Count 5 /Lang (EN-US) 425 0 obj endobj /K 30 endobj 109 0 obj << Category II; /Parent 15 0 R Get more information about cookies and how you can refuse them by clicking on the learn more button below. endobj They also contain discussion and examples of practices which hospitals . /CropBox [0 0 720 540] /S /Lbl /S /LBody /Contents 518 0 R endobj /P 7 0 R /Pg 68 0 R /Contents 535 0 R endobj endobj 431 0 obj endobj Evidence-based guidelines (EBGs) and national standards. << endobj Safety-related standards are established in many of the chapters. The route from the processor to the cabinet should not cross through the soiled processing area. << /ParentTree 52 0 R Pulp products, such as disposable bedpans and urine bottles, are also commonly kept in a clean utility room, before being sent for patient use. /P 810 0 R /display_urn:schemas-microsoft-com:office:office#23Editor () /Type /Page /Pg 77 0 R /A 679 0 R /P 114 0 R /A 983 0 R /P 640 0 R /Lang (EN-US) /S /Lbl /P 30 0 R We help you measure, assess and improve your performance. /Pg 61 0 R /P 1019 0 R /K 46 << 496 0 obj Improve Maternal Outcomes at Your Health Care Facility, Accreditation Standards & Resource Center, Ambulatory Health Care: 2023 National Patient Safety Goals, Assisted Living Community: 2023 National Patient Safety Goals, Behavioral Health Care and Human Services: 2023 National Patient Safety Goals, Critical Access Hospital: 2023 National Patient Safety Goals, Home Care: 2023 National Patient Safety Goals, Hospital: 2023 National Patient Safety Goals, Laboratory Services: 2023 National Patient Safety Goals, Nursing Care Center: 2023 National Patient Safety Goals, Office-Based Surgery: 2023 National Patient Safety Goals, New Assisted Living Community Accreditation Memory Care Certification Option, Health Care Equity Standard Elevated to National Patient Safety Goal, New and Revised Emergency Management Standards, New Health Care Equity Certification Program, Updates to the Advanced Disease-Specific Care Certification for Inpatient Diabetes Care, Updates to the Assisted Living Community Accreditation Requirements, Updates to the Comprehensive Cardiac Center Certification Program, The Joint Commission Retires Select Accreditation Requirements, Revisions Related to Licensed Practitioner Evaluation Time Frames, Revisions to Eliminate the Use of Licensed Independent Practitioner Terminology, Health Care Workforce Safety and Well-Being, Report a Patient Safety Concern or Complaint, The Joint Commission Stands for Racial Justice and Equity, The Joint Commission Journal on Quality and Patient Safety, John M. Eisenberg Patient Safety and Quality Award, Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity, Continuing Education Credit Information FAQs. >> /S /TextBox << /S /LBody /P 160 0 R /A 637 0 R /P 659 0 R /A 748 0 R /A 692 0 R endobj /K 56 Knowledge of maintenance procedures and frequency of maintenance should be exhibited by all staff. August 28, 2015. Learn more about the communities and organizations we serve. /K [131 0 R 132 0 R 133 0 R] /S /H1 Positive air pressure relationship to adjacent areas Minimum outdoor air exchange 2 per hour Minimum total air exchange 4 per hour Maximum relative humidity 60% Temperature range 72 to 78 F or 22 to 26 C CMS requirements: Depending on the type of facility, organizations must meet Conditions of Participation (CoP) or Conditions for Coverage (CfC). /A 786 0 R >> << Gather the data you need to create insights that will help you reduce risk, increase efficiency, and improve performance across your organization. /K [614 0 R] << /Pg 71 0 R /A 641 0 R endobj /P 7 0 R << 145 0 obj << /S /TextBox endobj << 194 0 obj /S /Lbl << >> /Lang (EN-US) /MediaBox [0 0 720 540] null null null 389 0 R null null null 390 0 R null null null 353 0 R null 354 0 R 355 0 R 356 0 R 357 0 R] endobj /K [257 0 R] << << null null 276 0 R null null null null null null null /K 13 /StructParents 15 Linen Management - Developing Requirements for Covering, Storage and Transport. /Lang (EN-US) endobj /S /Lbl >> 123 0 obj /P 95 0 R /P 971 0 R >> /K 67 /Contents 526 0 R /K 32 /K 54 /Pg 72 0 R endobj /K 158 /Annots [571 0 R 572 0 R 573 0 R] /Type /Page /Kids [79 0 R 80 0 R 81 0 R 82 0 R 83 0 R] endobj /P 982 0 R >> 264 0 obj endobj endobj endobj Reflects new or updated requirements: Changes represent new or revised requirements. Therefore, anything that a patient or staff member wears, ingests, or is treated with should not be stored under a sink. /K 61 /Lang (EN-US) << /P 7 0 R Legal disclaimer: This material is meant as an information piece only; it is not a standard or a Sentinel Event Alert. /P 7 0 R /S /Lbl >> /Contents 533 0 R /P 911 0 R 49 0 obj /K 17 >> /P 43 0 R View them by specific areas by clicking here. /Pg 61 0 R Updated: 12/22/2022. /StructParents 25 /Pg 85 0 R /S /LBody endobj /K [13 948 0 R] << /Tabs /S endobj /Group 512 0 R >> /K [192 0 R] >> /MediaBox [0 0 720 540] /P 113 0 R 271 0 obj >> /Lang (EN-US) /K 21 /S /Lbl /P 759 0 R /ParentTreeNextKey 36 126 0 obj << 421 0 obj /P 164 0 R >> /S /Lbl << /K [305 0 R] /S /Lbl /P 763 0 R /P 170 0 R /Lang (EN-US) /S /Figure /P 31 0 R << null 370 0 R 371 0 R 372 0 R 373 0 R 374 0 R 375 0 R 376 0 R 377 0 R 378 0 R endobj /Rotate 0 154 0 obj 290 >> (London Tradition)2001 /K 15 Get a deep dive into our standards, chapter-by-chapter, individually or as a team. 298 0 R null 299 0 R] 157 0 obj /A 1062 0 R /S /Lbl >> /A 754 0 R /CropBox [0 0 720 540] >> /Lang (EN-US) /Pg 70 0 R /S /P 504 0 obj /A 1063 0 R /Tabs /S /Pg 71 0 R /S /Lbl /A 979 0 R To help prevent the spread of infectious disease, The Joint Commission has set standards for managing endoscope reprocessing environments. /K 17 7 [null null null null null null null null 224 0 R null Positively pressurized rooms are usually designed to protect a patient, clean supplies, or equipment within the room. /Subject () /Pg 77 0 R endobj null null null null 363 0 R null null null 364 0 R null /S /TextBox << /S /LBody 240 0 obj /Group 512 0 R /A 731 0 R /Type /Page /P 915 0 R /Rotate 0 endobj /P 840 0 R >> 364 0 obj endobj >> >> << /Pg 86 0 R /K [236 0 R] endobj /S /Lbl << endobj /P 7 0 R << >> endobj 507 0 obj /K 62 /K 8 /S /LBody Learn about the development and implementation of standardized performance measures. 173 0 obj /Pg 78 0 R endobj /P 849 0 R The following hierarchical approach can guide your practices around storage of these products. /A 958 0 R 243 0 obj << 18 [null null null null null null null null 336 0 R null /K [13 896 0 R] Most EBGs agree that sterile supply areas must be clean, well ventilated and protect supplies from contamination, moisture, dust, temperature extremes, and humidity extremes. /Pg 86 0 R 355 0 obj endobj << >> endobj /A 670 0 R /S /LBody >> endobj endobj /S /LBody >> /CropBox [0 0 720 540] >> /P 796 0 R /A 791 0 R 111 0 obj Most EBGs agree that sterile supply areas must be clean, well ventilated and protect supplies from contamination, moisture, dust, temperature extremes, and humidity extremes. endobj endobj /Type /Pages /Pg 82 0 R /CropBox [0 0 720 540] >> /A 1026 0 R /P 164 0 R 29 0 obj >> 215 0 obj /K 13 /K [609 0 R] /P 1036 0 R >> << /S /P endobj /P 1031 0 R >> >> 260 0 obj >> /P 973 0 R 448 0 obj /A 690 0 R endobj endobj /S /Lbl >> << << /S /P /A 743 0 R 4 [null null null null null null null 100 0 R] /Pg 78 0 R Your organization must show evidence that, whether in a designated Central Surgical Supply area or in a storage room with mixed clean and sterile supplies, you are storing those supplies in a manner to protect from contamination and maintain the integrity of the packaging from damage. /Tabs /S 495 0 obj << In September 2018, the Joint Commission revised the scoring in seven areas related to HLD and sterilization. >> << << /Prev 12 0 R /A 893 0 R /K [629 0 R] /S /Lbl >> /S /Slide Drive performance improvement using our new business intelligence tools. 