Colorado Assisted Living: FGI Update January 2024
The Colorado Department of Public Health and Environment held an outreach meeting on the status of FGI review activities. This blog provides an overview of pertinent points for Colorado assisted living investors, owners and operators.
What is FGI?
FGI refers to the Facility Guideline Institute, which produces design guidelines for healthcare facilities ("Guidelines for Design and Construction of Health Care Facilities"). CDPHE adopted the 2018 FGI Guidelines, making them compulsory for the construction and remodel of a variety of healthcare facilities, including assisted living residences (“ALRs”). See 6 CCR 1011-1, Chapter 2. FGI review is also required for all new licenses.
“FGI Review” is a document-review process for either new facilities or existing facilities that are completing renovation and/or additions. The FGI review process is a prerequisite to the issuance of the initial or ongoing license.
During FGI Review, CDPHE will confirm that the designs meet FGI requirements and the requirements of the appropriate licensing regulation. For example, for ALRs, CDPHE will check to make sure the design complies with both FGI and 6 CCR 1011-1, Chapter 7 requirements (pertaining to assisted living residences).
You can request a FGI plan review here.
When to submit an application for FGI review?
FGI applications MUST be submitted at the time you apply to your local jurisdiction for your building permit. CDPHE noted that they are seeing a number of applications being submitted after the building is already well into the construction process. Not only does this violate the regulation, but it could result in costly change orders if the FGI review reveals areas of noncompliance.
Remember, even if you’re already well into construction, if the design doesn’t comply with FGI or licensing requirements, you will have to change it!
CDPHE discourages pre-application meetings because they don’t have the resources to handle them. However, if you or your design professional has a specific FGI question, you are free to contact them, preferably by email: fgireview@state.co.us.
What if you can’t meet FGI requirements?
Chapter 2, Sec. 3.4 sets out a procedure to request a waiver to an FGI requirement. FGI reviewers do not have the authority to grant any waiver. Rather, a waiver request goes to a different department within CDPHE.
It’s important to note that waivers are only good for one year (the term of the license). If a facility can’t correct the noncompliance that necessitated the waiver, then a new waiver request must be submitted each year with the license renewal request.
If you’re engaging in new construction, there is an expectation that the facility will be designed in compliance with FGI. There could be more leniency in the case of remodel/renovation, but there has to be a good reason to justify the waiver request. “Not wanting to do it” isn’t the basis for a waiver.
How long does it take?
Many of our clients ask how long they should expect to wait for the FGI review. Today, CDPHE said that the average wait time is approximately 5 months. A number of our clients have experienced a much longer wait time than this; however, these cases submitted applications during a peak time of applications and limited resources. The Department says that they have now streamlined procedures and put replacement staff in place.
Now, CDPHE calculates that they are processing about 100 applications at any given time, which is a high level plateau. Thus, despite the streamlining and staffing changes, they expect the 5 month wait time to continue.
One piece of good news is that CDPHE will no longer be conducting FGI review for behavioral health facilities. This should reduce the number of projects in the queue.
Find out where your project is in the queue here.
Here are some things that you can do to make the process go faster for you:
Use a design professional who knows the FGI requirements. If you have questions during the design process, our firm regularly consults with technical professionals.
Make sure your documents are complete when submitted and are of good quality. For example,
Are they legible?
Are the dimensions correct?
There will be a pre-licensing inspection and surveyors will bring a measuring tape, so if you say a room is a certain size, be prepared for that to be checked.
If FGI Reviewers have questions, respond to them promptly.
Avoid common errors.
In the assisted living realm, CDPHE notes that there is a common error regarding bedroom design for shared bedrooms. Chapter 7, Sec. 22.15 requires that shared rooms have 60 square feet per resident. But shared rooms also must comply with the FGI’s privacy requirements. See slide below.
Just because a design meets the room size requirement does not mean it meets the FGI privacy requirements.
[As a side note, surveyors are issuing deficiency citations if a privacy curtain touches the side of a resident bed. There must be sufficient space between the bed and curtain for infection control concerns.]
What about newer versions of FGI Guidelines?
CDPHE plans to start considering changes to Chapter 2 in June 2024 to, among other things, adopt the newer 2022 version of the FGI Guidelines. This drafting process should involve stakeholders and Pinkowski Law will be reaching out to the industry to determine if any inputs should be given. The amended version of Chapter 2 may be adopted by January 2025.
Until Chapter 2 is revised, the 2018 version of the FGI Guidelines will remain in place. In the meantime, like any uniform code, FGI periodically issues both informal and formal opinions. Design professionals should make sure to stay up-to-date on this changes. CDPHE provides helpful links to these opinions here.
The information herein is intended to be educational and an introduction to the subject matter presented. Despite any statutory or regulatory references cited in the article above, it is NOT specific legal advice to be relied upon for specific individual circumstances. Contact your own legal professional or reach out to our firm if you would like specific advice on this topic.
Look for additional blog posts on topics of interest to Assisted Living and Behavioral Health operators. We welcome topic suggestions! Write to info@pinkowskilaw.com if you are curious to learn more about a certain topic impacting assisted living or other group housing concerns.