(a) Compliance. All buildings in which existing hospitals licensed by the Texas Health and Human Services Commission (HHSC) are located shall comply with this subsection. This chapter shall not be applied retroactively to an operating hospital holding an active HHSC facility license before the effective date of this chapter that complies with the occupancy requirements in National Fire Protection Association 101, Life Safety Code, (NFPA 101), the Hospital Licensing Standards/Rules (1969, 1985, or 1998 editions as amended), and the hospital licensing rules under which the buildings or sections of buildings were constructed.
  (1) Minimum fire safety and construction requirements.
    (A) Code requirements. A limited services rural hospital (LSRH) shall meet the requirements for health care occupancies contained in the 1967, 1973, 1981, 1985, 1991, 1997, 2000, 2003, or 2010 editions of the NFPA 101, Life Safety Code, the Hospital Licensing Standards/Rules (1969, 1985, or 1998 editions as amended), and the hospital licensing rules under which the buildings or sections of buildings were constructed.
    (B) Existing construction requirements. Existing LSRHs or portions of existing LSRHs constructed before the adoption of any of the editions of NFPA 101, the Hospital Licensing Standards, and the hospital licensing rules listed in subparagraph (A) of this paragraph, shall comply with this section and Chapter 19, NFPA 101, 2012 edition.
  (2) Remodeling. All requirements listed in this chapter are applicable to renovations, additions and alterations unless stated otherwise.
    (A) Alteration or installation of new equipment. Any alteration or any installation of new equipment shall be accomplished as nearly as practicable with the subchapter requirements, except that when existing conditions make changes impractical to accomplish, minor deviations from functional requirements may be permitted if the intent of the requirements is met and if the care and safety of patients will not be jeopardized.
    (B) Installation, alteration, or extension approval. No new system of mechanical, electrical, plumbing, fire protection, or piped medical gas system may be installed or any such existing system may be replaced, materially altered or extended, until complete plans and specifications for the replacement, installation, alteration, or extension have been submitted to HHSC, reviewed and approved in accordance with §511.167 of this subchapter (relating to Preparation, Submittal, Review, and Approval of Plans, and Retention of Records).
    (C) Minor remodeling or alterations. All remodeling or alterations that do not involve alterations to load bearing members or partitions, change functional operation, affect fire safety (e.g., modifications to the fire, smoke, and corridor walls), add or subtract services for which the LSRH is licensed, and do not involve changes listed in subparagraph (B) of this paragraph, shall be submitted for approval without submitting contract documents. Such approval shall be requested in writing, with a brief description of the proposed changes in accordance with §511.167(f)(3) of this subchapter.
    (D) Major remodeling or alterations. Plans shall be submitted in accordance with §511.167 of this subchapter for all major remodeling or alterations. All remodeling or alterations that involve alterations to load bearing members or partitions, change functional operation, affect fire safety (e.g., modifications to the fire, smoke, and corridor walls), or add services over those for which the LSRH is licensed are considered as major remodeling and alterations.
    (E) Phasing of construction in existing facilities.
      (i) Projects involving alterations of and additions to existing buildings shall be programmed and phased so that on-site construction will minimize disruptions of existing functions.
      (ii) Access, exit access, and fire protection shall be maintained so that the safety of the occupants will 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.
    (F) Nonconforming conditions. When doing renovation work, if it is found to be infeasible to correct all of the nonconforming conditions in the existing LSRH in accordance with these rules, HHSC may grant a conditional approval if the operation of the LSRH, Americans with Disabilities Act accessibility requirements, and safety of the patients are not jeopardized by the nonconforming condition.
(b) Previously licensed hospitals. Buildings that have been licensed previously as general hospitals, special hospitals, or LSRHs but have been vacated or used for purposes other than as general hospitals, special hospitals, or LSRHs and that are not in compliance with the 1967, 1973, 1981, 1985, 1991, 1997, 2000, 2003, or 2010 editions of the NFPA 101, the Hospital Licensing Standards/Rules (1969, 1985, or 1998 editions as amended), and hospital licensing rules under which the building or sections of buildings were constructed shall comply with the requirements of §511.162 of this subchapter (relating to General Construction Requirements), §511.163 of this subchapter (relating to Spatial Requirements), §511.165 of this subchapter (relating to Building with Multiple Occupancies), §511.167 of this subchapter, and §511.168 of this subchapter (relating to Construction, Inspections, and Approval of Project).
(c) Service removal. Where removal of a patient care service occurs in a patient care bedroom, patient treatment room, patient diagnostic room, patient therapy room, or any other similar location where patient services are provided and the area does not hold an Architectural Review Unit application number, the following systems and furnishing shall be removed from that room, rooms, or unit affected:
  (1) access to the nurse call system equipment, including nurse call activation devises, and dome lights;
  (2) access to the medical gases;
  (3) access to cubicle curtains and cubicle curtain tracks; and
  (4) access to patient reading lights.

Source Note: The provisions of this §511.161 adopted to be effective October 5, 2023, 48 TexReg 5668