CHAPTER IV  GENERAL HOSPITALS
Part 1.  Statutory Authority and Applicability 
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1.102	Applicability
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(3)	When differing standards are imposed by federal, state, or local jurisdictions, the most stringent standard shall apply. 

Part 2.	General Provisions 
2.100	Definitions
2.200	Department Oversight
2.100	Definitions
2.101	General Definitions
(1)	“Dietary Services Equipment” means an article used in the operation of dietary services, such as, but not limited to a freezer, grinder, hood, ice maker, oven, mixer, range, slicer, or warewashing machine.  Dietary Services Equipment does not include items used for handling or storing large quantities of packaged foods received from a supplier in a cased or overwrapped lot, such as forklifts, hand trucks, dollies, pallets, racks and skids.  
(2)	(1) “Department” means the Department of Public Health and Environment.
(3)	(2) “General hospital” means a health facility that, under an organized medical staff, offers and provides twenty-four hours per day, seven days per week, inpatient services, emergency medical and surgical care, continuous nursing services, and necessary ancillary services, to individuals for the diagnosis or treatment of injury, illness, pregnancy, or disability.
(a)	A general hospital may offer and provide, but is not limited to, outpatient, preventive, therapeutic, surgical, diagnostic, rehabilitative, or any other supportive services for periods of less than twenty-four hours per day.
(b)	Services offered or provided by a general hospital may be provided directly or by contractual agreement in compliance with the regulations.  Direct inpatient services shall be provided on the licensed premises of the general hospital.
(c)	A general hospital may provide services through the use of more than one physical location pursuant to the provisions of Chapter II, sections 2.3, 2.6, and 2.7 of these regulations.
(4)	(3) “Critical care unit” means a designated area of the hospital containing a grouping of single bedrooms or enclosures accommodating not more than 6 beds each, and providing particularized specialized facilities and services to care for patients who require continuing, acute observation and concentrated, highly proficient care. 
(5)	“Food-contact surfaces” means those surfaces of equipment and utensils with which food normally comes in contact, and those surfaces from which food may drain, drip, or splash back onto surfaces in contact with food.  This excludes ventilation hoods.
(6)	(4) “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.
(7)	“Licensed independent practitioner” means an individual permitted by law and the facility to independently diagnose, initiate, alter or terminate health care treatment within the scope of his or her license.  
(8)	(5) “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 and appropriate nursing care and clinical management of inpatients; and that is thereby planned, organized, operated, and maintained to function as a separate and distinct unit. 
(9)	“Pharmacist” means a person licensed by the Colorado State Board of Pharmacy as a pharmacist.
(10)	(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.  
(11)	(7) “Respiratory care” is that service which is organized to provide facilities, equipment, and personnel who are qualified by training, experience and ability to treat conditions caused by deficiencies or abnormalities associated with respiration. 
(12)	(8) “Surgical recovery room” means designated room(s) designed, equipped, staffed, and operated to provide close, individual surveillance of patients recovering from acute affects of anesthesia, surgery, and diagnostic procedures. 
(13)	“utensil” means any implement used in the storage, preparation, transportation, or service of food.

2.200	Department Oversight
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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 January 1, 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 Additions and Relocations.  Applicable to new construction including replacement facilities, structural additions of any size and prefabricated structures.  Applicable to additions of previously uninspected or unlicensed square footage under the license to an existing occupancy and relocations of a currently licensed facility in whole or in part to another physical plant.  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 January 1, 2008.  However, facilities for which the application for the building permit from the local authority having jurisdiction is dated prior to January 1, 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.	
Part 3.	GOVERNING BOARD 
3.101	ORGANIZATION & Staffing 
(1)	The governing board shall be organized formally with written constitution or articles of incorporation and by-laws, have meetings at regularly stated intervals, but at least quarterly, and maintain records of these meetings.
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(4)	The governing board shall provide personnel necessary for the welfare and safety of patients. professional and ancillary personnel in sufficient numbers, types and qualifications necessary to protect the health, welfare and safety of patients commensurate with the scope and type of services provided.  
3.102	PROGRAMMATIC FUNCTIONS.  The governing board shall:
(1)	provide services and hospital departments necessary for the welfare and safety of patients.  The scope of care and services shall be defined in writing.
(2)	be responsible for all the functions performed within the hospital.  
(3)	ensure that training programs in the safe management of patients are conducted each facility service/department provides monthly training regarding the care and services provided by the facility.
(4)	adopt a written emergency management plan.
(a)	at minimum, the plan shall address the following emergency situations:
(i)	loss of heat or air conditioning.
(ii)	unanticipated interruption of serve of utilities, including water, gas, and electricity either within the facility or within a local widespread area.
(iii)	fire, explosion, or other physical damage to the hospital.
(iv)	local and widespread weather emergencies or natural disaster disasters endemic to the region.
(v)	pandemics or other situations where the community’s need for services exceeds the availability of beds and services regularly offered by the hospital.  The hospital response for emergency epidemics shall be directed by 6 CCR 1009-5, Regulation 2 – Preparations by General or Critical Access Hospitals for an Emergency Epidemic.
(b)	at minimum, the plan shall address the following components of the facility response:
(i)	the responsibilities of those involved in the emergency management activities within the facility, including authority to activate the plan.
(ii)	patient triage, care, and discharge.
(iii)	staff education and training.
(iv)	coordination with the external entities involved in the implementation of the plan, which at minimum shall include the local fire department and emergency management office.
(v)	evacuation and relocation plans.
(vi)	training of all personnel in emergency management at least annually.

(5)	ensure that the patients receive care in a safe setting.
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Part 5.	MEDICAL STAFF
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5.102	PROGRAMMATIC FUNCTIONS
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(3)	The admitting diagnosis, history, and physical examination shall be completed no more than seven (7) thirty (30) days prior to admission or within twenty-four (24) hours after the patient's admission to the hospital.  If the examination was completed prior to admission, an admission status examination of the patient shall be completed and documented in the medical record within twenty-four (24) hours after admission.  {Explanatory note:  conformance with 42 CFR 482.22(c)(5)}

