University of Minnesota Long Term Care Resource Center

Physical Environment - New Construction Application Process


Description of Federal Requirements
Comparison of State Requirements
Table Comparing States

Complete Transcript of State Regulations on Physical Environment - New Construction Application Process (PDF)

Federal Regulations & Related F-tags Applicable Federal Regulation
No K Tags or F tags are applicable to the Application Process
483.70 Physical Environment
483.15 Quality of Life
483.10 Resident Rights

Description of Federal Requirements    (TOP)    (NEXT)

There are no federal regulations addressing New Construction Application Process at this time.

Comparison of State Requirements    (TOP)    (NEXT)

Every state except Indiana and Louisiana address new construction applications. State regulations for new construction requirements are very state specific and it is difficult to generalize requirements between states. Alaska does not have state specific regulations rather any renovation, expansion, or new construction undertaken after May 4, 1997 must comply with the requirements of Guidelines for Construction and Equipment for Hospital and Medical Facilities, AIA, 1992-93 edition. Wyoming follows the Wyoming Design and Construction Minimum Standards for Health Care Facilities. Arkansas has extensive application requirements and incorporates by reference nine additional code and standards guidelines. New regulations in New York require following the Guidelines for the Design and Construction of Health Care Facilities, 2010 edition. It is important to check with each state for their specific requirements. Topics generally addressed include: site location; inspection; approvals; submission of plans, specifications and estimates; content and size of plans and specifications; and codes and standards. This narrative will address states that regulate the application process in great detail.

Connecticut addresses codes, minimum service requirements, standards and review of plans. New construction shall comply with the requirements of the Basic Building Code, as prepared by the Public Works Department, State of Connecticut; the State of Connecticut Fire Safety Code, the National Fire Protection Association - 101 Life Safety Code, the State of Connecticut Labor Laws, local fire safety codes, zoning ordinances, and in cases where private water supply and/or sewerage is required, written approval of the local health officer and environmental health services division of the state .of Connecticut department of health must be obtained. Only the most current code or regulation and the most stringent shall be used. Minimum services required include: Lobby, with visitors' toilet rooms (to include facilities for each sex) and public telephone; business or administration office; resident rooms; resident baths; resident toilet rooms; resident lounge or sitting room; resident dining and recreation rooms; resident recreation area; dietary facilities; central storage room; employees' facilities; details of construction; mechanical system; electrical system; emergency electric service and provision for holding expired persons (adequately sized and ventilated space in unobjectionable location.

In addition to the general requirements Georgia requires a program narrative shall be submitted prior to or along with the schematic or initial plans for construction. The program narrative should include the following: names and addresses of each owner, if the owner is a public stock corporation, the names and addresses of each officer shall be included; the geographical area to be served; admission policies; cooperative programs of service with local agencies, including hospitals; arrangements for medical and dental care, e.g., physicians on contract and agreements with hospital for patient referral; list of personnel by types of employees and proposed salaries; plans for securing the services of professional personnel including registered nurses, licensed practical nurses, social workers, dietitians, pharmacists, physicians and therapists and a description of the service to be provided the community, i.e., the level of care to be provided and the economic segments of the population to be served.

Iowa places great emphasis on codes and standards and includes the following list: American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Hand­books; American Society for Testing and Materials (ASTM) Standard E 84, Method of Test for Surface Burning Characteristics of Building Material; International Conference of Building Officials (ICBO) Uniform Building Code; Iowa State Building Code; Iowa State Plumbing Code; Labor Services Division, Department of Employment Services; National Fire Protection Association (NFPA) Standard 70, National Electrical Code; National Fire Protection Association (NFPA) Standard 90A & 90B; Installation of Air Conditioning and Ventilating Systems; National Fire Protection Association (NFPA) Standard 101, Life Safety Code; Food Service Sanitation Manual (DHEW Publication (FDA) 8-2081); Underwriters’ Laboratories, Inc. lists; American National Standards Institute (ANSI) Standard A 117.1-1986; American Standard Speci­fications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handi­capped. Addresses for obtaining this information are also included in the regulations.

Michigan puts a dollar amount on expenditures and also collects a few based on expenditures as follows: before contracting for and initiating a construction project involving new construction, additions, modernizations, or conversions of a health facility or agency with a capital expenditure of $1,000,000.00 or more, a person shall obtain a construction permit from the department and the department shall assess a fee for each review conducted under this section that is .5% of the first $1,000,000.00 of capital expenditure and .85% of any amount over $1,000,000.00 of capital expenditure, up to a maximum of $60,000.00.

