What is AHCA ? Introduction for New Professionals from ...ahcaseminar.com/PDF19X/What Is AHCA- Intro for New Players from … · AHCA works on 3-week cycles for PlanReview, Stand-ups

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What is AHCA? Introduction for New Professionals from Design Professionals

Oc tober 8, 2019

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What is AHCA?

Over 60 years combined AHCA Plans and Construction experience

Antonio Amadeo, AIA, ACHACEO/ArchitectLDC International, Inc.

23 years healthcare designand AHCA experience

Ryan A. Murphy, AAIA, NCARBVP/Manager

LDC International, Inc.12 years healthcare designand AHCA experience

Angela Holcomb, AIA, NCARBHealthcare Studio LeaderGresham Smith

16 years healthcare designand AHCA experience

Kevin Graff, Sr. Project Mgr.Smith Seckman Reid, Inc.12 years healthcare design

and AHCA experience

Your Guides

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What is AHCA?

Agenda� What is AHCA?

� Grey Areas of Plan Submissions� What is a reviewable project

� ICRA Interpretations

� Submission Types, Forms and Fees

� Schedule

� Presentation & Inspection preparation� How to get approved

� Dos and Dont’s

� Closing out

� (FGI) The Guidelines 2018 – Functional Narrative� How to write it focusing on safety and health

� Quiz – 6 questions

� Q & A

What is AHCA?





� Schedule



� Closing out

� Guidelines 2018 – Functional Narrative� How to write it focusing on safety and health


� Q & A

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What is AHCA?

AHCA is an agency created by Florida Statutes as the chief health policy and planning entity for the state. AHCA is responsible for $25.5 billion in Medicaid program and the licensure of over 48,500 health care facilities.

Other AHJ’s and codes

Florida Building Code (FBC) & NFPA 101-2015

Permitting for projects in addition to AHCA; City

and/or County

Hospital Accreditation -Life Safety and Other

surveys

FGI, FBC

NFPA-101 2015 & AHCA Standards

New Beds and

Licensing

Projects: New &

Renov.

NFPA-101-2012 and JC Standards

Life Safety

(Similar to TJC)

FBC

NFPA-101 2015 & AHCA Standards

CON

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Portions of the CON repealed as of July 1, 2019

Portions of the CON repealed as of July 1, 2019

Note: CON requirements will persist for New Comprehensive Medical Rehabilitation (CMR) and Psychiatric Hospitals until July 1, 2021.

A Certificate of Need (CON) will still be required for new Skilled Nursing Facilities (SNF) and new Hospice beds.

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CON map 1980

CON map Today

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Are other States similarly regulated?

OSHPD

AHCAHHS

Self

What is AHCA? Divisions and Departments

The Division of Health Quality Assurance (HQA) is the division in AHCA that is responsible for licensure and oversight of health care facilities.

Field Operations, Health Facility Regulation, and Plans and Construction, are bureaus within HQA.

The bureau of Plans and Construction is known as the "Office of Plans and Construction" or "OPC", because the bureau was originally formed under the bureau of Health Quality Assurance when all health and human services agencies were consolidated under the Department of Health and Rehabilitation Services (HRS).

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What is AHCA?

● Bureau of Field Operations

Routine Life Safety Inspections and complaints

Kim Smoak, Chief of Field Operations

● Office of Plans and Construction

(OPC)

Renovations and New Projects

Scott Waltz, Chief of Office of Plans and Construction

● Bureau of Regulation

New beds, new facilities applications

Laura MacLafferty, Chief of Facility Regulation

What is AHCA?

● Office of Plans and Construction (OPC)

Reviews and approves health care facilities' plans and specifications and surveys their construction. Hospitals, Nursing Homes, Ambulatory Surgery Centers, and Intermediate Care Facilities for the Developmentally Disabled (ICF-DD)

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AHCA’s OPC Key Contacts

Governor Ron DeSantis

Agency Secretary Mary Mayhew

Deputy Secretary Molly McKinstry

OPC Bureau Chief Scott Waltz, NCARB (850) 412-4485

Supervisors

Architectural: Said Baniahmad, AIA (850) 412-4470Regional Supervisor of Tallahassee and Tampa Offices

Mechanical: Shouxiang “Jason” Jiang, P.E. (850) 412-4487Regional Supervisor of Orlando Office

Electrical: Orlando Padin, P.E. (305) 593-3096 Regional Supervisor of Miami Office

Each Region has a Team Leader that schedules inspections

Learn more at: ahca.myflorida.com/MCHQ/Plans/ Or Google: “AHCA Plans and Construction”

AHCA OPC Teams

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What is AHCA?





