(a) General.
  (1) A limited services rural hospital (LSRH) owner or operator may not begin construction of a new building, additions to or renovations, or conversions of existing buildings until the Texas Health and Human Services Commission (HHSC) approves final construction documents.
  (2) Plans and specifications describing the construction of new buildings and additions or renovations and conversions of existing buildings shall be prepared by a registered architect, a licensed professional engineer, or both, and meet the requirements of this subchapter.
  (3) The names of spaces used in the LSRH's functional program narrative, preliminary documents, final construction documents, and specifications shall be consistent with the names of the spaces used in this chapter.
  (4) HHSC shall notify the LSRH's owner or operator of the result of its review of each type of submission discussed in this section.
  (5) The LSRH owner or operator shall respond to all HHSC requests for additional information, including providing a plan of correction for deficiencies cited by HHSC.
  (6) Once final construction documents are approved, the LSRH owner or operator shall request inspections in accordance with §511.168 of this subchapter (relating to Construction, Inspections, and Approval of Project).
  (7) When construction is delayed for longer than one year from the plan approval or self-certification approval date, the LSRH shall resubmit construction documents to HHSC for review and approval. The plans shall be accompanied by a new Application for Plan Review, plan review fee, and functional program narrative.
  (8) The LSRH owner or operator shall provide written notification to HHSC when a project has been placed on hold, canceled, or abandoned.
  (9) HHSC may close a project file after one year of assigning an application number to a project if the LSRH has placed the project on hold. Plan review fees are nonrefundable.
(b) Submission of projects and assignment of application number.
  (1) The LSRH owner or operator or representative shall submit the following items to HHSC in care of the mailing or overnight delivery address that appears on the Application for Plan Review.
    (A) A completed and signed Application for Plan Review. The Application for Plan Review may be obtained by contacting the HHSC Health Care Regulation Department Architectural Review Unit (ARU) using the contact information listed on the HHSC website.
    (B) The applicable plan review fee in accordance with §511.17 of this chapter (relating to Fees).
    (C) A functional program narrative in accordance with subsection (d) of this section.
    (D) Final construction documents in accordance with subsection (f) of this section.
  (2) The cost of submitting documents and plans and specifications shall be borne by the sender.
  (3) Once HHSC has determined that the submission required in paragraph (1) of this subsection is complete, HHSC will assign an application number to the project that must be referenced on all documents and correspondence related to the project. HHSC will review final construction documents in the chronological order received.
  (4) The LSRH shall satisfactorily resolve all deficiencies noted in the final plan review before HHSC will grant approval of the project for construction.
  (5) The LSRH shall not begin construction until the LSRH owner or operator receives written notification from HHSC that the final construction documents have been approved.
(c) Feasibility conference. An LSRH owner or operator or representative may request a feasibility conference, which is an informal meeting between a member of ARU staff and the LSRH owner or operator or representative, to determine the feasibility of a project, for consultation and informational purposes, and to facilitate and establish understanding of compliance with the rules and codes.
  (1) A feasibility conference is not a substitute for plan review.
  (2) An LSRH owner or operator or representative may schedule a feasibility conference by contacting ARU using the contact information listed on the HHSC website.
  (3) The LSRH owner or operator or representative shall provide at the feasibility conference the items in subsection (b)(1)(A) - (C) of this section and a set of preliminary plans or final construction documents.
  (4) The LSRH owner or operator or representative is responsible for recording conference notes and shall submit the notes to HHSC.
(d) Functional program narrative. The LSRH owner or operator or representative shall submit a functional program narrative to HHSC with each new project in accordance with subsection (b)(1)(C) of this section. The functional program narrative shall be presented on facility letterhead, signed by LSRH administration, include the functional description of each space, and the following:
  (1) departmental relationships, number of patient stations in each category, and other basic information relating to the fulfillment of the LSRH's objectives;
  (2) a description of each function to be performed, approximate space needed for these functions, occupants of the various spaces, projected occupant load, types of equipment required, interrelationship of various functions and spaces, and any special design features;
  (3) energy conservation measures, included in building, mechanical and electrical designs;
  (4) a description of the type of asepsis control in diagnostic and treatment areas; and
  (5) the type of construction (existing or proposed) as stated in Table 18.1.6.2 of National Fire Protection Association 101, Life Safety Code, 2012 edition (NFPA 101).
