Protecting and promoting the health and safety of the people of Wisconsin Health Care Construction Projects DHS and the Municipal AHJ Henry Kosarzycki, AIA, Director DHS Division of Quality Assurance Office of Plan Review and Inspection
What All Health Care Facilities Hospital Nursing home Hospice Assisted living* Ambulatory health care* Federal Survey Construction New construction, addition, renovation 1
Why It s your community Single State of Wisconsin contact One stop for external clients Comprehensive code, rule and standard Vulnerable occupants and users Patients Residents Defend in place 2
How Federal survey Pre design meetings Plan review Coordination with municipal AHJs Regulations and process Field presence 3
Federal Survey Centers for Medicare and Medicaid Services (CMS) Hospitals (including critical access) Nursing homes End stage renal dialysis Ambulatory surgery centers 4
Federal Survey Centers for Medicare and Medicaid Services (CMS) The regulatory bookshelf NFPA 101 Life Safety Code The survey process The statement of deficiencies The plan of correction 5
Federal Survey Centers for Medicare and Medicaid Services (CMS) DHS Division of Quality Assurance Health care and physical environment Citations Funding impact 6
Federal Survey The regulatory bookshelf NFPA 101 Life Safety Code Adopted codes and standards NFPA 99 Health Care Facilities Code Does not include State of Wisconsin 7
Federal Survey The survey process Unannounced Health and physical environment survey Document review and complete tour Identify deficiencies 8
Federal Survey The Statement of Deficiencies (SOD) within 10 days following exit Issued on behalf of CMS Provider submits Plan of Correction (POC) within 10 days following SOD (day 20) Last correction date for all citations day 45 DHS/DQA returns for verification 9
Federal Survey The Plan of Correction (POC) DHS/DQA Office of Plan Review and Inspection Focus on physical environment Construction timelines may go beyond 45 days Temporary waiver or permanent waiver These are not variances Municipal Permit 10
Pre design Meeting Who When Why What How 11
Pre design Meeting Who Owner Designer(s) Regulatory agencies State Municipal Contractor(s) Other stakeholders based on project scope 12
Pre design Meeting When Owner and design team driven Sooner than later Schematic or design development phase Multiple meetings based on project scope 13
Pre design Meeting Why Multiple stakeholders Multiple expectations Multiple communication links Time critical Structures that meet the minimum of the code 14
Pre design Meeting What Project scope Owner expectations Project schedule Design team Municipal issues Submittal process Construction phases 15
Pre design Meeting How Organized by owner/design team Multiple stakeholders to coordinate Facilitated by State DHS/DQA OPRI representative Agenda shapes the conversation All stakeholders contribute and shape the dialogue Minutes are captured and distributed 16
Plan Review Health care facility contract documents Statutory authority stat 101 reference to stat 50 DHS administrative rules and adoption of DSPS The Memorandum of Agreement DHS and DSPS Electrical, plumbing, elevators, boilers 17
Plan Review Health care facility contract documents Staff of architects and professional engineers Survey and construction administration teams Review of documents under Federal and State Broader scope Medical gases Federal guidelines institute Emergency and standby power Nurse call systems 18
Plan Review Statutory authority stat 101.12 101.12 Approval and inspection of public buildings and places of employment and components. (1) Except for plans that are reviewed by the department of health services under ss. 50.02 (2) (b), 50.025, 50.36 (2), or 50.92 (3m) 19
Plan Review Statutory authority stat 50 50.02 (2)(b) The department shall conduct plan reviews of all capital construction and remodeling of nursing homes to ensure that the plans comply with building code requirements under ch. 101 and with life safety code and physical plant requirements under s. 49.498, this chapter or under rules promulgated under this chapter. 50.025 CBRF 50.36 Hospitals 50.92 Hospice 20
Plan Review DHS Administrative Rules and Adoption of DSPS DHS 83 Community Based Residential Facility DHS 124 Hospital DHS 131 Hospice DHS 132 Nursing Home Adoption of SPS 361 366 21
Plan Review The Memorandum of Agreement Wisconsin Act 27 enacted July 26, 1995 and Assembly Bill 150 published July 28, 1995 Wisconsin Act 55 enacted July 12, 2015 and Senate Bill 21 published July 13, 2015. DHS and DSPS responsibilities 22
Plan Review The Memorandum of Agreement DSPS Boilers and pressure vessels Mechanical refrigeration systems Elevators Private onsite water treatment components Periodic fire inspections by local fire departments Plumbing components and inspections Erosion control Electrical 23
