Pennsylvania Healthcare Facility Licensure

The short version

• PA DOH licenses healthcare facilities. The Pennsylvania Department of Health's Bureau of Facility Licensure and Certification licenses hospitals, ambulatory surgical facilities (ASFs), nursing homes, pediatric extended care, and related facility types.
• Construction plan review is part of licensure. New construction and significant renovation of licensed facilities typically requires DOH plan review in parallel with local L&I permit review.
• 28 Pa. Code governs the licensure framework. Hospitals are regulated under Chapter 101; ASFs, nursing homes, and other categories have their own chapters in Title 28.
• FGI Guidelines are incorporated by reference for construction standards in most facility categories. The specific FGI edition depends on the current regulation and any DOH-issued guidance.
• NFPA 99 + NFPA 101 + NEC Article 517 apply to licensed healthcare facility design.

Where to go — primary sources

• PA DOH Facilities and Licensing — authoritative hub for all PA healthcare facility licensure.
• Hospitals — hospital-specific licensure hub, regulations, applications.
• Ambulatory Surgical Facilities — ASF-specific licensure hub.
• Nursing Homes — long-term care facility licensure.
• 28 Pa. Code — the governing regulatory title, accessible via pacode.com.

Facility categories and their regulations

• Hospitals (acute care) — 28 Pa. Code Chapter 101 et seq. DOH plan review required for construction and major renovation.
• Ambulatory Surgical Facilities (ASFs) — 28 Pa. Code Chapter 551 et seq. Separate licensure category with ASF-specific construction requirements.
• Long-Term Care Nursing Facilities — 28 Pa. Code Chapter 201 et seq.
• Home Health Agencies, Hospices, Pediatric Extended Care, and other categories — each has its own chapter.

Verify the current chapter number and the current edition of referenced external standards (FGI, NFPA) directly against the DOH facility-type landing page. Regulations have been revised; use the current version.

How DOH construction plan review works

1. Design team submits construction documents to DOH Bureau of Facility Licensure and Certification.
2. DOH reviews against 28 Pa. Code requirements and referenced standards (FGI, NFPA 99, NFPA 101, NEC 517).
3. Local L&I review proceeds in parallel for IBC / IMC / IPC / IEC compliance and local permit issuance.
4. Contractor constructs per approved drawings.
5. DOH conducts pre-licensure inspection before occupancy.
6. Upon passing inspection, licensure is issued or continued.

MEP-specific considerations for PA healthcare construction

• Ventilation. FGI tables apply to operating rooms, procedure rooms, PACU, AII rooms, and PE rooms. Pressure relationships are prescribed.
• Medical gas. NFPA 99 governs medical gas system design, testing, and verification.
• Essential electrical. NFPA 99 + NEC Article 517 for essential electrical branches and emergency power.
• Fire protection. NFPA 101 hospital occupancy provisions (smoke compartments, corridor widths, fire ratings); NFPA 13 sprinkler density for healthcare occupancies.
• Infection control. Pressurization, air flow direction, and HEPA filtration per FGI for specific space types; coordination with infection prevention staff during design is expected.
• Licensure-driven occupancy requirements (bed capacity, operating-room count, sterile processing) drive MEP loads — design coordination with the licensure team is essential early.

How Pennsylvania differs from neighboring states

• Hospital regulations in Chapter 101. PA's 28 Pa. Code structure is distinct; each facility category lives in its own chapter with different requirements.
• Parallel DOH + L&I review. Coordination between state facility-licensure review and local building-permit review is essential; neither replaces the other.
• Philadelphia and Pittsburgh coordination. Healthcare construction in larger PA cities adds municipal L&I complexity on top of DOH review.
• Hospital-specific Chapter 153 references. Some older references cite 28 Pa. Code Chapter 153 for hospital-related provisions; verify against the current Code.

Common pitfalls

• Submitting to L&I without parallel DOH submission.
• Using outdated FGI editions not matching the current DOH reference.
• Missing life-safety requirements for hospital occupancies (smoke compartments, compartment sizing, corridor separation).
• Under-estimating pre-licensure inspection timeline and necessary functional testing.
• Failing to coordinate with infection prevention during design (for ventilation and pressurization-critical spaces).

The practical workflow

1. Identify licensure category (hospital, ASF, nursing home, other).
2. Review the applicable 28 Pa. Code chapter and the current FGI/NFPA references.
3. Design MEP systems per referenced standards.
4. Submit construction drawings to PA DOH Bureau of Facility Licensure and Certification.
5. Submit local L&I permit application in parallel.
6. Address comments from both reviewers; revise as needed.
7. Construct per approved drawings.
8. Schedule DOH pre-licensure inspection; complete functional testing.
9. Obtain Certificate of Occupancy (L&I) and licensure issuance (DOH).

When to get direct help

For facility-type-specific licensure questions, contact the DOH facility category hub directly (hospitals, ASFs, nursing homes). For construction plan-review questions, the Bureau of Facility Licensure and Certification's construction review staff. Contact information lives on the PA DOH facility landing pages linked above.

Why we built this

PA healthcare construction catches teams who treat it like standard commercial work. DOH plan review is non-negotiable and on its own timeline; missing it means no licensure, regardless of how clean the L&I permit is. This page surfaces the dual-review structure and the MEP-specific requirements so project schedules account for both tracks.

Missing something? Email us.