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� Q & A

What is AHCA reviewable ?

- Any alteration, renovation, new constriction connected to hospital utilities. Meaning, any

project that has an impact on infection control risk

assessment (ICRA), life safety or utilities that is not

of an emergency nature, maintenance or repair.

- Emergency projects need to be notified and documentation submitted as soon as practicable.

- Emergency work may ultimately require a plan review, but AHCA will work to expedite review and approval.

- When in doubt, call AHCA’s Architect Supervisor or Engineer Administrator and issue a follow up letter with narrative describing scope. Letter can be from Design Professional or Facilities. Response usually within 7 calendar days.

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What is an ICRA?

● ICRA stands for Infection Control Risk Assessment. It is part of The Guidelines Safety Risk Assessment requirements (SRA).

● ICRA has different levels and those levels are determined by the facility in consultation with the interdisciplinary team (User, IC Staff, Design Professional and GC)

● A/E Plans must show ICRA elements.

● The GC implements and adheres to ICRA.

● Common elements of ICRA are;- Barriers

- Negative Exhaust

- Monitoring and documentation

What is an ICRA?

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What is an ICRA?

What is AHCA?





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� Q & A

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AHCA Submissions Types

Exemption Verification

Cursory Review (CRU)aka Desktop Review

Stand-up (PU, CDU) Stage I, II, III

Mail-in

- an e-mailed request for a determination that the project is

exempt from agency review.

- an e-mailed request for a determination that the project does not

require further agency review.

- an in-person meeting with ACHA’splan reviewers to present plans. Can

be preliminary (PDU) or construction documents (CDU).

- Delivering 100% Construction documents plans and specs to AHCA

by mail or courier for a 60 calendar day plan review.

AHCA Submissions - RequirementsF l orida Statute 59A-3.080

No construction can take place without AHCA approval.

Site Work or Early Demo, can take place if a Stage II preliminary review has been approved along with signed and sealed Demo or Site documents. Requires a letter form facility holding Agency harmless for any changes.

Submission of an ICRA form.

Only Florida registered Design Professionals having firm registration with DBPR except for those practicing as sole proprietor.

Plans may be submitted for review in stages (I, II, III). Only Stage III is mandatory.

Best practice: Become f amiliar with 59A-3 and AHCA requirements listed in website;

FLrules.org & ahca.myflorida.com

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AHCA Submissions & Forms - CRU

CRU has an Exemption Verification Option used for off-site outpatient facilities not offering surgical services or invasive treatment nor connected to hospital utilities.

Desk Review usually involves projects in any occupancy that are connected to hospital utilities; such as offices or non-clinical renovations. Summiting 100% CD’s and clear narrative helps expediting.

Submit application via email to; [email protected] Scope Narrative cover letter by a Design Professional. No fee required.

Expect a determination response via email within 7-10 calendar days.

AHCA Submissions & Forms – Stand-up

A Stand-up Plan Review is used for renovation projects typically up to 3,000 square feet in any occupancy. Larger projects at the agency prerogative if it can be reviewed within a 2 hour period or if the review is preliminary.

The request can be be of preliminary type (Stage I or II) (SDU) for large projects, but usually is 100% CDs (CDU) and best suited for imaging, including interventional, hybrid, clinical, equipment (HVAC) or Nurse Call replacements. Design Professional advises Owner on best track for submission based onOwner’s scope and schedule.

Expect approval for construction with comments. Do not start construction without official letter.

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A Stand-up Plan Review is also beneficial when an early demolition or site permit is needed. However, the project needs to receive a Stage II preliminary approval prior to submission of the early demo package.

A Stage I review is recommended for large and/or complicated projects.

The early demo plans can be presented at Stage II but must be submitted to Tallahassee with the Stage II preliminary AHCA approval letter with a hold harmless letter from Owner.

Expect approval for early demo with comments. Do not start construction without official AHCA letter.

Best practice: Design Prof essional makes sure the request f or $2,000 AHCA check and ICRA f orm has been made to the Owner well in adv ance of Stand-up. Conf irms with Owner the check is cut, and who will bring it to the Plan Rev iew Meeting.

Schedule Stand-ups a early as possible, backlog continues to grow.

Engage AHCA early in design process, do not wait until Stand-up to ask questions.


A Stand-up Plan Review is scheduled by the Architect by calling your OPC Team secretary to secure date and follow-up with e-mail request, along with a Scope Narrative cover letter by a Design Professional, including Team List and a key plan to;

Your AHCA’s region secretary

Although the Stand-up can be scheduled by Architect, Engineer or Owner, OPC prefers the architect as a single point of contact for scheduling.