(e) Preliminary documents. HHSC may request preliminary documents. If requested by HHSC, the submission shall consist of the items in subsection (b)(1)(A) - (C) of this section, preliminary plans, and outline specifications. The documents shall contain sufficient information to establish the project scope, description of functions to be performed, project location, required fire safety and exiting requirements, building construction type, compartmentation showing fire and smoke barriers, patient station count and services, and the usage of all spaces, areas, and rooms on every floor level.
(f) Final construction documents. Final construction documents and specifications shall be submitted to HHSC for review and approval prior to start of construction. All final documents and specifications shall be appropriately sealed and signed by the project registered architect and professional engineer licensed by the state of Texas.
  (1) Submission of final construction documents. The LSRH owner or operator shall submit to HHSC for review and approval the items in subsection (b)(1)(A) - (C) of this section (if not previously submitted with preliminary documents) and one set of final construction documents and specifications covering the construction of new buildings or alterations, additions, conversions, modernizations, or renovations to existing buildings.
  (2) Preparation of final construction documents. Construction documents shall be well-prepared so that clear and distinct prints may be obtained, shall be accurately and adequately dimensioned, and shall include all necessary explanatory notes, schedules, and legends and shall be adequate for contract purposes. Compliance with model building codes and this chapter shall be indicated. The type of construction, as classified by National Fire Protection Association 220, Standard on Types of Building Construction, 2012 edition, shall be provided for existing and new facilities. Final plans shall be drawn to a sufficiently large-scale to clearly illustrate the proposed design but not less than one-eighth inch equals one foot. All spaces shall be identified by usage (using the names of spaces used in this chapter) on all plans (architectural, fire safety, mechanical, electrical, etc.) submitted. Separate drawings shall be prepared for each of the following branches of work.
    (A) Architectural plans. Architectural drawings shall include the following.
      (i) A map of the area within a two-mile radius of the facility site with any hazardous and undesirable location noted in §511.162(a) of this subchapter (relating to General Construction Requirements) identified.
      (ii) A site plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new buildings and structures, roadways, parking, walks, easement, overhead or underground utilities or service lines, and the extent of the areas to be landscaped. All structures that are to be removed under the construction contract and improvements shall be shown. A general description of the immediate area surrounding the site shall be provided.
      (iii) A plan of each floor and roof to include fire and smoke separation, means of egress, and identification of all spaces.
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(iv) Schedules of doors, windows, and finishes.
      (v) Elevations of each facade.
      (vi) Sections through building.
      (vii) Scaled details as necessary.
    (B) Fire safety plans. These drawings shall be provided for all newly constructed buildings, conversions of existing buildings for facilities, additions to existing licensed facilities, and remodeled portions of existing buildings containing licensed facilities. Fire safety plans shall be of a sufficiently large-scale to clearly illustrate the proposed design but not less than one-sixteenth inch equals one foot and shall include the following information:
      (i) separate fire safety plans (preferably one floor plan per sheet) shall indicate location of fire protection-rated walls and partitions, location and fire resistance rating of each fire damper, and the required means of egress (corridors, stairs, exits, exit passageways);
        (I) when a new building is to contain a proposed facility, when an existing building is converted to a facility, or when an addition is made to an existing facility building, plans of each floor and roof shall be provided; and
        (II) when a portion of a building is remodeled or when a new service is added, only the plan of the floor where the remodeling will take place or new service will be introduced and the plan of the floor of discharge shall be provided;
      (ii) designated smoke compartments with floor areas of each compartment, location and fire resistance rating (one or two hour) of each smoke partition, and location, type, and fire resistance rating of each smoke damper;
      (iii) location of all required fire alarm devices, including all fire alarm control panels, manual pull stations, audible and visual fire alarm signaling devices, smoke detectors (ceiling and duct-mounted), fire alarm annunciators, fire alarm transmission devices, fire sprinkler flow switches and control valve supervisory switches on each of the floor plans; and
      (iv) areas protected with fire sprinkler systems (pendant, sidewall or upright, normal or quick response, and temperature rating shall be indicated), stand pipe system risers and sizes with valves and inside and outside fire department connections, fire sprinkler risers and sizes, and location and type of portable fire extinguishers.
    (C) Equipment drawings. Equipment drawings shall include the following.
      (i) All equipment necessary for the operation of the facility as planned. The design shall indicate provisions for the installation of large and special items of equipment and for service accessibility.
      (ii) Fixed equipment (equipment that is permanently affixed to the building or that must be permanently connected to a service distribution system designed and installed during construction for the specific use of the equipment). The term "fixed equipment" includes items such as laundry extractors, walk-in refrigerators, communication systems, and built-in casework (cabinets).
