| (a) Construction.
(1) Major construction. A limited services rural hospital
(LSRH) shall not commence construction, other than minor alterations,
until the LSRH has satisfactorily resolved final plan review deficiencies
and paid the appropriate plan review fee according to the plan review
schedule in §511.17 of this chapter (relating to Fees), and the
Texas Health and Human Services Commission (HHSC) has issued a letter
granting approval to begin construction. Such authorization does not
constitute release from the requirements contained in this chapter.
If the construction takes place in or near occupied areas, adequate
provision shall be made for the safety and comfort of occupants.
(2) Construction commencement notification. The architect
of record or the LSRH owner or operator shall provide written notification
to HHSC when construction will commence. HHSC shall be notified, in
writing, of any change in the completion schedules.
(3) Completion. Construction shall be completed in
compliance with the construction documents including all addenda or
modifications approved for the project.
(b) Construction inspections. All LSRHs, including
those that maintain certification under Title XVIII of the Social
Security Act (42 United States Code, §1395 et seq), and those
that maintain accreditation by a Centers for Medicare & Medicaid
Services-approved organization, are subject to construction inspections.
(1) Number of construction inspections. A minimum of
two construction inspections of the project is generally required
for the purpose of verifying compliance with Subchapter G of this
chapter and this subchapter and the approved plans and specifications.
The final plan approval letter will inform the architect of record
and the owner or operator as to the minimum number of inspections
required for the project.
(2) Requesting an inspection. The architect of record
or the LSRH owner or operator shall request an inspection by submitting,
at least three weeks in advance of the requested inspection date,
an Application for Inspection and the construction inspection fee
in accordance with §511.17(g) of this chapter for each intermediate
inspection, final inspection, and reinspection requested. Inspection
requests by contractors will not be honored.
(A) The architect of record or the LSRH owner or operator
shall request an intermediate construction inspection to occur at
approximately 80 percent completion. All major work above the ceiling
shall be completed at the time of the intermediate inspection; however,
ceilings shall not be installed.
(B) The architect of record or the LSRH owner or operator
shall request a final construction inspection at 100 percent completion.
One hundred percent completion means that the project is completed
to the extent that all equipment is operating in accordance with specifications,
all necessary furnishings are in place, and patients could be admitted
and treated in all areas of the project.
(3) Reinspections. Depending upon the number and nature
of the deficiencies cited during the final inspection, the inspector
may require that a reinspection be conducted to confirm correction
of all deficiencies cited. The inspector may also require a reinspection
if they determine that the project was not sufficiently complete to
warrant a final inspection. The request for reinspection shall be
submitted in accordance with paragraph (2) of this subsection.
(c) Approval of project. Patients and staff shall not
occupy a new structure or remodeled or renovated space until approval
has been received from the local building and fire authorities and
HHSC.
(1) Documentation requirements. The LSRH owner or operator
shall submit the following documents to HHSC before the project will
be approved.
(A) Written approval of the project by the fire authority.
(B) A certificate of occupancy for the project issued
by the local building authority.
(C) A copy of a letter or certification from a professional
engineer (P.E.) licensed in the state of Texas indicating the fire
sprinkler working plans, hydraulic calculation, the testing, and field
inspection of the installation of the new or modified sprinkler system
is in compliance with the requirements of NFPA 13, Standard for the
Installation of Sprinkler Systems, 2002 edition, if applicable. A
copy of a letter or certification of changes in existing fire sprinkler
system is not required when relocation of not more than twenty sprinkler
heads and hydraulic calculation is not involved.
(D) Fire alarm system certification (form FML-009 040392
of the Office of the State Fire Marshal), if applicable.
(E) A signed copy of a letter of certification from
a qualified certification agency or individual for the piped-in medical
gas system that was installed or modified and verification inspection
testing in this project in accordance with §511.162 (d)(4)(A)(iii)(IV),
(X) and (XI) of this subchapter (relating to General Construction
Requirements), if applicable.
(F) A copy of the test and a letter from the electrical
contractor certifying that the electrical system was tested and complies
with the standards of NFPA 99, Health Care Facilities, 2012 edition, §4.3.2.2.8
(Special Grounding) and §4.3.3.1 (Grounding System Testing),
if applicable to the project.
(G) A copy of documentation indicating the flame spread
rating and the smoke development rating of any wall covering installed
in this project. Provide a signed letter or statement corroborating
the installation of the product in the project.
(H) A copy of documentation indicating that draperies,
curtains (including cubicle curtains), and other similar loosely hanging
furnishings and decorations are flame-resistant as demonstrated by
passing both the small and large-scale tests of NFPA 701, Standard
Methods of Fire Tests for Flame-Resistant Textiles and Films, 2010
edition as required by NFPA 101, §18-7.5, and provide a signed
letter or statement corroborating the installation of the product
in the project.
(I) A written plan of correction signed by the LSRH
owner/operator for any deficiencies noted during the final inspection.
(J) A Final Construction Approval form signed by the
LSRH owner/operator.
(K) Any other documentation or information required
or requested due to the type of the project.
(2) Temporary occupancy approval.
(A) If, during the final inspection, the inspector
finds only a few minor deficiencies that do not jeopardize patient
health, safety and welfare, the inspector may grant temporary approval
for occupancy contingent upon the documents listed in paragraph (1)(A)
- (E) of this subsection being provided to and approved by the inspector
at the time of the final inspection.
(B) Temporary approval for occupancy allows the LSRH
owner or operator to occupy the project. However, the LSRH owner or
operator must submit the documents required in paragraph (1)(F) -
(K) of this subsection before the project receives final approval.
(3) Final approval. Upon its receipt and acceptance
of the documents required in paragraph (1) of this subsection, HHSC
will issue written final approval of the project.
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