Fee: $2,000.00 check.

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AHCA Submissions & Forms: Mail-in

A Mail-in Plan Review is a submission of drawings, either preliminary or 100% construction documents. Overnight the request with transmittals and return receipt, along with Functional Program. Include a Scope Narrative cover letter by a Design Professional, including Team List and ICRA form to Tallahassee offices;

Fee: $2,000.00 check.

Best practice: Architect secures a Stand-up date f rom AHCA’s OPC as soon as project scope is approv ed by Owner.

Best practice: Design Prof essional documents that all packages hav e been receiv ed and logged by AHCA, and a response date is secured.

AHCA Submissions & Forms: Mail-in

A Mail-in Plan Review period consists of 60 calendar days.

Expect approval with comments if project has received preliminary approval.

On some cases the project is disapproved in mail-in plan review, in which case the 60 day plan review for re-submission applies.

Fee Note: If the $2,000 check was submitted for a Stage I or II Stand-up, no further plan review fees are applicable.

Best practice: Design Prof essional communicates with AHCA rev iewers at interv als during rev iew to mitigate any salient issues.

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What is AHCA’s schedule?





� Schedule



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� Q & A

AHCA Schedule

AHCA works on 3-week cycles for Plan Review, Stand-ups and Inspections.Tallahassee and Tampa Teams – teams within each office alternate survey weeks

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AHCA Schedule

- CRU – Desktop 7 days $0.00

- Stand-up Up to 2 months backlog to get dates $2,000

- Plan Review (Mail-in) 2 months (60 day plan Review) $2,000*

- Inspections Every 3-week. Schedule 6-weeks ahead $100/hr**

- * If the project received a Stage I or II preliminary there is no additional cost for CD mail-in.

- ** per reviewer, fee also applies to plan reviews and stand-up reviews.

AHCA Schedule is posted on website; http://ahca.myflorida.com/MCHQ/Plans/Forms_Rules_Presentations.shtml

Best practice: Architect secures dates for inspections as soon as GC has provided a schedule to Owner. Architect sends e-mail to AHCA Team leader requesting dates that AHCA has available and calls to confirm. Sends follow-up confirmations and schedule Outlook Calendar invites to AHCA and A/E/C team.

How to get approved





� Schedule



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� Q & A

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Preparing for a successful Stand-up

Preparing for a successful Stand-up

A Stand-up Review is scheduled often months ahead. Although not required, owner’s representative attendance is encouraged. If Owner cannot attend, arrange

to have owner representative able to answer questions by phone.

Documentation is key to success; Functional Program or Narrative, ICRA form, vendor drawings, Pre-Test & Balance reports, electrical coordination curve and coordinated A/E drawings. New product documentation.

Best practice: Architect develops a check list and requests MEPF drawings in adv ance to insure all trades are coordinated. Do y our due diligence. Look abov e ceiling.

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What does AHCA reviewers look for?

- A clear and complete set of documents which is well coordinated.

- A narrative or functional program which meets FGI guidelines. The document needs owner’s approval.

- A workable and well-thought-out ICRA plan with negative exhaust, safety provisions during demolition and impact to adjacent areas; above and below.

- Air pressures and downstream impact of HVAC design.

- Emergency Power and utilities’ capacity.

- Structural and NOA (Florida Product approvals) documentation.

What does AHCA reviewers look for ?

Best practice: Architect ensures engineers hav e lif e safety plan barriers on their plans.

Rigging and Construction paths documented.

Existing conditions are documented and photos are prov ided in support. Include photos in drawings if mail-in submission.

Site specif ic vendor drawings prov ided.

If equipment change-out, provide pictures of like equipment.

Adherence to NEC f or separation between conductors.

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I t’s all about communications and clarity

Best practice: Mask y our drawings f or scope area and use color.

I t’s all about communications and clarity

Best practice: Mask y our drawings f or scope area and use color.

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Etiquette during a Stand-up


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Best practice: Architect introduces the team and thanks the rev iewers on behalf of the f acility for their time and assistance.

Architect arranges the drawing order to explain the project in a clear, ef f icient and succinct manner.

Any comments and follow-up are handled immediately .

Design team, Owner and Vendor are v ested and responsible for a successful approval.

- A/E team arrives early. All attendees must be together to start.

- Obtain direction from AHCA’s Team Leader on seating.

- Be ready to hand the check (by facility not A/E), ICRA forms and project documentation, such as Program or Narrative.

- Prior to going over drawings, verbally describe the project, read the narrative and point in a reference plan to the project location.

- Know the codes and guidelines; FGI, NFPA, FBC and 59A-3, F.A.C.

