(a) Construction.
  (1) Major construction. A limited services rural hospital (LSRH) shall not commence construction, other than minor alterations, until the LSRH has satisfactorily resolved final plan review deficiencies and paid the appropriate plan review fee according to the plan review schedule in §511.17 of this chapter (relating to Fees), and the Texas Health and Human Services Commission (HHSC) has issued a letter granting approval to begin construction. Such authorization does not constitute release from the requirements contained in this chapter. If the construction takes place in or near occupied areas, adequate provision shall be made for the safety and comfort of occupants.
  (2) Construction commencement notification. The architect of record or the LSRH owner or operator shall provide written notification to HHSC when construction will commence. HHSC shall be notified, in writing, of any change in the completion schedules.
  (3) Completion. Construction shall be completed in compliance with the construction documents including all addenda or modifications approved for the project.
(b) Construction inspections. All LSRHs, including those that maintain certification under Title XVIII of the Social Security Act (42 United States Code, §1395 et seq), and those that maintain accreditation by a Centers for Medicare & Medicaid Services-approved organization, are subject to construction inspections.
  (1) Number of construction inspections. A minimum of two construction inspections of the project is generally required for the purpose of verifying compliance with Subchapter G of this chapter and this subchapter and the approved plans and specifications. The final plan approval letter will inform the architect of record and the owner or operator as to the minimum number of inspections required for the project.
  (2) Requesting an inspection. The architect of record or the LSRH owner or operator shall request an inspection by submitting, at least three weeks in advance of the requested inspection date, an Application for Inspection and the construction inspection fee in accordance with §511.17(g) of this chapter for each intermediate inspection, final inspection, and reinspection requested. Inspection requests by contractors will not be honored.
    (A) The architect of record or the LSRH owner or operator shall request an intermediate construction inspection to occur at approximately 80 percent completion. All major work above the ceiling shall be completed at the time of the intermediate inspection; however, ceilings shall not be installed.
    (B) The architect of record or the LSRH owner or operator shall request a final construction inspection at 100 percent completion. One hundred percent completion means that the project is completed to the extent that all equipment is operating in accordance with specifications, all necessary furnishings are in place, and patients could be admitted and treated in all areas of the project.
  (3) Reinspections. Depending upon the number and nature of the deficiencies cited during the final inspection, the inspector may require that a reinspection be conducted to confirm correction of all deficiencies cited. The inspector may also require a reinspection if they determine that the project was not sufficiently complete to warrant a final inspection. The request for reinspection shall be submitted in accordance with paragraph (2) of this subsection.
(c) Approval of project. Patients and staff shall not occupy a new structure or remodeled or renovated space until approval has been received from the local building and fire authorities and HHSC.
  (1) Documentation requirements. The LSRH owner or operator shall submit the following documents to HHSC before the project will be approved.
    (A) Written approval of the project by the fire authority.
    (B) A certificate of occupancy for the project issued by the local building authority.
    (C) A copy of a letter or certification from a professional engineer (P.E.) licensed in the state of Texas indicating the fire sprinkler working plans, hydraulic calculation, the testing, and field inspection of the installation of the new or modified sprinkler system is in compliance with the requirements of NFPA 13, Standard for the Installation of Sprinkler Systems, 2002 edition, if applicable. A copy of a letter or certification of changes in existing fire sprinkler system is not required when relocation of not more than twenty sprinkler heads and hydraulic calculation is not involved.
    (D) Fire alarm system certification (form FML-009 040392 of the Office of the State Fire Marshal), if applicable.
    (E) A signed copy of a letter of certification from a qualified certification agency or individual for the piped-in medical gas system that was installed or modified and verification inspection testing in this project in accordance with §511.162 (d)(4)(A)(iii)(IV), (X) and (XI) of this subchapter (relating to General Construction Requirements), if applicable.
    (F) A copy of the test and a letter from the electrical contractor certifying that the electrical system was tested and complies with the standards of NFPA 99, Health Care Facilities, 2012 edition, §4.3.2.2.8 (Special Grounding) and §4.3.3.1 (Grounding System Testing), if applicable to the project.
    (G) A copy of documentation indicating the flame spread rating and the smoke development rating of any wall covering installed in this project. Provide a signed letter or statement corroborating the installation of the product in the project.
    (H) A copy of documentation indicating that draperies, curtains (including cubicle curtains), and other similar loosely hanging furnishings and decorations are flame-resistant as demonstrated by passing both the small and large-scale tests of NFPA 701, Standard Methods of Fire Tests for Flame-Resistant Textiles and Films, 2010 edition as required by NFPA 101, §18-7.5, and provide a signed letter or statement corroborating the installation of the product in the project.
    (I) A written plan of correction signed by the LSRH owner/operator for any deficiencies noted during the final inspection.
    (J) A Final Construction Approval form signed by the LSRH owner/operator.
    (K) Any other documentation or information required or requested due to the type of the project.
  (2) Temporary occupancy approval.
    (A) If, during the final inspection, the inspector finds only a few minor deficiencies that do not jeopardize patient health, safety and welfare, the inspector may grant temporary approval for occupancy contingent upon the documents listed in paragraph (1)(A) - (E) of this subsection being provided to and approved by the inspector at the time of the final inspection.
    (B) Temporary approval for occupancy allows the LSRH owner or operator to occupy the project. However, the LSRH owner or operator must submit the documents required in paragraph (1)(F) - (K) of this subsection before the project receives final approval.
  (3) Final approval. Upon its receipt and acceptance of the documents required in paragraph (1) of this subsection, HHSC will issue written final approval of the project.

Source Note: The provisions of this §511.168 adopted to be effective October 5, 2023, 48 TexReg 5668