HLT-39-10-00007-P Standards of Construction for Health Care Facilities

9/29/10 N.Y. St. Reg. HLT-39-10-00007-P

NEW YORK STATE REGISTER

VOLUME XXXII, ISSUE 39

September 29, 2010

RULE MAKING ACTIVITIES

DEPARTMENT OF HEALTH

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. HLT-39-10-00007-P

Standards of Construction for Health Care Facilities

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action:

Amendment of Parts 711, 712, 713, 714, 715 and 716 of Title 10 NYCRR.

Statutory authority:

Public Health Law, sections 2802 and 2803

Subject:

Standards of Construction for Health Care Facilities.

Purpose:

Update & clarify construction & physical environment standards for hospital, nursing home & certain ambulatory care facilities.

Substance of proposed rule (Full text is posted at the following State website:www.health.state.ny.us):

Title 10 of the Official Compilation of Codes, Rules and Regulations of the State of New York (NYCRR) Parts 711, 712, 713, 715 and 716 set forth the architectural, engineering, equipment and construction and other physical environment standards for all health facilities subject to Department of Health oversight pursuant to Public Health Law (PHL) Article 28.

Proposed Revisions to 10 NYCRR Part 711

10 NYCRR Section 711.1 would be revised to more clearly identify the facilities and the standards that are subject to regulation. In addition, language would be added to clearly identify construction related information that must be filed with construction applications. The proposal would clarify the process for submitting a construction application.

10 NYCRR Section 711.2 would be revised to require health care facilities to comply with more current National Fire Protection Association ("NFPA") standards, including NFPA 101, Life Safety Code, 2000 edition, which is the life safety code currently mandated by the federal government for Medicare and Medicaid certification. In addition, 10 NYCRR Section 711.2 would be revised to require that health care facilities comply with more current national codes addressing radiation protection, facility heating, cooling and ventilation (HVAC) and gas and vacuum systems. 10 NYCRR section 711.2 would be revised to require that future health care facility construction conform to the 2010 edition of Guidelines for Design and Construction of Health Care Facilities.

10 NYCRR Section 711.3, which establishes general site requirements for health care facilities, would be revised to clarify language, add requirements for facility occupants other than patients and eliminate outdated site requirements. 10 NYCRR Sections 711.4, 711.5, 711.7, 711.8, 711.9 and 711.10 would be repealed. New 10 NYCRR Section 711.9 would set forth specific requirements for obtaining waivers of construction standards.

Proposed Revisions to 10 NYCRR Part 712

The regulatory proposal would repeal existing 10 NYCRR Part 712, which includes standards of construction for some hospitals, and replace it with a new Part 712 (Standards of Construction for General Hospital Facilities). The proposal would consolidate all requirements specific to general hospital construction into 10 NYCRR Part 712. New Part 712 would be divided into two Subparts based on the date when general hospital construction was or is to be undertaken.

New Subpart 712-1 would set forth minimum construction and physical environment standards applicable to general hospitals built and to portions of general hospitals altered or renovated pursuant to Department or commissioner approval granted prior to October 14, 1998 and to general hospital construction projects not requiring such approvals that were completed prior to October 14, 1998. New Subpart 712-1 would include requirements in existing 10 NYCRR Section711.4 and existing 10 NYCRR Part 712.

New Subpart 712-2 would set forth minimum construction and physical environment standards applicable to general hospitals built and to portions of general hospitals altered or renovated pursuant to Department or commissioner approval granted on or after October 14, 1998 and to general hospital construction projects not requiring such approvals that were or will be completed after October 14, 1998. New Subpart 712-2 would require that construction projects comply with Guidelines for Design and Construction of Health Care Facilities and would include some additional regulatory requirements.

Proposed Revisions to 10 NYCRR Part 713

The regulatory proposal would repeal existing Part 713, which sets forth construction standards for some nursing homes, and replace it with a new Part 713 (Standards of Construction for Nursing Home Facilities). The proposal would consolidate all requirements specific to nursing home construction into 10 NYCRR Part 713. Part 713 would be divided into four subparts based on the date when nursing home construction was or is to be undertaken.

Subpart 713-1 would set forth minimum construction and physical environment standards applicable to nursing home facilities built, to portions of nursing homes facilities renovated or altered prior to August 25, 1975 and to nursing home construction projects approved by the commissioner or Department prior to August 25, 1975. New Subpart 713-1 would include requirements that are in existing 10 NYCRR Section 711.4.

Subpart 713-2 would set forth minimum construction and physical environment standards applicable to nursing home facilities built, to portions of nursing homes facilities renovated or altered between August 25, 1975 and July 1, 1990 and to nursing home construction projects approved by the commissioner or Department between August 25, 1975 and July 1, 1990. Subpart 713-2 would include requirements that are in existing 10 NYCRR Section 711.5.

