Feb 21 2017

Medical Office Building Occupancy Classification

Category: Blog,Occupancies,Questions and AnswersBKeyes @ 12:00 am

Q: A Hospital System that I do work for is in the process of constructing a Medical Office Building off-campus (over 250 yards from the Hospital). The building will house exam rooms, treatment rooms, and procedure rooms for a Provider Based Physician. In the past, we would consider this a Business Occupancy. We have heard that for an off-campus Provider Based Physician we will need to use a more restrictive code. Is this true, and if so, do we use the Healthcare Occupancy or the Ambulatory Healthcare Occupancy for this building type?

A: On June 30, 2016, CMS issued a correction to their Final Rule to adopt the 2012 Life Safety Code. This correction specifies that all ‘hospital outpatient surgical departments’ have to meet Ambulatory Health Care Occupancy (AHCO) requirements regardless how many outpatients are incapable of taking action for self-preservation.

One of the confusing issues in this CMS communication is the phrase ‘hospital outpatient surgical departments’. Initially, most people would think that phrase describes Ambulatory Surgical Centers (ASC) because the word ‘surgical’ is used. But in follow-up communications with CMS, they described this phrase ‘hospital outpatient surgical departments’ to mean any service that qualifies under the definition of AHCO.

Section of the 2012 LSC describes AHCO as:

  • Outpatient treatment for patients that renders the patient incapable of taking action for self-preservation under emergency conditions without the assistance of others;
  • Anesthesia that renders the patients incapable of taking action for self-preservation under emergency conditions without the assistance of others;
  • Emergency or urgent care for patients who, due to the nature of the injury or illness are incapable of taking action for self-preservation under emergency conditions without the assistance of others.

This description is beyond just ASC; it includes all sorts of procedures, such as:

  • Endoscopy
  • Bronchoscopy
  • Colonoscopy
  • MRI / CT Scan
  • Cath Labs
  • Some therapy units, such as Aqua-Therapy
  • Etc.

Since the 2012 LSC says four or more outpatients in order to qualify for AHCO, CMS felt the need to issue a correction to their Final Rule to say now it is 1 or more outpatients to qualify as an AHCO.

What this means, if the physician’s office was doing a minor procedure and it only involves one outpatient at a time, and that minor procedure qualifies under as being an AHCO, then the building (or story) must meet AHCO occupancy requirements even if there is only one outpatient involved in the entire facility. Under the 2012 LSC definition, that physician office would qualify as being a Business Occupancy, but with the new CMS correction to the Final Rule, it now must be AHCO.

And this is retroactive to existing conditions.

Feb 15 2017

Creating Separated Occupancies

Category: Occupancies,Questions and Answers,SeparationBKeyes @ 12:00 am

Q: I have a 3 story hospital and I would like to have a mixed occupancy classifications for different floors. The basement floor is for support – no patients are ever on this floor for any reason. The top floor is administration. Patients are occasionally on this floor if they are being transported to the adjacent hospital – always in the company of nursing staff and only for 1-2 minutes at a time during transport. No treatments and no overnight stays on this floor. Can I declare the main floor to be healthcare occupancy and the other two floors to be business occupancy? If so, what are the proper steps to make this happen; do I need to involve an architect, do the life safety plans need to be retitled, can I make this decision myself or do I need approval of some sort?

A: You should not make this decision by yourself. You need to employ an architect who has healthcare experience and a good working knowledge of the Life Safety Code.

You did not mention what your facility construction type is (according to NFAP 220). Take a look at of the 2012 LSC… there is a Table that lists all of the approved constructions types for existing hospitals. It is important to know because you will need a 2-hour fire rated barrier between the floors where you want separated occupancies in your facility.

It appears you should not have any issues in making the lower level a business occupancy, and there may be some possibility for the upper level as well. But the experienced architect needs to conduct a field review to ensure exiting, construction type and other factors are correct to allow separated occupancies in your facility.

Once the review has determined you can make these changes, then your Life Safety drawings need to be updated and perhaps your state or local AHJ may want to review this change as well.

Jan 30 2017

Exiting Through Other Occupancies

Category: Exits,Occupancies,Questions and AnswersBKeyes @ 12:00 am

Q: If I want to classify my building as a healthcare occupancy, even though I have a business or ambulatory healthcare occupancy in it, I know I need to meet the most restrictive occupancy, which would be healthcare. I know that I need to meet construction type, fire protection, and allowable floors for the healthcare occupancy, but what about exiting requirements?

A: Where inpatients are expected to exit through any other occupancy, you need to maintain the exiting requirements for healthcare occupancy even if the occupancy is something else. As an example, if an Emergency Department is classified as an ambulatory healthcare occupancy, the required width of corridors for exiting is 44 inches. However, if inpatients are expected to use the path of egress from the healthcare occupancy into and through the ambulatory healthcare occupancy, then the required width must be maintained for healthcare occupancy (which is 8 feet) even in the ambulatory healthcare occupancy.