For Alzheimer’s special care units, Nebraska requires a written statement of the overall philosophy and mission which reflects the needs of residents afflicted with Alzheimer’s disease, dementia, or related disorder as a part of very extensive regulations.

Pennsylvania is specific about the size of the overall plans that they be at least 15 by 24 inches and not exceed 32 by 2 inches in size including the border and that size requirements for site plan, floor plans, scale layout, exterior elevation be adhered to. In Vermont, proposals for new construction, expansion, renovation or substantial rehabilitation of a facility requiring Certificate of Need approval will not be approved by the licensing agency unless the construction proposal includes a plan for elimination or conversion of all three- and four-bed rooms to rooms which accommodate no more than two persons. 

Minnesota separates new construction requirements into the following categories: approval of plans; final inspection; final mechanical and electrical plans; final plans; incorporation by reference of 24 codes & standards; plan safekeeping; preliminary plans; preparation of plans and start of construction.

Throughout the eight pages of new construction regulations, Texas addresses the customary application requirements and also includes a large section on non-approval of new construction that states: if during the survey of completed construction, the surveyor finds certain basic requirements not met, DHS will not license the facility or approve it for occupancy. Such basic items may include the following: construction which does not meet minimum code or licensure standards for basic requirements such as corridor widths being less than eight feet clear width, ceilings installed at less than the minimum seven feet six inches height, resident bedroom dimensions less than required width, and other similar features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; no written approval by local authorities; fire protection systems not completely installed or not functioning properly including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems; required exits are not all usable according to Life Safety Code requirements; telephone not installed or not properly working; sufficient basic furnishings, essential appliances and equipment are not installed or not functioning; and any other basic operational or safety feature which the surveyor, as the authority having jurisdiction, encounters which in his judgment would preclude safe and normal occupancy by residents on that day. If the surveyor encounters deficiencies that do not affect the health and safety of the residents, licensure may be recommended based on an approved written plan of correction by the facility's administrator.

In Washington, if preliminary documents and specifications are submitted they must: include a narrative program with drawings that identifies how the design promotes a homelike environment and facilitates resident-centered care and services; functional space requirements; staffing patterns; each function to be performed; types of equipment required; and services that will not be provided directly, but will instead be provided through contract.

Waivers and Exceptions    (TOP)    (NEXT)

AlaskaMarylandNew JerseyNorth CarolinaOregon and Washington address waivers or exceptions specific to new construction in their state regulations.

In Alaska, facilities in existence previous to January 1, 1995 will be allowed a variance of 10 sq. feet from the standards for square footage as required by guidelines for Construction and Equipment for Hospital and Medical Facilities the standards that Alaska adheres to. If an equivalent alternative is provided, a waiver may be obtained by filing an application that includes: justification, explanation of why particular requirement cannot be satisfied; description of equivalent alternative; and if application for waiver involves fire safety or other municipal or state requirement and evidence that a review by appropriate municipal or state authorities has taken place.

In Maryland, in existing structures, the Department will entertain requests for waivers on items that will not endanger the health and safety for users and for items, if corrected, will result in substantial financial burden.

In New Jersey, all requirements for new construction projects are applicable to renovation projects except when existing conditions make changes impractical or unfeasible to accomplish. In those cases, acceptable compliance status may be recognized by the Licensing Agency if necessary access by the handicapped, and safety of the patients will not be jeopardized.

In North Carolina, due to extraordinary circumstances, new programs or unusual conditions, alternate methods, procedures, design criteria and functional variations from the physical plant requirements may be approved by the Division when the facility can effectively demonstrate to the Division's satisfaction, that the intent of the physical plant requirements are met and that the variation does not reduce the safety or operational effectiveness of the facility.

In Oregon, facilities that have been continuously licensed and operational since January 1, 1992 may be exempt from certain physical environment requirements. Exemptions do not apply if there is a change in the purpose for which the room is licensed. Exemptions may be terminated if the Division determines that the exemption adversely impacts the facility’s ability to meet nursing facility law.

In Washington, exemptions to new construction requirements may be granted for: alterations that serve to correct deficiencies or will upgrade the nursing home to better serve residents; substitution of procedures, material, or equipment when substitutions have been demonstrated to the director’s satisfaction to better serve residents; the exemptions are in writing and include approvals for local code enforcement authority and state fire marshal; and all exemptions are kept on file at the facility.