      (iii) Movable equipment (equipment not described in clause (ii) of this subparagraph as fixed). The term "moveable equipment" includes wheeled equipment, plug-in type monitoring equipment, and relocatable items.
      (iv) Equipment that is not included in the construction contract but that requires mechanical or electrical service connections or construction modifications. The equipment described in this clause shall be identified on the drawings to ensure its coordination with the architectural, mechanical, and electrical phases of construction.
    (D) Structural drawings. Structural drawings shall include:
      (i) plans for foundations, floors, roofs, and all intermediate levels;
      (ii) a complete design with sizes, sections, and the relative location of the various members;
      (iii) a schedule of beams, girders, and columns;
      (iv) dimensioned floor levels, column centers, and offsets;
      (v) details of all special connections, assemblies, and expansion joints; and
      (vi) special openings and pipe sleeves dimensioned or otherwise noted for easy reference.
    (E) Mechanical drawings. Mechanical drawings shall include:
      (i) complete ventilation systems (supply, return, exhaust), all fire and smoke partitions, locations of all dampers, registers, and grilles, air volume flow at each device, and identification of all spaces (e.g., corridor, patient room, operating room);
      (ii) boilers, chillers, heating and cooling piping systems (steam piping, hot water, chilled water), and associated pumps;
      (iii) cold and warm water supply systems, water heaters, storage tanks, circulating pumps, plumbing fixtures, emergency water storage tank(s) (if provided), and special piping systems such as for deionized water;
      (iv) nonflammable medical gas piping (oxygen, compressed medical air, vacuum systems, nitrous oxide), emergency shutoff valves, pressure gages, alarm modules, and gas outlets;
      (v) drain piping systems (waste and soiled piping systems, laboratory drain systems, roof drain systems);
      (vi) fire protection piping systems (sprinkler piping systems, fire standpipe systems, water or chemical extinguisher piping system for cooking equipment);
      (vii) piping riser diagrams, equipment schedules, control diagrams or narrative description of controls, filters, and location of all duct-mounted smoke detectors; and
      (viii) laboratory exhaust and safety cabinets.
    (F) Electrical drawings. Electrical drawings shall include:
      (i) electrical service entrance with service switches, service feeders to the public service feeders, and characteristics of the light and power current including transformers and their connections;
      (ii) location of all normal electrical system and essential electrical system conduits, wiring, receptacles, light fixtures, switches, and equipment that require permanent electrical connections, on plans of each building level:
        (I) light fixtures marked distinctly to indicate connection to critical or life safety branch circuits or to normal lighting circuits; and
        (II) outlets marked distinctly to indicate connection to critical, life safety, or normal power circuits;
      (iii) telephone and communication, fixed computers, terminals, connections, outlets, and equipment;
      (iv) nurses calling system showing all stations, signals, and annunciators on the plans;
      (v) in addition to electrical plans, single line diagrams prepared for:
        (I) complete electrical system consisting of the normal electrical system and the essential electrical system, including the on-site generator(s), transfer switch(es), emergency system (life safety branch and critical branch), equipment system, panels, subpanels, transformers, conduit, wire sizes, main switchboard, power panels, light panels, and equipment for additions to existing buildings, proposed new facilities, and remodeled portions of existing facilities (feeder and conduit sizes shall be shown with schedule of feeder breakers or switches);
        (II) complete nurses calling system with all stations, signals, annunciators, etc. with room number noted by each device and indicating the type of system (nurses regular calling system, nurses emergency calling system, or staff emergency assistance calling system);
        (III) a single line diagram of the complete fire alarm system showing all control panels, signaling and detection devices, and the room number where each device is located; and
      (vi) schedules of all panels indicating connection to life safety branch, critical branch, equipment system or normal system, and connected load at each panel.
  (3) Construction document changes. Any changes to the final construction documents that affect or change the function, design, or designated use of an area shall be submitted to HHSC for approval prior to authorization of the modifications.
(g) Special submittals.
  (1) Self-certification.
    (A) In an effort to shorten the plan review and approval process, the LSRH owner or operator or representative may request approval of final construction documents under the self-certification review process.
      (i) The owner or operator shall submit the items in subsection (b)(1)(A) - (D) of this section and a completed self-certification form, signed by the LSRH owner or operator, architect of record, and engineer of record attesting that the plans and specifications are based upon and comply with the requirements of this chapter.
      (ii) By signing and submitting the self-certification form, the LSRH owner or operator accepts the following conditions.
        (I) HHSC retains the right to review the final construction documents, conduct inspections of the project, and withdraw its approval.