Part 6.	 NURSING DEPARTMENT Services
6.101	ORGANIZATION AND STAFFING
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(5)	19.102 (2)(a)  At least one registered nurse shall be on duty at all times in each patient care unit. One registered nurse shall be designated in charge and shall be delegated the authority and responsibility for the nursing services on that patient care unit. Additional registered nurses, licensed practical nurses, or other auxiliary personnel shall be available.  {Explanatory note:  this is existing language that was moved from Part 19, General Patient Care Services}
(6)	The supervising nurse shall be responsible for ensuring that all nursing staff have the qualifications, skills and experience necessary to deliver the care assigned in accordance with professional standards of practice and facility policy and procedure.
6.102	PROGRAMMATIC FUNCTIONS
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(2)	There should shall be a plan for continuous evaluation of nursing care including that of private duty nurses.  The evaluation shall be patient-centered.  The nursing department should periodically evaluate the adequacy of facilities in terms of patient and nursing needs, and participate in planning facilities and services. 
(3)	Nursing staff shall conduct initial and ongoing assessments and screenings of the patient’s physical, cognitive, behavioral, emotional and psychosocial status individualized to meet the needs of the patient.  
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Part 7.	PERSONNEL
7.101	Organization and Staffing
(1)	Each hospital department or service shall have written organizational policies and procedures that identify the scope of the services to be provided, the lines of authority and accountability and the qualifications of the personnel performing the services.  Such policies and procedures shall be made available to employees at all times. 
(2)	Each department or service of the hospital shall be under the direction of a person qualified by training, experience, and ability to direct the department or service.
(3)	There shall be sufficient qualified personnel qualified by education and experience in each department or service to properly operate the department or service.
(4)	Facility staff shall be licensed or registered in accordance with applicable state laws and regulations. 
(5)	All persons assigned to the direct care of or service to patients shall be prepared through formal education, as applicable, and on-the-job training in the principles, the policies, the procedures, and the techniques involved so that the welfare of patients will be safeguarded.
7.102	Programmatic Functions
(1)	There shall be personnel records on each person of the hospital staff including employment application and verification of licensure, competencies and credentials for medical and professional staff.
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Part 8.	MEDICAL RECORDS DEPARTMENT 
8.101	ORGANIZATION AND STAFFING 
(1)	A complete and accurate medical record shall be maintained on every patient from the time of admission through discharge.  In addition, complete and accurate medical records shall be maintained for patients receiving emergency and outpatient services.
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8.102	PROGRAMMATIC FUNCTIONS
(1)	Medical records shall be stored safely to in a manner so as to:
(a)	provide protection from loss, damage, and unauthorized use.
(b)	preserve the confidentiality of health information.
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(5)	All orders for diagnostic procedures, treatments, and medications shall be signed by the physician or other licensed practitioner as authorized by law submitting them and entered in the medical record in ink or in type. The prompt completion of a medical record shall be the responsibility of the attending physician or other practitioner authorized by law. Authentication may be by written signature, identifiable initials or computer key. The use of rubber stamp signatures is acceptable under the following strict conditions:
(a)	The physician or other practitioner authorized by law whose signature the rubber stamp represents is the only one who has possession of the stamp and is the only one who uses it; and
(b)	The physician or other practitioner authorized by law places in the administrative offices of the hospital a signed statement to the effect that he or she is the only one who has the stamp and is the only one who will use it.  
(6)	The content of patient records shall be as follows.  
(a)	All patient records shall include the following:  
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(xi)	Nursing notes.  Progress notes, assessments, and plans of care.
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(xvi)	Autopsy protocol, if any.
(xvii)	As applicable, physical therapy/occupational rehabilitation services therapy treatment records to include a prescription and/or order for treatment signed by the physician, progress notes of the physical/occupational rehabilation therapist, and results of special tests and measurements.
(b)	Inpatient records shall include the following:
(i)	Date and time of admission and discharge.
(ii)	Admission diagnosis.
(iii)	Discharge plan and discharge summary, with outcome of hospitalization.  If the patient is discharged in less than 24 hours, the discharge summary and plan may be included in the physician’s progress notes. 
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Part 12.	DIETARY SERVICES 
12.101	ORGANIZATION AND STAFFING
(1)	There shall be an organized food service planned, equipped, and staffed to serve adequate meals to patients according to physicians' orders.  (4) Food prepared outside the hospital shall be from sources that comply with these regulations and other applicable laws and regulations. 
(2)	A dietitian or person qualified by training and experience in food service shall direct the dietary services.
(3)	A registered dietitian shall be responsible for the nutritional aspects of care, including but not limited to, the evaluation of the nutritional status and needs of patients, the review of modified and special diets for nutritional adequacy, and patient counseling. 
(4)	If 24-hour dietary services are not provided, other means of providing nourishment for patients shall be made available.
(5)	the facility’s dietary services shall be integrated, as necessary, with other departments and services of the facility, including but not limited to, infection control and pharmacy.  
12.102	PROGRAMMATIC FUNCTIONS
(1)  Policies and procedures for dietary practices shall be written. 
(1)	Patient Care
(a)	the nutritional needs of the patients shall be met in accordance with recognized dietary standards and in accordance with orders of the licensed independent practitioners responsible for the care of the patient. 
(b)	The facility shall develop and implement policies and procedures regarding:
(i)	the triggers and processes for conducting:  nutritional risk screening; assessment of clinically relevant malnutrition; and the integration of therapeutic interventions into the patient’s care plan.
(ii)	infection control methods for the provision of services to patients in isolation.  These policies and procedures shall be developed in conjuction with and reviewed periodically by the Infection Control Committee. (9)  Food served to patients in isolation, because of infectious diseases, shall be in disposable utensils or in utensils that shall be sterilized.
(2)	Therapeutic Diets
(c)	(a) All Therapeutic diets and nourishments shall be served as prescribed by the attending physician licensed independent practitioner.  (b)  A current diet manual shall be available to medical staff and personnel for fulfilling dietary prescriptions.
(d)	(3)(a) Menus shall be varied to meet patient needs.  Personal tastes, desires, and cultural patterns and religious beliefs of patients shall be considered and reasonable menu adjustments made.  (3)  Menus  (b)  Rotating menus are recommended.
(2)	Food:  Condition, Preparation/Handling, Storage
(a)	Condition
(i)	Food shall be in sound condition, free from spoilage, misbranding, or contamination, and shall be safe for human consumption.  
(ii)	 (4) All food served shall be from approved sources, and shall meet the standards of quality as established by applicable laws and regulations.  Approved sources are those that are acceptable to the Department, or it authorized agents, and employees based on determination and conformance with applicable documented standards and good health practices.
(iii)	 (7) Poisonous and toxic materials shall be labeled, stored separately from food, and used only in such ways that they will neither contaminate food nor be hazardous to employees.
(b)	Preparation and Handling
(i)	Food shall be palatable and prepared using methods that conserve nutritive value, flavor, and appearance.  
(ii)	(6) (a) Unwrapped food on display for service shall be protected against contamination by counter-protector sneeze guards and other devices. 
(iii)	(6) (a) Food being conveyed should shall be covered, completely wrapped or packaged to protect from contamination.
(iv)	(6) (b) Potentially perishable foods shall be maintained at a temperature of 41°F (5°C) 45° F. or below, or 135°F (57°C) 140° F. or above. {Explanatory Note:  the changes mirror standards set in the Colorado Retail Food Establishment regs, 6 CCR 1010-2, Sec 3-401.} Other foods should be stored at approximately 50° F.  
(v)	(6) (c) Convenient and suitable utensils, including self-service, such as forks, knives, tongs, and spoons shall be used to handle food at all points where food is prepared and served.
(c)	Storage
(i)	12.104 (3)  Containers of food shall be stored above the floor on clean racks, dollies, or other clean surfaces to protect them from contamination.
(ii)	Stored foods shall be clearly identifiable and dated, as appropriate.
(iii)	 (7) Poisonous and toxic materials shall be labeled, and stored separately from food., and used only in such ways that they will neither contaminate food nor be hazardous to employees.
(iv)	Food shall not be placed under:  sewer lines; water lines that are not protected to intercept potential drips, including leaking automatic fire protection sprinkler heads; or lines on which water has condensed. 
(3)	Hygienic Practices.  The facility’s dietary services shall be operated in a manner that prevents foodborne illness.
(a)	(5) Personal Staff Hygiene 
(i)	(5)(a) Employees shall wash their hands thoroughly in an approved a hand washing facility before starting work and as often as may be necessary to remove soil and contamination. Each employee shall wash his hands before resuming work after visiting the toilet room.  Handwashing shall not be conducted in kitchen sinks used for cleaning kitchenware or as part of food preparation; instead, separate handwashing facilities shall be used. 
(ii)	(5)(b) All dietary employees shall wear hair nets, head-bands, caps, or other effective hair restraints.  Beards and mustaches that are not closely cropped shall be covered.
(iii)	(5)(c) Employees shall not use tobacco in any form while engaged in food preparation, service, or equipment washing areas.
(iv)	No person, while infected with a disease in a communicable form which can be transmitted by foods or who is afflicted by a boil, or an infected wound, shall work in a food service setting in any capacity in which there is a likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting diseases to other persons.  {Explanatory note:  this language is taken from DCEED Division 6 CCR 1009-1, Regulation 7}
(b)	Food-contact surfaces, dietary services equipment, and utensils shall be:
(i)	non-toxic, smooth, made of impervious materials, free of open seams, not readily corrosible, and free of difficult-to-clean internal corners and crevices. 
(ii)	clean to sight and touch, except when current or recent usage precludes it. 
(iii)	cleaned and disinfected in a manner and at intervals that are in accordance with recognized standards and the facility’s written policies and procedures.  Food contact surfaces shall cleaned and disinfected using methods and agents approved as safe for food contact surface application and either at intervals not to exceed four hours when the surface is in continuous use ,or if not in continuous use, after final use each work day.
(c)	Warewashing
(i)	Utensils shall be pre-rinsed or pre-scraped, and when necessary pre-soaked to remove gross particles and soil. 
(ii)	Manual Warewashing.  Sinks shall be cleaned and disinfected before use. A thermometer shall be readily available and frequently used to monitor temperatures.  The temperature of the wash solution shall be not less than 110°F (43°C) unless a different temperature is specified on the cleaning agent manufacturer’s label instructions.  Ware shall be rinsed free of detergent and abrasive with clean water; disinfected and air-dried.  Disinfection shall be conducted in accordance with one of the following methods:
(A)	Immersion for at least 1 minute in a clean solution containing a minimum of 50 parts per million (mg/L) and no more than 200 parts per million (mg/L) of available chlorine as hypochlorite and having a temperature of at least 75°F (24°C); or
(B)	Immersion for at least 1 minute in a clean solution containing at least 12.5 parts per million of available iodine, having a pH range not higher than 5.0, unless otherwise certified to be effective by the manufacturer, and at a temperature of at least 75°F (24°C); or
(C)	Immersion in a clean solution containing a quarternary ammonia product or any other chemical sanitizing agent allowed under Sanitizers, 21 CFR Section 178.1010.  {Explanatory Note:  the changes mirror standards set in the Colorado Retail Food Establishment regs, 6 CCR 1010-2, Sec 4-403(A)(8)(d) and (4-403(A)(10)(b-d)} 
(iii)	Mechanical Warewashing.  Commercial ware washing machines shall be used.  Machines shall be operated in accordance with manufacturers’ instructions.  Easily readable thermometers shall be provided to indicate the temperature of the water in each tank of the machine and the temperature of the final rinse as it enters the manifold. (10)(a) A suitable detergent in effective concentration shall be used. Wash water shall be kept reasonably clean, and washing cycle properly timed. The wash water temperature shall be compatible with the detergent used. The final rinse water shall be unused water at temperature not less than 180° F. manifold temperature, 170° F. on the surface of the dishes. Rinsing cycles shall be timed accurately.  
(iv)	(10) (b)  Utility ware, pots, pans, and similar utensils shall be cleaned in an area separated from the dishwashing operation. 
(v)	 (10) (c)  Separate drainboards shall be used for soiled utensils prior to washing and for clean utensils following disinfecting.
(d)	Clean Environment
(i)	The walls, ceiling and floors of all areas where food is stored, prepared or served shall be kept clean and in good repair.
(ii)	All non-food contact surfaces of equipment, including transport vehicles, shall be cleaned as often as necessary to keep the equipment free from the accumulation of dust, dirt, food particles, and other debris.
(iii)	Dietary services areas and loading docks shall be protected from and free of vermin. (12)	Storage rooms, loading docks, and premises shall be free from rodent and insect infestation, odors, dust, and other sources of contamination.
(e)	Storage.  Utensils and dietary services equipment shall be cleaned and disinfected prior to storage.   {Explanatory note:  The language in this section mirrors the Colorado Retail Food Establishment Regs, specifically:  6 CCR 1010-2, Section 4-601, Equipment and Utensil Storage}
(i)	Cleaned and disinfected utensils and dietary services equipment shall be handled in a way that protects them from contamination.
(ii)	Spoons, knives, and forks shall be touched only by their handles.  Cups, glasses, bowls, plates, and similar items shall be handled without contact with inside surfaces or surfaces that contact the user’s mouth. (8)Storage and Handling of Utensils  (8) (a) Clean cups and glasses shall be handled so that fingers do not contact inside or lip-contact surfaces.
(iii)	Cleaned and disinfected utensils and dietary services equipment shall be stored 6 inches above the floor in a clean, dry location in a way that protects them from contamination by splash, dust, and other means.
(iv)	Utensils and dietary services equipment shall not be placed under:  sewer lines; water lines that are not protected to intercept potential drips, including leaking automatic fire protection sprinkler heads; or lines on which water has condensed. 
(v)	Utensils shall be air-dried before being stored or shall be stored in a self-draining position.
(vi)	Glasses and cups shall be stored inverted.  Other stored utensils shall be covered or inverted, wherever practical.  Facilities for the storage of knives, forks and spoons shall be designed and used to present the handle to the staff or user.  Unless tableware is pre-wrapped, holders for knives, forks and spoons at self-service locations shall protect these articles from contamination and present the handle of the utensil to the consumer.  
(8) (b) Portable equipment and utensils shall be cleaned, disinfected, and stored above the floor in a clean, dry location.  Utensils shall be air-dried before storing. Stored containers and utensils shall be covered or inverted.  Disposable serving utensils shall be stored, handled, and dispensed to prevent contamination; and shall be used only once.
(10)	Ware Washing and Storage
 (10) (a)  If washable dishes are used, commercial-type mechanical dishwashing equipment shall be provided equipped with an easily readable thermometer in each tank. In case of new hospital construction, or modification of an existing hospital facility this equipment shall be physically separated from food preparation and service areas. Equipment and utensils shall be prescraped and, when necessary, presoaked to remove soil. In case of new hospital construction, or modification of an existing hospital facility, the dishwash room must be arranged such that clean dishes are discharged from the dish machine onto a clean dish table outside of the dishwash room. Only air drying shall be employed after washing and rinsing. All dishes and utensils shall be stored in clean, dry areas free of contamination.  
(f)	Waste Disposal
(i)	(11) Garbage and refuse located in the dietary services area shall be placed in impervious containers equipped with tightly fitting covers when filled or stored, or not in continuous use. 
 (11) Containers shall be stored in a safe area or refrigerated space pending removal and shall be removed from the premises and cleaned at frequent intervals.
12.103	EQUIPMENT AND SUPPLIES
(1)	(3) Adequate equipment shall be provided for efficient preparation of meals.  Equipment and utensils should be resistant to denting, pitting, chipping, and excessive wear; should withstand repeated scrubbing, scouring, and corrosive action of cleaning and disinfecting agents; and should be in good repair.
(2)	(1) A minimum of two units of refrigeration shall be provided to protect foods kept on hand. Refrigerators and storerooms used for perishable foods shall be equipped with reliable thermometers.
(3)	(2) Walk-in refrigerators and freezers shall have inside lighting and inside lock releases, or an audiovisual signal system as a suitable safety device.
 (4)	Food-contact surfaces of equipment and utensils shall be smooth; free from breaks, open seams, cracks, chips, and similar imperfections; and free of difficult-to-clean internal corners and crevices.
(5)	Cutting blocks, boards, and table tops should be of hard material which is non-toxic; smooth; and free of cracks, crevices, and open seams.
(4)	(6) Equipment on tables or counters, unless readily movable, shall be installed so as to facilitate cleaning and safety.
(5)	(7) Floor-mounted equipment, unless readily movable shall be sealed to the floor to prevent liquids or debris from settling under the equipment. Lubricated bearings and gears shall be constructed so that lubricants cannot get into the food.
(6)	(8) Food waste grinders shall be installed in compliance with applicable laws and regulations and manufacturer’s instructions.
12.104	FACILITIES
(1)	Adequate space shall be provided to allow for fixed and movable equipment and employee functions for receiving and storage, refrigeration, food preparation, and dishwashing. and scullery.
(2)	Clean, well-ventilated food storerooms shall be provided. Food when being stored, prepared, displayed, served, or sold shall be protected from contamination.
(3)	Containers of food shall be stored above the floor on clean racks, dollies, or other clean surfaces to protect them from contamination.
(4)	Facilities and systems for storage of silverware shall be designed and maintained to prevent contamination.
(5)	Areas for preparing food and storing and cleaning utensils shall be adequately lighted.
(6)	Rooms for preparing and serving food and washing utensils warewashing shall be well ventilated. Filters shall be readily removable for cleaning or replacement.
(7)	Adequate, clean toilet facilities shall be provided.
(8)	Approved Handwashing facilities with soap and sanitary hand-drying accommodations shall be conveniently provided. In the case of new hospital construction, or modification of an existing hospital facility, this must be provided within the kitchen area.
(9)	Separate two-compartment sinks are required for manual washing operations, and they shall be of such length, width, and depth to permit complete immersion of equipment and utensils.  
(10)	In the case of new hospital construction, or modification of an existing hospital facility, the following shall apply:
(a)	Cart washing space must be provided, preferably in the dishwashing area. Hot water and a floor drain must be provided in this area.
(b)	A lounge, complete with lockers and toilet facilities for the dietary staff shall be provided near the kitchen.
(c)	Dining area(s) must be provided for staff, visitors and patients.
(d)	Warewashing Operations
(i)	12.102 (10)(a) Commercial mechanical dishwashing equipment shall be physically separate from food preparation and service areas.
(ii)	(9) In case of new hospital construction, or modification of an existing hospital facility, this area the area for The manual washing of utility ware, pots, pans and similar utensils must be physically separated from the dishwashing operation.
(ii)	12.102 (10)(a) The dishwash room shall be arranged such that clean dishes are discharged from the dish machine onto a clean dish table outside the dishwash room.
(iii)	(9) In the case of new hospital construction, or modification of an existing hospital facility, each compartment shall be supplied with hot and cold water under pressure through a mixing faucet.  On or after March 2, 2010, Separate three-compartment sinks are required for manual washing operations, and they shall be of such length, width, and depth to permit complete immersion of equipment and utensils.  Each sink compartment used in manual warewashing operations shall be supplied with hot and cold water under pressure through a mixing faucet.
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Part 18.	OCCUPATIONAL AND PHYSICAL THERAPY SERVICES 
18.100	Occupational Therapy
18.200	Physical Therapy
18.100	Occupational Therapy
18.101	ORGANIZATION AND STAFFING
(1)	The hospital may provide occupational therapy services.  The following standards shall apply only if the hospital provides such services.  
(2)	Occupational therapy services shall be rendered only by individuals qualified by training and experience.
18.102	PROGRAMMATIC FUNCTIONS
(1)	There shall be written policies identifying the organization, administration, performance standards, and direction and supervision of patient care rendered. 
18.103	EQUIPMENT AND SUPPLIES
(1)	There shall be appropriate equipment as determined by the professional staff to be essential to the requirements of care and treatment of referred patients.
18.104	FACILITIES
(1)	There shall be adequate facilities, space, and storage areas as determined by the professional staff to be essential to the requirements of care and treatment of referred patients.

