(Amendments to 6 CCR 1011-1, Chapter XVIII – Psychiatric Hospitals, adopted 03-19-08 - 
NOTE:  Items in bold and parentheses preceding the amended sections are notes/instructions for the CCR publisher and are not part of the Rules)
(Instructions:  Strike existing sections 6.6 and 6.7, Par IDs 853390 and 853391, and replace with the following:)
6.6  	WINDOWS. Each patient bedroom shall have a minimum window area equal to one-eighth of the floor area. The sills of such windows shall not be located below the finished ground level and shall not be more than 36 inches above the floor level.  The exterior ground level shall be maintained at or below the window sill for a distance of at least eight feet, measured direct to the window. A portion of the required window shall be openable sufficient to provide adequate ventilation, unless a mechanical ventilation system is provided. A means of privacy and control of light shall be provided at each window. 
6.7  	ENTRIES. Each patient bedroom shall have access to exit routes sufficient to meet the fire safety requirements of the Life Safety Code.  The door openings shall be at least 32 inches in clear width.  Doors shall not swing into the exit route unless emergency release hardware is provided. 

(Instructions:  Strike existing section 6.9.1, Par ID 853394, and replace with the following:)
6.9.1	Located immediately adjacent to private or multiple-bed bedrooms in the ratio of one facility for not more than four patient beds which include: 1) toilet; 2) incombustible waste paper receptacle, either seamless or with removable impervious liner, and 3) grab bars in some facilities and of a sufficient number to accommodate disabled patients. In new construction, the door to the toilet shall be at least thirty-two inches in clear width and shall not swing into the toilet room unless provided with rescue hardware or tool-released privacy bath sets.  

(Instructions:  Strike existing section 6.11.4, Par ID 853403, and replace with the following:)
6.11.4	One noncombustible waste receptacle, either seamless or with a removable impervious liner.

(Instructions:  Strike existing section 6.18.1, Par IDs 853426 and 853427, and replace with the following:)
6.18.1	The medication preparation area shall, as a minimum, be equipped with:
1)	cabinets with suitable locking devices to protect drugs stored therein; 2) refrigerator equipped with thermometer and used exclusively for pharmaceutical storage and powered from the critical branch of the essential electrical system; 3) counter work space; 4) sink, with approved handwashing facilities; 5) antidote, incompatibility, and metri-apothecary conversion charts. 

(Instructions:  Strike existing section 15.34, Par ID 853584, and replace with the following:)
15.34	VENTILATION. Rooms for preparing and serving food and washing utensils shall be well ventilated. 

(Instructions:  Strike existing sections 17.1 through 17.9, Par IDs 853597 through 853606,  and replace with the following:)
17.1	In psychiatric hospitals in which anesthetic agents are used in Electro-convulsive Therapy and other psychiatric procedures, practices employed in the administration of anesthesia shall be consistent with the written policies of the medical staff.
17.2	FACILITIES. There shall be facilities and equipment for the administration of anesthesia which are commensurate with the clinical procedures and programs conducted within the hospital.
17.3	STAFF. Anesthesia utilized in Electro-convulsive Therapy or in other psychiatric procedures shall be administered only by a physician qualified by training, experience, and ability to do so, or by a registered nurse anesthetist graduated from a certified school and who is under the supervision of the attending physician.
17.3.1	In the case of dental treatment, a dentist may administer local anesthetics.
17.4  	A written plan shall be established for the referral of patient for evaluation and treatment for services requiring anesthesia which are not provided in the facility.
17.5  	ANESTHESIA MACHINES. Persons administering anesthesia shall ensure that anesthetic gas cylinders are installed properly on machines that are pin-indexed.
17.6  	NURSING. Patients recovering from anesthesia shall remain under continuous care of a registered nurse. Nurses shall have been instructed in the care of post-anesthetic patients, shall have no other duties during the time they are caring for such patients, and shall have facilities for immediate communication with the attending surgeon, anesthesiologist, or qualified substitute person at the hospital.
17.7  	EQUIPMENT STERILIZATION. Anesthesia equipment shall be cleaned properly and sterilized after each use, except multi-use heat sensitive equipment may be disinfected using a process that is bactericidal, tuberculocidal and virucidal. Hypodermic needles, syringes and allied equipment shall be sterilized, in accordance with written procedures.

(Instructions:  Strike existing  sections 19.10.1 through and 19.10.6, Par IDs 853637 through 853642, and replace with the following:)  
19.10.1	Fume hoods shall be available where needed.
19.10.2	If tests are performed in the specialties of mycobacteriology, mycology, and/or virology, the laboratory shall be equipped with a microbiological safety cabinet, with an adequately filtered exhaust system.
19.10.3	Vacuum breakers shall be present on sinks where specimens are handled or discarded to ensure that the water supply is not contaminated.
19.10.4	Adequate precautions for discarding specimens shall be in use - sterilization, incineration, or both.

