Amendments to 6 CCCR 1011-1, Chapter XXII – Birth Centers
Adopted by the State Board of Health on May 20, 2009.  NOTE:  Items in parentheses preceding the amendments are notes/instructions for the Secretary of State/CCR Publisher and are not part of the Rules.
(Par ID 1689499:  Change Chapter title to plural as follows)
CHAPTER XXII - Birth CENTERS
(Strike existing Par 1689517 and replace with the following)
Definitions
Birth Center – Any public or private health facility or institution which is not licensed as a hospital or as part of a hospital and provides care during delivery and immediately after delivery for generally less than twenty-four hours.
Plan Review – The review by the Department, or its designee, of new construction, previously unlicensed space, or remodeling to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter XXII.  Plan review consists of the analysis of construction plans/documents and onsite inspections, where warranted.  For the purposes of the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.
Structural Element – For the purposes of plan review, means an element relating to load bearing or to the scheme (layout) of a building as opposed to a screening or ornamental element.  Structural elements of a building include but are not limited to:  floor joists, rafters, wall and partition studs, supporting columns and foundations.
(Under Section XVII, strike paragraph A, Par ID 1689742, and replace with the following)  
A.	Fire Safety Standards and Fees  
1.	Birth centers shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000), which is hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material. 
a.	Facilities licensed on or before June 30, 2009 shall meet Chapter 21, Existing Ambulatory Health Care Occupancies, NFPA 101.  
b.	Facilities licensed on or after July 1, 2009 or portions of facilities that undergo remodeling on or after July 1, 2009 shall meet Chapter 20, New Health Care Occupancies, NFPA 101.  In addition, if the remodel represents a modification of more than 50 percent of the total interior of the physical plant, the entire facility shall be renovated to meet Chapter 20, NFPA 101.  
c.	Notwithstanding NFPA 101 Life Safety Code (2000) provisions to the contrary:
i	When differing fire safety standards are imposed by federal, state or local jurisdictions, the most stringent standard shall apply.
ii	Any story containing an exterior door or an exterior window that opens to grade level shall be counted as a story.
iii	Licensed facilities shall be separated from unlicensed contiguous occupancies by an occupancy separation with a fire resistance rating of not less than 2 hours.
2.	Plan review and plan review fees are required as listed below.  If the facility has been approved by the Department to use more than one building for the direct care of patients on its campus, each building is subject to the applicable base fee plus square footage costs.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
a.	Initial Licensure, Additions, Relocations 
(i)	Plan review is applicable to the following, and includes new facility construction and new occupancy of existing structures:  
(I)	Applications for an initial license, when such initial license is not a change of ownership and the application is submitted on or after July 1, 2009.  
(II)	Additions of previously uninspected or unlicensed square footage to an existing occupancy and the building permit for such addition is issued on or after July 1, 2009 or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009. 
(III)	Relocations of a currently licensed facility in whole or in part to another physical plant, where the occupancy date occurs on or after July 1, 2009.
(ii)	Initial licensure, addition, and relocation plan review fees:  base fee of $2,250, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-25,000 sq ft	$0.10	This is the cost for the first 25,000 sq ft of any plan submitted.	
25,001+ sq ft	$0.02	This cost is applicable to the additional square footage over 25,000 sq ft.	
b.	Remodeling  
i.	Plan review is applicable to remodeling for which the application for the building permit from the local authority having jurisdiction is dated on or after July 1, 2009, or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009.  Remodeling includes, but is not limited to:
(I)	Alteration, in patient sleeping areas, of a structural element subject to Life Safety Code standards, such as egress door widths and smoke or fire resisting walls.
(II)	Relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage or 50% or more of a smoke compartment.  
(iii)	Conversion of existing space into birthing rooms.  
(iv)	Changes to egress components, specifically the alteration of a structural element, relocation, or addition of an egress component.  Examples of egress components include, but are not limited to, corridors, stairwells, exit enclosures, and points of refuge.   
(v)	Installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(vi)	Installation of any new fire alarm system, or addition, removal or relocation of 20 or more fire alarm system appliances including, but not limited to, pull stations, detectors and notification devices.
(vii)	Installation, removal or renovation of any kitchen hood suppression system.
(viii)	Essential electrical system:  replacement or addition of a generator or transfer switch.  However, replacement of either the generator or transfer switch with one having the same exact performance specifications is considered maintenance and not subject to plan review.
ii.	Remodeling plan review fees:  base fee of $1,750, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-20,000 sq ft	$0.07	This is the cost for the first 20,000 sq ft of any plan submitted.	
20,001+ sq ft	$0.02	This cost is applicable to the additional square footage over 20,000 sq ft.	

(Under Section XVII after paragraph M, Par ID 1689766, insert the following)
N.	The birth center shall be maintained to provide a safe, clean sanitary environment.
O.	The “Guidelines for Design and Construction of Health Care Facilities” (2006 Edition), American Institute of Architects (AIA), may be used by the Department in resolving health, building, and life safety issues for construction initiated or systems installed on or after July 1, 2009.  The AIA Guidelines are hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material.