18.200	Physical Therapy
18.201	ORGANIZATION AND STAFFING
(1)	The hospital may provide physical therapy services.  The following standards shall apply only if the hospital provides such services.  
(2)	The physical therapy services shall be under medical direction. This may be 1) A committee of the organized medical staff, or 2) A designated physician qualified by training and experience.
(3)	Physical therapy shall be rendered only by a physical therapist licensed to practice in the State of Colorado. All personnel assisting with the physical therapy of patients must be under the direct supervision of a licensed physical therapist.
18.202	PROGRAMMATIC FUNCTIONS
(1)	There shall be written policies governing physical therapy services.
18.203	EQUIPMENT AND SUPPLIES
(1)	There shall be appropriate equipment as determined by the professional staff, to be essential to the requirements of care and treatment of referred patients.
18.204	FACILITIES
(1)	The physical therapy services shall be located in an area convenient for in and out patients.
(2)	There shall be adequate facilities, space, appropriate equipment, and storage areas as determined by the professional staff to be essential to the requirements of care and treatment of referred patients.
Part 18.	REHABILITATION SERVICES
18.101	Organization and Staffing
(1)	The facility may provide rehabilitation services.  The following standards apply only if the facility provides such services.  Rehabilitation services includes physical therapy, occupational therapy, audiology, speech pathology, and other rehabilitative therapies.  
(2)	Rehabilitation services shall be performed under the supervision of qualified practitioners. 
(3)	The facility may provide a rehabilitation service under either a single-service or a multi-service rehabilitation department. 
(4)	The director of single- or multi-service rehabilitation department shall have the necessary education, training and experience to direct the services provided by the department. 
(5)	There shall be a sufficient number of qualified staff to evaluate each patient, initiate the plan of treatment, and supervise supportive personnel.
18.102	Programmatic Functions
(1)	Rehabilitation services shall be delivered in accordance with orders issued by the attending licensed independent practitioner or provided within the scope of practice and facility policy for the delivery of care provided by the therapist.
(2)	The facility shall develop and implement written policies and procedures governing the management and care of patients.  At minimum, the policies and procedures shall address:
(a)	initial patient evaluation and regular assessments.
(b)	care plans.  Care plans shall describe the patient’s: functional limitations; measurable short and long term goals; and type, amount, frequency and duration of services.
(c)	ensuring that the patient’s response to treatment is relayed to the attending licensed independent practitioner in a timely manner.
(d)	If rehabilitation services are provided on an outpatient basis, the facility shall specify how orders from outside sources will be managed.  
(3)	Treatment and progress shall be documented, including progress toward long and short-term goals for each visit or session.  
18.103	Equipment and Supplies
(1)	There shall be appropriate equipment and supplies to meet the rehabilitative care needs of patients.  
(2)	Equipment shall be appropriately cleaned and disinfected after use.
18.104	Facilities
(1)	There shall be adequate facilities, space and storage areas to meet the rehabilitative care needs of patients.

