# Title 33 — State Department of Health

## Article 33-03 — Public Health Division

## Chapter 33-03-36 — Extended Stay Center Registration

### § 33-03-36-01. Definitions.

1. "Ambulatory surgical center" means a facility that is certified as an ambulatory surgical center
by the centers for Medicare and Medicaid services.
2. "Facility" means an extended stay center.
3. "License" means a certificate of registration.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-02. Issuance of license and fees.

A facility shall obtain a license from the department in order to operate in this state.
1. Application to operate a facility must be made to the department prior to opening a facility
upon determination by the department that the facility meets the definition of a facility.
2. A facility shall apply to the department for a license in the form and manner prescribed by the
department.
3. Upon receipt of an application for an initial license, the department may schedule an
inspection. Upon completion of the inspection and consideration of the findings, the
department may issue an initial or provisional license, or deny the application.
4. An initial license is valid for a period not to exceed one year and shall expire on December
thirty-first of the year issued.
5. Licenses must be issued on a calendar year basis and expire on December thirty-first of each
year. An application for licensure renewal must be received by the department thirty days prior
to the beginning of the licensure period to process.

6. A provisional license may be issued to a facility that does not comply with this chapter if
practices in the facility do not pose a danger to the health and safety of the patients, as
determined by the department.
a. A provisional license must be accompanied by a written statement of the specific rules or
statutes the facility is in noncompliance of and the expiration date of the license, which is
not to exceed three months from the date of issuance.
b. If compliance with the requirements has been determined by the department prior to the
expiration of the provisional license, an annual license may be issued. If an acceptable
plan of correction has been approved by the department but compliance has not yet
been achieved, the provisional license may be renewed no more than one time for an
additional period up to three months at the discretion of the department.
7. The facility shall display the current license in a conspicuous place.
8. A facility shall notify the department and reapply for licensure upon any change in ownership
of the facility.
9. A license is not subject to sale, assignment, or other transfer, voluntary or involuntary. A
license is not valid for any premises other than those for which originally issued.
10. The department may, at any time, inspect a facility that the department determines meets the
definition of an extended stay center as described in North Dakota Century Code chapter
23-17.6 and this chapter, to determine compliance with licensure requirements and standards.
11. The department may deny, suspend, or revoke the license of a facility for noncompliance with
North Dakota Century Code chapter 23-17.6 or this chapter.
12. The facility shall provide the department access to any materials and information necessary,
as determined by the department, for determining compliance with licensure requirements and
standards.
13. The facility shall submit floor plans directly or through an architect or engineer for new
construction or a renovation project to be reviewed by the department. The estimated cost of
the project is to accompany the submission of the project. Based on the estimated cost of the
project, a letter is sent from the department to the facility administrator or designee indicating
the plan review fee that needs to be submitted. The plan review fee schedule based on size
and project costs is:
a. Small project: A fee of five hundred dollars for a project cost between zero and fifty
thousand dollars.
b. Medium project: A fee of one percent of the project costs for a project cost between fifty
thousand and one dollar and four million dollars.
c. Large project: A fee of forty thousand dollars plus twenty-five hundredths of one percent
of the project cost after four million dollars is subtracted for a project with project cost
greater than four million dollars.
14. An application for a license for facilities not owned by the state or its political subdivisions
must be accompanied by the following fees:
a. Ten thousand dollars for each initial application.
b. Two thousand five hundred dollars for each renewal application.
History: Effective July 1, 2023.

General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-03. Waiver provision.

The department may waive licensure requirements for specified periods of time provided
compliance with the requirement would result in an unreasonable hardship upon the facility and lack of
compliance does not adversely affect the health or safety of the patients.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-04. Governing body.

1. The facility shall have a clearly defined, organized governing body that assumes full legal
responsibility for the overall conduct and operation of the facility.
2. The governing body is responsible for approval and implementation of effective patient care
and administrative policies and procedures for the operation of the facility. These policies and
procedures must be in writing, signed, dated, reviewed annually, and revised as necessary.
3. The governing body shall appoint an administrator to be in charge of the general
administration of the facility. Provisions must be made in writing for an identified staff member
to be responsible for the onsite operation of the facility in the absence of the administrator.
4. The governing body shall ensure sufficient trained and competent staff are available to provide
twenty-four hour extended stay services whenever there are patients admitted.
5. The governing body shall ensure training and competency evaluation is completed for all staff
and volunteers specific to the care and services provided and necessary to meet the needs of
the patients.
6. The governing body shall ensure the facility has a written agreement with one or more
affiliated ambulatory surgery centers who have been certified for more than twenty-four
consecutive months. The agreement must clearly detail the responsibility of the parties
involved.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-05. Codes and standards.

