Complying With State Regulations

By Kathy Dix

When designing an ambulatory surgery center (ASC) or an addition/ expansion, the architect must comply with certain federal guidelines, which include specifications on dimensions related to the Americans with Disabilities Act (ADA).

However, builders and architects must also obey state regulations, which can be a hodgepodge of recommendations by professional associations, an extension of federal law, and specific geographic and weather considerations — such as hurricanes, tornadoes, earthquakes, and coastal concerns like tsunamis.

“Particulars may vary from state to state, but in general, outpatient surgery projects are similar in principle,” says William R. Massingill, AIA, NCARB, chief operating officer of Polkinghorn Group Architects, Inc. in Austin, Texas. “The American Institute of Architects (AIA) publishes healthcare guidelines and updates them somewhat frequently, and many states adopt those guidelines as their own regulations. While each state may be a little different when it comes to specific code requirements, the owner should consider at the beginning of a project whether their proposed facility will be certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Association of Ambulatory Surgery Centers (AAASC), or some other certifying organization. Those certifying entities typically require that facilities be designed loosely around guidelines such as the AIA’s or their own checklists. By confirming that a proposed project is designed in accordance with the state’s requirements as well as those of the certifying entities, the owner can ensure that their facility will be licensed and accredited with minimal post-occupancy modifications.”

“From the onset of the development of an ASC, it is the architecture and engineering team’s responsibility to identify, recommend, evaluate and insist corrective action be taken to meet or exceed state regulations,” says Mark Sherwood, director of marketing for The Stellar Group in Jacksonville, Fla.

“Each state has its own specific regulations, and all are slightly different. State regulations are continuing to evolve in order to provide the best in health facility licensure, inspection, regulatory enforcement, and the implementation of the certificate of need programs,” Sherwood says.

The liaisons between the state and the ASC, to determine what regulations must be met on a specific project, are generally the architect of record, the point contact, and the senior engineer for mechanical/plumbing and electrical, says Sam W. Burnette, AIA, senior project designer/ principal with Earl Swensson Associates, Inc. in Nashville. “The mechanical/plumbing and electrical engineer has responsibility for 40 percent to 45 percent of the building,” he adds.

On the design side, the architect and engineer ensures that state regulations are met, Burnette explains. “When the project is turned over to the contractor, it is in his hands to make sure the facility is constructed to specs.”

“From a construction aspect, the architect is the key liaison with the state construction review team,” agrees Peggy Zampetti, RN, senior vice president of facility development for Titan Health Corp. in Sacramento, Calif. “However, the construction review team does not oversee licensing regulations and many of the licensure requirements affect how a building needs to function.

“Some states have two review processes, one for construction and one for licensing, but this not the norm,” she adds. “Many design firms lack the clinical expertise to incorporate the function of a facility into the design. In our company, the facility development project managers have extensive clinical and operational experience to fully understand the licensing/operational requirements and are the liaisons between the state and the development team. Additionally, facility development is responsible for the licensure of all facilities. What is important in the development of any ASC project is to fully understand both the state construction requirements as well as the Medicare/licensing regulations.”

“The project managers in coordination with architecture, engineering, state, and local agencies, ensure that such regulations are met,” she adds.

Certain uncommon regulations are specific to particular states. “Each state has minor and major variations and hot buttons,” Burnette says. “For example, Florida and other coastal states are attuned to high-wind requirements. Florida, in fact, still has its own state regulations. For California and other earthquake-prone areas, the out-of-norm regulations are those addressing seismic requirements. Most states, however, are adopting the latest International Building Code (IBC) and the American Institute of Architect’s Guidelines for Design and Construction of Hospital and Health Care Facilities.”

“For the most part I find the states have similar requirements,” Zampetti says. “Some follow AIA guidelines; others have a modified version. Some states have their own guidelines. States may vary in the requirements for radiation protection, accessibility requirements (ADA guidelines), etc. However, the critical factor often comes down to how the rules are interpreted. This is often a judgment call on the part of the state reviewers, the local building department and/or the fire marshal. The key is to do your homework, know the rules and maintain a positive relationship with the state reviewers.”