Health Facilities and Emergency Medical Services Division
6 CCR 1011-1
standards for hospitals and health facilities
CHAPTER XIV.  MATERNITY HOSPITAL

Part 1.	Statutory Authority and Applicability
1.101	Statutory Authority
(1)	Authority to establish minimum standards through regulation and to administer and enforce such regulations is provided by Sections 25-1.5-103 and 25-3-101, C.R.S., et seq.
1.102	Applicability
(1)	All hospitals shall meet applicable federal and state statutes and regulations, including but not limited to:
(a)	6 CCR 1011-1, Chapter II.  1.  LICENSE. All Rehabilitation Centers shall be licensed as hospitals in accordance with the requirements specified in Chapter II, Licensure. 
(b)	This Chapter XIV.
(c)	Provisions of 6 CCR 1011-1, Chapter IV, General Hospitals, as referenced herein.
(2)	Contracted Services shall meet the standards established herein.

Part 2.	General Provisions 
2.100	Definitions
2.200	Department Oversight
2.300	Affiliation Agreement with General Hospital

2.100	Definitions
2.101	General Definitions.  
(1)	“Department” means the Department of Public Health and Environment, unless the context dictates otherwise.
(2)	“General Hospital” means a hospital licensed pursuant to 6 CCR 1011-1, Chapter IV, General Hospitals.  
(3)	“Governing board” means the board of trustees, directors, or other governing body in whom the ultimate authority and responsibility for the conduct of the hospital is vested. {Same as Chapter IV.}
(4)	“Patient care unit” means a designated area of the hospital that provides a bedroom or a grouping of bedrooms with respective supporting facilities and services to provide adequate nursing care and clinical management of inpatients; and that is thereby planned, organized, operated, and maintained to function as a separate and distinct unit. {Same as Chapter IV.}
(5)	DEFINITION.  “Maternity hospital” means a health facility planned, operated, and maintained to offer medical and nursing facilities, beds, and services over a continuous period exceeding 24 hours to women requiring care before, during, and recovery from obstetric delivery. Provision shall be made, by agreement with a General Hospital, or within the facility, for a clinical laboratory, diagnostic X-ray, treatment facilities for emergency, surgery, and definitive medical treatment under an organized medical staff.
(6)	“Plan review” means the review by the Department, or its designee, of new construction or remodeling plans to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter IV.  Plan review consists of the examination of new construction or remodeling plans and onsite inspections, where warranted.  In reference to the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.  
2.200	Department Oversight
2.201	General.  Reserved.
2.202	Licensure Fees.  7.2  Licensure Fees.  Fees shall be submitted to the Department as specified below.
(1)	7.2.1  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.  
(2)	7.2.2  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.
(3)	7.2.3  Change of ownership.  A license applicant shall submit a nonrefundable fee of $2,500 with an application for licensure.
(4)	7.2.4  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.
(5)	7.2.5  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.
2.203	Plan Review and Plan Review Fees.   Plan review and plan review fees are required as listed below 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 sq ft	$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.  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 2.203 (3), the fee in this Section 2.203 (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 2.203 (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 2.203 (3), the fee in this Section 2.203 (5) shall not apply.  Significant modifications include: 
(a)	Fire sprinkler:  100 or more sprinklers.  Notwithstanding the other provisions in this Section 2.203 (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.
2.300	Affiliation Agreement with General Hospital
6	WRITTEN AGREEMENT
(1)	A maternity hospital shall establish and implement a written agreement with a general hospital.  The written agreement shall address:
names of the owner or corporate officers authorized to sign the agreement, 
(a)	accurate clear statements which reflect that the operations provide: 1) Continuity and evaluation of patient care; 
(b)	2) Transfer from the maternity hospital to the general hospital of any patient by which the attending physician at the Maternity Hospital feels the best interest of the patient or her infant will be served;
(c)	4) Review and appraisal of the quality and appropriateness of medical care; and 
(d)	5) Procedural policies. 
(d)	3	FACILITIES AND SERVICES.  The facilities and services shall include provisions for prompt transfer of patients between a General Hospital and the Maternity Hospital, the degree of utilization of the General Hospital's diagnostic and treatment facilities,
(e)	and the sharing of knowledge between personnel in the General Hospital and Maternity Hospital.
5	INTEGRATION WITH GENERAL HOSPITAL
When the Maternity Hospital and the General Hospital have separate and distinct governing boards or authorities, an integrated affiliation shall be established by written agreement and certified in writing to the State Board of Health.
Part 3.	GOVERNING BOARD.  The facility shall have a governing board in conformance with the standards established in Chapter IV, Part 3, Governing Board.

Part 4.	ADMINISTRATIVE OFFICER.  The facility shall be have an administrative officer in conformance with the standards established in Chapter IV, Part 4, Administrative Officer.

Part 5.	MEDICAL STAFF.  The facility shall have medical staff through affiliation with a General hospital and in conformance with Chapter IV, Part 5, Medical Staff.
2.1	Requirements of chapter IV, Section 3 Medical Staff; and Section 8, Clinical Pathology, shall be met by affiliation of the facility with a General Hospital as set forth in 1.1 above.

Part 6.	NURSING DEPARTMENT.  The facility shall have nursing staff in conformance with the standards established in Chapter IV, Part 6, Nursing Department.

Part 7.	PERSONNEL.  The facility shall be in conformance with Chapter IV, Part 7, Personnel.  Further, 1.1 it shall further be a condition to obtaining a license that the professional services be under the supervision of the chief of the obstetrics and gynecology department of a General Hospital and other departments when necessary. 

Part 8.	MEDICAL RECORDS DEPARTMENT.  The facility shall have a medical records department in conformance with the standards established in Chapter IV, Part 8, Medical Records Department.