- Do not treat the presentation as a marketing presentation. This a very technical and prescribed process.

Inspections, what to expect

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Progress (80%) and Final (100%)

What is an 80% inspection?

It is a progress inspection to allow for issues that could be problematic during final inspection to be addressed early. Saves from possible disapproval at final 100% inspection.

Best for complex and larger projects.

Scheduled often months ahead.

Although not required, owner’s representative attendance is encouraged.

Best practice: Show AHCA progress f or new innov ative or complex projects requiring more f amiliarity.

Coordinate schedule with GC as soon as a schedule is av ailable Schedule it whenev er possible with AHCA ev en if tentative.

Be f amiliar with inspection CONSTRUCTION SURVEY CHECKLIST posted by AHCA.

Conduct a Pre-AHCA Inspection by architect and engineers.

Conf irm that the project is 100% complete bef ore re-confirming AHCA inspection.

Re-conf irm all inspections via e-mail with AHCA Team Leader.

Survey Checklists

Learn more on website; http://ahca.myflorida.com/MCHQ/Plans/Forms_Rules_Presentations.shtml

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Inspections, what to expect

Best practice: Architect reconf irms inspection time.

Architect makes sure that all responses to Stand-up or mail-in comments hav e been received by AHCA in Tallahassee well in adv ance of inspection. Inspection will not be scheduled by AHCA if comments have not been submitted and rev iewed by AHCA.

A set location is conf irmed for meeting AHCA team. A set path to take the team to the project site is pre-determined.

- A/E team arrives 30 minutes prior to AHCA’s team. Design Team, GC, key subs and the Owner meet the AHCA team. Subs and Equipment Vendors wait at the job site with ladders, flashlights, ready to address inspector’s direction.

- Be prepared for Architect and Engineer to describe the project and go over the drawings and any prior correspondence or response to comments. This can be in a conference area or the job site.

What is the inspector looking for ?

Best practice: Architect and Engineer rev iew GC’s inspection binder ahead of inspection.

Comments are addressed and corrected during the inspection if possible.

GC tests damper operation and f ire alarms ahead of inspection

- Project must be 100% completed.

- If an Equipment Change-out, the equipment must be installed.

- UL certifications for equipment

- Test & Balance Reports

- Med Gas certifications

- A full set of Construction Documents with any marked-up field changes for inspector’s review.

- Signed and sealed shop drawings matching as-built condition.

- Some inspectors review ICRA logs for the project.

- Electrical panels labeled correctly. Junction boxes color coded.http://ahca.myflorida.com/MCHQ/Plans/pdfs/I

nformation_for_Project_Review_Packet.pdf

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What is the inspector looking for ?

Best practice: GC rev iews AHCA inspection readiness and prov ides project binder tabbed and completed.

Clear notes and understanding of ACHA comments during debrief. Architect thanks the AHCA team and all inv olv ed in the completion of the project.

- Penetrations sealed and UL labeled.

- 5-side boxes on rated assemblies.

- Clearly seen stenciling on barriers.

- Nurse Call Master location.

- Smoke heads announcing to Smoke compartment on Life Safety drawings.

- Above ceiling open J-boxes and items hanging from sprinkler piping.

- Adherence to NFPA 13 for sprinkler installation.

- Project binder with copies of certifications, T&B, warranties, NOA, fire proofing, shielding reports (if applicable), submittals and shop drawings.

Closing out the project

Best practice: Design Prof essional f ollows-up with AHCA on f inal inspection comments prior to the next Tuesday and prior the f inal approv al letter is issued. If not, a f ollow-up surv ey has to be scheduled.

GC f orwards to architect as-builts and project closeout binder in CSI f ormat. A/E team review and binder is f inalized prior to f inal Pay Application.

Contact y our local AHCA representativ e to have your specif ic topic included in their next agenda.

- Projects can not be closed unless AHCA receives responses and conducts pick-ups. Do not delay resolution of minor “pick-up” comments. Then a final approval letter is issued. AHCA Life Safety requires close-out letters, can also affect licensure.

- AHCA closes projects after final approval or when no activity has been logged by AHCA after 1 year.

- AHCA is now conducting internal discipline specific coordination meetings to address consistency on interpretations and grey areas.

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Guidelines – Functional Narrative





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What is a Functional Program Narrative

● The primary purpose of the functional program shall be to communicate the owner’s intent for the project to the designers of record as a basis for design at the initiation of the project.

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What is a Functional Program Narrative

● The narrative is required for every project except for minor alterations not changing the facility function of character. Life safety upgrades or equipment change-outs are exempt.