Subpart 713-3 would set forth minimum construction and physical environment standards applicable to nursing home facilities built, to portions of nursing homes facilities renovated or altered between July 1, 1990 and December 31, 2010 and to nursing home construction projects approved by the commissioner or Department between July 1, 1990 and December 31, 2010. Subpart 713-3 would incorporate by reference Guidelines for Design and Construction of Health Care Facilities. Additional requirements not addressed in this document would be included in the proposed Subpart.

Subpart 713-4 would set forth minimum construction and physical environment standards applicable to nursing home facilities built, to portions of nursing homes facilities renovated or altered after December 31, 2010 and to nursing home construction projects approved by the commissioner or Department after December 31, 2010. Subpart 713-4 would require that construction projects comply with the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities as well as additional regulatory requirements.

Proposed Revisions to 10 NYCRR Part 714

The regulatory proposal would consolidate all requirements specific to adult day health care program facility construction into 10 NYCRR Part 714, including requirements in existing 10 NYCRR Part 713. It would require future adult day health care program facility construction to comply with the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities as well as additional regulatory requirements.

Proposed Revisions to 10 NYCRR Part 715

The regulatory proposal would repeal existing 10 NYCRR Part 715 and replace it with a new Part 715 (Standards of Construction for Freestanding Ambulatory Care Facilities). The regulatory proposal would consolidate all requirements specific to freestanding ambulatory care facilities into 10 NYCRR Part 715. New Part 715 would be divided into two Subparts based on the date when ambulatory care facility construction was or is to be undertaken.

New Subpart 715-1 would set forth minimum construction and physical environment standards applicable to: (1) diagnostic center and treatment center facilities built and to portions of such facilities renovated or altered prior to January 1, 2011; (2) general hospital offsite outpatient facilities built and to portions of such facilities renovated or altered prior to January 1, 2011; and, (3) general hospital offsite outpatient facility construction projects and diagnostic center and treatment center facility construction projects approved by the commissioner or Department prior to January 1, 2011. New Subpart 715-1 would include requirements that are in existing 10 NYCRR Section 711.7 and existing 10 NYCRR Part 715.

New Subpart 715-2 would set forth minimum construction and physical environment standards applicable to:(1) diagnostic center and treatment center facilities built and to portions of such facilities renovated or altered after January 1, 2011; (2) general hospital offsite outpatient facilities built and to portions of such facilities renovated or altered after January 1, 2011; and, (3) general hospital offsite outpatient facility construction projects and diagnostic center and treatment center facility construction projects approved by the commissioner or department after January 1, 2011. New Subpart 715-2 would require future ambulatory care construction to comply with the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities as well as additional regulatory requirements.

Proposed Revisions to 10 NYCRR Part 716

The regulatory proposal would repeal existing 10 NYCRR Part 716 and replace it with a new Part 716 (Standards of Construction for Rehabilitation Facilities). The regulatory proposal would consolidate into New Part 716 all standards of construction specifically applicable to rehabilitation facilities. New Part 716 would include requirements that are in existing 10 NYCRR Section 711.8 and existing 10 NYCRR Part 712. New Part 716 would also require that future rehabilitation facility construction comply with the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities as well as additional regulatory requirements.

Text of proposed rule and any required statements and analyses may be obtained from:

Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Summary of Regulatory Impact Statement

The Department believes that the proposed regulatory amendments offer many benefits to regulated parties and would improve the quality of health care facility construction while reducing construction costs. The proposal to amend these regulations would reorganize, simplify and clarify construction and physical environment requirements applicable to health care facilities licensed pursuant to PHL Article 28 and would eliminate irrelevant and redundant requirements. It would update state required life safety code standards so that they would be equivalent to the life safety code standards required for Medicaid and Medicare certification; health care facilities would no longer have to comply with two sets of life safety code standards. The proposal would also require health care facilities to comply with updated national codes relating to: radiation protection; facility heating, cooling and ventilation; food service: plumbing; and gas and vacuum systems. The regulatory proposal would require future facility construction to comply with most current nationally recognized architectural guidelines for health facility construction. If promulgated, these regulatory amendments would make it easier for facility staff, design architects and engineers, construction managers, and the Department’s regulatory and surveillance staff to ensure the safety and appropriateness of existing facilities as well as the appropriate design and construction of new facilities. The proposed regulatory amendments would also result in cost savings in the construction of facilities.

Regulatory Flexibility Analysis

Finding:

The proposed regulatory amendments do not impose any economic impact on small businesses or local governments that do not operate or propose to operate a health care facility licensed pursuant to Public Health Law (PHL) Article 28. They do not impose reporting, record keeping or other compliance requirements on such entities. The proposed amendments do not impose an adverse impact on small business and local governments that operate or propose to operate a health care facility licensed pursuant to PHL Article 28. The regulatory proposal's reporting, record keeping and compliance requirements are less burdensome than existing reporting, record keeping and compliance mandates.

