(Amendments to 6 CCR 1011-1, Chapter XXI – Hospice – Adopted by the State Board of Health on March 18, 2009.  NOTE:  Items  in parentheses preceding the amendments are notes/instructions for the Secretary of State/CCR Publisher and are not part of the Rules)
(Change the chapter title, Par ID 854045, from “Hospice” to “Hospices” as follows) 
CHAPTER XXI  HOSPICES
(In the Definitions section, after Section 1.20, Par ID 854073, insert the following new definitions:)
1.21	Plan review means the review by the Department, or its designee, of new construction, previously unlicensed space, or remodeling to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter XXI.  Plan review consists of the analysis of construction plans/documents and onsite inspections, where warranted.  For the purposes of the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.  
1.22	Structural element for the purposes of plan review, means an element relating to load bearing or to the scheme (layout) of a building as opposed to a screening or ornamental element.  Structural elements of a building include but are not limited to:  floor joists, rafters, wall and partition studs, supporting columns and foundations.  
(Strike Section 14.34.5, Par ID 854457, and renumber succeeding sections, Par IDs 854458 through 854467, accordingly.)
(Strike section 14.35.1 and subsections (1) and (2) - Par IDs 854469, 854470 and 854471 - and replace with the following:)  
14.35.1	Hospices maintained as residential facilities shall provide documentation of approval from local zoning commissions, fire departments, code enforcement and building departments.

(Strike existing Part 17. References, in its entirety  - Par IDs 854498 through 854505 - and replace with the following new section:)  
17.  GENERAL BUILDING AND LIFE SAFETY CODE REQUIREMENTS
17.1	Compliance with the Life Safety Code.  Facilities with one or more inpatient or residential beds shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000), which is hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material. 
17.1.1	Facilities licensed on or before March 11, 2003 shall meet Chapter 19, Existing Health Care Occupancies, NFPA 101 (2000).  
17.1.2	Facilities licensed on or after March 11, 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, NFPA 101 (2000).  
17.1.3	Notwithstanding NFPA 101 Life Safety Code provisions to the contrary:
(1)	when differing fire safety standards are imposed by federal, state or local jurisdictions, the most stringent standard shall apply.
(2)	any story containing an exterior door or an exterior window that opens to grade level shall be counted as a story. 
(3)	licensed facilities shall be separated from unlicensed contiguous occupancies by an occupancy separation with a fire resistance rating of not less than 2 hours.  
(4)	a health care occupancy shall be defined as the operation in such occupancy of one or more inpatient or residential beds.  
17.2	Plan Review and Plan Review Fees.  Plan review and plan review fees are required as listed below.  If the facility has been approved by the Department to use more than one building for the direct care of patients on its campus, each building is subject to the applicable base fee plus square footage costs.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
17.2.1	Initial Licensure, Additions, Relocations 
(1)	Plan review is applicable to the following, and includes new facility construction and new occupancy of existing structures:  
(a)	applications for an initial license, when such initial license is not a change of ownership and the application is submitted on or after July 1, 2009.  
(b)	additions of previously uninspected or unlicensed square footage to an existing occupancy and the building permit for such addition is issued on or after July 1, 2009 or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009. 
(c)	relocations of a currently licensed facility in whole or in part to another physical plant, where the occupancy date occurs on or after July 1, 2009.
(2)	Initial licensure, addition, and relocation plan review fees:  base fee of $2,500, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-25,000 sq ft	$0.10	This is the cost for the first 25,000 sq ft of any plan submitted.	
25,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 25,000 sq ft.	
17.2.2	Remodeling  
(1)	Plan review is applicable to remodeling for which the application for the building permit from the local authority having jurisdiction is dated on or after July 1, 2009, or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009.  Remodeling includes, but is not limited to:
(a)	alteration, in patient sleeping areas, of a structural element subject to Life Safety Code standards, such as egress door widths and smoke or fire resisting walls.  
(b)	relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage or 50% or more of a smoke compartment.  
(c)	conversion of existing space not previously used for providing patient services, including storage space, to resident sleeping areas.  
(d)	changes to egress components, specifically the alteration of a structural element, relocation, or addition of an egress component.  Examples of egress components include, but are not limited to, corridors, stairwells, exit enclosures, and points of refuge.  
(e)	installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(f)	installation of any new fire alarm system, or addition, removal or relocation of 20 or more fire alarm system appliances including, but not limited to, pull stations, detectors and notification devices.
(g)	installation, removal or renovation of any kitchen hood suppression system.
(h)	essential electrical system:  replacement or addition of a generator or transfer switch.
(2)	Remodeling plan review fees:  base fee of $2,000, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-20,000 sq ft	$0.08	This is the cost for the first 20,000 sq ft of any plan submitted.	
20,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 20,000 sq ft.	
17.3	The “Guidelines of Design and Construction of Health Care Facilities” (2006 Edition), American Institute of Architects (AIA), may be used by the Department in resolving health, building, and life safety issues for construction initiated or systems installed on or after July 1, 2009.  AIA Guidelines are hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material.