60 0 obj endobj endobj << /S /Lbl >> /A 861 0 R << /K 21 /S /LBody >> 213 0 R null null null null 214 0 R null 215 0 R 216 0 R 217 0 R /A 588 0 R /K 36 >> 39 0 obj /P 811 0 R /A 654 0 R /K [202 0 R] >> << these include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., food and drug administration, u.s. environmental protection agency, u.s. department of labor, occupational safety and health administration, and u.s. department of justice); 3) guidelines and standards from building and equipment /Pg 89 0 R /A 862 0 R 414 0 obj endobj /A 1058 0 R /Parent 18 0 R << Personally, I would say no, don't do it. endobj /Next 13 0 R >> 262 0 obj >> /Contents 541 0 R /A 1075 0 R /Lang (EN-US) endobj endobj /K 34 endobj endobj null null null null 405 0 R null null null null 406 0 R 336 0 obj /K 8 Ensure that fresh-air requirements for the area are met. /Lang (EN-US) /S /Lbl /P 653 0 R /A 797 0 R /K 95 /S /Lbl 133 0 obj << /K 42 /S /LBody 427 0 obj /K 89 endobj 20 [null null null null null null null null 358 0 R null /Contents 511 0 R /P 32 0 R >> /S /LBody 490 0 obj endobj /K 7 /S /Lbl /S /LBody /Pg 71 0 R /Pg 73 0 R /S /LBody /P 7 0 R /P 7 0 R >> /Company () /Pg 76 0 R >> /Pg 79 0 R /K 18 /Resources 546 0 R /Tabs /S /Pg 66 0 R << /A 1046 0 R 208 0 R null null null 209 0 R null null null 210 0 R null >> /S /LBody endobj endobj /K 8 /Producer () /S /Slide /A 630 0 R /Group 512 0 R endobj /K 22 << /P 27 0 R ] /Prev 1081 0 R /K 64 /S /Lbl << /S /Table /S /P endobj /K [353 0 R] endobj /A 724 0 R endobj /K [621 0 R] Another aspect to ensuring the safety of packaged sterile devices and instruments relates to monitoring temperature and humidity. 303 0 obj /P 31 0 R /Lang (EN-US) SCOPE STORAGE Flexible scopes stored in closed cabinet - Venting for air circulation - Internal surfaces cleanable - Adequate height; sufficient space Separate clean scope storage room preferred /A 678 0 R /P 27 0 R endobj 10 245 0 R 11 [null null null null null null null null 251 0 R null /K 30 /Resources 556 0 R << /P 181 0 R << 300 0 obj /Lang (EN-US) 168 0 obj << << /S /H1 /Pg 63 0 R << /K 8 /K [501 0 R] 361 0 obj /Pg 75 0 R >> 340 0 obj /A 762 0 R /S /H1 Learn about the "gold standard" in quality. /S /H1 Save 24.7% On Infection Control Equipment Today endobj /Lang (EN-US) /A 787 0 R << /S /TextBox << /A 859 0 R /S /LBody /K [114 0 R 115 0 R 116 0 R] >> << /Lang (EN-US) 386 0 obj 343 0 R 344 0 R 345 0 R 346 0 R 347 0 R] /P 874 0 R endobj /P 825 0 R /Lang (EN-US) /K 8 204 0 obj /Pg 77 0 R /P 655 0 R << These are provided in the 2012 edition of NFPA 99 which references the 2008 edition of ASHRAE 170 table 7.1. /Contents 567 0 R /S /TextBox /Resources 558 0 R 371 0 obj << /Pg 73 0 R 380 0 obj << /Group 512 0 R /CropBox [0 0 720 540] /K [13 830 0 R] /Parent 18 0 R /S /LBody /P 796 0 R endobj /P 36 0 R << /Pg 84 0 R 124 0 obj /P 7 0 R Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides. /P 917 0 R /S /LBody /P 165 0 R /K 31 endobj /K 49 381 0 obj /P 917 0 R /S /LBody /Name (Background) Please see ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in health care facilities for more information, Section 3.3.3.1 and Annex M. /A 995 0 R /Rotate 0 /K 44 /Pg 61 0 R /S /LBody /K 31 << /S /TextBox /Lang (EN-US) >> /Subtype /BG /K 8 null null 383 0 R null null null null 384 0 R null null >> /A 895 0 R endobj /P 140 0 R /A 884 0 R /Pg 80 0 R /Nums [0 [null null null null null null null null 188 0 R null endobj /S /P /Pg 60 0 R << See how our expertise and rigorous standards can help organizations like yours. /Outlines 5 0 R >> /K 31 409 0 obj /K 38 /K [391 0 R] /Pg 75 0 R 202 0 obj /A 940 0 R /P 41 0 R >> >> /Pg 82 0 R endobj /P 41 0 R 66 0 obj /Pg 69 0 R 370 0 obj 453 0 obj 57 0 obj << /S /LBody /S /P 78 0 obj /Tabs /S endobj /Pg 79 0 R /S /Lbl << endobj << /Length 9 0 R /Lang (EN-US) >> endobj /S /LBody /S /Slide The first level of the hierarchy is ensuring that your organization is compliant with all building code requirements. Publication Number: CEC-600-2022-064. /A 886 0 R endobj >> /P 876 0 R 405 0 obj /P 38 0 R << >> /CropBox [0 0 720 540] /P 43 0 R /Pg 88 0 R >> 349 0 obj /K 21 65 0 obj >> endobj /P 31 0 R endobj /Count 5 << Managing commercially prepared sterile supplies and devices can be challenging for healthcare organizations. 473 0 obj 211 0 obj << >> /S /LBody /P 818 0 R /K 14 >> << endobj /S /LBody >> /K 66 and approved corrugated boxes should be stored on a different shelf underneath patient care supplies or different area of the closet. endobj endobj |
endobj /S /LBody /K 70 /Tabs /S /Pg 76 0 R /A 883 0 R /K 41 /S /P /Tabs /S >> /Lang (EN-US) /S /LBody /S /Lbl 25 0 obj << /K [300 0 R] /MediaBox [0 0 720 540] /K [39 1056 0 R] /Resources 540 0 R /StructParents 5 /K 26 << endobj << 3 0 obj /S /LBody << << /P 102 0 R /P 740 0 R << >> /K 146 << /K 20 /Rotate 0 /Order [11 0 R] /RBGroups [] /S /LBody /K [176 0 R 177 0 R 178 0 R] /A 847 0 R 175 0 obj /Pg 84 0 R endobj /K 22 CMS requires that sterile packages are stored so that sterility is not compromised, and sterile items are inspected for integrity before use. /Pg 75 0 R /K 30 >> /S /LBody << /K [27 903 0 R] << /Pg 87 0 R /Pg 78 0 R /Lang (EN-US) /S /Lbl /P 172 0 R /Parent 16 0 R /P 866 0 R 138 0 obj /S /P endobj /Lang (EN-US) /P 1047 0 R /P 1029 0 R /S /Link The table above shows examples of common symbols that may be included on packaged sterile products and their meanings. Benefits of Joint Commission Accreditation. The Joint Commission. 82 0 obj >> |
397 0 obj /Pg 85 0 R endobj >> >> /P 868 0 R null null null null null 420 0 R null null null null /P 39 0 R >> /P 7 0 R joint commission clean supply storage requirements 31 October, 2022 31 October, 2022 /P 127 0 R /S /Lbl 269 0 obj /P 753 0 R 389 0 obj /Lang (EN-US) endobj /Lang (EN-US) There must be an eyewash station and hand wash station, both easily accessible. /Lang (EN-US) /P 158 0 R 43 0 obj >> >> /S /TextBox /A 828 0 R /K 63 << endobj endobj /S /LBody /CropBox [0 0 720 540] Do not bend or coil the flexible shaft of the transducer in less than a 1-ft diameter circle"2. endobj /P 1031 0 R >> >> - . /Type /Page /Pg 71 0 R 259 0 obj 273 0 obj /Pg 75 0 R << 93 0 obj /P 759 0 R 292 0 obj >> << endobj /P 835 0 R /P 805 0 R /K 60 /K 51 /P 1008 0 R << /K 46 endobj /A 970 0 R 441 0 obj /P 765 0 R /Lang (EN-US) << /K [336 0 R] /P 1021 0 R /Pg 67 0 R Find the exact resources you need to succeed in your accreditation journey. /S /H1 454 0 obj >> 433 0 obj 330 0 obj /K 14 Types of changes and an explanation of change type:
/K [617 0 R] << 399 0 obj << 320 0 R null null null null null 321 0 R null null null endobj /Pg 88 0 R /P 908 0 R If, for example, the manufacturer of the sterile supply item requires a specific temperature and humidity requirement for storage, your organization would need to meet that requirement. /S /P /Lang (EN-US) /P 7 0 R >> /S /Lbl endobj /MediaBox [0 0 720 540] /Rotate 0 /CropBox [0 0 720 540] << /K 17 /S /TextBox /Pg 68 0 R /Pg 68 0 R 341 0 obj 19 [null null null null null null null null 348 0 R null /P 647 0 R /Pg 65 0 R endobj 320 0 obj /K 35 Certifications from The Joint Commission represent the most stringent, comprehensive and evidence-based proof of the success of your program available. endobj >> /K 8 440 0 obj /S /Slide /A 674 0 R >> /S /LBody /K 31 /K 8 null null null 433 0 R null null null 434 0 R null null /A 1044 0 R Deemed organizations must fulfill Centers for Medicare and Medicaid Services (CMS) ventilation requirements which outline criteria for new or renovated existing facilities (constructed or plans approved on or after July 5, 2016).
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