1. A facility must be designed, constructed, equipped, maintained, and operated in compliance
with:
a. North Dakota Century Code section 54-21.3-04.1, relating to accessibility standards;
b. The requirements for food and beverage establishments issued by the department;
c. Article 62-03.1 relating to plumbing standards;
d. Article 24.1-06 relating to electrical wiring standards; and
e. Article 45-12 relating to boiler rules and regulations.

2. A facility shall comply with all applicable building codes, ordinances, and rules of city, county,
or state jurisdictions. The most stringent requirement must be applied.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-06. Plans and specifications.

1. A facility shall submit plans and specifications to the department for approval for all
construction, remodeling, and installations subject to review. The plans and specifications
must be prepared by an architect or engineer licensed in North Dakota, unless otherwise
determined by the department.
2. A facility shall contact the department prior to any substantial changes in or alterations to any
portion of the structure to determine to what extent it is subject to review. A substantial change
includes alterations affecting the fire safety or structural integrity of the building, changes in
service areas or services provided within a service area, changes in bed capacity, or any other
change governed by the standards of this chapter. The department may request plans,
specifications, or other information as may be required and shall make the final determination
on those areas subject to review.
3. Start of construction prior to approval by the department of the final plans and specifications is
not permitted.
4. All construction, remodeling, and installations must be in accordance with the final plans and
specifications approved by the department. Modifications or deviations from the approved
plans and specifications must be submitted to and approved by the department.
5. The department may make inspections of construction, remodeling, or installations and
arrange conferences with the facility to ensure conformance with approved plans and
specifications.
6. The construction specifications must require the contractor to perform tests to ensure all
systems conform to the approved plans and specifications.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-07. General building requirements.

1. The facility shall design and equip areas for the comfort and privacy of each patient. Each
patient room must have:
a. A bed, a mattress, appropriate bedding, a bedside stand, and a chair appropriate to the
needs and comfort of the patient. All furniture and furnishings must be well-constructed,
comfortable, in good repair, kept clean and maintained in a serviceable condition.
b. Physical space for private visiting.
c. Physical space to ensure visual privacy for personal care.
d. If a hardwired communication system is used in patient rooms, each patient must be
provided with a call device. Calls must be initiated by a patient activating a device that
sends a call signal to the staff call station or a hand-held mobile device carried by a staff
member.

e. A window with a shade.
f. Patient toilet room with a handwashing station. Each patient shall have access to a toilet
room without having to enter a corridor. Toilets used by patients must allow sufficient
clearance on both sides to enable physical access and maneuvering by caregivers who
may have to assist patients in wheelchair-to-toilet transfers and returns.
2. The facility shall provide space for storage of clean linen, clean supplies, patient care
equipment, housekeeping, and cleaning supplies.
3. Grab bars must be installed in all patient toilet rooms, showers, and bathing facilities. Grab
bars must comply with all local, state, and federal requirements.
4. Ground fault circuit interrupters must be provided for outlets within six feet [1.83 meters] of the
outside edge of a sink.
5. A convenience portable space heater, portable halogen lamp, household-type electric blanket,
or household-type heating pad may not be used in a facility.
6. The storage and transfilling of oxygen cylinders or containers must meet the requirements of
the National Fire Protection Association 99, Standard for Health Care Occupancies, 2012
edition.
7. Electrically powered exhaust ventilation must be provided in all soiled areas, wet areas, toilet
rooms, and storage rooms. Clean storage rooms may also be ventilated by supplying and
returning air from the building's air-handling system. The facility shall provide for adequate
ventilation to assure an odor-free, comfortable environment.
8. Office space and other areas must be furnished with desks, chairs, lamps, cabinets, benches,
worktables, or other furnishings essential to the proper use of the area.
9. The facility shall provide a dedicated staff toilet room.
10. An essential electrical source must provide lighting for at least a ninety-minute duration during
an interruption of the normal electrical supply. Illumination must be automatic and is permitted
to be met by means such as:
a. Two separate electric lighting systems with independent wiring. One system is permitted
to be supplied from an outside source, such as a public utility service, and the other from
an electric generator on the premises driven by an independent source of power, or
b. An electric circuit, or circuits, used only for means of egress illumination, with two
independent electric sources arranged so that, on the failure of one, the other will
automatically and immediately operate. One such source is permitted to be a connection
from a public utility, or similar outside power source, and the other an approved storage
battery with suitable provisions to keep it automatically charged.
11. Emergency lighting for safe egress and access shall be evaluated for all facilities. Each patient
room must have general lighting and night lighting.
12. Functional testing shall be conducted monthly for not less than thirty minutes for generators
and not less than thirty seconds for battery-powered lighting. Functional testing shall also be
conducted annually for a minimum of ninety minutes.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02