● New in 2018;- 1.2-2.2.5.1 The clinical and support areas affected by the

project shall be identified.

- 1.2-2.2.7.2 Relevant operational circulation patterns, including movement of staff, patients and their companions, members of the public, and materials and equipment

- 1.2-3 Space Program- A space program shall be provided that contains a list

organized by department or other functional unit that shows

each room in the proposed project, indicating its size by gross floor area (DGSF) and clear floor area and citing relevant

paragraph numbers(s) from this document.

How to write a Program Narrative

● Follow the nomenclature and numbering from The Guidelines

● Provide an executive summary of the program

● State the purpose of the project

● Construction Type/Occupancy and Building Systems

● Project Components and Scope

● Indirect Support Functions

● Operational Requirements

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● Sample Section showing format


Best practice: Architect

prov ides an outline to owner f or v alidation and assists owner who is ultimately responsible for the project intent.

It is the most important piece of documentation in AHCA plan review.

If it s not done properly and clearly can lead to confusion and delay in plan approval.

The length and complexity of the functional program will vary greatly depending on project scope.

The functional program for a small simple project might consist of a simple sketch or a description of a few sentences.

The functional program can be used as a supplement to the construction documents; it is not intended to be approved by the authority having jurisdiction (AHJ).

The governing body may delegate documentation of the functional program to the architect or another consultant.

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Short Quiz





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� Q & A

Quiz: Question 1

What is not required for a successful AHCA final inspection?:

A. Attendance by EOR (Engineer of Record)

B. Final Test & Balance Report

C. Change Orders

D. Resolution of “pick-up”

E. Donuts and Coffee

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Quiz: Question 1

What is not required for a successful AHCA final inspection?:

A. Attendance by EOR (Engineer of Record)

B. Final Test & Balance Report

C. Change Orders

D. Resolution of “pick-up”

E. Donuts and Coffee

Quiz: Question 2

Who determines the ICRA (Infection Control Risk Assessment) protocols for an Air Handler replacement project in an Ambulatory occupancy?:

A. The Architect

B. The MEP Engineer

C. The Owner

D. The Construction GC and HVAC trade team

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Quiz: Question 2

Who determines the ICRA (Infection Control Risk Assessment) implementation for an Air Handler replacement project in an Ambulatory occupancy?:

A. The Architect

B. The MEP Engineer

C. The Owner

D. The Construction GC and HVAC trade team

Answer: Question 2

ICRA (Infection Control Risk Assessment);

For CMS (Center for Medicare and Medicaid Services) eligible entities, CMS charges the Owner for infection prevention protocols.

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Quiz: Question 3

Which project requires AHCA notification:

A. AHU Replacement in Outpatient Business Occupancy

B. New Patient Room finishes

C. Interventional Radiology Scan Room floor replacement like for like

D. Nurse station replacements in OR suite

E. All of the above.

Quiz: Question 3

Which project requires AHCA notification:

A. AHU Replacement in Outpatient Business Occupancy

B. New Patient Room finishes

C. Interventional Radiology Scan Room floor replacement like for like

D. Nurse station replacements in OR suite

E. All of the above

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Answer: Question 3

Any project that requires ICRA, affects patient care and is connected to the hospital utilities ought to be notified.

The hospital IC team determines the risk and an control measures.

Use CRU track to determine.

Quiz: Question 4

What are some of the new requirement for the Functional Program in The 2018 Guidelines?:

A. Dietary regulations

B. Clinical and Support Areas affected

C. Name consistency with Guidelines

D. Construction types

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Quiz: Question 4

What are some of the new requirement for the Functional Program in The 2018 Guidelines?:

A. Dietary regulations

B. Clinical and Support Areas affected

C. Name consistency with Guidelines

D. Construction types

Quiz: Question 5

Which of the following is not an AHCA submission track?:

A. Exemption Verification

B. CRU aka Desktop

C. Stand-up (PU, CDU)

D. Mail-in

E. Skip Gregory

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Quiz: Question 5

Which of the following is not an AHCA submission track?:

A. Exemption Verification

B. CRU aka Desktop

C. Stand-up (PU, CDU)

D. Mail-in

E. Skip Gregory

Quiz: Question 6

Which of these projects is AHCA reviewable?:

A. Perioperative AHU’s Replacement

B. Business Office Renovations

C. Minor Clinic Renovations

D. SPD Sterilizer replacement

E. All of the above

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Quiz: Question 6

It depends.

Reviewable depends on ICRA, drawings, narrative, AHCA’s

knowledge of the facility,

occupancy, emergency power and utilities.

Key is; “is patient safety affected”

Questions?

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Thank you for your attention!