Part 9.	ANESTHESIA SERVICES.  The facility shall have anesthesia services in conformance with the standards established in Chapter IV, Part 9, Anesthesia Services.  .2  The Governing Board shall certify the type of anesthesia to be used. Such certification shall be endorsed by the supervising chief of the obstetric and gynecology department of the General Hospital with which the facility is affiliated.   However, when the only types of anesthesia certified by the Governing Board are non-inhalation types of anesthesia, subparagraphs 2.2.1 and 2.2.2 shall apply. 2.2.1  When inhalation anesthesia is not used within the facility, cChapter IV, Section 7 Part 9, Anesthesia Services, shall not apply and Section 9.5(3), Delivery Suite Equipment, the delivery suite shall include supplies for spinal and local anesthesia.
2.2.2	Chapter III, General Building and Fire Safety, Section 4, Codes and Regulations, Bulletin 56, Flammable Anesthetics. National Fire Protection Association, 1962 (except for electrical isolation systems), shall not apply.

Part 10.	laboratory services.  The facility shall provide laboratory services through an affiliation with a General Hospital.
2.1	Requirements of chapter IV, Section 3 Medical Staff; and Section 8, Clinical Pathology, shall be met by affiliation of the facility with a General Hospital as set forth in 1.1 above.

Part 11.	Pregnancy, Labor and Delivery.  The facility shall provide pregnancy, labor and delivery services in conformance with the standards established in Chapter IV, Part 11, Pregnancy, Labor and Delivery.

Part 12.	Dietary Services.  The facility shall provide dietary services in conformance with the standards established in Chapter IV, Part 12, Dietary Services.  

Part 13.	Emergency Services.  The facility shall provide emergency services in conformance with the standards established in Chapter IV, Part 13, Emergency Services or provide such services through affiliation with a General hospital. 
2.3	Provision shall be made for chapter IV, Section 11, Emergency and Outpatient Services, within the facility or with the General Hospital.

Part 14.	OUTPATIENT Services.  The facility shall provide outpatient services in conformance with the standards established in Chapter IV, Part 14, Outpatient Services or provide such services through affiliation with a General hospital.
2.3	Provision shall be made for chapter IV, Section 11, Emergency and Outpatient Services, within the facility or with the General Hospital.

Part 15.	INFECTION CONTROL SERVICES.  The facility shall provide infection control services through affiliation with a general hospital and in conformance with the standards established in Chapter IV, Part 15, Infection Control Services.  

Part 16.	SOCIAL SERVICES
16.101	Organization and Staffing  
(1)	4.1  PROVISIONS. The Maternity Hospital shall provide appropriate social services to patients and families and consultation to the staff.
(2)	4.1  PROVISIONS. The social services may be provided by:  
(a)	1) A qualified social worker employed full or part time by the facility; 
(b)	2) Contract with a recognized agency for the provision of social services by, or under the supervision of, a qualified social worker to include some combination of direct service to patients and/or families and consultation to personnel of the facility; 
(c)	3) A designated member of the staff of the facility for whom there is an effective arrangement for consultation from a qualified social worker from a recognized public or private agency that provides social work consultation.
16.102	PROGRAMMATIC FUNCTIONS.  Reserved.  
16.103	EQUIPMENT AND SUPPLIES.  Reserved.  
16.104	FACILITIES.  Reserved.  

Part 16.	CRITICAL CARE SERVICES.  The facility may provide critical care services.  If the facility provides critical services, such services shall be in conformance with the standards established in Chapter IV, Part 17, Critical Care Services.

Part 17.	GENERAL PATIENT CARE SERVICES.  The facility shall provide patient care services in conformance with the standards established in Chapter IV, Part 19, General Patient Care Services.

Part 18.	PHARMACEUTICAL SERVICES.  The facility shall provide pharmaceutical services in conformance with the standards established in Chapter IV, Part 21, Pharmaceutical Services.

Part 19.	surgical and recovery services.  The facility shall provide surgical and recovery services in conformance with the standards established in Chapter IV, Part 23, Surgical and Recovery Services.
2.4	Requirements of Chapter IV, Section 23, Surgical Suite and Recovery Room(s) shall apply only when surgical suite and services are provided within the facility.

Part 20.	Diagnostic Imaging Services.  The facility shall provide diagnostic imaging services in conformance with the standards established in Chapter IV, Part 24, Diagnostic Imaging Services or through an affiliation with a general hospital.
2.5	Requirements of chapter IV, Section, Radiological Services shall apply only when radiological services are provided within the FACILITY .  If not provided within the facility, radiological services shall be provided by affiliation with a General Hospital as set forth in 1.1 above.

Part 21.	Central Medical-Surgical Supply Services.  The facility shall[provide medical-surgical supply services in conformance with the standards established in Chapter IV, Part 26, Central Medical-Surgical Supply Services. 

Part 22.	Housekeeping Services.  The facility shall provide housekeeping services in conformance with the standards established in Chapter IV, Part 27, Housekeeping Services. 

Part 23.	Linen and Laundry services.  The facility shall provide linen and laundry services in conformance with the standards established in Chapter IV, Part 28, Linen and Laundry Services.

Part 24.	Maintenance services.  The facility shall provide maintenance services in conformance with the standards established in Chapter IV, Part 29, Maintenance Services. 

Part 25.	waste disposal services.  The facility shall provide waste disposal services in conformance with the standards established in Chapter IV, Part 30, Waste Disposal Services.   

Part 26.	physical plant.  The facility shall be in conformance with the standards established in Chapter IV, Part 31, Physical Plant.  
2 Applicability of Other Sections.  Maternity Hospitals shall conform to all sections of Chapter III, General Building and Fire Safety, and chapter IV, General Hospitals, except as modified hereafter: