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