Table Comparing States   (TOP)

Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Physical Environment - New Construction Application Process by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Physical Environment - New Construction Application Process at the bottom of the Table.

483.70 Physical Environment

New Construction Application Process
(Note: Certain sections of 483.15, Quality of Life and 483.10 Resident Rights may also apply.)
State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
Alabama Yes Application process
Alaska Yes Follows: Guidelines for Construction & Equipment for Hospitals & Medical Facilities
Arizona Yes Application Process
Arkansas Yes Application process, codes & standards, plans & specifications
California Yes Plans & specifications
Colorado Yes Facilities wishing to open a secure unit shall submit the fee for opening a secured unit, along with its plans for physical plant, staffing, and program
Connecticut Yes Codes, standards, minimum service requirements, review process
Delaware Yes Follows: General Standards of Construction & Equipment for Hospitals & Medical Facilities
District of Columbia Yes Compliance reports required to be maintained pursuant to the BOCA National Building Code plans
Florida Yes Review and approval of plans; fees and costs
Georgia Yes Requires program narrative to be submitted with design schematic
Hawaii Yes Drawings and specs for all new construction, alterations or repairs. Work must commence within one year
Idaho Yes Application process, rules relevant to new construction after 1/1/1988
Illinois Yes Application process, codes & standards
Indiana No State regulations do not address new construction
Iowa Yes Explicit application process, multiple codes & standards
Kansas Yes Required site location specifics
Kentucky Yes Extensive description of application requirements
Louisiana No State regulations do not address new construction
Maine Yes Forms for application provided by Department
Maryland Yes Codes, construction guidelines for basements, detached structure, waivers
Massachusetts Yes Approval of final plans, conversion of structure to long term care facility
Michigan Yes Application process, fee structure
Minnesota Yes Approval, final plans & inspection, multiple codes & standards
Mississippi Yes Submission of plans & size of floor plans
Missouri Yes Application process, completion guidelines
Montana Yes Follows 2001 Guidelines for Design & Construction of Hospitals & Health Care Facilities
Nebraska Yes Detailed application process, codes & standards, plans & specifications, requires statement of Alzheimer's special care unit's mission & philosophy, final inspection
Nevada Yes Follows: Guidelines for Design & Construction of Hospitals & Health Care Facilities
New Hampshire Yes Standards, comply with New Hampshire Code of Administrative Rules
New Jersey Yes Follows: Uniform Construction Code of NJ, waivers
New Mexico Yes Codes, standards, guidelines
New York Yes

New requirements as of 2010, Construction, including fire-resistive requirements, Standards of Construction for Health Care Centers, 12/29/2010

North Carolina Yes Minimum requirements, waivers
North Dakota Yes New construction standards and requirements
Ohio Yes By definition, resident full bathroom required in all new construction
Oklahoma Yes New construction includes additions & alterations
Oregon Yes Plan review, New construction shall not be eligible for "exceptions" as provided in these rules unless specifically authorized by the Division
Pennsylvania Yes Plan review, equipment standards, floor plan size
Rhode Island Yes Detailed list of codes & regulations
South Carolina Yes Construction standards including cosmetic requirements
South Dakota Yes Submission of plans
Tennessee Yes Guidelines for submission & modifications
Texas Yes Detailed list of codes, regulations, extensive details & size of plan schedules & potential items surveyor may cite for non-approval
Utah Yes Guidelines for submission & deadlines
Vermont Yes Proposal denied unless contains rules for elimination or conversion of all 3-4 bed rooms
Virginia Yes Plan should address noise, steam, odors, hazards & unsightliness to bedrooms, dining rooms & lounge
Washington Yes Extensive guidelines including requirement of narrative program with drawings and provision for resident's comfort during construction
West Virginia Yes Plan submission & fees
Wisconsin Yes Plan submission, extensive fee schedule
Wyoming Yes Follows: Wyoming Design & Construction Minimum Standards for Health Care Facilities

Complete Transcript of State Requirements on Physical Environment - New Construction Application Process    (TOP)

Sub-sections of
Physical Environment-
New Construction
Application Process

Waivers and Exceptions



Resources for New Construction

Environmental Checklist: New Construction MN

Environmental Checklist: New Construction Completion MN