Part 19.	GENERAL PATIENT CARE SERVICES 
19.101	ORGANIZATION AND STAFFING
(1)	There shall be patient care services commensurate with the services provided by the facility.  The Facility shall provide patient care in accordance with recognized standards of practice, facility policy and procedure, medical orders, and the established plan of care.  
(2)	The nursing care required by different types of patients shall be the major consideration in determining the number, quality, and category of nursing personnel that are needed in any given situation.  {Explanatory note:  This provision is a duplicate of Part 6, Nursing Department, Section 6.101 (3).}
19.102	PROGRAMMATIC FUNCTIONS
(1)	Admissions
(a)	Each patient admitted to the hospital shall have a visible means of identification placed on his or her person.
(b)	No patient shall be admitted for inpatient care to any room or area other than one regularly designated as a patient bedroom. There shall be no more patients admitted to a patient bedroom than the number for which the room is designed and equipped.  Emergencies are exceptions.
(c)	Patients shall only be accepted for care and services when the facility can meet their identified and reasonably anticipated care, treatment, and service needs.  
(2)	Patient Care Unit.  (b) Written policies for patient care shall be established.  Policies and Procedures.  Written policies and procedures shall be developed and implemented by each department/service that provides direct patient care including, but not limited to:
(a)	procedures for medical emergencies. 
(b)	coordination of care across multiple services/departments, as applicable.
(a)	At least one registered nurse shall be on duty at all times in each patient care unit. One registered nurse shall be designated in charge and shall be delegated the authority and responsibility for the nursing services on that patient care unit. Additional registered nurses, licensed practical nurses, or other auxiliary personnel shall be available. {Moved to Part 6 Nursing Department} 
(3)	Patient Assessment and Care Plan  
(a)	Patient assessments shall document patient needs, capabilities, limitations and goals.  Qualified staff shall:
(i)	conduct an initial assessment of the patient’s physical and psychological status.
(ii)	conduct an assessment or screening upon each initial contact with therapy, social, nursing, and dietary services and at regular intervals thereafter.  
(b)	(3) A nursing care plan shall be prepared for each patient, (3) The plan shall be reviewed and revised as needed.  Care plans shall:
(i)	be in writing and maintained current.
(ii)	be individualized and designed to meet the patient’s needs.
(iii)	demonstrate patient-centered coordination when the patient is receiving services from multiple departments/services.  
(iv)	address the pain management needs of the patient.
(4)	Medications
(a)	Medications shall be identified with at least the name, strength, dosage, and frequency and mode of administration of the medication; and the name of the patient for whom the medication is prescribed.  This identification shall be verified not only when the medicine is prepared but also when it is administered. {Moved to Pharmaceutical Services}
(4)	(5) Orders
(a)	Medications and treatments shall be given only on the order of a physician or other practitioner authorized by law. 
(b)	Verbal orders.  Verbal orders shall be:  
(i)	(c) Physician orders for treatment may be received by members of the appropriate discipline as specified by law and approved by the medical staff, nursing services, and the governing board.  Orders shall be reduced to writing.
(ii)	(5)(d)  Orders shall be transferred to the medical record by a member of the specific discipline responsible for implementing the order.
(iii)	authenticated within 24 hours.
(c)	(5)(b) Orders shall be received by a house physician or registered nurse; shall be written and shall include the date, time, practitioner giving the order, and specifications of the order.  For medications, the name, strength, dosage, frequency and route of administration shall be indicated.
(d)	(5)(e) Orders prescribing dangerous drugs, i.e., narcotics, sedatives, anticoagulants, antibiotics, etc., shall include a time limit. Such time limit shall be agreed upon by the medical staff and shall be so recorded in the rules and regulations of the organized medical staff.  
(e)	Medical staff in conjunction with the pharmacist shall establish standard stop orders for all medications not specifically prescribed as to time or number of doses.  
(5)	Discharge Planning  
(a)	The facility shall develop a discharge plan for each inpatient.  Discharge planning shall be initiated early in the care, service or treatment process.  
(b)	The facility shall develop and implement policies and procedures regarding discharge planning.  At minimum, the policy and procedure shall address:
(i)	the discharge planning process.
(ii)	the qualifications of the staff responsible for implementing discharge planning.
(iii)	initiation of discharge planning in a timely manner to allow for the arrangement of post-hospital care, as needed.
(iv)	evaluation of the discharge planning process periodically for effectiveness.  
(c)	The discharge plan shall:
(i)	include an evaluation of the post-hospital care needs of the patient and the availability of corresponding services.
(ii)	identify the role of the facility staff, patient, patient’s family or designated representative in initiating and implementing the discharge planning process.
(d)	For a patient with a discharge plan indicating the need for a post-hospital health care service, the facility shall:
(i)	inform the patient of the patient’s freedom to choose among providers of post-hospital care. 
(ii)	provide a comprehensive list of relevant, licensed post-hospital care providers in the geographic area requested.  The information regarding post-hospital providers shall be presented in a manner that does not unduly direct patients to use a provider in which the hospital or hospital personnel has a financial stake.
(iii)	ensure that the receiving health care provider and the patient’s primary care physician receive written documentation of the patient’s discharge diagnosis, continuing care orders, current medications prior to discharge and the patient’s discharge or transfer instructions.  Documentation shall also include contact information for the attending licensed independent practitioner.  The admission and discharge summary shall be forwarded to the receiving health care facility within 14 days of discharge. 
(e)	For a patient with a discharge plan who is not transferred to another facility, the facility shall provide the patient with:
(i)	a contact to call in case the patient has questions after discharge.
(ii)	written instructions about self-care, follow up care, modified diet, and medications, signs and symptoms to be reported to the practitioner, if relevant. 
(f)	The facility shall prepare a discharge summary to facilitate continuity of care that is signed by the attending physician and includes the following:
(i)	reason for admission.
(ii)	significant findings.
(iii)	procedures and treatment provided.
(iv)	patient’s discharge condition.
(v)	patient and family instructions.
(vi)	a medication list indicating new, changed, or discontinued.
(vii)	a list of outstanding medical issues and pending tests at the time of discharge that require follow-up.
(6)	Program Evaluation.  Each patient care unit shall conduct patient-oriented evaluations of the care provided.  Adverse events and outcomes shall be subject to immediate review.  {Explanatory Note:  This will be addressed in the future, in a quality assurance section.}
19.103	EQUIPMENT/FURNITURE AND SUPPLIES
(1)	All equipment used for patient care services shall be used in accordance with current standards practice, documented policies and procedures of care, as well as manufacturer’s instructions. 
(2)	(1)  The following shall be readily available at all times: 1) Oxygen; 2) Suction; 3) Portable emergency equipment, supplies and medications; 4) Compatible supplies and equipment for immediate intravenous therapy.
(3)	(2)  Patient bedrooms shall be equipped with movable furniture and equipment with the following for each patient: 1) Adjustable, washable bed with side rails; 2) Cabinet or bedside table; 3) Overbed table; 4) Complete personal care equipment that is sterile sanitized or disposable including water carafe, mouth wash cups, emesis basin, wash basin, bedpan and urinal (when necessary).

