Current through Reg. 49, No. 38; September 20, 2024
(a) All buildings in which existing ESRD
facilities licensed by the department are located shall comply with this
subsection.
(1) A licensed ESRD facility which
is licensed prior to the effective date of these rules is considered to be an
existing licensed ESRD facility and shall continue, at a minimum, to meet the
licensing requirements under which it was originally licensed.
(2) Existing licensed ESRD facilities shall
meet the requirements for Existing Ambulatory Health Care Occupancies contained
in Chapter 21 of the 2000 edition of the National Fire Protection Association
101, Life Safety Code, (NFPA 101), the ESRD Standards/Rules (1996, 1999, or
2006 editions as amended), and the ESRD rules under which the buildings or
sections of buildings were constructed. All documents published by NFPA as
referenced in this section may be obtained by writing or calling the NFPA at
the following address or telephone number: National Fire Protection
Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800)
344-3555.
(3) In lieu of meeting
the requirements in paragraph (1) of this subsection, an existing licensed ESRD
facility may, instead, comply with National Fire Protection Association (NFPA)
101, Life Safety Code 2003 Edition (NFPA 101) Chapter 21, Existing Ambulatory
Health Care Occupancies.
(b) All major remodeling, renovations,
additions and alterations to an existing ESRD facility shall be done in
accordance with the requirements for new construction in §
117.102
of this title (relating to Construction Requirements for a New End Stage Renal
Disease Facility). All areas of an existing ESRD facility that are not part of
a major remodel, renovation, addition or alteration to the ESRD facility, are
not required to meet these new construction requirements as long as the
existing portion of the facility met the rules and codes that were in effect
when it was originally constructed and licensed. When existing conditions make
such changes impractical, the department may grant a conditional approval of
minor deviations from the requirements of §
117.102
of this title, if the intent of the requirements is met and if the care, safety
and welfare of patients will not be jeopardized. The operation of the ESRD
facility, accessibility of individuals with disabilities, and safety of the
patients shall not be jeopardized by a condition(s) which is not in compliance
with §
117.102
of this title and this section.
(1) Any
alteration, modification, replacement, or any installation of new building
equipment, such as mechanical, electrical, emergency power equipment,
energy/utility management, conveying systems, plumbing, fire protection, or
other equipment with a primary function of building service that affects life
safety, infection control, changes the functional operation, or the health,
safety and welfare of patients or staff shall comply with the requirements for
new construction and shall not be replaced, materially altered, or extended in
an existing ESRD facility until complete plans and specifications have been
submitted to the department, and the department has reviewed and approved the
plans and specifications in accordance with §
117.104
of this title (relating to Preparation, Submittal, Review and Approval of
Plans, and Retention of Records).
(2) Minor remodeling or alterations within an
existing ESRD facility which do not involve alterations to load bearing members
and partitions, change functional operation, affect fire safety, or involve any
of the major changes listed in paragraph (1) of this subsection are considered
to be minor projects and require evaluation and approval by the department. An
ESRD facility shall submit by mail or fax a written request and floor plan for
evaluation, a brief description of the proposed changes, and sketches of the
area being remodeled. Based on such submittal, the department shall evaluate
and determine whether any additional submittals or inspections are required.
The department shall notify the ESRD facility of its decision. The patching,
restoration, or painting of materials, elements, equipment, or fixtures for the
purpose of maintaining such materials, elements, equipment, or fixtures in good
or sound condition would not require submission to the department for
approval.
(3) All remodeling or
alterations which involve alterations to load bearing members or partitions,
change functional operation, add treatment stations, or affect fire safety are
considered major projects. An ESRD facility shall comply with this section
prior to beginning construction of major projects.
(A) Plans shall be submitted in accordance
with §
117.104
of this title for all major remodeling or alterations.
(B) As of February 9, 2009, all new
facilities or increasing the number of in-center dialysis treatment stations in
existing facilities shall have an isolation room or be granted a waiver by
Center for Medicare and Medicaid Services. The waiver shall demonstrate that
there is sufficient capacity in the geographic area for isolation rooms for
hepatitis B positive patients. A written request for waiver shall be made
through the Texas Department of State Health Services, Health Facility
Compliance Group, Mail Code 1979, P.O. Box 149347, Austin, Texas, 78714-9347
for transmission to CMS.
(C)
Phasing of construction in existing facilities.
(i) Projects involving alterations of or
additions to existing buildings shall be programmed and phased so that on-site
construction shall minimize disruptions of existing functions.
(ii) Access, exit access, and fire protection
shall be maintained so that the safety of the occupants shall not be
jeopardized during construction.
(iii) A noncombustible or limited combustible
dust and vapor barrier shall be provided to separate areas undergoing
demolition and construction from occupied areas. When a fire retardant plastic
material is used for temporary daily usage, it shall be removed at the end of
each day.
(iv) The air inside the
construction area shall be protected by mechanical filtration that recirculates
inside the space or is exhausted directly to the exterior.
(v) The area shall be properly ventilated and
maintained. The area under construction shall have a negative air pressure
differential to the adjoining areas and shall continue to operate as long as
construction dust and odors are present.
(vi) Temporary sound barriers shall be
provided where intense prolonged construction noises will disturb patients or
staff in the occupied portions of the building during patient treatment
times.
(vii) When construction is
done after hours or on weekends, the facility shall assure that all areas of
construction are cleaned thoroughly and a clean safe environment is provided
before patients are treated. All fire safety protection and building systems
are in place and working properly.
(c) A previously licensed ESRD facility which
has been vacated or used for other purposes shall comply with all the
requirements for new construction contained in §
117.102
of this title in order to be licensed.
