Physical Plant Improvements of New or Existing Ambulatory Surgical Facilities

Florida Administrative Code (FAC), Chapter 59A‑ Sections 5.022

AHCA Information for Project Review Packet 

State of Florida Application for Plan Review 

For new projects as well as additions and renovations to existing facilities, the architect selected for the project must be familiar with sections FAC 59A‑5.020 through 59A‑5.031.  An architect unfamiliar with AHCA Office of Plans and Construction and its inspections will often cause costly delays in receiving occupancy approval.  The architect will arrange on‑site inspections for review of construction by AHCA staff or contracted experts.  These inspection dates and times are announced so the appropriate staff such as electrical engineers can be present.  Inspectors will complete an inspection when the facility is at 40% completed, 80% completed and again at 100% completion.  They will remove ceiling tiles to check for fire wall integrity, pull the fire alarm to check the shut down of air handlers, and will conduct many other tests to ensure the safety of the facility.  Only by contracting with an architect who has familiarity with licensed medical facility construction can you expect the project to proceed smoothly.  Following are elements given consideration when pursuing facility renovation or construction:

1.   Scope

The following description applies to free‑standing ambulatory surgical facilities licensed independently and not affiliated with a hospital.  For facilities which are to be added to a hospital license the requirements of FAC Chapter 59A‑3 are applicable in lieu of 59A‑5.  The Agency for Health Care Administration (AHCA) serves as the regulatory control through its Office of Plans and Construction.  This department reviews and enforces the requirements listed in FAC Chapter 59‑5 which we will discuss shortly.  Administrators of either proposed new or existing ambulatory surgical facilities need to be aware of the procedures for physical plant improvements or new construction, because of the impact on project construction costs and schedule.  Facilities seeking licensure can sometimes be overwhelmed by the costs associated with upgrading to meet the physical plant requirements of the codes.  This is due to significant and more stringent controls which include functional spaces, life safety compartmentation, details and finishes, mechanical HVAC, electrical, nurse call, fire alarm and emergency electrical systems.

In addition, the duration of a typical project is longer because of the need to obtain approved construction documents from AHCA prior to submission to local building departments.  Once under construction, AHCA must survey the work in addition to the local building inspectors.  Due to the availability and assignment cycle of AHCA field surveyors, this time frame is often prolonged.  In this section, we have highlighted some basic steps of the procedures to start an ASC construction project and take it through completion.  Further detail can be obtained by reviewing FAC sections 59A‑5.020 and 59A‑5.021, found elsewhere in this manual.

2.   Applicability

A common question is, “What exactly is the threshold requiring AHCA review of a project and what level of code compliance is necessary?”  New ambulatory surgical centers, additions, major alterations or renovations to existing ambulatory surgical centers need to meet the requirements of the codes identified in FAC Chapter 59A‑5 [59A‑5.020(1)].  Existing ASCs already in operation will be reviewed individually and are subject to compliance with a plan of correction for those areas requiring remedial work to meet code [59A‑5.020(2)].  Major alterations and renovations requiring conformance with the physical plant standards for new ambulatory surgical centers are defined to constitute those elements affecting:  the structural integrity of the building; fire safety; substantial change of functional operations; or change in number of constructed recovery beds or operating rooms [59A‑5.020(3)].

3.   Plan Review Process

All new buildings and all additions, alterations, conversions and renovations to existing buildings shall be submitted for approval or exemption from the plan review process.  When construction is contemplated, either for new buildings, additions or alterations to existing buildings, plans and specifications shall be prepared by a Florida Registered Architect and by a Florida Registered Professional Engineer [59A‑5.021(2)].  The plan review process consists of three stages:  schematic, preliminary and construction documents.  Typically the first two stages can be combined for simple projects and are conducted as a stand‑up review with the design team (Architect and Engineer of Record) at the Regional District Office of AHCA (Tallahassee, Orlando or Miami).  The time frame is dependent on the scope of the project and on how quickly the owner and design team can arrive at an acceptable design scheme.  Stage three is typically a mail‑in review of the final construction documents.  By statute, AHCA must respond within 60 days either approving or disapproving the project.  Assuming the project is approved, the owner must start construction within one year following approval or otherwise reapproval must be obtained [59A‑5.021(1)].

4.   Construction

Once all AHCA construction document approvals have been obtained, permitting documents may be submitted to the local building department.  Upon the start of construction, the architect and contractor should decide on and request interim and final surveys from AHCA.  The timing of AHCA surveys is critical, since their approval is necessary to achieve occupancy.  A failed inspection survey can delay occupancy by a month, until the next available visit by the AHCA team.  The time frame, once again, is dependent on the scope and size of the project.  Upon the completion of construction, the owner should receive from the design team, a set of “record documents” depicting the actual conditions of the finished work.  This set of documents will be very useful the next time a future project is contemplated, since it provides a base from which to start anew.