. . . 
Part 21.	PHARMACEUTICAL SERVICES
21.101	ORGANIZATION AND STAFFING
(1)	The pharmaceutical services of the hospital shall be organized and maintained primarily for the benefit of the hospital patients, and shall be operated in accordance with federal and state laws and regulations. 
(2)	The pharmacy service shall be under the direction or direct supervision of a pharmacist licensed to practice pharmacy in the State of Colorado.  
(3)	Provision shall be made for convenient and prompt 24-hour availability of drugs for administration to patients.  Emergency pharmacy services shall be available 24 hours per day.  If a pharmacist is not available on site on a 24-hour basis, a pharmacist shall be available on-call within 30 minutes.  
(4)	A pharmacist shall be responsible for compounding, preparing, labeling, transferring between containers, and dispensing drugs, including direct supervision of qualified personnel performing such tasks. 
21.102	PROGRAMMATIC FUNCTIONS
(1)	Written policies shall be developed by the hospital and the supervising pharmacist to indicate the pharmacist’s responsibility for periodic inspection of medications, dispensing, inventory control, and establishment of necessary records.
(1)	The pharmacist shall initiate and develop policies of the service.    Pharmacy and Therapeutic Commmittee.  There should shall be a hospital pharmacy and therapeutic committee to assist in the formulation of broad professional policies regarding the evaluation, selection, procurement, distribution, use, safety procedures, and other matters relating to drugs in hospitals. It is recommended that a formulary be adopted and operations be under the formulary system.
(3)	Unused prepared medications shall be disposed of in accordance with documented procedures.
(4)	A pharmacist's responsibilities shall include: 1) Preparation of pharmaceuticals; 2) Filling and labeling of all drug containers from which medications are to be administered; 3) Dispensing of drugs, antibiotics, biological, and pharmaceutical preparations which shall meet the standards established by the United States Pharmacopeia, National Formulary, or New and Non-official Drugs: 4) Dispensing of narcotics, hypnotics, amphetamines, alcohol preparations, and the maintenance of a perpetual inventory of them; 5) Maintenance of an approved stock of antidotes and emergency drugs; 6) Periodic inspection of all pharmaceuticals and biological supplies on all services; 7) Distribution of information concerning medications to physicians, dentists, and nurses; 8) Preparation, sterilization, and analysis of injectable medications when compounded in the pharmacy; 9) Establishment and maintenance of a system of records and accounting in accordance with hospital policies.
(5)	Only physicians, who are so authorized under the laws of the State of Colorado, and are registered with the Director of Internal Revenue, shall prescribe narcotics.
(2)	Compliance with External Standards.  Pharmacies shall:
(a)	be registered by the Colorado State Board of Pharmacy.  
(b)	have a current Drug Enforcement Administration registration.
(3)	Inventory.  The facility shall develop and implement policies and procedures regarding:
(a)	stocking of medications.  The pharmacy shall maintain a current formulary of approved drugs and biologicals.  The facility shall maintain an adequate stock of the medications listed in the formulary.  The facility shall be responsible for the quality, quantity and sources of supply of all medications. Drug Stocks shall not contain outdated, unusable, or mislabeled products.  
(b)	pharmaceutical service transactions.  Current records shall be maintained that account for the receipt, distribution, disposition, and destruction of drugs and biologicals. 
(c)	controlled substances and other drugs subject to abuse and illegal distribution.  The receipt, distribution, administration, and disposition of controlled substances shall be readily traceable. Mechanisms shall be implemented to ensure the security of the drugs and prevent and detect the diversion of controlled substances and other drugs that be abused or illegally sold.  When diversion is detected, corrective measures shall be implemented, as appropriate.
(d)	after-hours access.  If the pharmacy is not open 24 hours, 7 days per week, the facility shall have a policy and procedure regarding after-hour access.  The policy and procedure shall specify the personnel permitted access to the drug storage area(s). There shall be accountability for all doses of drugs removed when the pharmacist is not present.  Such policy shall be consistent with rules promulgated by the Colorado State Board of Pharmacy. 
(e)	recall and drug discontinuation management.  The facility shall alert appropriate staff to remove any drugs or biologicals subject to a recall or discontinuation for safety reasons.  
(f)	disposal of unused prepared medications.
(4)	Storage.  The facility shall develop and implement policies and procedures regarding:
(a)	the prevention of unauthorized access to drugs and biologicals.  All drugs and biologicals shall be kept in a secure area.  All controlled drugs shall be kept in a locked secure area. 
(b)	maintenance of therapeutic integrity.  Drugs and biologicals shall be stored under the proper conditions of sanitation, temperature, light, moisture, ventilation, and segregation. 
(5)	Medication Administration.  19.102 (4) (a) Medications shall be identified with at least the name, strength, and dosage.  and frequency and mode of administration of the medication; and the name of the patient for whom the medication is prescribed.  This identification shall be verified not only when the medicine is prepared but also when it is administered.  Prior to administration, the name, strength, dosage, frequency and route of administration on the patient order shall be checked.  The facility shall develop and implement policies and procedures regarding:
(a)	safe administration of drugs and biologicals.  Only persons who are appropriately trained and authorized by law and the facility shall administer medications.
(b)	monitoring and documenting the effects of medication, including but not limited to, the  process for monitoring the first dose of a medication that has been identified as one with the potential for serious adverse reactions.
(c)	identification and reporting of adverse reactions, interactions, and medication errors.
(d)	self-administration.  Policies and procedures shall include, but not be limited to, storage and documentation of the self-administered drugs.  Patients shall only be permitted to self-administer medications pursuant to an order from a licensed independent practitioner.  
(e)	use of the patient’s own medications.  Drugs and biologicals brought into the facility by the patient may be administered only if the medication can be accurately identified by the pharmacy, secured, and pursuant to an order from an the attending licensed independent practitioner. 
(f)	medications brought into the facility by practitioners to be administered to patients.  
(6)	Information resources.  Up-to-date resources shall be made readily available to professional staff regarding the appropriate use of drugs and biologicals, including but not limited to:  therapeutic use, potential adverse effects, dosage, and routes of administration.
(7)	Medication Use.  There shall be an ongoing medication use evaluation program, described in writing, to determine that medications are used appropriately, safely, and effectively.  At minimum, the program shall require: 
(i)	the review of patient drug profiles. 
(ii)	the review of medication orders by a pharmacist for appropriateness.  
(iii)	identifying and reporting adverse drug events, including but not limited to, medication errors and adverse drug reactions.
(8)	Investigational drugs.  Policies and procedures shall be implemented for the safe and proper use of investigational drugs.  Investigational drugs shall be dispensed and administered to consenting patients according to an approved protocol.  
21.103	EQUIPMENT.  Reserved.
(1)	21.104 (2) A refrigerator with thermometer and freezing compartment shall be provided for the proper storage of thermolabile products. 
(2)	The facility shall have a Laminar flow or other class 100 environment for preparing intravenous admixtures.
21.104	FACILITIES
(1)	Facilities shall be provided for the adequate storage, safe-guarding, preparation, and dispensing of drugs with security, proper lighting, temperature control, moisture, ventilation, and sanitation facilities. In addition to adequate safeguards for all drugs, special safety precautions should be given to the storage of alcohol.