### § 33-03-36-08. Fire safety.

1. Each facility must be a maximum of two stories in height with a minimum construction type
rating of one hour, that is arranged, equipped, maintained, and operated to ensure the safety
of its occupants from fire, smoke, fumes, or resulting panic during the period of time
necessary for escape from the structure in case of fire or other emergency. Walls and ceilings
separating each patient room must have a one-hour fire rating. Patient room doors must be
substantial doors, such as those of one and three-fourths inch [4.45 centimeters] thick, solid
bonded wood-core construction or of other construction of equal or greater stability and fire
integrity. These doors must be self-closing or automatic closing and must be provided with
latches or other mechanisms suitable for keeping the doors closed.
2. Every patient room must have access to a primary and secondary means of escape located to
provide a safe path of travel to the outside. Designated means of escape must be
continuously maintained free of all obstructions.
3. No doors in any means of escape may be locked against egress when the building is
occupied.
4. The facility shall provide an automatic fire alarm system with a means for manual activation.
Occupant notification must be provided automatically and without delay. Private operating
mode must be permitted to be used. This allows staff and other personnel required to
evacuate patients to be notified. The notification must include means to readily identify the
area or building in need of evacuation. Each sleeping room must be provided with an
approved smoke alarm that is interconnected to the fire alarm system. The fire alarm system
must be installed and tested in accordance with National Fire Protection Association 72,
National Fire Alarm and Signaling Code, 2010 edition.
5. The facility must be protected throughout by an approved automatic sprinkler system using
quick-response, residential sprinklers or domestic sprinklers and must initiate the fire alarm
system. All habitable areas, closets, roofed porches, roofed decks, and roofed balconies must
be protected by the sprinkler system. An automatic sprinkler system with a minimum of a
thirty-minute water supply must be permitted. The sprinkler system supervision must be in
accordance with the type of sprinkler system that is installed and the testing for the system
must be in accordance with National Fire Protection Association 25, Standard for the
Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 edition.
Attics used for storage or fuel-fired equipment must be protected with automatic sprinklers.
Attics not used for storage or fuel-fired equipment must be provided with one of the following:
a. Protected throughout by a heat detection system arranged to activate the building fire
alarm system;
b. Protected with automatic sprinkler system;
c. Must be noncombustible construction; or
d. Constructed of fire-retardant-treated wood.
6. Any space where there is a storage or activity having fuel conditions exceeding those of a one
or two-family dwelling and that possesses the potential for a fully involved fire must have a
one-hour fire resistance rating. These spaces must also be provided with an automatic fire
detection system connected to the fire alarm system and the area must have automatic
sprinkler protection.
7. Interior wall and ceiling finish materials must be class A, class B, or class C.

