CHAPTER XIV.  MATERNITY HOSPITALS
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.  
(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.	Definitions
2.100	
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. 
(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. 
(5)	“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 XIV.  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.  
Part 3.	DEPARTMENT OVERSIGHT
3.101	Application Fees.   Fees shall be submitted to the Department as specified below.
(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)	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)	Change of Ownership.  A license applicant shall submit a nonrefundable fee of $2,500 with an application for licensure.
(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)	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 Department shall assess the fee based on the anticipated costs of monitoring compliance with the conditional license.  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.
Part 4.	Fire Safety and Physical Plant Standards
4.101	Plan Review and Plan Review Fees.  Plan review and plan review fees are required as listed below in Sections (1) through (5).  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 4.101 (3), the fee in this Section 4.101 (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 4.101 (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 4.101 (3), the fee in this Section 4.101 (5) shall not apply.  Significant modifications include: 
(a)	Fire sprinkler:  100 or more sprinklers.  Notwithstanding the other provisions in this Section 4.101 (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.

4.102	Compliance with the Life Safety Code
(1)	The facility shall be in conformance with the standards established in Chapter IV, Section 4.102 (1).  This Section 4.102 (1) incorporates by reference, 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 referenced material.
Part 5.	Facility Operations.  The facility shall provide services in accordance with Subpart 5.100 - Central Medical-Surgical Supply Services, Subpart 5.200 - Housekeeping Services, Subpart 5.300 - Maintenance Services, Subpart 5.400 - Waste Disposal Services and Subpart 5.500 - Linen and Laundry Services.  
Part 6.	GOVERNance and Leadership.  The facility shall have a governing board, administrative officer, and medical staff in conformance with the standards established in Chapter IV, Part 6, Governance and Leadership.  In addition, the Chief of Staff shall be board certified in obstetrics and gynecology.  The qualifications of the medical staff shall meet the needs of the patients in accordance with the scope of services provided by the facility.
Part 7.	PERSONNEL Department.  The facility shall be in conformance with Chapter IV, Part 7, Personnel Department.
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.	INFECTION CONTROL SERVICES.  The facility shall provide infection control services in conformance with the standards established in Chapter IV, Part 9, Infection Control Services.  
Part 10.	Patient Rights.  The facility shall be in compliance with 6 CCR 1011-1, Chapter II, Part 6.  
Part 11.	GENERAL PATIENT CARE SERVICES.  The facility shall provide patient care services in conformance with the standards established in Chapter IV, Part 11, General Patient Care Services.
Part 12.	NURSING Services.  The facility shall have nursing staff in conformance with the standards established in Chapter IV, Part 12, Nursing Services.  The qualifications of the nursing staff shall meet the needs of the patients in accordance with the scope of services provided by the facility.
Part 13.	PHARMACEUTICAL SERVICES.  The facility shall provide pharmaceutical services in conformance with the standards established in Chapter IV, Part 13, Pharmaceutical Services.
Part 14.	laboratory services.  The facility shall provide laboratory services in conformance with the standards established in Chapter IV, Part 14, Laboratory Services. 
Part 15.	Diagnostic Imaging Services.  The facility shall provide diagnostic imaging services in conformance with the standards established in Chapter IV, Part 15, Diagnostic Imaging Services.
Part 16.	Dietary Services.  The facility shall provide dietary services in conformance with the standards established in Chapter IV, Part 16, Dietary Services.  
Part 17.	ANESTHESIA SERVICES.  The facility shall provide anesthesia services in conformance with the standards established in Chapter IV, Part 17, Anesthesia Services.
Part 18.	Emergency Services 
18.101	Organization and Staffing 
(1)	Each facility shall be organized and equipped to provide emergency treatment to patients who have been admitted to the facility.
(2)	Provision shall be made for medical staff coverage at any hour.
(3)	A roster of physicians on call, including physicians on second call, shall be posted, together with methods whereby specialized medical services may be obtained.
18.102	PROGRAMMATIC FUNCTIONS
(1)	Policies and procedures for staff action in the event of an emergency shall be developed by the medical staff and incorporated in a manual for staff use. 
(2)	The facility shall establish a transfer agreement with a general hospital to provide patients with a higher level of care when needed. 
18.103	EQUIPMENT AND SUPPLIES
(1)	Emergency equipment, supplies and medications shall be provided commensurate with the scope of emergency services as specified in the written policies and procedures. 
18.104	FACILITIES.  Reserved.  
Part 19.	OUTPATIENT Services.  The facility may provide outpatient services in conformance with the standards established in Chapter IV, Part 19, Outpatient Services.
Part 20.	Pregnancy, Labor and Delivery, and Nursery.  The facility shall provide pregnancy, labor and delivery, and nursery services.  Such services shall be in conformance with the standards established in Chapter IV, Part 20, Pregnancy, Labor and Delivery.  A maternity hospital licensed under this Chapter that is certified by the Centers for Medicare and Medicaid Services may elect to participate in a public umbilical cord blood collection program.  A maternity hospital that so elects shall comply with all requirements of 6 CCR 1011-1,Chapter IV, Part 20.150.  For the purpose of this Part 20, the term “hospital licensed under this Chapter” referenced in 6 CCR 1011-1, Chapter IV, 20.152 (1) extends to a maternity hospital licensed under this Chapter XIV.
Part 21.	surgical and recovery services.  The facility shall provide surgical and recovery services in conformance with the standards established in Chapter IV, Part 21, Surgical and Recovery Services.
Part 22.	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 22, Critical Care Services.
Part 23.	Reserved.
Part 24.	Reserved.
Part 25.	SOCIAL SERVICES
25.101	Organization and Staffing  
(1)	The facility shall provide appropriate social services to patients and families and consultation to the staff.
(2)	The social services may be provided by:  
(a)	A qualified social worker employed full or part time by the facility; 
(b)	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; 
25.102	PROGRAMMATIC FUNCTIONS.  Reserved.  
25.103	EQUIPMENT AND SUPPLIES.  Reserved.  
25.104	FACILITIES.  Reserved.  
Part 26.	Reserved.
Part 27.	Reserved.