. . . 
Part 31.	Physical Plant
31.101 	Compliance with the Life Safety Code
. . . 
(2)	The publication “Guidelines for Design and Construction for 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 (effective date of the regs will be inserted).  The 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.  

{Note to Reader:  Please see next page for proposed renumbering} 

Proposed Renumbering – No substantive changes intended
Part 1.	Statutory Authority and Applicability
1.101	Statutory Authority 
1.102	Applicability
Part 2.	Definitions (includes existing section 2.100 - Definitions)
Part 3.	Department Oversight 
3.101	Application Fees (includes existing section 2.202 - Licensure Fees)
3.102	Facility Reporting Requirements.  Reserved.
Part 4.	Fire Safety and Physical Plant Standards
4.101	Life Safety Code Compliance (includes existing section 31.101 - Compliance with Life Safety Code)
4.102	AIA Guidelines
4.103	Plan Review and Plan Review Fees (includes existing section 2.203 - Plan Review)
Part 5.	Governance and Leadership
5.101	Governing Board (includes existing Part 3, Governing Board)
5.102	Administrative Officer (includes existing Part 4 - Administrative Officer)
Part 6.	Personnel Department (includes existing Part 7 - Personnel) 
Part 7.	Medical Records (includes existing Part 8 - Medical Records)
Part 8.	Infection Control Services (includes existing Part 15 - Infection Control Services)
Part 9.	Patient Rights (new section, will simply refer to Chapter II, Part 6)
Part 10.	General Patient Care Services (includes existing Part 19 - General Patient Services) 
Part 11.	Medical Staff (includes existing Part 5 Medical Staff)
Part 12.	Nursing Services (includes existing Part 6 - Nursing Department)
Part 13.	Dietary Services (includes existing Part 12 - Dietary Services)
Part 14.	Laboratory Services (includes existing Part 10 - Laboratory Services)
Part 15.	Diagnostic Imaging (includes existing Part 24 - Diagnostic Imaging Services)
Part 16.	Pharmaceutical Services (includes existing Part 21 - Pharmaceutical Services)
Part 17.	Outpatient Services (includes existing Part 14 - Outpatient Services)
Part 18.	Emergency Services (includes existing Part 13 - Emergency Services)
Part 19.	Pregnancy, Labor and Delivery (includes existing Part 11 - Pregnancy, Labor and Delivery)
Part 20.	Anesthesia Services (includes existing Part 9 - Anesthesia Services)
Part 21.	Surgical and Recovery Services 
Part 22.	Critical Care Services (includes existing Part 17 - Critical Care Services)
Part 23.	Respiratory Care Services (includes existing Part 16 - Respiratory Care Services)
Part 24.	Rehabilitative Services (includes existing Part 18 - Occupational and Physical Therapy Services)
Part 25.	Pediatric Patient Care Services (includes existing Part 20 - Pediatric Patient Care Services)
Part 26.	Psychiatric Patient Care services (includes existing Part 22 - Psychiatric Patient Care Services)
Part 27.	Nuclear Medicine Services (includes existing Part 25 – Nuclear Medicine Services)
Parts 28 thru 35.  Reserved.
Part 36.	Central Medical-Surgical Supply Services (includes existing Part 26 - Central Medical-Surgical Supply Services)
Part 37.	Linen and Laundry Services (includes existing Part 28 - Linen and Laundry Services)
Part 38.	Housekeeping Services (includes existing Part 27 - Housekeeping Services)
Part 39.	Maintenance Services (includes existing Part 29 - Maintenance Services)
Part 40.	Waste Disposal Services (includes existing Part 30 - Waste Disposal Services)

All internal references will be changed accordingly.
CHAPTER XI	CONVALESCENT CENTERS
. . . 
1.2	APPLICABILITY OF OTHER SECTIONS. Convalescent Centers shall conform to all applicable sections of Chapter IV, General Hospital, with regard to area and operational requirements, environmental sanitation, physical plant maintenance, safety, food service, and patient care units and services.
. . . 

CHAPTER XII   CHIROPRACTIC CENTERS AND HOSPITALS

1.	Statutory Authority and Applicability
(a)	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.  
(b)	Applicability.  All chiropractic centers and hospitals shall meet applicable federal and state statutes and regulations, including but not limited to:
(i)	6 CCR 1011-1, Chapter II.
(ii)	This Chapter XII.
(iii)	Applicable sections of 6 CCR 1011-1, Chapter IV – General Hospitals with regard to:  general provisions, except for Section 2.202; operational requirements; patient care services; environmental sanitation; maintenance; and physical plant.
2.	SURGERY AND OBSTETRICS. There shall be neither surgical nor delivery suites. Neither surgery nor obstetrics shall be performed.
3.	DRUGS AND MEDICATIONS. Neither drugs nor medications shall be administered by persons under conditions prohibited by law.
4.	CHIROPRACTIC STAFF. The chiropractic staff shall consist of chiropractors licensed under the Chiropractic Practice Act in the State of Colorado.
5.	PATIENT CARE SERVICES. All patient care services shall be provided by an adequate staff.

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.	GENERAL PROVISIONS 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	LICENSURE 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.
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, Patients’ Rights.  
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 Department.  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.  
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.

CHAPTER XIX  HOSPITAL UNITS
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. 
1.102	Applicability 
(1)	All hospitals UNITS shall meet applicable federal and state statutes and regulations, including but not limited to:
(a)	6 CCR 1011-1, Chapter II.
(b)	This Chapter XIX.
(2)	Contracted services shall meet the standards established herein.
Part 2.	Definitions
2.100
2.100	Definitions
(1)	“Hospital unit” means a physical portion of a licensed or certified general hospital, psychiatric hospital, maternity hospital, or rehabilitation hospital which is leased or otherwise occupied pursuant to a contractual agreement by a person other than the licensee of the host facility for the purpose of providing outpatient or inpatient services.
Part 3.	Department Oversight
3.101	Licensure Application Fees.  Nonrefundable 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 fee with an application for licensure as follows:  base fee of $5,300 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 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 $3,000. 
(3)	Change of Ownership.  A license applicant shall submit a 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 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 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 
(1)	Initial Licensure.  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 January 1, 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.  New construction including replacement facilities, structural additions of any size and prefabricated structures that are licensed under this Chapter XIX.  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 January 1, 2008.  However, facilities for which the application for the building permit from the local authority having jurisdiction is dated prior to January 1, 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.  Relocation, removal or installation of walls resulting in 50% or more of a smoke compartment being reconfigured.  Fee: See table below.  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 January 1, 2008.  Minimum fee:  $2,000.

