| (a) Location. Any proposed limited services rural hospital
(LSRH) shall be easily accessible to the community and to service
vehicles such as delivery trucks, ambulances, and fire protection
apparatus. No building may be converted for use as an LSRH which,
because of its location, physical condition, state of repair, or arrangement
of facilities, would be hazardous to the health and safety of the
patients.
(1) Hazardous locations.
(A) Underground and above ground hazards. New LSRHs
or additions to existing LSRHs shall not be constructed within 150
feet of easement boundaries or setbacks of hazardous underground locations
including liquid butane or propane, liquid petroleum or natural gas
transmission lines, high pressure lines, and not within the easement
of high voltage electrical lines.
(B) Fire hazards. New LSRHs and additions to existing
LSRHs shall not be built within 300 feet of above ground or underground
storage tanks containing liquid petroleum or other flammable liquids
used in connection with a bulk plant, marine terminal, aircraft refueling,
bottling plant of a liquefied petroleum gas installation, or near
other hazardous or hazard producing plants.
(2) Undesirable locations.
(A) Nuisance producing sites. New LSRHs shall not be
located near nuisance producing industrial sites, feed lots, sanitary
landfills, or manufacturing plants producing excessive noise or air
pollution.
(B) Cemeteries. New LSRHs shall not be located near
a cemetery in a manner that allows direct view of the cemetery from
patient windows.
(C) Flood plains.
(i) Previously licensed eligible general or special
hospital. An existing building or a portion of an existing building
located in a designated 100-year flood plain that was previously licensed
as a general or special hospital but has been vacated or used for
purposes other than a hospital, will not be licensed as an LSRH.
(ii) Existing LSRH. Access and required functional
LSRH components shall be constructed above the designated flood plain
in a new addition to an existing LSRH located in a designated 100-year
flood plain.
(D) Airports. Construction of new LSRHs shall be avoided
in close proximity to airports. When LSRHs are proposed to be located
near airports, recommendations of the Texas Aviation Authority and
the Federal Aviation Authority shall apply. An LSRH may not be constructed
within a rectangular area formed by lines perpendicular to and two
miles (10,560 feet) from each end of any runway and by lines parallel
to and one-half mile (2,640 feet) from each side of any runway.
(b) Environmental considerations. Development of an
LSRH site and LSRH construction shall be governed by state and local
regulations and requirements with respect to the effect of noise and
traffic on the community and the environmental impact on air and water.
(c) LSRH site.
(1) Paved roads and walkways. Paved roads shall be
provided within the lot lines to provide access from public roads
to the main entrance, emergency entrance, entrances serving community
activities, and to service entrances, including loading and unloading
docks for delivery trucks.
(A) Emergency entrance. An LSRH shall have its emergency
entrance well-marked to facilitate entry from the public roads or
streets serving the site.
(B) Access to emergency department. Access to the emergency
entrance shall not conflict with other vehicular traffic or pedestrian
traffic and shall be located so as not to be compromised by floods.
(C) Pedestrian traffic. Finished surface walkways shall
be provided for pedestrians.
(2) Parking. Off-street parking shall be available
for visitors, employees, and staff. Parking structures directly accessible
from an LSRH shall be separated with two-hour fire rated noncombustible
construction. When used as required means of egress for LSRH occupants,
parking structures shall comply with National Fire Protection Association
(NFPA) 88A, Standard for Parking Structures, 2011 edition. This requirement
does not apply to freestanding parking structures.
(A) Number of parking places. In the absence of a formal
parking study, one parking space shall be provided for each day shift
employee plus one space for each patient station. This ratio may be
reduced in an area convenient to a public transportation system or
to public parking facilities on the basis of a formal parking study.
Parking facilities shall be increased accordingly when the size of
existing facilities is increased.
(B) Additional parking. Additional parking shall be
required to accommodate medical staff, outpatient and other services
when such services are provided.
(C) Emergency and delivery parking. Separate parking
facilities shall be provided for ambulances and delivery vehicles.
(d) Building design and construction requirements.
Every building and every portion thereof shall be designed and constructed
to sustain all dead and live loads in accordance with accepted engineering
practices and standards and the local governing building codes. Where
there is no local governing building code, the LSRH shall be constructed
in accordance with the International Building Code, 2003 edition.
(1) General architectural requirements. All new construction,
including conversion of an existing building to an LSRH, and establishing
a separately licensed LSRH in a building with an existing licensed
LSRH, shall comply with Chapter 18 of the NFPA 101, Life Safety Code,
2012 edition (NFPA 101), Subchapter F of this chapter (relating to
Fire Prevention and Safety), and this subchapter. An LSRH shall submit
construction documents to the Texas Health and Human Services Commission
(HHSC) in accordance with §511.167 of this subchapter (relating
to Preparation, Submittal, Review, and Approval of Plans, and Retention
of Records).
(A) Physical environment. A physical environment that
protects the health and safety of patients, personnel, and the public
shall be provided in each LSRH. The physical premises of the LSRH
and those areas of the LSRH's physical structure that are used by
the patients (including all stairwells, corridors, and passageways)
shall meet the local building and fire safety codes, Subchapter F
of this chapter, and this subchapter.
(B) Construction type. An LSRH may occupy an entire
building or a portion of a building, provided the LSRH portion of
the building is separated from the rest of the building in accordance
with subparagraph (C) of this paragraph and the entire building or
the LSRH portion of the building complies with this subchapter's requirements
(type of construction permitted for hospitals by NFPA 101 §18.1.6.2),
and the entire building is protected with a fire sprinkler system
conforming with requirements of NFPA 13, Standard for the Installation
of Sprinkler Systems, 2010 edition.
(C) Separate buildings. Portions of a building divided
horizontally with two-hour fire rated walls that are continuous (without
offsets) from the foundation to above the roof shall be considered
as a separate building. Communicating openings in the two-hour wall
shall be limited to public spaces such as lobbies and corridors. All
such openings shall be protected with self-closing one and one-half
hour, Class B fire door assemblies.
(D) Design for the accessibility. Special considerations
benefiting staff, visitors, and patients with disabilities shall be
provided. An LSRH shall comply with the Americans with Disabilities
Act (ADA) of 1990, Public Law 101-336, 42 United States Code, Chapter
126, and Title 36 Code of Federal Regulations, Part 1191, Appendix
A (relating to Accessibility Guidelines for Buildings and Facilities)
or 16 TAC Chapter 68 (relating to Elimination of Architectural Barriers),
Texas Accessibility Standards (TAS), April 1, 1994 edition, issued
by the Texas Department of Licensing and Regulation, under Texas Government
Code Chapter 469 (relating to Elimination of Architectural Barriers).
(E) Patient safety. In developing construction documents
for submission to HHSC in accordance with §511.167 of this subchapter,
the owner shall comply with the requirements of Texas Health and Safety
Code Chapter 256 (relating to Safe Patient Handling and Movement Practices).
Texas Health and Safety Code §256.002(b)(8) requires an LSRH's
governing body to consider the feasibility of incorporating patient
handling equipment or the physical space and construction design needed
to incorporate that equipment at a later date.
(F) Other regulations. The more stringent standard,
code or requirement shall apply when a difference in requirements
for construction exists.
(G) Exceeding minimum requirements. Nothing in this
subchapter shall be construed to prohibit a better type of building
construction, more exits, or otherwise safer conditions than the minimum
requirements specified in this subchapter.
Cont'd... |
