N.H. Code Admin. R. Ann. He-P — Former Division of Public Health Services

Partial collection: 16 of 17 listed publisher documents are included. 1 missing or unavailable documents and their reasons are recorded in the collection metadata.

Chapter He-P 300 Diseases

Part He-P 301 Communicable Diseases

N.H. Code Admin. R. Ann. He-P 301.01 Definitions

(a) "Acceptable immunization" means the immunizations required in RSA 141-C:20-a and the doses and age requirements in He-P 301.14.

(b) "Admitting official" means the principal or his or her designated representative, headmaster or director of the public or non-public school, state agency, or child care agency.

(c) "Applicant" means the person for whom application is made to either the AIDS drug assistance or the tuberculosis patient care financial assistance program, and who becomes a recipient if he or she is determined to be medically and financially eligible.

(d) "Carrier" means a person or animal that harbors a specific infectious agent in the absence of discernible clinical disease and serves as a potential source of infection.

(e) “Case” means any person afflicted with a communicable disease.

(f) “Chief complaint” means the patient’s set of symptoms and illnesses when the patient first presents to the emergency department of a hospital.

(g) "Child care agency" means “child care agency” as defined in RSA 141-C:2, IV-b.

(h) “Commissioner" means “commissioner” as defined in RSA 141-C:2, IX.

(i) “Communicable disease” means “communicable disease” as defined in RSA 141-C:2, VI.

(j) "Common cup" means an open drinking vessel shared by individuals in public places without disinfection between uses.

(k) "Conditional enrollment" means the temporary enrollment of a student who has documentation of at least one dose of each required vaccine and an appointment date(s) for the next scheduled dose(s).

(l) “Congregate setting” means any setting or location where people come together including, but not limited to, schools, childcare centers, healthcare facilities, emergency shelters, workplaces, public events, retail outlets, or other business gathering locations.

(m) "Contact" means a person who has been in association with an infected person or animal or a contaminated environment in a manner that provides an opportunity to acquire the infective agent.

(n) "Date of application" means the date on which the program receives the signed application for AIDS drug assistance or for the tuberculosis patient care financial assistance.

(o) "Department" means “department” as defined in RSA 141-C:2, X.

(p) “Diversion” means the illegal use, tampering, substitution, or theft of drugs intended for patients by healthcare or non-healthcare personnel.

(q) “Documentation” means written authenticated evidence of a laboratory test result or immunization.

(r) “Dose of vaccine” means the amount of vaccine appropriate to develop or confer immunity as specified in the manufacturer’s documentation accompanying the vaccine, also known as the package insert.

(s) “Emergency department visit” means an encounter where a person is treated, evaluated or both, in the emergency department of a hospital.

(t) “Exclude” means to prevent a person from being in a public or communal setting, such as preventing an employee from reporting to work and from performing any job responsibilities within the employee’s place of employment.

(u) “Health care facility” means facilities required to be licensed pursuant to RSA 151:2, I and those facilities exempt from licensing pursuant to RSA 151:2, II.

(v) "Health care provider" means any physician or other person self-employed or representing or employed by a governmental or private agency, department, institution, clinic, laboratory, hospital, health maintenance organization, pharmacist, association or other entity who assesses or diagnoses the health status of any person or who treats any reportable disease or illness.

(w) "Health care setting" means any governmental or private agency, department, institution, clinic, laboratory, hospital, health maintenance organization, pharmacist, association, or other entity which assesses or diagnoses the health status of, or provides medical care or treatment to any person.

(x) “Hospital” means an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons, and which is licensed in accordance with RSA 151 and He-P 802. The term “hospital” also includes psychiatric and substance abuse treatment hospitals.

(y) "Household" means one or more adults, with or without children, related by marriage or living together in the same residence.

(z) "Human Immunodeficiency Virus (HIV)" means “human immunodeficiency virus” as defined in RSA 141-F:2, V.

(aa) "Institutional setting” means any group living situation such as in a nursing home, hospital, sheltered care facility, residential treatment and rehabilitation facility, correctional facility, transitional housing, long term care facility, or any group care facility.

(ab) “Invasive” means the organism causing the communicable disease is detected or isolated from a normally sterile site.

(ac) "Isolation" means “isolation” as defined in RSA 141-C:2, XII.

(ad) “Laboratory” means “laboratory” as defined in He-P 808, namely, “any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of disease.”

(ae) “Month” means 28 days, or 4 weeks.

(af) “Outbreak” means cases of illness or disease occurring in a community, region or specific population at a rate clearly in excess of what is normally expected.

(ag) "Quarantine" means “quarantine” as defined in RSA 141-C:2, XIII.

(ah) "Reportable disease" means a communicable disease, as defined in RSA 141-C:2, VI, required to be reported to the commissioner pursuant to RSA 141-C:7 and He-P 301.02.

(ai) “Restrict” means to limit activities of a person in a public or communal setting such as, limiting the activities of an employee such that the employee is able to report to work and perform certain job duties as long as that activity poses no threat to the public’s health.

(aj) “Sterile site” means an area of the body where bacteria are not found growing, and which, when found, is indicative of infection. These areas of the body include, but are not limited to, cerebrospinal fluid, blood, joint fluid, pleural fluid, peritoneal fluid, pericardial fluid, bone, and any other internal body sites and organs in which bacterial are not normally found.

(ak) “Suspect case” means any patient who a health care provider has reason to believe is or might be afflicted with a reportable disease such that diagnostic procedures, treatments, regimens, or preventive and/or control measures appropriate for the reportable disease are then instituted by the physician and/or the commissioner.

History

• #2017, eff 5-10-82; amd by #2339, eff 4-15-83; amd by #2430, eff 6-30-83; amd by 2545, eff 11-29-83; ss by #3172, eff 1-2-86; ss by #4230, eff 2-23-87; amd by #4425, eff 5-27-88; ss by #4946, eff 10-2-90; amd by #6053, eff 6-24-95; ss by #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.02 Reportable Diseases

(a) Health care providers shall report to the department diagnosis, suspicion of diagnosis, or suspected incident involving the following, in accordance with He-P 301.03, in the following time frames:

(1) Within 24 hours following diagnosis or suspicion of diagnosis or suspected incident of:

a. Anthrax;

b. Arboviral infection; including but not limited to West Nile Virus, Eastern Equine Encephalitis Virus, Dengue, Chikungunya virus, Powassan virus, Zika virus and St. Louis Encephalitis;

c. Botulism;

d. Brucellosis;

e. Cholera;

f. Creutzfeld-Jacob disease

g. Diphtheria;

h. Haemophilus influenzae, invasive disease;

i. Hantavirus Pulmonary Syndrome;

j. Hepatitis, viral: A;

k. Measles;

l. Neisseria meningitidis, invasive disease;

m. Mumps;

n. Pertussis;

o. Psittacosis;

p. Plague;

q. Poliomyelitis;

r. Rabies in Humans or Animals;

s. Rubella, including Congenital Rubella Syndrome;

t. Tuberculosis Disease;

u. Tularemia;

v. Typhoid Fever;

w. Typhus;

x. Vibrio species including V. cholerae; and

y. Any suspect outbreak, cluster of illness, unusual occurrence of communicable disease, or other incident that may pose a threat to the public’s health.

(2) Within 72 hours following diagnosis or suspicion of diagnosis of:

a. Acquired Immune Deficiency Syndrome (AIDS);

b. Acute flaccid myelitis;

c. Anaplasmosis;

d. Babesiosis;

e. Campylobacteriosis;

f. Chlamydia;

g. Coccidioidomycosis;

h. Cyclospora infection;

i. Cryptosporidiosis;

j. Ehrlichiosis;

k. Enterobacteriaceae species demonstrating resistance to carbapenem or production of a carbapenemase;

l. Escherichia coli O157 infection and other shiga toxin producing E. coli;

m. Giardiasis;

n. Gonorrhea;

o. Hepatitis, viral, newly diagnosed infections only: B, C;

p. Hepatitis, viral: positive B surface antigen in a pregnant woman;

q.. HIV, including HIV exposure in infants;

r. Legionellosis;

s. Leprosy, Hansen’s Disease;

t. Leptospirosis;

u. Listeriosis;

v. Lyme Disease;

w. Malaria;

x. Pneumococcal disease, invasive;

y. Psittacosis;

z. Rocky Mountain Spotted Fever;

ab. Salmonellosis;

ac. Shigellosis;

ad. Syphilis, including Congenital Syphilis Syndrome;

ae. Tetanus;

af. Toxic-Shock Syndrome (TSS), Streptococcal or Staphylococcal;

ag. Trichinosis;

ah. Varicella; and

ai. Yersiniosis.

(b) Laboratories shall report to the department any laboratory test indicative of or highly correlated with infection of the following microorganisms in accordance with He-P 301.03(h):

(1) Within 24 hours:

a. Arboviral infection, including but not limited to West Nile Virus, Eastern Equine Encephalitis Virus, Dengue, Chikungunya virus, Powassan virus, Zika virus and St. Louis Encephalitis;

b. Bacillus anthracis;

c. Bordetella pertussis;

d. Clostridium botulinum;

e. Corynebacterium diphtheriae;

f. Francisella tularensis;

g. Haemophilus influenzae, sterile site;

h. Hantavirus;

i. Hepatitis, viral: A, E;

j. Mumps;

k. Mycobacterium tuberculosis: isolation of the organism or detection of its DNA;

l. Neisseria meningitidis, sterile site;

m. Polio;

n. Rabies;

o. Rubella;

p. Rubeola;

q. Salmonella typhii;

r. Vancomycin resistant Staphylococcus aureus (VRSA);

s. Vibrio species including V. cholerae; and

t. Yersinia pestis.

(2) Within 72 hours:

a. Anaplasmosis phagocytophilum;

b. Babesia microti;

c. Borrelia burgdorferi;

d. Brucella species;

e. Campylobacter species;

f. Chlamidophila psittaci;

g. Chlamydia trachomatis;

h. Clostridium tetani;

i. Coccidioides immitis;

j. Cryptosporidium parvum;

k. Cyclospora cayetanensis;

l. Ehrlichia species;

m. Enterobacteriaceae species demonstrating resistance to carbapenem or production of a carbapenemase;

n. Escherichia coli O157 and other shiga toxin producing E. coli;

o. Giardia species;

p. Hepatitis, viral: positive B surface antigen in a pregnant woman:

q. HIV, including HIV exposure in infants;

r. Legionella pneumophila;

s. Leptospira species;

t. Listeria monocytogenes;

u. Mycobacterium leprae;

v. Mycobacterium tuberculosis: blood assays only;

w. Neisseria gonorrhoeae;

x. Plasmodium species;

y. Rickettsia prowazekii;

z. Rickettsia rickettsii;

aa. Salmonella species other than Salmonella typhii;

ab. Shigella species;

ac. Streptococcus pneumoniae, sterile site;

ad. Treponema pallidum;

ae. Trichinella spiralis; and

af. Yersinia enterocolitica.