Square Footage	Cost per square foot	Explanatory note	
0-35,000	$0.25	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 is the cost applicable to the additional square footage over 200,000 sq ft.	
(4)	Remodeling – Egress Components.  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 January 1, 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.  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 Section 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 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.	GENERAL Hospital services
5.101	If the hospital unit is providing general hospital services, the hospital unit shall comply with the following parts of Chapter IV, General Hospitals:
(1)	Reserved.
(2)	Part 2.  Definitions
(3)	Reserved.
(4)	Reserved.
(5)	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, and Subpart 5.500 - Linen and Laundry Services; however, such services may be provided through a contract with a qualified provider.  Subpart 5.400 - Waste Disposal Services shall apply only if the unit has an incinerator; and these services may be provided through a contract with a qualified provider.
(6)	Part 6.  Governance and Leadership.  (However, where more than one unit is operated by a licensee, a single administrative officer may be delegated responsibility for all such units.)
(7)	Part 7.  Personnel Department
(8)	Part 8.  Medical Records Department.  (Medical records services may be provided by arrangement with the host facility or a related licensed facility; and the records required under 8.102(6)(f) shall be as applicable to the services offered by the unit.)
(9)	Part 9.  Infection Control Services.   (However, infection control services may be provided only by arrangement with the host facility or related licensed facility.)
(10)	Part 10.	Patient Rights.  The facility shall be in compliance with 6 CCR 1011-1, Chapter II, Part 6, Patients’ Rights.  
(11)	Part 11.  General Patient Care Services.  (This part applies only if inpatient care is provided by the unit.) 
(12)	Part 12.  Nursing Services
(13)	Part 13.  Pharmaceutical Services.  (However, pharmaceutical services may be provided through a contract with qualified provider.)
(14)	Part 14.  Laboratory Services.  (However, clinical pathology services may be provided through a contract with a qualified provider.)
(15)	Part 15.  Diagnostic Imaging Services.  (This part applies only if radiological services are provided by a unit; and services may be provided through a contract with a qualified provider.)
(16)	Part 16.  Dietary Services.  (Dietary services may be provided through a contract with a qualified provider.)
(17)	Part 17.  Anesthesia Services.  (This part shall apply only if anesthesia services are provided.)
(18)	Part 18.  Emergency Services.  (This part shall apply only if emergency services are provided by the unit.)
(19)	Part 19.  Outpatient Services.  (This part shall apply only if outpatient services are provided by the unit.)
(20)	Part 20.  Pregnancy, Labor and delivery.  (This part shall apply only if pregnancy, labor and delivery services are provided by the unit.)
(21)	Part 21.  Surgical and Recovery Services.  (However, surgical suite and recovery room services may be provided only by arrangement with the host facility or related licensed facility.) 
(22)	Part 22.  Critical Care Services.  (This part applies only if critical care services are provided by a unit.)
(23)	Part 23.  Respiratory Care Services.  (This part applies only if respiratory care service is provided by a unit; and services may be provided through a contract with a qualified provider.)
(24)	Part 24.  Rehabilitation Services.  (However, rehabilitation services may be provided through a contract with qualified provider.)
(25)	Part 25.  Pediatric Patient Care Services.  (This part applies only if pediatric services are provided by a unit.)
(26)	Part 26.  Psychiatric Patient Care Services.  (This part applies only if psychiatric services are provided by a unit.)
(27)	Part 27.  Nuclear Medicine Services.  (This part applies only if nuclear medicine services are provided by a unit.)

Part 6.	REHABILITATION Center services
6.101	If the hospital unit is providing Rehabilitation Center services, the hospital unit shall comply with the following parts of Chapter X, Rehabilitation Centers:
(1)	Reserved.
(2)	Part 2.  DEFINITIONS
(3)	Parts 5 through 27. 
Part 7.	MATERNITY Hospital services
7.101	If the hospital unit is providing Maternity Hospital services, the hospital unit shall comply with the following parts of Chapter XIV, Maternity Hospitals:
(1)	Reserved.
(2)	Part 2.  DEFINITIONS
(3)	Parts 5 through 27.  
Part 8.	Psychiatric Hospital services
8.101	If the hospital unit is providing Psychiatric Hospital services, the hospital unit shall comply with the following parts of Chapter XVIII, Psychiatric Hospitals, and definitions:
(1)	Part 1.  Governing BOARD
(2)	Part 2.  Administrative Officer.  (However, where more than one unit is operated by a licensee, a single administrative officer may be delegated responsibility for all such units [2.1], and a single combined audit may be performed [2.4].)
(3)	Part 3.  Medical STAFF
(4)	Part 4.  Admissions
(5)	Part 5.  Outpatient Emergency Psychiatric Services.  (This section shall apply only if outpatient emergency psychiatric services are provided by the unit.)
(6)	Part 6.  Psychiatric Patient Care Unit
(7)	Part 7.  Patient Care POLICIES
(8)	Part 8.  Physical Medicine Service.  (This section shall apply only if physical medicine services are provided by the unit.)
(9)	Part 9.  Child/Adolescent Psychiatric Patient Care Unit.  (This section shall apply only if child/adolescent psychiatric services are provided by the unit.)
(10)	Part 10.  Activity Therapy.  (However, activity therapy services may be provided through a contract with a qualified provider.)
(11)	Part 11.  Medical Records.  (However, medical records services may be provided only by arrangement with the host facility or a related licensed facility; the records required under 11.9 shall be as applicable to the services offered by the unit.)
(12)	Part 12.  Nursing Service
(13)	Part 13.  Outpatient Services.  (This section shall apply only if outpatient services are provided by a unit.)
(14)	Part 14.  Communicable Disease Control Program.  (However, communicable disease control services may be provided only by arrangement with the host facility or a related licensed facility.)
(15)	Part 15.  Dietary Services.  (However, dietary services may be provided through a contract with a qualified provider.)
(16)	Part 16.  Disaster Plan
(17)	Part 17.  Anesthesia and Gases.  (This section shall apply only if anesthesia services are provided by a unit; may be provided through a contract with a qualified provider.)
(18)	Part 18.  Central Medical Supply.  (However, central medical supply services may be provided through a contract with a qualified provider.)
(19)	Part 19.  Clinical Pathology 
(20)	Part 20.  Pharmaceutical Services.  (However, pharmaceutical services may be provided through a contract with a qualified provider.)
(21)	Part 21.  Radiological Services.  (However, radiological services may be provided through a contract with a qualified provider.)
(22)	Part 22.  Referrals
(23)	Part 23.  Personnel
(24)	Part 24.  Environmental Services.  (However, environmental services may be provided through a contract with a qualified provider.)
(25)	Part 25.  Linen and Laundry.  (However, linen and laundry services may be provided through a contract with a qualified provider.)
(26)	Part 26.  Maintenance.  (However, maintenance services may be provided through a contract with a qualified provider.)
(27)	Part 27.  Incinerator.  (However, incineration may be provided through a contract with a qualified provider.)
(28)	Part 28.  Insect, Pest and Rodent Control.  (However, insect, pest and rodent control services may be provided through a contract with a qualified provider.)
(29)	Part 29.  Waste Disposal.  (However, waste disposal services may be provided through a contract with a qualified provider.)
(30)	Part 30.  Confidentiality  
(31)	Part 31.  Physical Plant.  This Part 31 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 the referenced material.  