Reasons for the Finding:

The proposed regulatory amendments are intended to achieve greater consistency between New York State regulations and the American Institute of Architects/U.S. Department of Health and Human Services Guidelines (hereinafter referred to as the Guidelines). Existing inconsistencies between state regulatory requirements and national construction standards have increased construction costs to correct errors and increase consulting and architectural fees. The benefits of consistency and flexibility projected by the original adoption of the Guidelines by New York State in 1998 have been achieved, and this latest proposal to adopt the latest edition of the Guidelines is expected to maintain those advantages. Also, similar to current Guidelines inconsistencies; increased construction costs are necessary to correct errors.

Updating the Life Safety Code 101 to the edition recently adopted by the U.S. Centers for Medicare and Medicaid Services (CMS) is essential to ensure that all existing and future health facility construction is compliant with applicable federal standards. Therefore, the proposed amendments do not impose new compliance requirements on those health care facilities and design and consulting firms that are small businesses, nor on local governments that run medical facilities since they need to conform to such standards in any event.

Measures Taken to Ascertain the Finding:

Consistent with the previous major revision effort in 1998, the Department sought assistance from the Construction Standards Advisory Group (CSAG), which represented health care facilities, architects, engineers, design consultants, construction managers, health care administrators and other organizations and businesses most affected by this proposal. Among the most important factors that influenced the CSAG to recommend a regulatory amendment was that the amendment would not increase the costs of design, construction or operation of health care facilities. After numerous meetings throughout 2008 and 2009 where CSAG members compared the current State Hospital Code with the 2006, and then 2010 edition of the Guidelines, the CSAG concluded in June 2009 that this amendment was the most logical course to take, and would not increase costs to the system.

Department staff deals with architects, construction managers and facility planners on a daily basis in the interpretation and application of construction regulations for individual projects. There have been numerous statements, including high profile media reports that attest to the potential savings of this update with its alignment with federal regulations and national standards. The long-term involvement and input of industry professionals (i.e., architects and engineers) demonstrates the economic and technical feasibility of complying with these new standards.

Rural Area Flexibility Analysis

No Rural Area Flexibility Analysis is required pursuant to section 202-bb(4)(a) of the State Administrative Procedures Act. The proposed provisions apply uniformly throughout New York State, including in rural areas.

The proposed amendments, if promulgated, would not have an adverse impact on facilities in rural areas. They would not impose reporting, record keeping or other compliance requirement on facilities in rural areas that are not licensed pursuant to PHL Article 28. The additional flexibility in design approval and code enforcement afforded the Department of Health by reliance on the functional program (architectural and design plans for health care facilities) actually facilitate the approval of projects in rural areas, where lower volume and less predictable levels of occupancy and utilization often make it advisable to design and operate services (e. g. nursing units) on a smaller scale than the minimal levels specified in regulation. Similarly, adoption by reference of the 2010 Guidelines for Design and Construction of Health Care Facilities on an expanded basis to include diagnostic or treatment centers will also benefit rural areas due the inclusion of new standards for small primary care clinics and mobile units, which are particularly applicable to rural locations.

Job Impact Statement

Nature of Impact:

The proposed amendments will continue to offer health care providers the opportunity to be more innovative in the designing and functioning of health care facilities, and in tailoring the physical plant and equipment more to individual programs of care. The Department of Health expects that providers will continue to undertake projects necessary to maintain and preserve their existing physical plants, which represent significant investments and capital assets. These circumstances will prompt most facilities to retain staff currently employed in facility planning and design or to continue to rely on design consulting firms for such services. No significant negative impact on employment as a result of the proposed regulations is anticipated. This projection has been borne out by experience subsequent to the original adoption of the Guidelines and updated Life Safety Code 101 in 1998.

Categories and Number Affected:

The categories of jobs most affected by changes in the design and construction of health care facilities are those in the architecture and engineering professions. However, as discussed above, no significant negative effects on employment are anticipated with reference to these or any other occupations. Implementation of the latest edition the Guidelines in future health care facility construction will positively affect health care workers and patients. The enhanced health care environment resulting from these standards suggest increased staff satisfaction and safety, resulting in fewer staff injuries and minimizing workforce turnover. With the proposed expansion of Guidelines use for outpatient facilities and nursing homes, these benefits will be available to a greater number of health care workers.

Regions of Adverse Impact:

The proposed amendments will not impose an adverse impact on any regions of the State.

Minimization of Adverse Impact:

There are no adverse impacts to this rule. Therefore, no measures to minimize adverse impact are necessary.

The proposed amendments are not expected to have a negative effect on self-employment opportunities for architects and engineers who specialize in health care facility design.