(c) Laboratories shall report to the department within 72 hours the results of all CD4+ lymphocyte laboratory tests.

(d) Laboratories shall report any tests indicative of HIV infection including antibody, antigen PCR based, and all viral load tests, including those with no virus detectable.

(e) Laboratories that are owned, operated, and located on the licensed premises of a hospital shall electronically report the test results listed in (b)-(d) above.

(f) Each hospital referred to in (d) and (e) above shall establish an electronic submission process and commence routine electronic reporting by December 31, 2018; and

(g) Hospitals referred to in (d) and (e) above shall format electronic submissions in accordance with guidance provided by the Department in the New Hampshire Local Implementation Guide for Electronic Laboratory Reporting using HL7 2.5.1, Version 4.0, 5/23/2016, available as noted in Appendix A.

(h) Laboratories shall submit clinical isolate material as requested by DHHS for the purpose of public health surveillance and investigation.

(i) Laboratories that are owned, operated, and located on the licensed premises of a hospital shall submit annually a hospital antibiogram report if one exists.

(j) The person in charge, or their designee, of any healthcare setting shall report to the department any investigation of suspected or actual incident of diversion of injectable medications in a health care setting within 72 hours of initiation of such investigation.

History

• #3172, eff 1-2-86; ss by #4230, eff 2-23-87; ss by #4946, eff 10-2-90; amd by #6053, eff 6-24-95; ss by #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.03 Reporting of Communicable Diseases

(a) Any physician or other health care provider who assesses, diagnoses, or treats a person believed to be a case or suspect case of a reportable disease shall immediately make a report to the department by:

(1) Telephone at one of the following: 1-603-271-4496, from 8:00 a.m. to 4:00 p.m., or after hours and on weekends at: 603-271-5300;

(2) Facsimile at 603-271-0545; or

(3) Electronic transmission by requesting from the Department during business hours an account in the NH Electronic Disease Surveillance System (NHEDSS) on forms provided by the commissioner.

(b) Reports provided pursuant to (a) above shall include:

(1) The full name, age, date of birth, sex, race, ethnicity, address, telephone number, occupation, and place of occupation of the patient;

(2) The name of the disease;

(3) The date of onset;

(4) Diagnostic test(s) performed, specimen type(s), date(s), and result(s);

(5) The name of the person reporting; and

(6) Treatment information including the name and amount of the medication prescribed.

(c) When no physician or other health care provider is in attendance, the person in charge of any institution, including but not limited to a public or non-public school, child care agency, hotel, restaurant, boarding house, labor camp or other camp, vessel, workplace, hospital, dispensary, pharmacy, or charitable, penal, or other institution or place of detention in which there is a case or suspect case of a reportable disease, shall report the same immediately to the department as provided in paragraph (a) above.

(d) Reports provided pursuant to (c) above shall include:

(1) The full name, age, date of birth, sex, race, ethnicity, address, telephone number, occupation, and place of occupation of the patient;

(2) The name of the disease or incident;

(3) The date of onset; and

(4) The name, affiliation, and contact information of the person reporting.

(e) Local boards of health shall report immediately to the department those cases or suspect cases of reportable diseases of which they have knowledge.

(f) Reports required pursuant to (e) above shall include:

(1) The full name, age, date of birth, sex, race, ethnicity, address, telephone number, occupation, and place of occupation of the patient;

(2) The name of the disease or incident;

(3) The date of onset;

(4) The name of the original reporting source; and

(5) The name, affiliation, and contact information of the person reporting.

(g) The person in charge of any diagnostic laboratory testing human or animal specimens shall report immediately to the department as provided in paragraph (a) above, the following except for laboratories which after December 31, 2018 shall report to the department pursuant to He-P 301.02(f):

(1) The isolation or identification of causative agents, positive diagnostic acute immunological responses to causative agents, or any other positive diagnostic test results for any of the conditions listed in He-P 301.02(b);

(2) If the laboratory test was conducted on a human specimen:

a. The full name, age, date of birth, sex, race, ethnicity, address, telephone number, occupation, and place of occupation of the person from whom the specimen was taken;

b. The date the specimen was received;

c. The name of the care provider; and

d. The name of the person reporting; and

(3) If the laboratory test was conducted on an animal specimen:

a. The full name, address, and telephone number of the owner of the animal from whom the specimen was taken;

b. The species of animal from which the animal specimen originated;

c. The date the specimen was received;

d. The name of the veterinarian; and

e. The name of the person reporting.

(h) Every physician or other health care provider, or the person in charge of any hospital, institution, dispensary, public or non-public school, child care agency, hotel, restaurant, boarding house, labor camp or other camp, vessel, workplace or charitable, penal, or other institution or place of detention having knowledge of the occurrence of case(s) or suspect case(s) of illness within the workplace or institution believed to have been due to consumption of food or water shall report the same immediately to the department as provided in paragraph (a) above.

(i) Hospitals with emergency departments shall electronically report all emergency department visits data to the department within 24 hours of the patient encounter, for the purpose of early detection of reportable diseases and outbreaks, to describe emerging public health issues, and to identify potential public health threats.

(j) Hospitals shall format electronic submissions in accordance with guidance provided by the Department in the New Hampshire Local Implementation Guide for Syndromic Surveillance Reporting, Version 1.07, 2/15/2015, available as noted in Appendix A.

(k) Hospitals with emergency departments shall commence routine electronic submission of properly formatted data not later than December 31, 2017.

(l) Investigations by the department of emergency department encounter reports shall include obtaining other clinical data necessary for case ascertainment including but not limited to the chief complaint. The findings of the investigation shall be used to identify communicable diseases, other health threats, and to institute control measures to reduce the risk of disease spread or to reduce exposures in a public health emergency.

History

• #3172, eff 1-2-86; ss by #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.04 Methods of Isolation

Hospitals and other health care facilities shall institute appropriate precautions consistent with the Healthcare Infection Control Practices Advisory Committee 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007 and the Healthcare Infection Control Practices Advisory Committee, Management of Multi-drug Resistant Organisms in Healthcare Settings, HICPAC Advisory Committee. October, 2006, available as noted in Appendix A.

History

• #2017, eff 5-10-82; amd by #2339, eff. 4-15-83; amd by $2430 eff. 6-30-83; amd by #2545 eff. 11-29-83; ss by #3172, eff. 1-2-86; ss by #4230, eff. 2-23-87; ss by #4946, eff 10-2-90; EXPIRED 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.05 Restriction and Control Measures for Isolation and Quarantine for Specific Diseases

(a) For a case or suspect case of cutaneous and inhalation anthrax, hospitals and other institutional settings shall institute standard precautions according to He-P 301.04 for the duration of the illness.

(b) For a case or suspect case of diphtheria, isolation precautions shall be instituted as follows:

(1) For a case, suspect case or carrier of pharyngeal or cutaneous diphtheria, hospitals and other institutional settings shall maintain appropriate isolation in accordance with He-P 301.04 until 2 cultures from both throat and nose or skin lesions in cutaneous diphtheria taken not less than 24 hours apart and not less than 24 hours after cessation of antimicrobial therapy, fail to show diphtheria bacilli;

(2) Where culture is impractical, isolation may be ended after 14 days of appropriate antibiotic treatment; and

(3) For all close contacts of cases or suspect cases of pharyngeal or cutaneous diphtheria, employers shall exclude close contacts of cases or suspect cases from the following job duties until cultures prove them not to be carriers:

a. Job duties involving the handling of food;

b. Child care job duties; and

c. Direct care of hospitalized and institutionalized patients.

(c) For a case or suspect case of gonococcal ophthalmia neonatorum:

(1) Precautions shall be instituted in accordance with He-P 301.04; and

(2) The health care provider shall institute isolation of the individual for the first 24 hours after administration of effective therapy.

(d) For a case or suspect case of invasive Haemophilus influenzae infection, the health care provider shall institute appropriate isolation in accordance with He-P 301.04 for 24 hours after the start of appropriate antibiotic therapy.

(e) For a case or suspect case of hepatitis, isolation precautions shall be as follows:

(1) For persons with hepatitis A:

a. Employers shall exclude cases or suspect cases from the following job duties until one week after onset of jaundice or until hepatitis A has been ruled out:

1. Job duties involving the handling of food;

2. Child care job duties; and

3. Direct care of hospitalized and institutionalized patients; and

b. Cases or suspect cases shall be excluded from attending child care agencies until one week after the onset of jaundice or until hepatitis A has been ruled out; and

(2) For persons with hepatitis B or C, precautions shall be instituted in accordance with He-P 301.04.

(f) For a case or suspect case of measles or rubeola, the following control measures shall be instituted:

(1) The admitting official shall exclude a case or suspect case from the grounds of public and non-public schools and child care agencies for at least 4 days after appearance of the rash;

(2) Hospitals and other institutional settings shall institute appropriate isolation in accordance with He-P 301.04 from recognition of clinical illness through the fourth day of rash; and

(3) If the case or suspect case occurs in a health care facility:

a. The facility shall ensure that the following susceptible personnel receive a dose of measles vaccine:

1. All employees who cannot provide documentation of:

(i) Two doses of measles vaccine on or after their first birthday, the second dose

a minimum of 28 days from the first; or

(ii) Serologic evidence of immunity to measles; and

b. The facility shall exclude susceptible personnel who have been exposed from direct patient contact from the 5th to the 21st day after exposure regardless of whether they received vaccine or immune globulin after the exposure.

(g) For a case or suspect case of meningococcemia, or infection with invasive Neisseria meningitidis, the health care provider shall institute appropriate isolation in accordance with He-P 301.04 for 24 hours after start of antibiotic therapy.

(h) For a case or suspect case of mumps, the following control methods shall be instituted:

(1) The admitting official shall exclude a case or suspect case from public and non-public schools or child care agencies for 5 days from onset of salivary gland swelling; and

(2) For a case or suspect case in hospitals or other institutional settings:

a. The health care provider shall institute appropriate isolation in accordance with He-P 301.04; and

b. The health care provider shall isolate the confirmed or suspect case in a private room for 5 days from onset of salivary gland swelling; and

(3) For all close contacts of cases or suspect cases of mumps, employers shall exclude susceptible close contacts of cases or suspect cases from the following job duties from days 12-26 post exposure:

a. Job duties involving the handling of food;

b. Child care job duties; and

c. Direct care of hospitalized and institutionalized patients.