CHAPTER X.  REHABILITATION CENTERS
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 X.
(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 Definitions
2.100
2.101	GENERAL DEFINITIONS 
(1)	“Department” means the Department of Public Health and Environment, unless the context dictates otherwise.
(2)	“Division” means the Health Facilities and Emergency Medical Services Division, unless the context dictates otherwise.
(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)	“General Hospital” means a hospital licensed pursuant to 6 CCR 1011-1, Chapter IV, General Hospitals.  
(5)	“Occupational therapy” means a rehabilitation procedure guided by a qualified therapist who, under medical supervision, uses any purposeful activity to gain from the patient the desired physical function and/or mental response.
(6)	“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. 
(7)	“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 X.  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.
(8)	“Rehabilitation center” means a facility that is intended to provide a community with a type of facility, licensed as a hospital, capable of rendering quality service to those patients not acutely ill and not requiring surgical, intensive, maternity, or extensive radiological or clinical laboratory services, on a direct admission thereto or as a secondary referral admission subject to the clinical judgment of attending physicians, and who may, therefore, receive a relatively high level of special medical and nursing care directed primarily to a rehabilitative or restorative process commensurate with the individual clinical diagnosis. In general, but subject to specific conditions governing a particular facility within a given community, it is intended that a Rehabilitation Center offer its services on the basis of a full spectrum of community need without singular identification with any specific age groups or economic status of patients served.
(9)	“Respiratory care” is that service which is organized to provide facilities, equipment, and personnel who are qualified by training, experience and ability to treat conditions caused by deficiencies or abnormalities associated with respiration. 
Part 3.	DEPARTMENT OVERSIGHT
2.201	GENERAL.  Reserved.
3.101	LICENSURE 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), 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 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 Section 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 the referenced material.  In addition, the architectural design must provide for easy, independent access to all areas of the facility by handicapped persons. Appropriate ramps, rails, and elevators must be provided.
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 have training and expertise in rehabilitation medicine.  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.  The facility shall be in conformance with the standards established in 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 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, Patients Rights.  
Part 11.	GENERAL PATIENT CARE SERVICES.  The facility shall provide services in conformance with the standards established in Chapter IV, Part 11, General Patient Care Services.
Part 12.	NURSING DEPARTMENT.  The facility shall have a nursing department in conformance with the standards established in Chapter IV, Part 12, Nursing Services.
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 16.	DIETARY SERVICES. The facility shall provide services in conformance with the standards established in Chapter IV, Part 16, Dietary 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 17.	ANESTHESIA SERVICES.  The facility may provide anesthesia services.  If such services are provided, they shall be in conformance with the standards established in Chapter IV, Part 17, Anesthesia Services.  
Part 18. EMERGENCY SERVICES
18.101	ORGANIZATION AND STAFFING
(1)	Each rehabilitation center 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
19.101	ORGANIZATION AND STAFFING
(1)	The hospital may provide outpatient services.  Where outpatient services are provided, the type and quantity of facilities shall be such as to provide safe, prompt service to the number and types of patients served.
(2)	The privilege of physicians and dentists in the outpatient service shall be defined in terms of their training and ability, in the same manner as their privilege in the inpatient services.
(3)	There shall be sufficient qualified registered nurses and other nursing personnel to render adequate nursing service to patients.
19.102	PROGRAMMATIC FUNCTIONS.  Reserved.
19.103	EQUIPMENT AND SUPPLIES.  Reserved.
19.104	FACILITIES.  Reserved.
Part 20. Reserved.
Part 21.	Reserved.
Part 22.	SOCIAL AND PSYCHOLOGICAL SERVICES
22.101	ORGANIZATION AND STAFFING  
(1)	Psychological services shall be available, by persons qualified by training, experience and ability, to patients who need this service. 
(2)	Social services shall be provided by persons qualified by training, experience and ability.  
22.102	PROGRAMMATIC FUNCTIONS.  Reserved. 
22.103	EQUIPMENT AND SUPPLIES.  Reserved.
22.104	FACILITIES
(1)	Office and work space for psychological testing, evaluation and counseling shall be provided.
(2)	Social services office space for private interview and counseling shall be provided.
Part 23.	RESPIRATORY CARE SERVICES.  The facility may provide respiratory care services.  If such services are provided, they shall be in conformance with the standards established in Chapter IV, Part 23, Respiratory Care Services.
Part 24.	REHABILITATION THERAPIES & SERVICES 
24.100	Occupational Therapy
24.200	Physical Therapy
24.300	Speech Therapy
24.400	Vocational Counseling
24.100	OCCUPATIONAL THERAPY
24.101	ORGANIZATION AND STAFFING
(1)	The occupational therapy services shall be under direction of a physician who is licensed to practice medicine in the State of Colorado, preferably a diplomate of the American Board of Physical Medicine and Rehabilitation.  However, nothing in this Section 18.101 (1) shall preclude the facility from having one medical director who is responsible for all rehabilitation therapies and services.  
24.102	PROGRAMMATIC FUNCTIONS
(1)	There shall be written policies for the occupational therapy services which are determined jointly by the physician and the rehabilitation center administrator. There shall be evidence that these policies are reviewed and revised at regular intervals.
24.103	EQUIPMENT AND SUPPLIES
(1)	There shall be adequate and appropriate equipment and supplies as determined by the professional staff to meet the requirements for care and treatment of patients.
24.104	FACILITIES
(1)	The occupational therapy services shall be located in an area convenient for all patients. 
(2)	The occupational therapy area shall have a reception area, an examining room, treatment area, separate toilet and lavatory facilities for patients and staff, and storage areas. 
(3)	There shall be adequate space in the reception area to accommodate ambulatory and wheel chair patients. 
(4)	The following specific evaluation and treatment facilities must be provided by all rehabilitation centers: Occupational Therapy. (1) Office and work space for occupational therapy staff; (2) Therapy area; (3) Storage space for supplies and equipment.
(5)	Facilities for teaching activities of daily living.
24.200	PHYSICAL THERAPY
24.201	ORGANIZATION AND STAFFING
(1)	Physical therapy services shall be under the direction of a physician who is licensed to practice medicine in the State of Colorado, who has a particular interest in physical medicine, and who preferably is a diplomate of the American Board of Physical Medicine and Rehabilitation.  However, nothing in this Section 18.201 (1) shall preclude the facility from having one medical director who is responsible for all rehabilitation therapies and services.
(2)	Physical therapy shall be rendered only by a physical therapist licensed to practice in the State of Colorado.  All personnel assisting with the physical therapy of patients must be under the direct supervision of physical therapists at all times.
24.202	PROGRAMMATIC FUNCTIONS
(1)	There shall be written policies for the physical therapy services which are developed jointly by the physician and the chief physical therapist and approved by the rehabilitation center administrator. There shall be evidence that these policies are reviewed and revised at regular intervals.
(2)	Prosthetic and orthotic services may be provided either within the rehabilitation center or through arrangements with a qualified facility.  The program may be worked out in cooperation with other health facilities of the area and with official and nonofficial agencies concerned. This program should include the possibility of disaster involving loss of the rehabilitation center or serious impairment of its facilities.
24.203	EQUIPMENT AND SUPPLIES
(1)	There shall be adequate and appropriate equipment and supplies as determined by the professional staff to meet the requirements for care and treatment of patients.
24.204	FACILITIES
(1)	The physical therapy services shall be located in an area convenient for all patients. 
(2)	The physical therapy area shall have a reception area, an examining room, treatment area, separate toilet and lavatory facilities for patients and staff and storage areas. 
(3)	There shall be adequate space in the reception area to accommodate ambulatory, stretcher and wheel chair patients.
(4)	The following specific evaluation and treatment facilities must be provided by all rehabilitation centers:  Physical Therapy. (1) Office and work space for physical therapy staff; (2) Rehabilitation gymnasium; (3) Physical therapy treatment area; (4) Storage for supplies and equipment; (5) Outdoor exercise area (desirable but not mandatory).
(5)	If orthotic and prosthetic devices are provided within the facility, space shall be provided, for fitting and adjustment services for prosthetic and orthotic devices.
24.300	SPEECH THERAPY
24.301	ORGANIZATION AND STAFFING  
(1)	Speech therapy services shall be provided by persons qualified by training, experience and ability.
24.302	PROGRAMMATIC FUNCTIONS.  Reserved.
24.303	EQUIPMENT AND SUPPLIES
(1)	Suitable equipment and supplies for speech therapy shall be provided either within the facility or through arrangements with existing community services. 
(2)	Suitable equipment for audiometric and other sensory testing and evaluation shall be provided either within the facility or through arrangements with existing community facilities.
24.304	FACILITIES 
(1)	Suitable space for speech therapy shall be provided either within the facility or through arrangements with existing community services.
24.400	VOCATIONAL COUNSELING
24.401	ORGANIZATION AND STAFFING  
(1)	Vocational services shall be provided by persons qualified by training, experience and ability.  
24.402	PROGRAMMATIC FUNCTIONS.  Reserved.
24.403	EQUIPMENT AND SUPPLIES.  Reserved.
24.404	FACILITIES
(1)	Office space for vocational counseling and evaluations shall be provided.
Part 25.	PEDIATRIC PATIENT CARE SERVICES.  The facility may provide pediatric patient care services.  If such services are provided, they shall be in conformance with the standards established in Chapter IV, Part 25, Pediatric Patient Care Services.
Part 26.	Reserved.
Part 27.	Reserved.