Coordination with Municipal AHJs What we Do Pre design meetings Plan review Limited inspections What we Don t Do Permits Certificates of Occupancy 24
Coordination with Municipal AHJs Pre design meetings Coordination with all stakeholders Regulatory authority State (DHS) and municipal (bldg., fire, dpw, zoning) Expectation Schedule, process, roles Communication 25
Coordination with Municipal AHJs Plan review DHS scope Bldg., HVAC, fire alarm, fire suppression Municipal scope Municipal review criteria Timing and coordination After State or simultaneous 26
Coordination with Municipal AHJs Limited inspections Community resource based Technical focus Limited authority Orders to correct Permit issuance by Municipal AHJ 27
Coordination with Municipal AHJs Permits Municipal authority stat 101.12 (3)(h) Require all local officers not authorized by the department to grant approvals as provided in pars. (a) and (b) to deny permits or licenses for construction or use of public buildings, public structures and places of employment until the required drawings and calculations have been examined by the department. Subsequent inspections and closed permits 28
Coordination with Municipal AHJs Certificates of Occupancy Municipal authority Zoning, use, aesthetic, landscape, community Separate from DHS licensure Required for DHS licensure Occupancy and use remain subject to municipal authority 29
Regulations and Process stat 101.12 references stat 50 DHS 124 Hospitals DHS 132 Nursing Homes DHS 131 Hospice DHS 83 CBRFs DHS 88 / DHS 89 Adult Family Homes & RCACs 30
Regulations and Process DHS 124 Hospitals NFPA 101 Life Safety Code NFPA 99 Health Care Facilities Code Portions of The Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities Wisconsin Commercial Building Code 31
Regulations and Process DHS 132 Nursing Homes NFPA 101 Life Safety Code NFPA 99 Health Care Facilities Code Portions of The Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities Wisconsin Commercial Building Code 32
Regulations and Process DHS 131 Hospice NFPA 101 Life Safety Code NFPA 99 Health Care Facilities Code Wisconsin Commercial Building Code 33
Regulations and Process DHS 83 Community Based Residential Facilities A place where 5 or more adults who are not related to the operator or administrator and who do not require care above intermediate level nursing care reside and receive care, treatment or services that are above the level of room and board but that include no more than 3 hours of nursing care per week per resident. 5 8 Residents Regulated under the Uniform Dwelling Code 9 or more Residents Regulated under the Wisconsin Commercial Building Code 34
Regulations and Process DHS 88 Adult Family Homes A place where 3 or 4 adults who are not related to the operator reside and receive care, treatment or services that are above the level of room and board and that may include up to 7 hours per week of nursing care per resident. Not reviewed by OPRI Regulated under the Uniform Dwelling Code 35
Regulations and Process DHS 89 Residential Care Apartment Complex A place where 5 or more adults reside that consists of independent apartments, each of which has an individual lockable entrance and exit, a kitchen, including a stove, and individual bathroom, sleeping and living areas, and that provides, to a person who resides in the place, not more than 28 hours per week of services that are supportive, personal and nursing services. No review by OPRI unless attached to HC Facility Regulated under the Wisconsin Commercial Building Code 36
Regulations and Process NFPA 101 Life Safety Code Occupancy based Front end general Chapters address specific use (new or existing) ch 18 New Health Care / ch 19 existing ch 20 Ambulatory Health Care / ch 21 existing 37
Field Presence Coordinate with municipal AHJs DHS does not issue permits Health care focus Schedule and time sensitive Project close out 38
Field Presence Coordinate with municipal AHJs Building Construction phases Fire Construction phases Scheduled and coordinated 39
Field Presence DHS does not issue permits Municipal authority following approval Municipal authority to issues orders Municipal authority to withdraw permit Municipal authority to close permit Municipality issues Certificate of Occupancy 40
Field Presence Health care focus Complexity of health care components Involvement of health care codes and standards Coordinated inspection with municipal AHJs Licensing based on closed permit and occupancy Initial survey following occupancy 41
Field Presence Schedule and time sensitive Pre design meeting coordination Project meetings Inspections based on phasing Availability of DHS OPRI representative Collaboration and follow up 42
Field Presence Project close out DHS project close out checklist Closed permits, Certificate of Occupancy, compliance statement, fire alarm and fire sprinkler testing and certification, HVAC balance report, med gas report, interior finish documentation 43
Thank You 44