(i) For a case or suspect case of pertussis, the following control methods shall be instituted:

(1) Confirmed or suspect cases in hospitals or other institutional settings shall be placed in appropriate isolation in accordance with He-P 301.04 by the health care provider until they have received 5 days of antibiotics;

(2) Admitting officials and employers shall exclude confirmed or suspect cases and symptomatic household contacts from the following places until they have received at least 5 days of appropriate antibiotics:

a. Public and non-public schools;

b. Child care agencies; and

c. Work places; and

(3) Health facilities shall exclude health care workers and other adults with suspect or confirmed pertussis from patient/public contact until they have received 5 days of a course of antibiotics.

(j) For confirmed or suspect cases of poliomyelitis, hospitals shall institute isolation in accordance with He-P 301.04.

(k) For confirmed or suspect cases of rabies, hospitals shall institute appropriate isolation in accordance with He-P 301.04.

(l) For confirmed or suspect rubella, including congenital rubella syndrome, the following control methods shall be instituted:

(1) In hospitals and institutions, patients suspected of having rubella shall be managed under appropriate isolation in accordance with He-P 301.04 and placed in a private room for 7 days after the onset of rash;

(2) Admitting officials and employers shall exclude cases or suspect cases from public and non-public schools, child care agencies and work places for 7 days after onset of rash; and

(3) Hospitals and other health care facilities shall ensure that both male and female health care personnel who may be exposed to patients with rubella are immunized unless there is evidence of previous immunity.

(m) For a case or suspected case of shigellosis, E. coli 0157, and other shiga toxin producing E. coli:

(1) Precautions shall be instituted in accordance with He-P 301.04;

(2) Employers shall exclude cases or suspect cases from the following job duties until stool cultures are free of the microorganism on 2 consecutive specimens collected not less than 24 hours apart and at least 48 hours after the last dose of antibiotics, if prescribed:

a. Job duties involving the handling of food;

b. Child care job duties; and

c. Direct care of hospitalized and institutionalized patients; and

(3) Children who are cases or suspect cases shall be excluded from child care settings until stool cultures are free of the microorganism on 2 consecutive specimens collected not less than 24 hours apart and at least 48 hours after the last does of antibiotics, if prescribed.

(n) For a case or suspected case of tuberculosis (TB), the following control methods shall be instituted:

(1) Employers and admitting officials shall exclude confirmed or suspect cases of TB from congregate settings, with the exception of patients being cared for in a healthcare facility under appropriate precautions, until TB has been ruled out or the confirmed or suspect case is deemed to be non-infectious by the department; and

(2) Health care providers shall order a drug susceptibility test on all initial M. tuberculosis cultures performed on the initial isolate in order to assure proper prescription of treatment.

(o) For a case or suspected case of typhoid fever:

(1) Precautions shall be instituted in accordance with He-P 301.04;

(2) Employers and admitting officials shall exclude cases or suspect cases with the Salmonella typhii organism from the following job duties until released from supervision by the local health authority:

a. Job duties involving the handling of food;

b. Child care job duties; and

c. Direct care of hospitalized and institutionalized patients;

(3) Children who are cases or suspect cases shall be excluded from child care settings until released from supervision by the local health authority; and

(4) The local health authority shall supervise confirmed or suspect cases until:

a. Not less than 3 consecutive cultures of feces, each taken at least 24 hours apart and at least 48 hours after last dose of any antibiotic and not earlier than one month after illness onset are negative; and

b. If any one of the cultures in a. above is positive, the culture series shall be repeated at intervals of one month during the 12-month period following illness onset until at least 3 consecutive negative cultures are obtained.

(p) For a case or suspect case of varicella disease:

(1) Admitting officials and employers shall exclude a case, suspect case, or an individual with vesicular eruption related to varicella disease , from the following places for 5 days after eruption first appears until vesicles become dry, or in immunized people without crusts, until no new lesions appear within a 24 hour period:

a. Public and non-public schools;

b. Child care agencies; and

c. Work places; and

(2) Hospitals shall maintain appropriate isolation in accordance with He-P 301.04 for 5 days after eruption first appears or until vesicles become dry or until no new onset of lesions appear within 24 hours if the lesions do not crust, i.e. form macules or papules only instead of vesicles.

(q) For any communicable disease that poses a threat to the public’s health and not already described in He-P 301.05, all cases, suspect cases, and close contacts of cases or suspect cases of a communicable disease who work in sensitive occupations, such as healthcare, food service, and child care, or who are otherwise located in a congregate setting ,shall be excluded or restricted from certain activities until they are no longer infectious in accordance with RSA 141-C:4 if necessary to protect the health and safety of the public from a communicable disease, and based on the best available guidance and recommendations from the Centers for Disease Control and Prevention or other established sources.

(r) Individuals described in (r) above with symptoms of acute gastrointestinal illness shall be excluded from duties involving direct patient care, childcare, or serving of food or the handling of clean dishware, utensils, or equipment until 48 hours after the resolution of symptoms or until such time the employee can provide certification from a physician that the illness is from a non-infectious cause.

History

• #2017, eff 5-10-82; ss by #3172, eff 1-2-86; ss by #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.06 Prevention of Gonococcal Ophthalmia Neonatorum and Perinatal Hepatitis B Infection

(a) All hospitals and healthcare facilities at which births are attended shall administer neonatal prophylaxis against gonococcal ophthalmia.

(b) All hospitals and healthcare facilities at which births are attended shall administer hepatitis B immune globulin (HBIG) and the first hepatitis B vaccine dose within 12 hours of birth to all infants born to hepatitis B surface antigen positive women.

(c) For infants born to women of unknown hepatitis B surface antigen status, the hospital or healthcare facility at which the birth was attended shall:

(1) Administer the first hepatitis B vaccine dose within 12 hours of birth; and

(2) If the mother tests positive for hepatitis B surface antigen, the hospital or healthcare facility at which the birth was attended or the health care provider shall administer HBIG to the infant within 7 days of birth.

History

• #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.07 Procedures for Conduct of Investigation

(a) In accordance with RSA 141-C:3 the department shall investigate the incidence of communicable diseases or potential transmission of communicable diseases posing a threat to the citizens of the state.

(b) Methods for conducting such investigations shall include the following:

(1) Surveying pertinent populations, health care providers and others by use of questionnaires;

(2) Telephone interviews with cases and suspect cases, contacts, health care providers, employees, and employers of the suspect source of the disease;

(3) Personal interviews with cases and suspect cases, contacts, health care providers, employees, and employers of the suspect source of the disease;

(4) Collection and analysis of samples of food, body fluids or other clinical specimens of cases, suspect cases and suspect sources or any other items and individuals suspected in a disease incident; and

(5) Review of individual case medical records, business records, reports and x-rays of cases, suspect cases and contacts in an incident.

(c) All tests of biological specimens taken from New Hampshire residents for the diagnosis of reportable diseases shall be performed in a laboratory certified under 42 CFR 493. If more extensive laboratory tests will aid in better awareness of the disease causing agent, the commissioner shall order tests performed by the New Hampshire public health laboratories (PHL).

(d) Whenever a laboratory submits a specimen, portion of a specimen, or culture to the PHL for testing, laboratory reporting requirements shall be deemed to have been fulfilled, provided that the minimum information specified in RSA 141-C:7 and He-P 301.03 accompanies the specimen or culture.

(e) The PHL shall hold negative specimens for 30 days and positive specimens for one year or until the conclusion of the investigation or study if longer.

History

• #4230, eff 2-23-87; ss by #4271, eff 6-25-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.08 Procedures for Disclosure of Information

(a) Requests for release of information under RSA 141-C:10, shall be made to the commissioner or his or her designee and shall describe the type, the purpose, and the ultimate disposition of the requested information.

(b) In the case where the department receives a report that a person, who works outside from his or her primary residence, or who provides child care in his or her primary residence, or who prepares food in his or her primary residence for sale to the public, is diagnosed with a reportable disease, or with a condition that can pose a threat to the public health, the following steps shall be taken:

(1) The department shall disclose to the manager of the place of employment:

a. The name of the individual employee so diagnosed;

b. The name of the reportable disease;

c. The laboratory test results associated with the reportable disease; and

d. What steps the manager shall take to assure protection of the health of the public from exposure to the risks associated with the reportable disease; and

(2) The personal identity of the employee shall be kept confidential by the manager to whom a disclosure is made as described in (1) above in accordance with RSA 141-C:10, I.

History

• #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.09 Procedures for Decontamination

(a) The method of decontamination of a commodity, conveyance, baggage, or cargo shall include one or more of the following:

(1) Washing and rinsing;

(2) Application of pesticides disinfecting agents or both;

(3) Incineration;

(4) Chemical treatment; and

(5) Other methods proposed by the decontaminator which the commissioner determines will achieve decontamination equivalent or superior to that achieved in (1) - (4) above.

(b) The owner or owners of such commodities, conveyance, baggage, or cargo shall ensure that decontamination is conducted according to the order of the commissioner. No commodity, conveyance, baggage, or cargo shall be removed until decontamination is completed and release has been ordered by the commissioner’s designee.

History

• #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.10 Distribution of Pharmaceutical Agents

(a) Health care providers requesting pharmaceutical agents from the department shall make such requests via the online Vaccine Ordering Management System (VOMS) provided by the department at least 7 days prior to the desired delivery date. The department shall provide VOMS enrollment information upon request.

(b) Requestors pursuant to (a) above shall provide the following information via VOMS:

(1) The name of the physician, practice, or facility;

(2) The provider’s number provided by the department’s immunization program;

(3) The address of the practice or provider;

(4) The person responsible for ordering pharmaceutical agents;

(5) The phone number of the person named in (4) above; and

(6) The type and number of doses of pharmaceutical agents being ordered.

(c) Health care providers obtaining pharmaceutical agents from the department shall ensure proper storage and handling to prevent deterioration, in compliance with the requirements of RSA 318. All pharmaceutical agents shall be stored in accordance with the manufacturer's instructions that accompany each shipment of pharmaceutical agents. Providers shall be responsible for replacement of pharmaceutical agents if loss occurs due to the facility’s negligent storage or handling procedures.

(d) Health care providers receiving vaccines from the department shall inform the recipients of such vaccines of their benefits and risks, in accordance with 42 CFR 110, vaccine information materials.

