Architectural Review

An architectural review is one of the processes that is necessary in order to receive license approval from the Texas Health and Human Services Commission and must be completed for hospitals, ambulatory surgical centers, dialysis facilities, free standing emergency medical care facilities, and special care facilities.

The owner/operator may not begin construction of a new building, new addition, renovation, alteration, modification, or conversion of an existing building until the HHSC Architectural Review Unit approves final construction and necessary documents.

Contact Information

Map and directions to the Exchange Building.

Mailing addresses may be found on the contact page.

Applications and Forms

The Architectural Review Process

Architectural Review Process at a Glance

When is an application required?

An application is required for construction, erection, repair, remodeling, renovations, modifications, additions, alterations, removal, conversion, change of service(s), change of function, change of licensed beds or ESRD stations, change of licensed facility type, large/stationary equipment replacement, building system equipment upgrade, demolition, initial facility license or re-opening a closed General or Special Hospital, Private Psychiatric Hospital or Crisis Stabilization Unit, Ambulatory Surgical Center, End Stage Renal Disease Facility, Freestanding Emergency Medical Care Facility, or Special Care Facility. If a facility type is not mentioned above, do not submit project to the ARU. Refer to the Application Package Instructions, ARU-21 (PDF), and the Application Form, ARU-01 (PDF), from this website.

When can construction, remodel, etc. (items mentioned in above paragraph) begin?

Construction can only commence after ARU's written approval is obtained, which is based on an approved application package. The term construction shall not be construed to include excavation or site preparation.

When can patients occupy?

Upon obtaining the Final Architectural Review Form issued by ARU, FM ARU-03, the facility may occupy the newly constructed space with staff only when a facility receives a new or modified license from the Facility Licensing Unit. Under no circumstance shall patients be admitted, transferred in, or procedures performed until the facility receives their new or modified license. Inspection Instructions, ARU-22 (PDF).

Upon obtaining the Final Architectural Review Form, FM ARU-03, the facility may occupy the newly constructed space if a construction project does not require changes in the facility's license. With the Final Architectural Review Form, staff may occupy the design space and services may be provided to patients (e.g. construction of an operating room, catheterization lab, or imaging suite). Inspection Instructions, ARU-22 (PDF).

Is a plan review required before construction or change of service/function?

Written approval from ARU is required before any work or change of function can occur and is obtained either by approval of self-certification request or approval of plan review comments. Written approval shall provide the type of inspections required.

In lieu of a plan review, the facility can opt for self-certification. If a plan review is requested by the facility, indicate this request in the project narrative. The review time is approximately 120 business days, depending on the size of the project. If the facility opts out of the plan review, they may request the self-certification process. Self-certification is a process where registered architects and professional engineers may bypass a full review of a building project by filling out the third page of the application form. With this streamlined approval process, registered architects and professional engineers may self-certify that their project complies with all applicable laws and codes, and requests the project be approved without a full review or any oversight by ARU.

When are fees required?

Application and inspection fees are required for:

  • Major or Fast Track Application Packages for any General, Special, Psychiatric Hospital, Crisis Stabilization Unit or Special Care Facility.
  • Minor Application Package does not require an application fee, even where a project occurs at a hospital or a special care facility.
  • Fee is not due for ASC, ESRD or FEMC. Refer to the Application Package Instructions, ARU-21 (PDF), 8.3 & 8.4 for application fee schedule. Refer to the Inspection Instructions, ARU-22 (PDF), 10.11.

Do applications expire?

Incomplete application package submittals remain in ARU's office for 30 calendar days, and then are discarded.

Application packages with application numbers remain active for 360 calendar days but will expire on the 361st calendar day if the project has not received an inspection, or after the date of the last inspection that shows progress towards completion of the project. An expired application must be resubmitted before any inspection is conducted. Refer to the Application Package Instructions, ARU-21 (PDF).

Is professional staff available for consultation prior to application?

Code questions and answers can be obtained via three options.

  • Call in-office Inspector at 512-834-6649.
  • Email Inspector at AskARU@hhsc.state.tx.us.
  • Schedule a feasibility conference by calling 512-834-4577.

Feasibility conferences are held at our office on Tuesday, Wednesday and Thursday at 10 a.m., 1 p.m. and 3 p.m. on first scheduled basis. Conferences determine the feasibility of a project, provide consultation regarding project questions, and establish understanding of compliance with the rules and codes. This is not a plan review.

Feasibility conferences can be held at any stage of initial design through final design. Feasibility conferences are a maximum of 90 minutes and multiple projects can be discussed during this time frame. Only a sketch of the plan(s) is required for the meeting. Stakeholders shall keep the meeting minutes and submit them to the Inspector, who conducted the conference for their approval.

What type of work is exempt from an application package?

Maintenance work does not require notification to ARU. Replacing a building system and interior or exterior finish upgrade is not maintenance work and does require an application package to ARU. Refer to maintenance definition in Application Package Instructions, ARU-21 (PDF).

What happens after the work has been completed?

Once the work is completed, a final architectural inspection shall be required. Upon approval of the final architectural inspection, the Final Architectural Inspection Form, FM ARU-03, shall be issued by the ARU. Refer to Project Closeout Instructions, ARU-25 (PDF).

How is a license obtained? How are licensed beds or ESRD stations modified?

An architectural review is one of the processes that are necessary in order to receive license approval/modification from the Facility Licensing Unit. Refer to the Facility Licensing Unit webpage or call 512-834-6648 for further information.

What documents are required at a final inspection?

Refer to Inspection Instructions, ARU-22 (PDF). Chapters 8 and 9. Chapter 9 contains a list when a previously licensed facility is opening as an initial application. Chapter 8 address any other final inspection's required documents.

What is the application or inspection or project closeout process?

Other Helpful Resources

Applicable Laws & Rules

State Regulations

Texas Health and Human Services Commission: Title 25 and Title 26 Texas Administrative Code.

NFPA Standards

NFPA 101, 2012 edition and NFPA 99, 2012 edition for General and Special Hospital, Private Psychiatric Hospital and Crisis Stabilization Unit, Ambulatory Surgical Center who receive Medicare reimbursements.

NFPA 101, 2003 edition and NFPA 99, 2002 edition for each End Stage Renal Disease Facility, each Freestanding Emergency Medical Care Facility, each Special Care Facility and any Ambulatory Surgical Center or any hospital or CSU who does not receive Medicare reimbursements.