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(II) The LSRH owner or operator has a continuing obligation to make any changes HHSC requires to comply with the licensing rules whether physical plant construction or alterations have been completed.
        (III) The LSRH owner or operator is ultimately responsible for compliance with Texas Health and Safety Code Chapter 241 (relating to Hospitals) and this chapter.
    (B) HHSC will review the request for self-certification and notify the LSRH owner or operator if the request is approved or denied. If denied, HHSC will review the final construction documents in the chronological order in which the documents were received. Construction may not begin until HHSC has reviewed and approved the final construction documents.
  (2) Minor project. If an LSRH owner or operator believes that a proposed project is a minor project as described in §511.161(a)(2)(C) of this subchapter (relating to Requirements for Buildings in Which Existing Licensed Hospitals are Located), the LSRH owner or operator shall provide HHSC a brief written description of the proposed project and floor plans of the areas of work.
    (A) If HHSC determines the proposed project is a minor project, HHSC will notify the LSRH owner or operator of the approval, and state the number of inspections that will be required. HHSC will conduct a minimum of one inspection.
    (B) HHSC will notify the LSRH owner or operator that a proposed project is not approved as a minor project if the project involves any of the following:
      (i) remodeling or alterations that involve alterations to load bearing members or partitions;
      (ii) a change in functional operation;
      (iii) affects fire safety (e.g., modifications to the fire, smoke, and corridor walls);
      (iv) adds services for which the LSRH is not currently licensed; and
      (v) significantly changes the mechanical, electrical, plumbing, fire protection, or piped medical system.
    (C) The LSRH owner or operator shall submit final construction documents in accordance with subsection (f) of this section if HHSC determines the project is not a minor project.
  (3) Fire sprinkler systems.
    (A) When the sole purpose of a project is installation of a sprinkler system, whether a partial or complete system, the LSRH owner or operator shall submit to HHSC for approval the items in subsection (b)(1)(A) - (C) of this section and sprinkler documents.
    (B) Fire sprinkler systems shall comply with the requirements of National Fire Protection Association 13, Standard for the Installation of Sprinkler systems, 2010 edition (NFPA 13), and shall be designed or reviewed by an engineer who is registered by the Texas Board of Professional Engineers in fire protection specialty or is experienced in hydraulic design and fire sprinkler system installation. A short resume shall be submitted if registration is not in fire protection specialty.
      (i) Fire sprinkler working plans, complete hydraulic calculations, and water supply information shall be prepared in accordance with NFPA 13, §§14.1, 14.2 and 14.3, for new fire sprinkler systems and alterations of and additions to existing ones.
      (ii) One set of fire sprinkler working plans, calculations and water supply information shall be forwarded to HHSC together with the professional engineer's (professional engineer (P.E.) licensed in the state of Texas) certification letter stating that the sprinkler system design complies with the requirements of NFPA 13. Certification of the fire sprinkler system shall be submitted prior to system installation.
      (iii) Upon completion of the fire sprinkler system installation and any required corrections, written certification by the engineer, stating that the fire sprinkler system is installed in accordance with NFPA 13 requirements, shall be submitted prior to or with the written request for the final construction inspection of the project.
(h) Retention of drawings, manuals and design data.
  (1) As built drawings. Upon occupancy of the building or portion thereof, the owner shall retain as part of the LSRH's permanent records, a complete set of legible architectural plans of each building level, fire safety plans as described in subsection (f)(2)(B) of this section for each floor reflecting fire safety requirements, and all single line diagrams described in subsection (f)(2)(F)(v) of this section, drawings for fixed equipment, and mechanical and electrical systems, as installed or built.
  (2) Manuals. Upon completion of the contract, the owner shall retain as part of the LSRH's permanent records a complete set of manufacturers' operating, maintenance, and preventive maintenance instructions; parts lists; and procurement information with numbers and a description for each piece of equipment. Facility staff shall also be provided with instructions on how to properly operate systems and equipment. Required information shall include energy ratings as needed for future conservation calculations.
  (3) Design data. The owner shall retain in the LSRH's permanent records complete design data for the facility. This shall include structural design loadings; summary of heat loss assumption and calculations; estimated water consumption; medical gas outlet listing; list of applicable codes; and electric power requirements of installed equipment. All such data shall be supplied to facilitate future alterations, additions, and changes, including, energy audits and retrofit for energy conservation.

Source Note: The provisions of this §511.167 adopted to be effective October 5, 2023, 48 TexReg 5668