8. The facility shall maintain a written plan that specifies action and procedures for responding to
emergency situations such as fire, severe weather, loss of utility services such as heat, water,
sewer, or electricity, communicable disease outbreaks, or a missing individual. The plan must
be developed with the assistance and advice of the local fire or rescue authority or any other
appropriate resource. An accident or incident report must be maintained for at least one year.
A copy of the plan must be readily available at all times.
9. The emergency plan must be clearly communicated to all staff during orientation. Each staff
must be knowledgeable of and must implement the emergency plan. The duties and
responsibilities under the emergency plan must be reviewed by the staff not less than every
twelve months. The emergency plan must include:
a. Assignment of staff to specific tasks and responsibilities in case of an emergency
situation;
b. Instructions relating to the use of alarm systems and signals;
c. Systems for notification of appropriate entities outside of the facility;
d. Information on the location of emergency equipment in the facility;
e. Specification of evacuation routes and procedures; and
f. A requirement that emergency egress drills must be conducted not less than six times
per year on a bimonthly basis, with not less than two drills conducted during the night
when patients may be sleeping. These records must include dates, times, duration,
names of staff participating, and a brief description of the drill, including the escape path
used and evidence of simulation of a call to the fire department. The emergency drills
must be permitted to be announced to the patients in advance. These emergency drills
must be conducted without disturbing patients by choosing the location of the simulated
emergency in advance and by closing the doors in the vicinity prior to initiation of the drill.
The purpose of an emergency drill is to test the efficiency, knowledge, and response of
staff in implementing the emergency plan. Its purpose is not to disturb or excite patients.
Patients and families are not required to actively participate in the drill.
10. Portable fire extinguishers must be maintained in a fully charged and operable condition and
must be kept in their designated locations at all times when they are not being used. Fire
extinguishers must be installed so the maximum travel distance to an extinguisher is seventy-
five feet [22.86 meters] and must be located along normal paths of travel, including exits from
areas.
11. A facility may be directed to remove or correct other hazardous conditions not covered in this
chapter if the department considers the conditions to have the potential to cause injury or
illness to the patients or staff.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-09. Patient records.

1. The facility shall keep accurate, current, and confidential records of all patients.
2. The facility shall provide for secure maintenance and storage of all patient records.
3. Patient records must include:

a. Complete identification of each patient, including information on the patient's next of kin
and responsible person.
b. Initial and subsequent assessments of each patient.
c. The current person-centered care plan.
d. Complete documentation of all services rendered.
e. An admission note.
f. A medication administration record documenting medication administration consistent
with applicable state laws, rules, and practice acts.
g. Consent and authorization forms.
h. A discharge note, including disposition of the patient's personal effects, money, or
valuables deposited with the facility.
4. The facility shall maintain patient records for a period of not less than five years from the date
of discharge.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-10. Pharmacy and medication administration services.

1. The facility shall provide assistance to the patient in obtaining necessary medications and
medical supplies.
2. Drugs and biologicals must be administered by an individual certified or licensed to administer
medications or the patient.
3. The facility shall provide a secure area for medication storage and shall have policies and
procedures for the control, storage, handling, administration, recordkeeping, and disposal of
medication, including medications the patient brought from home.
4. All medications used by patients which are administered or supervised by staff must be:
a. Properly recorded by staff at the time of administration.
b. Kept and stored in original containers labeled consistently with state laws.
c. Properly administered.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-11. Dietary services.

The facility shall meet the dietary needs of the patients, provide dietary services, and the sanitary
requirements for food establishments in compliance with chapter 33-33-04.1.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02

### § 33-03-36-12. Housekeeping and laundry services.

The facility shall provide housekeeping and maintenance services necessary to maintain the
interior and exterior of the facility in a safe, clean, orderly, and comfortable manner and provide sanitary
laundry services.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-13. Admission and discharge criteria.

Admission and discharge criteria must be specified in writing.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-14. Staffing.

1. The facility shall employ or contract with a registered nurse to supervise patient care to meet
the needs of the patients at all times.
2. The facility shall maintain a sufficient number of qualified staff who are trained and competent
to provide the care and services necessary to meet the needs.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-15. Patient rights.

The facility shall develop, adopt, and implement a statement of the rights and responsibilities of
patients. This statement must be provided to the patient or the patient representative prior to or at the
time of admission to the facility. The statement must include provisions assuring each patient the
following minimum rights:
1. The right to be clearly informed of the responsibilities of the facility for care of the patient,
including services to be provided.
2. The right to be fully informed, at the time of admission, of the materials and equipment
available to the patient, any financial policies, and estimated cost.
3. The right to privacy in treatment and in caring for personal needs, and confidentiality in the
treatment of personal and service records.
4. The right to be informed of any change in patient status.
5. The right to be treated courteously, fairly, and with the fullest measure of dignity.
History: Effective July 1, 2023.
General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
### § 33-03-36-16. Data and metrics reporting.

The facility shall provide data and metrics to the department as determined by the department.
History: Effective July 1, 2023.

General Authority: NDCC 23-17.6-02
Law Implemented: NDCC 23-17.6-02