Oct 13 2014

Ambulatory Surgical Center Mixed Occupancies

Q: We have an Ambulatory Surgical Center (ASC) located in a one story nonsprinklered building, and is separated from a physician’s office. The exit access from the ASC leads into a corridor which is within the physician’s practice. Since this corridor is not technically part of the ASC, is the ASC responsible for having the corridor wall opposite from the occupancy separation to be 1-hour fire rated?

A: You raise an excellent point: Once you leave the ambulatory health care occupancy and enter a different occupancy type, does the means of egress have to comply with ambulatory health care requirements? According to sections 20/ of the 2000 edition of the Life Safety Code (LSC), the answer is yes. This section says all means of egress from ambulatory health care occupancies that traverse non-ambulatory health care spaces must conform to requirements of the LSC for ambulatory health care occupancies. The exception to this requirement would be if the barrier between the ambulatory health care occupancy and the contiguous occupancy qualifies as a horizontal exit, then the means of egress in the contiguous occupancy does not have to meet the more rigorous requirements for ambulatory health care occupancy, provided the means of egress is not through a high-hazard area. Horizontal exits are required to be 2-hour fire rated. So, how does this apply to you? If your ASC qualifies as new construction (built after March 11, 2003), then the means of egress in the physician area (outside of the ASC) must have 1-hour fire rated walls that extend from the floor to the deck above (unless they terminate at a ceiling that is also 1-hour fire rated); or if the building is protected with automatic sprinklers throughout; or the barrier between the ASC and the physician’s offices is a 2-hour fire rated horizontal exit. If the ASC qualifies as existing construction (built on or before March 11, 2003) then there are no requirements for the corridors, and what you currently have would be acceptable.

Dec 23 2013

Separation of Occupancies

Q: Do different occupancies have to be separated by fire-rated barriers both horizontally as well as vertically? We are considering installing a dialysis unit on the second floor of a medical office building and the CMS interpretive guidelines say it must be separated from other tenants on the same floor by a one-hour fire wall. Shouldn’t a horizontal barrier be required as well?

A: Yes, I would agree. The 1-hour fire rated separation that the Life Safety Code (2000 edition), section requires does include horizontal separations as well as vertical. I agree with you that the interpretive guidelines do not clearly state horizontal separations, but the LSC does make the generic statement that the ambulatory care occupancy must be separated from other occupancies with 1-hour fire rated construction, and does not limit the separation to just vertical barriers.

Apr 15 2013

Conversion from Business Occupancy to Ambulatory Care Occupancy

Q:  We discovered our offsite free standing Dialysis center is in a building that is classified as Business Occupancy, but we were recently told by a consultant that the building has to be classified as Ambulatory Care Occupancy. Is this true? If so, what differences between the two occupancies should we be aware of?

A: It really depends if you are under the authority of CMS or not. If the dialysis center receives Medicare & Medicaid reimbursements, then you must follow CMS’s requirements. In a memo to their state survey agencies (S&C Letter 09-24) dated February 11, 2009, the dialysis unit must be classified as either existing ambulatory care occupancy, or new ambulatory care occupancy. In this memo CMS defines a new occupancy as a dialysis facility that receives their approval for construction on or after February 9, 2009, and they define an existing occupancy which receives approval for construction or renovation prior to February 9, 2009. However, if you are not under the authority of CMS, then the occupancy type is determined by the number of patients in the unit that are incapable of self-preservation. If there are 4 or more patients incapable of self-preservation at any given time, then the unit would have to be considered ambulatory care occupancy. But many authorities having jurisdiction (AHJ) have made the interpretation that all patients on dialysis is incapable of self-preservation, therefore, if you have 4 or more patients in the Dialysis center, then ambulatory care occupancy requirements apply. To be sure, you need to determine how your AHJ interprets the capability of the average dialysis patient to be able to disconnect themself from the machine, arise, and walk out of the unit under their own power, without assistance from anyone. There are differences between ambulatory care and business occupancies. Here is a short-list of ambulatory care occupancy requirements that differ from business occupancy:

  • Construction type: sprinklers required if Type II (000) Type III (000) and Type V (000)
  • Corridor width (44 inches)
  • Two approved exits from the unit
  • Travel distance to the exit cannot exceed 150 feet (200 feet if sprinklered)
  • Minimum door opening is 32 inches
  • A manual fire alarm system
  • Smoke compartment barriers unless the unit is less than 5,000 square feet and protected with smoke detectors, or unless the unit is less than 10,000 square feet and the area is protected with automatic sprinklers
  • A 2-hour fire rated barrier separating the dialysis unit from a healthcare occupancy, or a 1-hour fire rated barrier separating it from any other occupancy