(a) Multiple hospitals located within one building.      
        (1) Identifiable location. Each hospital shall conform with all the requirements contained in Chapter 18 of the National Fire Protection Association 101, Life Safety Code, 2012 edition (NFPA 101), relating to New Health Care Occupancies.                  (A) The guest hospital shall be in one separately contiguous location.                   (B) In no case may a person leave the guest hospital, traverse the host hospital, and then reenter the guest hospital to access the remaining portion of the guest hospital.                   (C) A connecting stair within the host hospital may be used to connect the vertical contiguous areas of the guest hospital.                   (D) A guest hospital may not occupy two or more noncontiguous areas of a host hospital that contain intervening space of the host hospital even if on the same floor.                   (E) Construction of the host hospital building shall conform to the requirements of NFPA 101 Chapter 18, and the building shall be fully sprinklered.         
        (2) Separate facilities. Each limited services rural hospital (LSRH) shall provide the following separate facilities:                  (A) a nursing unit in accordance with the requirements of §511.163(q) of this subchapter (relating to Spatial Requirements);                   (B) an administration office with an adjacent waiting room or waiting area;                   (C) a medical records room that conforms with the requirements of §511.163(m) of this subchapter;                   (D) a pharmacy suite that complies with §511.163(s) of this subchapter;                   (E) employee locker facilities that comply with requirements of §511.163(f)(1) of this subchapter;                   (F) a housekeeping room that complies with the requirements of §511.162(d)(2)(A)(xxviii) of this subchapter (relating to Construction Requirements);                   (G) emergency facilities as required by §511.163(e)(1)(A) of this subchapter;                   (H) imaging and other diagnostic services and facilities, in accordance with §511.46 of this chapter (relating to Radiologic Services) and §511.163(j) of this subchapter respectively;                   (I) laboratory services and a laboratory suite that comply with §511.163(k) of this subchapter, and §511.45 of this chapter (relating to Laboratory Services) of this chapter respectively;                   (J) where surgical services are provided, a surgical suite in accordance with §511.163(x) of this subchapter;                   (K) dietary services and dietary suite, including staff dining facilities, which comply with §511.53 of this chapter (relating to Dietary Services) and §511.163(d) of this subchapter respectively;                   (L) external signage at the building entrance that identifies each hospital; and                   (M) internal signage that provides directions to each hospital.         
        (3) Means of egress. Means of egress from the host or guest hospital shall not be through a psychiatric hospital or a crisis stabilization unit or other area subject to locking. Means of egress may traverse through a hospital that conforms with the requirements of §511.161 of this subchapter (relating to Requirements for Buildings in Which Existing Licensed Hospitals are Located) or §511.162 of this subchapter. Stairs must have guardrails from the floor of the guest hospital to the level of exit discharge in accordance with NFPA 101 §7.2.2.4.5.       
        (4) Additional services and facilities. Additional services and facilities when required in each licensed hospital may be provided by contractual agreement with the other hospital when the services and facilities comply with the specific requirements of Subchapter C of this chapter (relating to Operational Requirements) and §511.163 of this subchapter. Some services may be provided by contractual agreement with a commercial contractor; however, the following minimal facilities shall be provided on site by the host hospital and be located in one of the hospitals. If the host hospital fails to provide the facilities and services, the guest hospital shall describe to the Texas Health and Human Services Commission (HHSC) how it plans to provide services:                  (A) cart cleaning and sanitizing services and facilities that comply with §511.163(b) of this subchapter;                   (B) general storage services and facilities that comply with §511.163(h) of this subchapter;                   (C) housekeeping rooms as required in §511.162(d)(2)(A)(xxviii) of this subchapter;                   (D) parking facilities, in accordance with §511.162(c)(2) of this subchapter;                   (E) physical therapy, occupational therapy services and facilities, or both in accordance with §511.57 of this chapter (relating to Therapy Services), and §511.163(u) of this subchapter respectively;                   (F) patient activity facilities shall comply with the requirements for the specific service in accordance with §511.163 of this subchapter as follows: mental health and chemical dependency nursing units §511.163(n)(1) and rehabilitation therapy suite §511.163(u)(1)(A)(i) and (ii) of this subchapter;                   (G) respiratory care services and respiratory therapy suite that comply with §511.70 of this chapter (relating to Respiratory Care Services) and §511.163(v) of this subchapter respectively;                   (H) body-holding room that complies with §511.163(o)(1)(D) of this subchapter;                   (I) central sterile supply that complies with §511.163(c) of this subchapter respectively;                   (J) waste and waste disposal services and waste processing and storage units shall comply with §511.71 of this chapter (relating to Waste and Waste Disposal); and                   (K) emergency water storage requirement in Texas Administrative Code Title 25 §133.162(d)(4)(A)(i)(VIII) shall be required for the LSRH and the hospital and be located in either the LSRH or other hospital.         
