(a) Services. A nursing facility must either contain the elements described in this section or the facility must indicate the manner in which the needed services are to be made available.
(b) Sizes. The sizes of the various departments will depend upon program requirements and the organization of services within the facility. Some functions requiring separate spaces or rooms in these minimum requirements may be combined, provided that the resulting plan will not compromise the best standards of safety and of medical and nursing practices.
(c) Shared or combined services. A nursing facility may be operated together with a hospital and may share administration, food service, recreation, janitor service, and physical therapy facilities, but must have clearly identifiable physical separations, such as a separate wing or floor. A nursing facility with different levels of care will require identifiable physical separations. Combined attendant or nurses’ stations and medication room areas will require some separating construction features. An assisted living facility may be operated together with a nursing facility and may share food and laundry service, but must have clearly identifiable physical separations such as a separate wing, or floor, and each facility must independently meet all other requirements within their licensed areas.
(d) Exterior finishes. Unless otherwise approved by HHSC, the exterior finish material of a building classified as fire resistive or protected noncombustible construction, per NFPA 220, must have a flame spread index no greater than 25 and a smoke developed index no greater than 450, when tested according to ASTM E84 or UL 723. All others exterior materials must have a flame spread index no greater than 75 and a smoke developed index no greater than 450. Items of trim may be of combustible material subject to approval by HHSC. Roof covering assemblies must have a Class A or Class B rating, when tested according to ASTM E108 or UL 790.
(e) Accessibility requirements. The facility must comply with accessibility requirements for individuals with disabilities in the revised regulations for Title II and III of the Americans with Disabilities Act of 1990 at 28 CFR Part 35 and Part 36, also known as the 2010 ADA Standards for Accessible Design, and the TAS adopted by the Texas Department of Licensing and Regulation (TDLR) at 16 TAC Chapter 68. A facility must register plans for new construction, substantial renovations, modifications, and alterations with TDLR, Attn: Elimination of Architectural Barriers Program, and comply with the TAS.

Source Note: The provisions of this §554.353 adopted to be effective March 22, 2018, 43 TexReg 1646; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871