(Instructions:  Strike existing Part 31, Par IDs 1428644 through 1428651, in its entirety, and replace with the following Parts 31 and 32):
31	PHYSICAL PLANT
31.1	Compliance with the Life Safety Code
31.1.1	Facilities shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000).  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of the referenced material.  
(a)	Facilities licensed on or before September 30, 2003 shall meet Chapter 19, Existing Health Care Occupancies, NFPA 101 (2000).
(b)	Facilities licensed on or after October 1, 2003 or portions of facilities that undergo remodeling on or after October 1, 2003 shall meet Chapter 18, New Health Care Occupancies, NFPA 101 (2000).  In addition, if the remodel represents a modification of more than 50 percent, or more than 4,500 square feet of the smoke compartment, the entire smoke compartment shall be renovated to meet Chapter 18, New Health Care Occupancies, NFPA 101 (2000).
32	Department Oversight
32.1	GENERAL.  Reserved. 
32.2	LICENSURE FEES.  Nonrefundable fees shall be submitted to the department with an application for licensure as follows:
32.2.1	Initial License: (when such initial licensure is not a change of ownership).  A license applicant shall submit a nonrefundable fee with an application for licensure as follows:  base fee of $5,700 and a per bed fee of $50.  The initial licensure fee shall not exceed $10,500.  
32.2.2	Renewal License.  A license applicant shall submit a nonrefundable fee  with an application for licensure as follows:  base fee of $1,600 and a per bed fee of $12.  The renewal fee shall not exceed $8,000.
32.2.3	Change of Ownership.  A license applicant shall submit a nonrefundable fee of $2,500 with an application for licensure.
32.2.4	Provisional License.  The license applicant may be issued a provisional license upon submittal of a nonrefundable fee of $2,500.  If a provisional license is issued, the provisional license fee shall be in addition to the initial license fee.
32.2.5	Conditional License.  A facility that is issued a conditional license by the Department shall submit a nonrefundable fee ranging from 10 to 25 percent of its applicable renewal fee.  The percentage shall be determined by the Department.  If the conditional license is issued concurrent with the initial or renewal license, the conditional license fee shall be in addition to the initial or renewal license fee.
32.3	Plan Review and Plan Review Fees.  Plan review and plan review fees are required as listed in Sections (1) through (5), below.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.
(1)	Initial Licensure.  Applicable to applications for an initial license, when such initial license is not a change of ownership.  This includes new facility construction and existing structures.  The requirement for plan review and the fee applies to initial license applications submitted on or after May 15, 2008.  Fee:  see table below.

Square Footage	Cost per square foot	Explanatory Note	
0-35,000	$0.37	This is the cost for the first 35,000 sq ft of any plan submitted.	
35,001-200,000	$0.03	This cost is applicable to the additional square footage over 35,000 and up to 200,000 sq ft.	
200,001+	$0.01	This cost is applicable to the additional square footage over 200,000 sq ft. 	
(2)	New Construction.  Applicable to new construction including replacement facilities, structural additions of any size and prefabricated structures.  The requirement for plan review and the fee applies to construction for which the application for the building permit from the local authority having jurisdiction is dated on or after May 15, 2008. However, facilities for which the application for the building permit from the local authority having jurisdiction is dated prior to May 15, 2008 may request a partial plan review.  The partial plan review is subject to a ten (10) to twenty-five (25) percent reduction of the fee, as determined by the Department, dependent on the phase of facility construction; except that the fee shall not be below the minimum fee established by this subsection.  Fee:  see table below.  Minimum fee:  $2,000.

Square Footage	Cost per square foot	
Explanatory Note	
0-35,000	$0.37	This is the cost for the first 35,000 sq ft of any plan submitted.	
35,001-200,000	$0.03	This cost is applicable to the additional square footage over 35,000 and up to 200,000 sq ft. 	
200,001+	$0.01	This cost is applicable to the additional square footage over 200,000 sq ft.	
(3)	Remodeling – General.  Applicable to relocation, removal or installation of walls resulting in 50% or more of a smoke compartment being reconfigured.  The cost per square footage listed in the table below is to be assessed for the entire smoke compartment(s) being reconfigured.   The requirement for plan review and the fee applies to construction for which the application for the building permit from the local authority having jurisdiction is dated on or after May 15, 2008.  Fee: see table below.  Minimum fee:  $2,000.

Square Footage	Cost per square foot	Explanatory note	
0-35,000	$0.25	This is cost for the first 35,000 sq ft of any plan submitted.	
35,001-200,000	$0.03	This cost is applicable to the additional square footage over 35,000 and up to 200,000 sq ft.	
200,001+	$0.01	This cost is applicable to the additional square footage over 200,000 sq ft.	
(4)	Remodeling – Egress Components.  Applicable to the relocation, removal, or addition of any egress component, including but not limited to corridors, stairwells, exit enclosures, or points of refuge.  (Widening of an egress component is not relocation.)  The requirement for plan review and the fee applies to construction for which the application for the building permit from the local authority having jurisdiction is dated on or after May 15, 2008.  Fee:  $2,000.  However, if these renovations are part of the smoke compartment reconfiguration subject to the fee listed in Section 32.2.3 (3), the fee in this Section 32.2.3 (4) shall not apply.
(5)	Remodeling – Specific Systems.  Applicable to significant modifications to the following systems:  fire sprinkler, fire alarm, medical gas, kitchen exhaust/suppression system, and essential electrical system.  The requirement for plan review and the fee applies to significant modifications where construction is initiated on or after July 1, 2008.  For the purposes of this subsection 32.2.3 (5), construction of significant modifications is deemed initiated when there is an alteration associated with the remodeling to an existing structure that results in a physical change.  Fee:  $2,000 for up to four smoke compartments, plus $500 for each additional compartment.  However, if these renovations are part of the smoke compartment reconfiguration subject to the fee listed in Section 32.2.3 (3), the fee in this Section 32.2.3 (5) shall not apply.  Significant modifications include: 
(a)	Fire sprinkler:  100 or more sprinklers.  Notwithstanding the other provisions in this Section 32.2.3 (5), the extension of a sprinkler system involving the installation of 25 to 99 sprinkler heads for an area previously unsprinklered is subject to a partial plan review consisting of the review of the remodeling plans and a fee of $500.  
(b)	Fire alarm: any modification to the fire alarm system that involves the replacement of the main fire alarm control unit (panel).
(c)	Medical gas:  modifications that affect 50% or more of a smoke compartment.
(d)	Kitchen exhaust/suppression system:  replacement of the suppression or hood exhaust/duct system.
(e)	Essential electrical system:  replacement or addition of a generator or transfer switch.