        (5) Building systems and equipment.                  (A) The following systems shall be provided separately in each hospital at a 24-hour staffed location.                      (i) Nurses calling systems shall be provided separately in each hospital in accordance with §511.162(d)(5)(L) and Table 7 in §511.169(g) of this subchapter (relating to Tables).                       (ii) Medical gas alarms shall be provided in each hospital.                       (iii) Fire alarm annunciator panels shall be provided in each hospital so that each hospital can monitor the other.                       (iv) An emergency generator annunciator panel shall be provided in each hospital.                     (B) Where applicable, the following systems may serve more than one hospital provided the systems meet the new construction requirements of §511.162 of this subchapter.                      (i) Air conditioning, heating, and ventilating systems.                       (ii) Drainage systems.                       (iii) Elevators.                       (iv) Fire sprinkler systems. The guest hospital may not be constructed in a host hospital when the host hospital is not fully sprinklered. The host and guest hospitals shall be fully sprinklered.                       (v) Medical piping systems.                       (vi) Stand pipe systems.                       (vii) Steam systems.                       (viii) Water supply systems, hot and cold (including emergency water storage).                       (ix) Electrical service and equipment.                          (I) Where applicable, the building electrical service, lighting, essential electrical system, and fire alarm system may be a part of or extension of those in the existing hospital, provided the existing systems meet these requirements. The host hospital shall be responsible for maintenance, testing and upkeep of the essential electrical system. Power and lighting distribution panels shall be within each hospital served and comply with the requirements of §511.162(d)(5)(E) of this subchapter. Electrical installation details shall conform with all requirements contained in §511.162(d)(5)(A) of this subchapter.                           (II) When the existing essential electrical system is nonconforming, the following options are available:                              (-a-) a separate conforming essential electrical system shall be provided in the guest hospital; or                               (-b-) separate transfer switches connected to the existing on-site generator(s) shall be provided when adequate capacity is available and the host hospital existing nonconforming system shall be corrected. Corrections shall be made in accordance with a plan of correction approved by HHSC.               
      (b) LSRHs located in buildings with licensed health care facilities other than hospitals.      
        (1) Before an LSRH is licensed in a building containing other licensed health care facilities, all the requirements of this chapter and the following requirements shall be met.                  (A) Construction of the building shall conform to the requirements of NFPA 101 Chapter 18 and the building shall be fully sprinklered.                   (B) The LSRH shall be in one identifiable contiguous location and shall be separated (vertically and horizontally) with two-hour fire rated noncombustible construction from the other licensed health care facility and comply with the requirements of this chapter.                      (i) In no case may a person leave the LSRH, traverse other licensed health care facilities, and then reenter the LSRH to access the remaining portion of the hospital.                       (ii) A connecting stair and elevator within the building shall be provided to connect the vertical contiguous areas of the LSRH.                       (iii) An LSRH may not occupy two or more noncontiguous areas of other licensed health care facilities that contain intervening space of the other licensed health care facilities even if on the same floor.                       (iv) Access to the LSRH shall be directly from a main lobby or an elevator lobby, if on an upper floor. The required means of egress from the LSRH may be through the other licensed health care facility except not through a psychiatric hospital or a crisis stabilization unit or other area subject to locking.                          (I) Each licensed facility shall be identified with external signage at the building entrance.                           (II) Internal signage shall provide direction to the LSRH.                         (v) The LSRH shall have services and facilities separate from the other licensed health care facility. The required facilities shall be located within the proposed LSRH proper.                       (vi) Common use of facilities using time-sharing concepts may be permitted on a case-by-case basis when the other health care facilities comply with the requirements contained in NFPA 101 Chapter 18 and §511.163 of this subchapter, and provided this chapter and the other health care facility licensing regulations allow.                     (C) The equipment and systems required in each new LSRH may be provided exclusively for the LSRH or by contractual agreement with a licensed health care facility. The equipment and systems shall comply with §511.162 of this subchapter.                      (i) The following equipment and systems shall be provided for the exclusive use of the LSRH, except where noted otherwise.                          (I) Where the LSRH is served by the building's normal electrical system, the breaker serving the LSRH shall originate in the main switchboard and shall be labeled, "Hospital Service - Contact Hospital Representative Prior to Opening Breaker".                           (II) The LSRH distribution panel board shall be within the LSRH.                           (III) An electrical room for the distribution of type I essential electrical system shall be provided separate from the building electrical room. The LSRH staff shall have access at all times to the essential electrical system room and the building's electrical room. The LSRH shall be responsible for maintenance, testing, and upkeep of the essential electrical system. When the existing essential electrical system owned and operated by the other licensed health care facility is nonconforming, the following options are available:                              (-a-) a separate conforming essential electrical system shall be provided in the new LSRH; or                               (-b-) separate transfer switches connected to the existing on-site generator shall be provided when adequate capacity is available and the other health care facility existing nonconforming system shall be corrected. Corrections shall be made in accordance with a plan of correction approved by HHSC.                             (IV) An emergency generator may be shared when adequate capacity is available. Separate transfer switches shall be provided to serve the LSRH and other licensed health care facilities. The LSRH shall be the owner of the generator, have access to the generator at all times, and shall be responsible for maintenance, testing and upkeep of the generator.                           (V) The LSRH shall meet the emergency water storage requirement under 25 TAC §133.162(d)(4)(A)(i)(VIII) and the storage shall be located within the LSRH.                           (VI) When the other licensed health care facilities have a fire alarm control center or a main building alarm panel at the main lobby entrance, the LSRH shall have an annunciator panel at a 24-hour staffed location. The LSRH staff shall have access at all times to the main building fire alarm system panels and shall be responsible for verifying the maintenance and upkeep of such system.                           (VII) Fireman's test valve for the fire sprinkler system.                          Cont'd...