Facility Planning Legal & Regulatory Issues Week 3.

Facility PlanningLegal & Regulatory Issues

Week 3

Objectives for Week 3Legal & Regulatory Issues

Examine local, state, and federal legal and regulatory requirements.

Develop a plan for waste management, fire and safety, and disaster management

Examine Local, State, & Federal legal and regulatory

requirementsRegulatory considerations

FederalInternational Building CodeNational Electrical CodeAmericans with Disabilities Act (ADA)

Governs accessibility requirements Details required sizes of patient rooms, bathrooms, etc., for wheelchair accessibilityIncludes signage requirementsRequires and determines grab bar placementStipulates handicap parking requirements


requirementsFederal (con’t)

National Fire Protection Association (NFPA) 101 Life Safety Code for Healthcare Occupancies

Requirements for fire alarms, emergency lighting, and fire suppression equipmentStipulates distances to exits, fire pull stations, fire extinguishers, etc.Determines fire and smoke ratings required for most aspects of the building and some furnishings, such as wall and floor coverings and some fabrics Governs smoke barrier requirementsDining room elevator requirementsSome states, like California, have requirements that are stricter than the federal government


requirementsHealth Insurance Portability And Accountability Act (HIPAA) governs patient privacy concerns and information security

OSHA Requires worker safeguards (may affect equipment selection or design of work areas) Specific policies and procedures must be in place by opening date related to

Bloodborne pathogensConfined spaces (elevators)Material Safety Data Sheets (MSDS) – Hazard Communication PlanElectrical safety (lock-out, tag-out)Other worker safety issues


requirementsFederal (continued):

Clinical Laboratory Improvement Amendments (CLIA) governs clinical laboratoriesMedicare and Medicaid Conditions of Participation


requirementsState

State health planning; Certificate of Need (CON) laws still apply in some statesState licensing agency (Department of Health, Aging or Senior Services)

Must approve architectural/detailed construction plans before construction startsConducts onsite inspections of the construction in progress

State fire codes enforced by the state fire marshallState building codes


requirementsLocal

Planning and zoning lawsLocal building codesLocal fire department and city-specific fire requirementsArchitectural/detailed construction plans must be approved and a building permit issued before construction beginsConduct periodic surveys of the construction in progress


requirements

If the completed project will be accredited (by JCAHO, CARF/CCAC, other), architectural plans should be reviewed to assure compliance with applicable standards.


requirementsLicenses and permits required for operating the facility

Must be in place before the facility opensOccupancy permit (issued by local authority)License from the state licensing agency (Department of Health, Aging or Senior Services)A local business license may be required


requirementsLicenses and permits required for operating the facility

Separate business or operating licenses may be required for:

Food service departments, restaurants, and cafeteriasBarber and beauty shopsGift shop

Drug Enforcement Agency permits (for storing and dispensing medications). If selling medications to outpatients, a retail pharmacy license will be required.Clinical Laboratory Improvements Act (CLIA) for clinical laboratory services. LTC facilities will require a CLIA waiver


requirementsLicensing, certifying, and opening the new facility:

The state licensing agency will conduct a survey of the completed facility. If all requirements are met, the license to operate will be issuedRequirements for passing the licensure survey

Building and grounds 100% completeAll building systems working properlyAll furnishings, equipment, and supplies in placeRequired staff hired, trained and some on duty during the licensure survey


requirementsLicensing, certifying, and opening the new facility:

All policies and procedures finalizedDisaster plan complete Waste management plan completeAll contracts for any contracted services negotiated and in effect

After state operating license has been issued and the first patients have been admitted, Medicare/Medicaid surveyors will arrive to check for compliance with the Medicare and Medicaid Conditions of Participation. If the facility is in substantial compliance, the facility will be certified to receive payment for Medicare and Medicaid patients.

Plans for Waste Management, Fire and Safety, and Disaster

ManagementWaste management

Regulatory standards for waste management originated with the World Health Organization (WHO)

Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) govern many of the U. S. waste management requirements


ManagementWaste managementThe waste management plan must address:

Sorting of waste (where it is generated is best)Handling (as little as possible)Interim storage—short term (1 to 2 days) before final disposalFinal disposal

Solid medical wasteLiquid medical wasteContaminated sharpsWaste anesthesia gasesRadioactive materials

Required recordkeeping


ManagementGuidelines for disaster planning or emergency management defined by the Department of Homeland Security

Sample disaster or emergency management plans and guidance for developing plans are available from many states. An example from Kansas for long-term care facilities is located at: http://www.jocoem.org/documents/Plan_Templates/Adult_Care_Homes_Disaster_Plan_Template.pdfShould address business continuity planning as well as specific disaster conditions that might occur

http://www.jocoem.org/documents/Plan_Templates/Adult_Care_Homes_Disaster_Plan_Template.pdf




ManagementHealth care facilities should also address their role for providing assistance when disasters occur elsewhere in their community

Disaster plan should include a section on responding to firesKey points in business continuity planning

Carefully assess how your organization functions and create a business flow chart if none existsIdentify operations critical to survivalInclude emergency payroll, expedited financial decision making, and accounting systemsDetermine management successionIdentify your suppliers, resources, and other business partners

Disaster Management

Develop additional professional relationships in case primary suppliers are unable to service needsCreate a contact list to use in emergencies and keep with emergency supplies at an off-site locationPlan what you will do if your building is not accessiblePlan for payroll continuityDefine crisis management procedures and individual responsibilities in advanceReview and update the plan annuallyDevelop a plan for maintaining communication with employees

Disaster Management

Keep important records like building plans, insurance policies, employee contact and identification information in a safe off-site location

Ensure you have employees able to workSupplies

Focus first on the basics of fresh water, food, clean air, and warmth. Create a plan for having essential medical supplies on hand or available

Create evacuation plansDevelop policies and procedures about deciding whether to stay or evacuateEnsure all employees are well trained in the procedures

Questions?Next week……..

Individual – Toolwire Model

(alternate assignment is a powerpoint –you need a PHOTO of every key element)

Team Summary

Facility Planning Legal & Regulatory Issues Week 3.

Documents

Transcript of Facility Planning Legal & Regulatory Issues Week 3.