|(a) All buildings in which existing ESRD facilities licensed by the department are located shall comply with this subsection. (1) A licensed ESRD facility which is licensed prior to the effective date of these rules is considered to be an existing licensed ESRD facility and shall continue, at a minimum, to meet the licensing requirements under which it was originally licensed. (2) Existing licensed ESRD facilities shall meet the requirements for Existing Ambulatory Health Care Occupancies contained in Chapter 21 of the 2000 edition of the National Fire Protection Association 101, Life Safety Code, (NFPA 101), the ESRD Standards/Rules (1996, 1999, or 2006 editions as amended), and the ESRD rules under which the buildings or sections of buildings were constructed. All documents published by NFPA as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 344-3555. (3) In lieu of meeting the requirements in paragraph (1) of this subsection, an existing licensed ESRD facility may, instead, comply with National Fire Protection Association (NFPA) 101, Life Safety Code 2003 Edition (NFPA 101) Chapter 21, Existing Ambulatory Health Care Occupancies. (b) All major remodeling, renovations, additions and alterations to an existing ESRD facility shall be done in accordance with the requirements for new construction in §117.102 of this title (relating to Construction Requirements for a New End Stage Renal Disease Facility). All areas of an existing ESRD facility that are not part of a major remodel, renovation, addition or alteration to the ESRD facility, are not required to meet these new construction requirements as long as the existing portion of the facility met the rules and codes that were in effect when it was originally constructed and licensed. When existing conditions make such changes impractical, the department may grant a conditional approval of minor deviations from the requirements of §117.102 of this title, if the intent of the requirements is met and if the care, safety and welfare of patients will not be jeopardized. The operation of the ESRD facility, accessibility of individuals with disabilities, and safety of the patients shall not be jeopardized by a condition(s) which is not in compliance with §117.102 of this title and this section. (1) Any alteration, modification, replacement, or any installation of new building equipment, such as mechanical, electrical, emergency power equipment, energy/utility management, conveying systems, plumbing, fire protection, or other equipment with a primary function of building service that affects life safety, infection control, changes the functional operation, or the health, safety and welfare of patients or staff shall comply with the requirements for new construction and shall not be replaced, materially altered, or extended in an existing ESRD facility until complete plans and specifications have been submitted to the department, and the department has reviewed and approved the plans and specifications in accordance with §117.104 of this title (relating to Preparation, Submittal, Review and Approval of Plans, and Retention of Records). (2) Minor remodeling or alterations within an existing ESRD facility which do not involve alterations to load bearing members and partitions, change functional operation, affect fire safety, or involve any of the major changes listed in paragraph (1) of this subsection are considered to be minor projects and require evaluation and approval by the department. An ESRD facility shall submit by mail or fax a written request and floor plan for evaluation, a brief description of the proposed changes, and sketches of the area being remodeled. Based on such submittal, the department shall evaluate and determine whether any additional submittals or inspections are required. The department shall notify the ESRD facility of its decision. The patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition would not require submission to the department for approval. (3) All remodeling or alterations which involve alterations to load bearing members or partitions, change functional operation, add treatment stations, or affect fire safety are considered major projects. An ESRD facility shall comply with this section prior to beginning construction of major projects. (A) Plans shall be submitted in accordance with §117.104 of this title for all major remodeling or alterations. (B) As of February 9, 2009, all new facilities or increasing the number of in-center dialysis treatment stations in existing facilities shall have an isolation room or be granted a waiver by Center for Medicare and Medicaid Services. The waiver shall demonstrate that there is sufficient capacity in the geographic area for isolation rooms for hepatitis B positive patients. A written request for waiver shall be made through the Texas Department of State Health Services, Health Facility Compliance Group, Mail Code 1979, P.O. Box 149347, Austin, Texas, 78714-9347 for transmission to CMS. (C) Phasing of construction in existing facilities. (i) Projects involving alterations of or additions to existing buildings shall be programmed and phased so that on-site construction shall minimize disruptions of existing functions. (ii) Access, exit access, and fire protection shall be maintained so that the safety of the occupants shall not be jeopardized during construction. (iii) A noncombustible or limited combustible dust and vapor barrier shall be provided to separate areas undergoing demolition and construction from occupied areas. When a fire retardant plastic material is used for temporary daily usage, it shall be removed at the end of each day. (iv) The air inside the construction area shall be protected by mechanical filtration that recirculates inside the space or is exhausted directly to the exterior. (v) The area shall be properly ventilated and maintained. The area under construction shall have a negative air pressure differential to the adjoining areas and shall continue to operate as long as construction dust and odors are present. (vi) Temporary sound barriers shall be provided where intense prolonged construction noises will disturb patients or staff in the occupied portions of the building during patient treatment times. (vii) When construction is done after hours or on weekends, the facility shall assure that all areas of construction are cleaned thoroughly and a clean safe environment is provided before patients are treated. All fire safety protection and building systems are in place and working properly. (c) A previously licensed ESRD facility which has been vacated or used for other purposes shall comply with all the requirements for new construction contained in §117.102 of this title in order to be licensed.