CHAPTER IX
COMMUNITY CLINICS AND COMMUNITY CLINICS AND EMERGENCY CENTERS
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SECTION 1	DEFINITIONS
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1.6	Plan review – means 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 IX.  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.
1.7	qualifying community clinic – for the purposes of plan review, means a clinic with a total interior physical plant square footage of under 2,500 square feet where the services do not include treatment that renders patients incapable of self-preservation without the assistance of others during an emergency situation.  (Qualifying community clinics do not include community clinics and emergency centers.)
1.8	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.
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10.1	Limited Stay. A community clinic or a community clinic and emergency center may provide inpatient services to ill or injured persons where a determination has been made that transportation to a hospital or other appropriate facility when a higher level of care is not immediately necessary provided that the needs of such patients can be met by the facility during a short stay not to exceed 72 hours. “Meeting the needs of patients” shall include, appropriate provider staff consistent with the licensure requirements related to such staff. licensed provider staff, patient care services, equipment and supplies, and physical plant.
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SECTION 13	PHYSICAL PLANT AND ENVIRONMENT
13.1	13.1 (b)  Pest Control. Policies shall be developed and procedures implemented for the effective control of insects, rodents, and other pests.
13.2	13.1 (c)  Waste disposal. All wastes shall be disposed in compliance with local, state and federal laws.
13.3	13.1 (d)  Preventive Maintenance. A preventive maintenance program to ensure that all essential mechanical, electrical and patient care equipment is maintained in safe operating condition shall be provided. Emergency systems, and all essential equipment and supplies shall be inspected and maintained on a frequent or as needed basis.
13.4	13.1 (e)  Housekeeping. Housekeeping services to ensure that the premises are clean and orderly at all times shall be provided and maintained. Appropriate janitorial storage shall be maintained.
13.5	13.1 (f)  Laundry and Linens. Laundry and linen services shall be provided by in-house staff or by contract. Separate clean and soiled linen areas shall be provided and maintained. 
13.7	13.1  The community clinic or and the community clinic and emergency center shall be constructed and maintained to ensure access to all patients and to ensure the safety of patients.
13.8	13.1(a)(1)  Other Building Requirements. The community clinic or the community clinic and emergency center shall also demonstrate compliance with all other the building and fire safety requirements of local governments and other state agencies. , including but not limited to structural, mechanical, plumbing, and electrical requirements.
13.1(a)	Life Safety Code. All community clinics or community clinics and emergency centers shall comply with the Life Safety Code, National Fire Protection Association 101, 1991 for new and existing ambulatory health care facilities. A community clinic or a community clinic and emergency center that is currently licensed and was lawfully constructed and found to be in compliance at the time of initial licensure and during any subsequent surveys may continue to utilize existing, approved life safety systems provided that they present no hazard to the life, health, and safety of patients. The community clinic or the community clinic and emergency center shall, in the event of any renovation to the facility of 50 percent or greater of the total interior of the physical plant, after the effective date of these regulations, comply with the requirements of the Life Safety Code, National Fire Protection Association 101, 1991.
13.9	Compliance with the Life Safety Code.  Applicable facilities 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 March 11, 2003 shall meet Chapter 21, Existing Ambulatory Health Care Occupancies, NFPA 101.  However, a qualifying community clinic shall meet Chapter 39, Existing Business occupancies, NFPA 101.  
(b)	Facilities licensed on or after March 12, 2003 or portions of facilities that undergo remodeling on or after March 12, 2003 shall meet Chapter 20, New Ambulatory 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.  However, a qualifying community clinic shall meet Chapter 38, New Business 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 38, 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.
13.10	Plan Review and Plan Review Fees.  This Section 13.10 applies to community clinics and community clinics and emergency centers with the exception of facilities operated in prisons under the auspices of the Department of Corrections.
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, or in the case of a qualifying community clinic, to the set fee.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
(a)	Initial licensure, Additions, Relocations 
1)	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.
2)	Initial licensure, addition, and relocation plan review fees:  
(i)	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.	
(ii)	Notwithstanding paragraph 13.10, (a) (2) (i) above, the fee for a qualifying community clinics is:  $1,250.
(b)	Remodeling  
1)	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 not previously used for providing patient services, including storage space, to space used for the delivery of services to patients.  
(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.
2)	Remodeling plan review fees:  
(i)	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.	
(ii)	Notwithstanding paragraph 13.10, (b) (2) (i) above, the fee for a qualifying community clinic is:  $750.
13.11	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.