(e) Health care providers who wish to order state-supplied vaccines shall complete, on an annual basis, the vaccine provider’s immunization certification form on which the provider certifies annually that he or she will comply with the following requirements:

(1) Exercise individualized medical judgment in the administration of state-supplied vaccines;

(2) Provide the recipient or parent or guardian of each recipient of such vaccine copies of the current vaccine information materials;

(3) Retain a written immunization record of the vaccine administered for a period of at least 3 years following the end of the calendar year in which the immunization was given and, upon request, furnish copies of the record to the department or the federal Centers for Disease Control and Prevention;

(4) Make no charge for vaccines provided by the department excluding usual or customary office or professional fees charged for vaccine administration;

(5) For medicaid federal vaccine eligible children to accept the reimbursement for immunization administration set by the state medicaid agency or the contracted medicaid health plans.

(6) Provide state-supplied vaccine to individuals regardless of their inability to pay vaccine administration fees, and prominently display a sign that vaccines will be so provided;

(7) To screen children for eligibility if mandated by state or federal vaccine programs; and

(8) To minimize vaccine wastage;

(9) To manage ordering, storage, and disposal of vaccine, including:

a. Ordering vaccine and maintaining appropriate inventories;

b. Not storing vaccine in dormitory-style units at any time;

c. Storing vaccine under proper storage conditions at all times, including using:

1. Refrigerator and freezer vaccine storage units; and

2. Temperature monitoring equipment and practices that meet NH Immunization Program (NHIP) storage and handling requirements as provided by the department; and

d. By returning all spoiled or expired public vaccines to the Center for Disease Control’s (CDC) centralized vaccine distributor within 6 months of spoilage or expiration date;

(10) Develop policies to avoid fraud and abuse as defined in 42 CFR 455.2;

(11) Participate in vaccine for children (VFC) compliance site visits including unannounced visits, and other educational opportunities associated with VFC program requirements;

(12) All healthcare providers and medical director’s or equivalent responsible representative shall certify the following:

a. That all healthcare provider staff, medical director, or equivalent responsible representative having access to the VOMS shall comply with all CDC regulations and guidelines and other applicable federal law related to accessing a CDC system and ordering publically funded vaccines;

b. That all healthcare providers or medical director, or equivalent responsible representative shall identify any individual staff, or representative of the healthcare provider who is authorized to order vaccines for the healthcare provider;

c. That a record will kept of any changes in staff or additions of new healthcare provider staff or representatives, and will maintain an accurate list of who is authorized to order vaccines;

d. That the name of anyone no longer authorized in (12)c. above shall be provided shall be provided to NH Division of Public Health Services within 24 hours; and

e. That the identity of the medical director or responsible representative has been accurately included on the provider enrollment form;

(13) Provide a statement that the healthcare provider medical director or the equivalent shall replace any vaccine purchased with state and federal funds that are deemed non-viable due to provider negligence on a dose-for-dose basis;

(14) Provide a statement that the healthcare provider medical director or the equivalent understands that healthcare provider or New Hampshire Immunization Program (NHIP) may terminate the agreement at any time; and

(15) Provide a statement that if the healthcare provider terminates the agreement, the unused federal vaccine shall be returned to NHIP as directed by NHIP.

(f) Vaccine providers shall document the following minimum information on the vaccine recipient’s medical record:

(1) Type of vaccine;

(2) Date of vaccine administration;

(3) Manufacturer of vaccine administered;

(4) Lot number of vaccine;

(5) Route and site of vaccine administration;

(6) Name and title of the person administering the vaccine;

(7) Address where the vaccine was administered; and

(8) Results of eligibility screening of the child for federal vaccine assistance programs.

(g) When ordering vaccines, health care providers shall provide the following vaccine utilization information via the online VOMS provided by the department:

(1) Type, numerical sequence, and number of doses of vaccine administered for each specified age group;

(2) Current inventory with lot numbers;

(3) Expiration dates;

(4) Wastage in doses;

(5) Number of doses ordered;

(6) Physician or facility’s vaccine provider number;

(7) Both mailing and street addresses;

(8) Name of provider or facility using vaccine;

(9) Person responsible for ordering vaccine; and

(10) Physician or facility’s phone and fax numbers.

(h) In the case of an individual experiencing a vaccine-associated adverse medical event from a state-supplied vaccine, the health care provider shall immediately report to the national Vaccine Adverse Event Reporting System at www.vaers.org or 1-800-822-7967 and notify the department of the report.

History

• #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.11 HIV/AIDS NH Comprehensive Aids Resource Emergency (CARE) Program

(a) HIV/AIDS financial assistance shall be provided to applicants meeting the eligibility requirements set forth in this section. Applications for financial assistance shall be considered in chronological order among all eligible applicants. However, assistance to which these rules apply shall be subject to the availability of funds and shall not be financially open-ended.

(b) Qualified applicants shall be eligible to receive financial assistance for outpatient health services, insurance services, and drugs that receive Food and Drug Administration approval for use as therapy for individuals infected with HIV and infants perinatally exposed to HIV and are authorized for payment through the program’s current formulary.

(c) Financial assistance for outpatient health services, insurance services, and approved drug therapies shall be provided to applicants who meet the following eligibility requirements:

(1) Are residents of the state of New Hampshire;

(2) Are infected with HIV or infants perinatally exposed to HIV and have a physician's prescription for one or more of the drugs covered under this program;

(3) For drug services only, currently be prescribed antiretroviral drugs for the treatment of HIV/AIDS or meet one or more criteria under the US Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents available as noted in Appendix A; and

(4) Have an annual gross household income which is less than 500% of the Federal poverty income guidelines. The program shall maintain flexibility in implementation of the income limit, up to 10% above or below the 500% FPL threshold. The flexibility shall be utilized if changes occur in the federal funding environment or if access to health insurance and medications becomes limited.

(d) The program shall be the payer of last resort and nothing contained in these rules shall authorize or require the program to provide payment for drugs, diagnostics, or monitoring services which would otherwise be paid for by medicaid, medicare, or any other medical insurance program or policy.

(e) Each recipient of financial assistance shall notify the program in writing within 30 days of any change in the recipient’s medical insurance coverage which results in coverage for drugs which are currently being paid for by the program.

(f) An application for financial assistance shall be submitted to the program before the program provides financial assistance.

(g) The application referred to in (f) above shall include:

(1) Information about the applicant including:

a. The name and address of the applicant;

b. The first three letters of the applicant’s mother’s first name;

c. The status of the applicant’s housing and the applicant’s contact information and mailing address; and

d. Information relating to contacting the applicant by answering machine, email or mail;

e. Information relating to contacting the applicant by telephone, voicemail, email, or mail;

(2) Proof of NH residency;

(3) Documentation of HIV positive status;

(4) The name and contact information for the applicant’s primary and specialty care physician and pharmacy contact information;

(5) A statement of financial resources, including any of the following:

a. The current income tax form of those persons whose income is considered in determining family income;

b. Recent pay stubs for the individuals referred to in (4)a. above;

c. A letter from the employer(s) of those individuals referred to in a. above attesting to present wages; and

d. In the case of zero income, a letter from the case manager attesting to means of financial support; and

(6) A signed authorization to collect medical data and prescription coverage information through medicaid, medicare, or any medical insurance or policy necessary to determine eligibility as described in He-P 301.11 (c)(2);

(7) A certification that the applicant understands that the department of health and human services shall not discriminate against people because of their age, sex race, creed, color, marital or familial status, physical or mental disability, national origin, sexual orientation or political affiliation or belief, and shall follow all federal and state laws and rules prohibiting such discrimination, and including information about filing a report of any perceived such discrimination;

(8) An acknowledgement by the applicant that he or she understands and agrees with a client certification, authorizing releases for a period of one year, and certifies the truthfulness and completeness of the financial information provided, as follows:

a. That the applicant declares all financial statements are correct and true to the best of his or her knowledge;

b. That any intentional misrepresentation shall result in potential legal action on the basis of state or federal laws;

c. That participation in NH CARE program shall be denied if the applicant withholds information, provides inaccurate or refuse to provide all necessary information;

d. That the applicant agrees to notify the NH CARE program within 30days of any change in the applicant’s name, address, eligibility, financial, or insurance status, or household size, and agrees to provide evidence of income and medical expenses, medicaid or medicare status, or health insurance policy, and agrees to send any refunds to the program which were sent to the applicant but owed to NH CARE program;

f. That in order to be considered for participation in the NH CARE program, the applicant authorizes his or her physician to release information requested by NH CARE program relative to the content of the applicant’s medical record;

g. That the applicant understands that the information relative to the medical record shall be maintained under strict conditions of confidentiality and that the applicant’s identity shall not be revealed to any person outside of the department (DHHS);

h. The understanding that all information given to the NH CARE program is strictly confidential and shall not be released to any other parties unless allowed by law;

i. That the applicant authorizes the staff of the NH CARE program to communicate with and release information, to administer and ensure the best possible planning and delivery of services on the applicant’s behalf, and to authorize NH CARE program to speak with the applicant’s employer or insurance or consolidated omnibus budget reconciliation act (COBRA) provider to ensure coverage and resolve billing issues;

j. That the applicant authorizes the department and the “City of Boston/Trustees of Health and Hospitals” to access the applicant records for monitoring purposes and shall not copy, record or remove anything from the record for a period of two years, notwithstanding the general release provided in (h)(7) above, and

k. That authorization in (h)(7) and paragraph (h)(7)j. may be revoked by the applicant at any time in writing; and

(9) A certification by the applicant authorizing the applicant’s physician as follows: “I hereby authorize my physician or physician’s representative, to release information requested by the NH CARE program, relative to the content of my medical record. I understand that this information will be maintained under strict confidentiality, will not be revealed to persons outside the NH department of health and human services, and will be used solely for my benefit. This release is valid for one (1) year from date of signature unless revoked by me in writing.”

(h) The commissioner shall determine whether the applicant meets the eligibility requirements pursuant to paragraph (c) above.

(i) The commissioner shall authorize the commencement, duration, redetermination of eligibility, and reapplication according to the following:

(1) When the commissioner determines that an applicant is eligible for financial assistance in accordance with He-P 301.11(c), the applicant shall remain eligible for 6 months commencing with the date of eligibility;

(2) The commissioner shall not reimburse the applicant or any other person for any payment that was made or debt that was incurred before the eligibility commencement or after its termination;

(3) The commissioner shall evaluate eligibility for financial assistance prior to the expiration of the 6 month period described in (1) above; and

(4) A household or individual who has applied for financial assistance and has been determined to be ineligible may reapply when and if the financial, insurance, or medical status changes.

(j) Notice of determination or other action shall be as follows:

(1) The commissioner shall notify the applicant within 10 days from the date of receipt of their application that the commissioner has determined the applicant’s eligibility for assistance; and

(2) The commissioner shall notify a recipient in writing at least 30 days in advance of any action which affects the recipient’s eligibility including termination of eligibility.

(k) An applicant may appeal an eligibility determination as follows:

(1) If an applicant is dissatisfied with any eligibility determination, the applicant may request, within 30 days of the date of the commissioner’s notification letter, an informal case review conference;

(2) The commissioner shall notify the applicant within 14 days after the case review conference whether the commissioner concurs, modifies, or revokes the determination; and

(3) If the applicant or applicant’s guardian is dissatisfied with the result of the case review conference, the applicant or guardian may request within 30 days of notification of the results of the case review conference, an adjudicative proceeding held in accordance with RSA 541-A.

(l) The applicant may contact the office of the ombudsman at any point in the process for a neutral resolution of the applicant’s complaint.

(m) The applicant shall contact the NH CARE Program manager if eligibility is denied; and may

contact the NH section director if dissatisfied with the response from the NH CARE program manager.

History

• #4230, eff 2-23-87; ss by #4946, eff 10-2-90; amd by #5587, eff 2-22-93; ss by #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #12586, eff 7-24-18

N.H. Code Admin. R. Ann. He-P 301.12 Procedures for Written Orders

(a) Upon receiving a report that a person has a communicable disease, is suspected of having a communicable disease or has been exposed to a communicable disease, the department shall promptly commence an investigation into the matter in order to confirm the report.

(b) Upon confirming the report, the department shall make a determination, based on the best available guidance and recommendations from the Centers for Disease Control and Prevention or other established sources, as to whether the circumstances of the case require that the affected person be maintained in isolation or quarantine, undergo a medical examination, or receive medical treatment.

(c) All orders of isolation, quarantine or treatment shall be issued in accordance with RSA 141-C:11 and 12, except that written orders for treatment shall include the reason for and nature of the medical treatment, where that treatment will be provided, and the duration of time for which the person will need to undergo the treatment.

(d) If the person subject to an order of treatment cannot be removed to a health care provider or to a health care facility for treatment without danger to his life or to the citizenry, the commissioner shall impose isolation or quarantine under RSA 141-C:11 and shall arrange for treatment and care as necessary to mitigate the threat.

(e) The cost of treatment and care, except treatment provided under RSA 141-C:15, III, shall be in accordance with RSA 141-C:15, IV.

(f) Action taken to enforce an order of isolation, quarantine or treatment shall be consistent with the provision of RSA 141- C:13, 14 and 15.

(g) All persons who are subject to orders of isolation, quarantine or treatment shall be entitled to the due process rights set for in RSA 141-C:14-a.

History

• #4425, eff 5-27-88; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.13 Documentation of Immunization

(a) Every parent or guardian of a child to be admitted or enrolled in any New Hampshire public or non-public school, pre-school or child care agency shall, prior to the child’s admittance, provide documentation, as defined in He-P 301.01(n), to the admitting official of acceptable immunization of the child as specified in He-P 301.14.

(b) The admitting official may enroll a child under conditional enrollment when the parent or guardian provides the following:

(1) Documentation of at least one dose of each required vaccine; and

(2) The appointment date for the next due dose(s) of required vaccine.

(c) The appointment date referred to in (b)(2) above shall serve as the exclusion date if the child fails to keep the scheduled appointment.

(d) Conditional enrollment shall not be extended to the next school year for the same dose of vaccine.

(e) In accordance with RSA 141-C:20-c, the admitting official shall exempt a child from immunization requirements only if:

(1) The parent or guardian provides a completed “New Hampshire Childcare/School Immunization Religious Exemption Form” (March 2023) that states:

“The administration of immunizing agents conflict with the religious beliefs of the parent or legal guardian of the student listed above. Pursuant to NH Statute RSA 141-C:20-d, I understand, in the event of an outbreak of vaccine-preventable disease, for which immunization is required, an exempt student shall be excluded from school attendance”; or

(2) A licensed health care provider provides a letter, on letterhead, certifying that immunization against a particular disease may be detrimental to the child’s health.

(f) The admitting official shall require the following documentation of immunization:

(1) For measles, mumps, rubella, and hepatitis B:

a. The month, day, and year of immunization; or

b. Documentation of immunity by confirming laboratory test results;

(2) For diphtheria, tetanus, pertussis (DTP/DTaP/DT/Td/Tdap), the month, day, and year of immunization;

(3) For poliomyelitis vaccine, the month, day, and year of immunization;

(4) For Haemophilus influenzae type b, (Hib) the month, day, and year of administration; and

(5) For varicella, one of the following:

a. The month, day, and year of immunization;

b. Documentation of immunity by confirming laboratory test results; or

c. For students enrolled in kindergarten prior to 2009, parental or medical provider verification of history of disease.

History

• #4425, eff 5-27-88; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #7605, eff 12-4-01; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #13460, INTERIM, eff 10-12-22, EXPIRES: 4-10-23; ss by #13605, eff 3-28-23

N.H. Code Admin. R. Ann. He-P 301.14 Immunization Requirements

(a) The number of immunization doses, dosage, route of administration, spacing, and age requirements shall be defined by the Recommended Immunization Schedules for Persons Aged 0-18 years – United States, 2016, as published by the Centers for Disease Control and Prevention (CDC) and as approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), available as noted in Appendix A.

(b) Unless the child has received an exemption from the vaccination requirement pursuant to RSA 141-C:20-c, public or private primary or secondary schools, pre-schools and child care agencies shall not admit a child without first receiving documentation, as defined in He-P 301.01(n), showing that the child has received the following age-appropriate and acceptable immunizations:

(1) With regard to diphtheria, tetanus, pertussis (DPT) or diphtheria, tetanus, accellular pertussis (DTaP) or tetanus, diphtheria, accelluar pertussis (Tdap), or if pertussis vaccine is medically contraindicated, then diphtheria-tetanus toxoid (DT/Td), the following doses:

a. Unless the 4th dose was administered on or after the fourth birthday, five doses;

b. For children 6 years and under, 4 or 5 doses, with the last dose administered on or after the 4th birthday;

c. For children 7 years of age and older, a minimum of 3 doses with the last dose administered on or after the 4th birthday;

d. Children between 7 and 10 years of age who have not completed their primary immunization schedule or have an unknown vaccine history, a single dose of Tdap, except that if after receiving the dose of Tdap, they require additional tetanus and diphtheria toxoid doses, a dose of Td; and

e. Beginning August 1, 2017 a single dose of Tdap prior to entering 7th grade, unless that child received Tdap at age 7 years or older, in which case no further doses are required;

(2) Four doses of trivalent polio vaccine, with the fourth dose administered on or after the 4th birthday and separated by 6 months from the 3rd dose, unless:

a. The third dose of an all oral polio vaccine (OPV) or all inactivated polio vaccine (IPV) series was administered on or after the 4th birthday; with the last two doses separated by 6 months, or;

b. If the child was enrolled prior to 2011, 3 doses of all oral polio vaccine (OPV) or all inactivated polio vaccine (IPV) series, with the last dose given on or after the 4th birthday;

(3) With regard to measles, mumps, rubella (MMR) vaccine:

a. One dose given on or after 12 months of age; and

b. For all students in grades kindergarten through 12th grade 2 valid doses, with the first dose administered on or after 12 months of age;

(4) Three doses of hepatitis B vaccine;

(5) For varicella vaccines unless laboratory evidence of immunity for the specific child is provided:

a. One dose given on or after 12 months of age;

b. For all students entering kindergarten after 2009, 2 valid doses of varicella vaccine, with the first dose administered on or after 12 months of age; and

c. For children enrolled in kindergarten prior to 2009, parental or medical provider verification that those children have had varicella disease; and

(6) For Haemophilus influenza Type b (Hib), with regard to children under the age of 59 months who are enrolled in child care and pre-school;

a. 4 doses, with the last dose administered on or after 12 months of age; or

b. One dose on or after 15 months of age.

History

• #4425, eff 5-27-88; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #7605, eff 12-4-01; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.15 Procedures for Record Keeping

(a) Every public or non-public primary and secondary school, pre-school, and child care agency shall maintain an immunization record for children enrolled at their public or non-public school, pre-school, or child care agency. This record shall include the date of each immunization and shall be separated from the child’s other medical records and educational records for the purpose of immunization record audit.

(b) Each admitting official or his or her designee of all public and non-public primary and secondary schools, pre-school, and child care agencies shall review the immunization records of every newly admitted or enrolled child at their public or non-public school or child care agency.

(c) All record reviews shall determine into which one of the following categories to place each child:

(1) Children whose immunizations are documented and acceptable in accordance with He-P 301.13 and He-P 301.14;

(2) Children who are conditionally enrolled;

(3) Children who are exempt from immunization under RSA 141-C:20-c; and

(4) The total number of children enrolled in the school.

(d) Each admitting official or his or her designee shall report the results of this record review to the commissioner by November 15 of each year.

(e) If the admitting official finds during the record review that the child’s immunizations are insufficiently documented or unacceptable, he or she shall notify the child’s parent or guardian stating:

(1) That the child does not have documentary proof of acceptable immunization; and

(2) That the child shall not be lawfully admitted or enrolled at the public or non-public school, pre-school, or child care agency unless:

a. Documentary proof of acceptable immunization is provided to the admitting official;

b. The parent or guardian submits a certificate of medical or religious exemption, as provided under RSA 141-C:20-c; or

c. The child is admitted or enrolled conditionally if the child qualifies.

(f) During the conditional enrollment period, the admitting official or his or her designee shall monitor the records of any conditionally enrolled child to ensure that the conditionally enrolled child receives the vaccinations necessary in order to make the child acceptably immunized. The conditional enrollment period shall allow for the routine immunization schedule to be followed, observing appropriate intervals between doses of vaccine(s), and shall not allow for extension into the following school year for the same dose of vaccine.

(g) The admitting official of a school, pre-school, or child care agency shall, at the end of the conditional enrollment period, exclude from attendance any conditionally enrolled child who does not have documentary proof of acceptable immunization or immunity as required in these rules and who has not been exempted under RSA 141-C:20-c.

(h) The admitting official shall readmit or re-enroll the child exempted as described in (g) above only when the parent or guardian provides:

(1) Documentary proof of acceptable immunization;

(2) Documentation of immunity by confirming laboratory test results; or

(3) A certificate of medical or religious exemption, as provided under RSA 141-C:20-c.

(i) When a transfer of immunization records is necessary, the admitting official of the child’s previous school shall provide to the parent or guardian the child’s immunization record or a copy thereof to present to the admitting official at the new school on arrival.

(j) Admitting officials or their designees shall furnish immunization records or copies thereof to each parent or guardian of a child upon his graduation or final attendance at a secondary school.

History

• #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.16 The Use of the Common Cup

(a) A common cup used for the purpose of drinking shall not be utilized in public places.

(b) Paragraph (a) above shall not restrict the use of a common chalice or similar article during the performance of a religious ceremony.

History

• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16

N.H. Code Admin. R. Ann. He-P 301.17 Tuberculosis Patient Care Financial Assistance Program

(a) Tuberculosis (TB) patient care financial assistance shall be provided for tuberculosis related treatment and services to applicants meeting the eligibility requirements set forth in this section. Applications for financial assistance shall be considered in chronological order among all eligible applicants. However, assistance to which these rules apply shall be subject to the availability of funds and shall not be financially open-ended.

(b) Qualified applicants shall be eligible to receive financial assistance for the following patient care:

(1) Medications approved by the Federal Food and Drug Administration for the treatment of tuberculosis, latent tuberculosis infection, or any medical condition caused by tuberculosis or tuberculosis medications;

(2) Licensed healthcare provider visits for active tuberculosis and high risk latent tuberculosis diagnosis, treatment and follow-up, when indicated;

(3) Diagnostic procedures to diagnose or monitor the disease;

(4) Laboratory tests related to the diagnosis of tuberculosis or its treatment; and

(5) Home health agency visits to provide directly observed therapy.

(c) Financial assistance for approved TB patient care shall be provided for applicants who meet the following eligibility requirements:

(1) Are residents of the state of New Hampshire;

(2) Are infected with active tuberculosis or high-risk Latent Tuberculosis Infection, or those undergoing diagnostic procedures because of suspected TB;

(3) Are under a physician’s care for TB; and

(4) Have an annual gross household income which is less than 300% of the Federal poverty income guidelines.

(d) As the payor of last resort, nothing contained in these rules shall authorize or require the program to provide payment for drugs, diagnostics or monitoring services which would otherwise be paid for by medicaid, medicare or any other medical insurance program or policy.

(e) Each recipient shall notify the program in writing within 30 days of any change in the recipient’s medical insurance coverage which results in coverage for patient care costs which are being paid for by the program.

(f) An application for financial assistance shall be submitted to the program before the program provides financial assistance. The application shall include:

(1) The name and address of the applicant;

(2) Documentation of active tuberculosis or high-risk latent tuberculosis infection diagnosis, or a statement that the applicant is undergoing diagnostic procedures because of suspected TB;

(3) Proof of New Hampshire residency;

(4) A statement of financial resources signed by the applicant, including any of the following:

a. The most recent income tax form of those persons whose income is considered in determining family income;

b. A recent pay stub for each individual in (g)(4)a. above;

c. A letter from the employer(s) of those individuals in a. above attesting to present wages; and

d. In the case of zero income, a letter from the healthcare provider or public health nurse case manager attesting to means of financial support.

(g) An application for financial assistance shall be submitted to the program before the program provides financial assistance.

(h) The application referred to in (g) above shall include:

(1) The name and address of the applicant; and additional information about the applicant including:

a. Place of birth, social security number, race, sexual orientation, and ethnicity;

b. The first three letters of the applicant’s mother’s first name;

c. The status of the applicant’s housing and the applicant’s contact information and mailing address; and

d. Information relating to contacting the applicant by answering machine, email or mail;

(2) Proof of NH residency;

(3) Documentation of active tuberculosis or high-risk latent tuberculosis infection;

(4) The name and contact information for the applicant’s primary and specialty care physician and pharmacy contact information;

(5) A statement of financial resources, including any of the following:

a. The current income tax form of those persons whose income is considered in determining family income;

b. Recent pay stubs for the individuals referred to in (4)a. above;

c. A letter from the employer(s) of those individuals referred to in a. above attesting to present wages; and

d. In the case of zero income, a letter from the case manager attesting to means of financial support; and

e. Copy of insurance card or proof of insurance, if applicable;

(i) A signed authorization that:

(1) The applicant understands that DHHS:

a. Shall not discriminate against people because of their age, sex race, creed, color, marital or familial status, physical or mental disability, national origin, sexual orientation or political affiliation or belief;

b. Shall follow all federal and state laws and rules prohibiting such discrimination; and

c. Shall provide the applicant with access to information about filing a report of any perceived such discrimination;

(2) That financial statements made as part of the application and eligibility determination are true and correct to the best of the applicant’s knowledge,

(3) The applicant understands that:

a. Intentional misrepresentations may result in legal action on the basis of state or federal laws; and

b. That participation and eligibility shall be denied if information is intentionally withheld, misrepresented or omitted;

(5) The applicant shall notify NH TB Financial Assistance Program within 30 days of any change in name, address, eligibility, financial, insurance status or household size, income or medical expenses and to provide evidence thereof;

(6) The applicant authorizes his or physician, or physician’s representative to release information relative to the content of the applicant’s medical record to NH TB Financial Assistance Program and the department for the purpose of determining eligibility as described in He-P 301.17(c);

(7) The information from the medical record including the applicant’s identity shall be maintained in strict confidence and not revealed to any person outside of the department;

(8) The applicant authorizes the staff at NH TB Financial Assistance Program to communicate with and release information including the applicant’s diagnosis to physicians and other health care professionals including the applicant’s pharmacist, case manager and other treatment providers to ensure planning and delivery of services to the applicant; and

(9) The releases in (6) and (8) above are valid for one year from the date of signature unless revoked by the applicant in writing.

(j) The commissioner shall determine whether the applicant meets the eligibility requirements pursuant to paragraph (g) above.

(k) The commissioner shall authorize the commencement, duration, redetermination of eligibility and reapplication according to the following:

(1) When the commissioner determines that an applicant is eligible for financial assistance in accordance with He-P 301.17(c), the applicant shall remain eligible for 12 months commencing with the date of eligibility;

(2) The commissioner shall not reimburse the applicant or any other person for any payment that was made before the eligibility commencement;

(3) The commissioner shall evaluate eligibility for financial assistance prior to the expiration of the 12 month period described in (1) above; and

(4) A household or individual who has applied for financial assistance and has been determined to be ineligible can reapply when and if the financial or medical status changes.

(l) Notice of determination and notice of other action shall be as follows:

(1) The commissioner shall notify the applicant within 10 days from the date of receipt of application that the commissioner has determined that the applicant is eligible or ineligible for assistance; and

(2) The commissioner shall notify a recipient in writing at least 30 days in advance of any other action which the commissioner has decided to take which affects the recipient’s eligibility including termination of eligibility.

(m) An applicant may appeal an adverse eligibility determination as follows:

(1) If an applicant is dissatisfied with any determination, the applicant may request, within 30 days of the date of the commissioner’s notification letter, an informal case review conference;

(2) The commissioner shall notify the applicant in writing after the case review conference whether he or she concurs, modifies or revokes the determination; and

(3) If the applicant is dissatisfied with the result of the case review conference, he or she may request, within 30 days of notification of the results of the case review conference, an adjudicative proceeding held in accordance with RSA 541-A.

(n) The applicant may contact the office of the ombudsman at any point in the process for a neutral resolution of the applicant’s complaint.

(o) The applicant shall contact the NH CARE program manager if eligibility is denied; and may contact the NH section director if dissatisfied with the response from the NH CARE program manager.

(p) The applicant shall contact the ID Care Services manager if eligibility is denied, and may contact the NH section director if dissatisfied with the response from the ID Care Services manager.

(q) Reimbursement shall be made directly to the provider of the service or to the pharmacy and not directly to the applicant.

History

• #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #12586, eff 7-24-18

Part He-P 304 Cancer Registry Rules

N.H. Code Admin. R. Ann. He-P 304.01 Definitions

(a) “Clinic” means a health care facility licensed by the state of New Hampshire, where a physician, nurse practitioner, or other health care professional provides cancer diagnosis and treatment or both, and that is not an operational entity of and not affiliated with a hospital. Such facilities include urology clinics, dermatology clinics, out-patient surgical centers, ambulatory oncology treatment centers, ambulatory radiation treatment centers, and physician group practices devoted to oncology.

(b) “Commissioner” means the commissioner of the department of health and human services.

(c) “Confidence interval” means an estimated range of values, which is likely to include an unknown population parameter, the estimated range being calculated from a given set of sample data.

(d) “Courier service” means a mail delivery service that provides guaranteed delivery of documents or packages by using a reliable tracking system.

(e) “Definitive report” means information or data in the format of an electronic or paper document, or report, describing a reportable cancer, including the information described in He-P 304.02(e), that is submitted to the state cancer registry (SCR) as follows:

(1) No sooner than 90 days and no later than 180 days of an initial diagnosis or treatment; or

(2) In cases where the patient has died, or is transferred to hospice care, within 90 days of death and transfer.

(f) “Department” means the New Hampshire department of health and human services.

(g) “Facility” means “facility” as defined in RSA 141-B:3, VI, namely, “a governmental or private agency, department, institution, clinic, laboratory, hospital, health maintenance organization, association, physician, or other similar unit diagnosing or providing treatment for cancer.”

(h) “Medical laboratory” means a facility performing tests or analyses of human samples from patients suspected to have cancer.

(i) “Mutual agreement” means an understanding, arrangement, or stipulation which establishes the responsible reporter to the SCR as made between 2 facilities, clinics, or physicians, which can be confirmed in writing, but for which written documentation is not required.

(j) “Pathology report” means electronic or paper report(s) prepared by a pathologist providing a description of laboratory test results, and an evaluation of cells, tissues, and organs based on evidence from a sample of body tissue, which is used to diagnose and characterize disease.

(k) “Protected health information” means protected health information as defined in 45 CFR 160.103.

(l) “Rapid report” means information or data in an electronic or paper document or report, describing a reportable cancer, including the information described in He-P 304.02(d), that is submitted to the SCR within 45 days of diagnosis.

(m) “Reportable cancer” means any syndrome, condition, or disease listed in “Table 2 “NAACCR Layout Version 15: Comparison of Reportable Cancers” (Thornton ML, (ed.)) “Standards and Registry Operations/Volume II/Data Standards and Data Dictionary,” Version 15, 19th ed. (Posted October 2014, Revised February 27, 2015)/Chapter III, “Standards for Tumor Inclusion and Reportability” “Table 2 NPCR Requirements”, Springfield, Ill., North American Association of Central Cancer Registries. As listed in Appendix A and available as a free electronic document at http://www.naaccr.org.

(n) “State cancer registry (SCR)” means the department or, if the department meets its statutory obligations by contract, an organization, system, or individual contracted by the department to collect, manage and store information on cases of reportable cancer pursuant to RSA 141:B:5 and RSA 141-B:10.

History

• #4055, eff 5-27-86; amd by #4869, eff 7-24-90; ss by #5601, eff 3-24-93; amd by #6075, eff 8-5-95; ss by #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.02 Reporting Requirements

(a) In accordance with RSA 141-B:7, all facilities shall report diagnosis or treatment of a reportable cancer to the SCR in accordance with the rules specified below, and using the means described in He-P 304.02(f), (g) and (h). SCR may be contacted through http://geiselmed.dartmouth.edu/nhscr/contact.

(b) Pursuant to (a) above, all facilities shall include information and data in each report describing cancer diagnosis or treatment according to one of the following standards, as applicable:

(1) The North American Association of Central Cancer Registries (NAACCR), “Standards for Cancer Registries, Volume II/Data Standards and Data Dictionary, 19th Edition, Record Layout Version 15,” (January 1, 2015) Edited by Monica Thornton, Revised (February, 27, 2015.), as listed in Appendix A and available as a free document at www.naaccr.org;

(2) The North American Association of Central Cancer Registries (NAACCR), “Standards for Cancer Registries/Volume V: “Pathology Laboratory Electronic Reporting, Version 4.0.” Klein Wt., Havener L (eds.), Springfield (IL); North American Association of Central Cancer Registries, Inc., April, 2011, as listed in Appendix A and available as a free electronic document at www.naaccr.org; or

(3) The National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control, “Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries HL7 Clinical Document Architecture (CDA) Release 1.1” (March, 2014), as listed in Appendix A and available as a free electronic document in PDF format at http://cdc.gov/cancer/npcr/ehrmeaningfuluse/cancer.htm.

(c) Each report shall contain information or data required by the appropriate standard in (b) above, as listed in elements (1)-(10) below, and include any supporting information, as follows:

(1) Item numbers defining demographics;

(2) Item numbers defining cancer identification;

(3) Item numbers defining hospital-specific information;

(4) Item numbers defining stage prognostic factors;

(5) Item numbers defining the first course of treatment;

(6) Item numbers defining follow-up, recurrence, and death;

(7) Item numbers defining confidential patient information;

(8) Item numbers defining confidential hospital information;

(9) Item numbers defining other confidential information; and

(10) Item numbers defining diagnosis.

(d) Of the item numbers specified in (b) and (c) above, the following shall require rapid reporting as defined in He-P 304.01(l) and described in He-P 304.03(b) and (c):

(1) Item numbers defining demographics;

(2) Item numbers defining cancer identification;

(3) Item numbers defining hospital-specific information;

(4) Item numbers defining confidential patient information; and

(5) Item numbers defining other confidential information.

(e) The items listed in (c) above shall require definitive reporting as defined in He-P 304.01(e), and described in He-P 304.03(a), He-P 304.03(d), He-P 304.04(a), and He-P 304.06(a) and (b).

(f) All facilities making an electronic report to the SCR in accordance with (a) above, shall submit through a secure internet-based encrypted mechanism, such as a direct file transfer, or a web-based reporting form supported by the SCR.

(g) All facilities reporting electronically shall format reports as specified by one of the following standards, as applicable:

(1) The North American Association of Central Cancer Registries (NAACCR), “Standards for Cancer Registries, Volume II/Data Standards and Data Dictionary, 19th Edition, Record Layout Version 15.” (January 1, 2015) Edited by Monica Thornton, Revised (February, 27, 2015), as listed in Appendix A and available as a free document at http://www.naaccr.org;

(2) The North American Association of Central Cancer Registries (NAACCR), “Standards for Cancer Registries/Volume V: Pathology Laboratory Electronic Reporting, Version 4.0.” Klein Wt., Havener L. (eds.) Springfield (IL); North American Association of Central Cancer Registries, Inc., (April, 2011), as listed in Appendix a and available as a free electronic document at http://www.naaccr.org; or

(3) The National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control, “Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries HL7 Clinical Document Architecture (CDA) Release 1.1” (March, 2014), as listed in Appendix A and available as a free electronic document in PDF format at http://cdc.gov/cancer/npcr/ehrmeaningfuluse/cancer.htm.

(h) Where electronic reporting is not feasible, facilities shall complete and file the New Hampshire State Cancer Registry (NHSCR) “Cancer Report Form” (July, 2015) provided by the SCR and faxed or mailed by the facilities to the SCR, via regular mail or a courier service.

History

• #4055, eff 5-27-86, EXPIRED: 5-27-92
• #5601, eff 3-24-93; amd by #6075, eff 8-5-95; ss by #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.03 Reporting of Information by Hospitals Licensed by the State of New Hampshire

(a) Hospitals licensed by the state of New Hampshire that diagnose or treat at least 105 new reportable cancer cases per year shall employ a cancer registrar to abstract the definitive report.

(b) Hospitals licensed by the state of New Hampshire that diagnose or treat at least 105 new reportable cancer cases per year shall provide a rapid report to SCR in accordance with He-P 304.01(l) and a definitive report in accordance with He-P 304.01(e).

(c) Hospitals licensed by the state of New Hampshire that diagnose or treat fewer than 105 reportable cancer cases per year shall provide a rapid report to SCR in accordance with He-P 304.01(l), and a paper or electronic report to SCR in accordance with He-P 304.02.

(d) Hospitals licensed by the state of New Hampshire that diagnose or treat fewer than 105 reportable cancer cases per year shall make available to SCR the medical records of all patients with a reportable cancer for the creation of the definitive report in accordance with He-P 304.01(e).

(e) Facilities owned by a hospital licensed by the state of New Hampshire shall have met the reporting requirements of this rule if reports are submitted to SCR on their behalf by the hospital.

History

• #4055, eff 5-27-86, EXPIRED: 5-27-92
• #5601, eff 3-24-93, EXPIRED: 3-24-99
• #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.04 Reporting of Information by a Physician Licensed by the State of New Hampshire

(a) A physician, surgeon, or other licensed health care practitioner who diagnoses or treats cancer patients shall complete and provide a definitive report in accordance with He-P 304.01(d) for each newly diagnosed cancer case when that patient will not be immediately referred to a hospital or other treatment center for additional diagnosis or treatment.

(b) A physician, surgeon, or other licensed health care practitioner shall provide additional information to SCR regarding a patient as is considered necessary for abstraction of required cancer incidence data in accordance with He-P 304.07(a).

(c) A physician, surgeon, or other licensed health care practitioner may fulfill his or her responsibility for cancer reporting for a cancer patient through a mutual agreement allowing cases to be reported by a hospice or other facility that provided medical or nursing care to that cancer patient.

(d) A physician, surgeon or other licensed health care practitioner shall make available to the SCR the medical records of all patients with a reportable cancer for creation of the definitive report in accordance with He-P 304.01(e).

History

• #4055, eff 5-27-86, EXPIRED: 5-27-92
• #5601, eff 3-24-93, EXPIRED: 3-24-99
• #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.05 Reporting of Information by a Medical Laboratory Licensed by the State of New Hampshire

(a) A medical laboratory licensed by the state of New Hampshire that obtains a specimen of human tissue which, upon examination, shows evidence of cancer, shall:

(1) Within 180 days after that pathology report is complete, provide information concerning its findings to the SCR; and

(2) Fax, mail, or electronically transmit a copy of the pathology report using procedures described in this section.

(b) A medical laboratory may fulfill its responsibility for cancer reporting through a mutual agreement allowing cases to be submitted by the cancer registrar at an affiliated hospital or other facility.

(c) The SCR shall be granted access to pathology reports used to confirm or rule out a diagnosis of cancer by medical laboratories for the purpose of case finding and quality assurance.

(d) The SCR shall be authorized to identify cancer cases from the pathology reports and request information about missing cancer reports from the reporting facility.

History

• #4055, eff 5-27-86; amd by #4869, eff 7-24-90; ss by #5601, eff 3-24-93, EXPIRED: 3-24-99
• #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.06 Reporting of Information by Clinics that Diagnose or Treat Patients With Cancer.

(a) A clinic shall provide a definitive report for each case in accordance with He-P 304.01(e).

(b) A clinic licensed by the state of New Hampshire shall:

(1) Be responsible for the submission of all definitive reports to the SCR; or

(2) Develop a mutual agreement with a cancer registrar at a hospital or other affiliated facility for the submission of a definitive report to the SCR.

(c) A clinic shall provide additional information to SCR regarding a cancer patient as necessary for abstraction of required cancer incidence data in accordance with He-P 304.07(a).

History

• #4055, eff 5-27-86; ss by #4377, eff 3-1-88; ss by #5601, eff 3-24-93, EXPIRED: 3-24-99
• #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.07 Quality Assurance, Verification, and Confidentiality

(a) All facilities shall respond to SCR requests for case information pursuant to He-P 304.02(b) and (c) within 14 working days of receipt of such requests.

(b) All facilities shall respond to SCR requests to perform a site visit.

(c) SCR shall perform a site visit at each facility in order to:

(1) Audit pathology reports and other information to ensure that no cancer cases are overlooked in reporting; and

(2) Monitor the completeness and accuracy of the cancer reports.

(d) Each facility shall make available for reviewing and copying all paper or electronically stored information including the following:

(1) Laboratory analyses including tissue, cytology, and pathology reports;

(2) Records regarding radiological examinations, in relation to cancer diagnoses or treatment;

(3) Reports of diagnoses of malignant disease, and notations of the reasons for such diagnoses, including both primary clinicians’ reports and consultants’ reports;

(4) Pharmacy records;

(5) Reports regarding any operations or an autopsy;

(6) Discharge plans and abstracts regarding cancer diagnoses; and

(7) A list of the applicable discharge diagnoses or treatment as identified in the “Casefinding Lists, Current Lists/Code List,” (October 1, 2015-September 30, 2016), as listed in Appendix A and available as a free electronic document at http://seer.cancer.gov/tools/casefinding/case2016-icd10cm.html.

(e) Pursuant to 42 USC 280e(c)(2)(D)(viii), individuals complying with the law shall not be held liable in any civil action with respect to a report of cancer provided to the SCR, or with respect to access to data or information provided to the SCR.

History

• #4377, eff 3-1-88; ss by #5601, eff 3-24-93, EXPIRED: 3-24-99
• #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.08 Procedures for Disclosure of Protected Health Information

(a) The SCR shall use and disclose protected health information in accordance with RSA 141-B:9 and the provisions of 45 CFR 164 generally, and specifically, 45 CFR 164.502, 164.506 and 164.512.

(b) The department shall maintain the confidentiality of reports submitted to the SCR pursuant to RSA 141-B:9 except in accordance with (c) below.

(c) A report submitted to the SCR concerning an individual, and any other information maintained by the SCR, which, because of a personal identifier, can be readily associated with an individual, shall only be released:

(1) To the individual upon:

a. Receipt of a written request which shall be signed by the individual; and

b. Presentation of identification, such as a driver’s license, by the individual;

(2) If the individual is a minor, to a parent of the individual upon:

a. Receipt of a written request, which shall be signed by the parent;

b. Receipt of a certified copy of the birth certificate of the individual; and

c. Receipt of a copy of the parent’s identification, such as a driver’s license of the parent;

(3) If the individual has a court-appointed guardian or if the individual is deceased, to the court-appointed guardian or to the executor or administrator of the individual’s estate upon:

a. Receipt of a written request, which shall be signed by the court-appointed guardian, executor, or administrator of the estate;

b. Receipt of a certified copy of the order or decree which appoints the guardian, executor, or administrator; and

c. Receipt of a copy of identification, such as a driver’s license, by the guardian, executor, or administrator;

(4) To an attorney or other person designated by the individual upon receipt of a written medical release request which shall be signed by the individual;

(5) To persons conducting health related research, upon receipt and approval pursuant to He-P 304.09 of a written application to the department, which shall be signed by the applicant and includes:

a. The following information about the principal investigator:

1. Name, address, and phone number;

2. Organizational affiliation;

3. Professional qualification; and

4. Name and phone number of principal investigator’s contact person, if any;

b. The following information about the data or record copies being requested:

1. Type of event or record copies;

2. Time period of the data or record copies;

3. Specific data items required, if applicable;

4. Medium in which the data or record copies are to be supplied by the bureau; and

5. Any special format or layout of data required by the principal investigator;

c. A research protocol which shall contain:

1. A summary of background and origin of the research;

2. A statement of the health-related problem or issue to be addressed by the research;

3. The primary research hypothesis to be tested;

4. The research design, which shall include:

(i) Case definition;

(ii) Method of case selection; and

(iii) Method of data analysis;

5. The research methodology, which shall include:

(i) The way in which the requested data will be used; and

(ii) The procedures for follow-back to any persons or facilities named in records, if applicable;

6. Procedures to obtain informed consent from the research participants, if applicable;

7. The procedures that shall be followed to maintain the confidentiality of any data or copies of records provided to the requester; and

8. The intended completion date;

d. A statement signed by the principal investigator agreeing to the following:

1. The investigator shall acknowledge the department as the source of the data in any and all public reports, publications, or presentations generated by the requester from these data;

2. The investigator shall specify that the analyses, conclusions, and recommendations drawn from such data are solely those of the requester and are not necessarily those of the department;

3. Any data or record copies provided shall not be used for any purpose other than that described in the application;

4. The principal investigator and the research staff shall not disclose the identity of individuals revealed in the data or record copies to any persons except as is necessary to perform the research described in the application;

5. The data record shall not be further released to any other person or organization without the written consent of the commissioner or his designee; and

6. No form of information derived from the data or record copies that identify any individuals shall be made public;

e. A written statement ensuring that the investigator shall hold all information confidential; and

f. When contact with patients will occur, submission of an Institutional Review Board (IRB) approval for the study by an IRB formed in accordance with the requirements of the U.S. Department of Health and Human Services Code of Federal Regulations for Protection of Human Subjects, 45 CFR 46, June 23, 2005; or

(6) In association with an audit as required under Title III of Public Health Services Act, 42 U.S.C. 241 et seq.

(d) Persons fraudulently requesting data or information shall be subject to penalty for unsworn falsification pursuant to RSA 641:3.

History

• #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.09 Approval Criteria for Release of Confidential Data for Research Purposes

(a) The commissioner shall review applications for the use of confidential SCR data, based on the following criteria:

(1) Completeness of application, pursuant to He-P 304.08(b)(5);

(2) Documentation of adequate measures to insure confidentiality of patients, pursuant to He-P 304.08(b)(5);

(3) Determination of whether the study, if carried out according to the application submitted pursuant to He-P 304.08(b)(5), will be able to answer the research hypothesis as stated in this application; and

(4) Qualifications of investigator(s) and research staff, as indicated by:

a. Documentation of training and previous research, such as peer reviewed publications, in the proposed or related area; and

b. Affiliation with a university, medical center or other institution, which will provide sufficient research resources.

(b) The commissioner shall deny an application in accordance with RSA 541-A: 29, II (a) when it has been determined that one or more of the requirements of He-P 304.08(b)(5) or He-P 304.09(a) have not been met.

History

• #9046, eff 12-5-07; ss by #11054, eff 3-15-16

N.H. Code Admin. R. Ann. He-P 304.10 Aggregate Data

The number of cancer cases shall not be released in any document where the numbers of cancer cases are between 1 and 4.

History

• #9046, eff 12-5-07; ss by #11054, eff 3-15-16

Part He-P 305 Hiv - Expired

N.H. Code Admin. R. Ann. He-P 305.01 Definitions

(a) "Anatomical parts" mean "anatomical parts" as defined in RSA 291-A.I.V.

(b) "Autologous donor" means an individual who provides a blood product or anatomical part for self-use.

(c) "Blood transfusion centers" mean those facilities referenced in RSA 141-F:5, I which receive for distribution or use, donated whole blood or blood components.

(d) "Blood components" mean whole blood constituents or derivatives.

(e) "Clinical laboratory improvement amendments of 1988 (CLIA)" means the revision of Section 353 of the Public Health Service Act (42 U.S.C. 263(a)), compliance with which certifies that laboratories may accept human specimens for the purposes of performing laboratory examinations or procedures.

(f) "Confirmatory test" means a test that utilizes a different methodology than the screening test and has equal or greater specificity than the screening test.

(g) "Human immunodeficiency virus" or HIV means "human immunodeficiency virus" as defined in RSA 141-F:2, V.

(h) "Indeterminate" test result means that a test result does not meet the criteria for either a reactive or nonreactive test. The term includes "equivocal".

(i) "Initial test" means the first HIV test performed on the specimen.

(j) "Laboratory" means any building or place for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body.

(k) "Proficiency testing" means a form of external quality control in which specimens are received from outside the laboratory, analyzed as routine specimens, and the results returned to a central location for comparison with other participating laboratories.

(l) “Reactive” means that a component of the patient’s specimen has formed detectable complexes with the HIV antigen or antibody supplied by the laboratory scientist during the analysis as defined by the procedure used.

(m) "Researcher" means an individual who conducts HIV tests, for the purpose of increasing the scientific knowledge of HIV, in accordance with RSA 141-F:5, III.

(n) "Screening test" means any test which requires further testing by a different methodology in order to definitively report the presence of a condition.

(o) "Specimen" means a portion of tissue or body fluid material from a human body.

(p) "Test kit" means all components of a test procedure that are packaged together by the manufacturer.

(q) "Tissue procurer" means a physician licensed or registered to practice in New Hampshire, or person authorized by such physician, who obtains, processes, distributes, or uses anatomical parts.

History

• #4637, eff 6-19-89; EXPIRED 6-19-95
• #6563, eff 8-21-97; ss by #8355, eff 5-24-05, EXPIRED:5-24-13

N.H. Code Admin. R. Ann. He-P 305.02 Licensing and Certification Requirements

The following shall apply:

(a) Any laboratory, business or other organization either testing or collecting specimens shall be licensed in accordance with RSA 151; and

(b) Any laboratory, business or other organization either testing or collecting specimens shall be in compliance with the Clinical Laboratory Improvement Act (CLIA)as implemented in 42CFR 493.

History

• #4637, eff 6-19-89; EXPIRED: 6-19-95
• #6563, eff 8-21-97; ss by #8355, eff 5-24-05, EXPIRED: 5-24-13

N.H. Code Admin. R. Ann. He-P 305.03 Procedures for HIV Testing of Whole Blood or Blood Components by Blood Transfusion Centers and of Donors of Anatomical Parts by Tissue Procurers

(a) Pursuant to RSA 141-F:5, I, and II, any New Hampshire blood transfusion center which receives, for distribution or use, whole blood or a blood component not previously tested for the presence of an antibody to, or antigen of, HIV, or New Hampshire tissue procurer who obtains, for distribution or use, anatomical parts, the donors of which were not previously tested for the presence of an antibody to, or antigen of, HIV, shall:

(1) Have the whole blood, blood component, or the donor of anatomical parts tested by the New Hampshire department of health and human services, public health laboratories or other laboratories, businesses or organizations which test human blood, tissue or other samples as part of their operations;

(2) Maintain for at least 4 years a record of the number of tests performed on specimens collected; and

(3) Maintain for at least 4 years a record on the number of tests described in He-P 305.02 (b) that were positive or indeterminate for each type of test performed;

(b) Notwithstanding He-P 305.02 (a), HIV testing for autologous donors shall be pursuant to 21 CFR 610.45.

History

• #4637, eff 6-19-89; EXPIRED: 6-19-95
• #6563, eff 8-21-97; ss and moved by #8355, eff 5-24-05 (from He-P 305.02) , EXPIRED: 5-24-13

N.H. Code Admin. R. Ann. He-P 305.04 Procedures for Confidentially Testing HIV Specimens for Medical Research

(a) Any New Hampshire facility engaged in medical research which tests specimens for the presence of an antibody to, or antigen of, HIV pursuant to RSA 141-F:5, III shall assign a principal investigator.

(b) The principal investigator shall:

(1) Be a licensed physician;

(2) Be responsible for ensuring that the specimen being tested is free of any personal identifiers prior to its release to a researcher;

(3) Be responsible for ensuring that any personal identifiers can not be retrieved;

(4) Be responsible for ensuring that an alphanumeric identifier is assigned to the specimen which shall be used in all future reference to the specimen; and

(5) Be responsible for review of all completed research data and reports to ensure that no personal identifiers can be recognized by anyone reading the completed data or report.

History

• #4637, eff 6-19-89; EXPIRED: 6-19-95
• #6563, eff 8-21-97; ss and moved by #8355, eff 5-24-05 (from He-P 305.03), EXPIRED: 5-24-13

N.H. Code Admin. R. Ann. He-P 305.05 Procedures for Conducting HIV Tests in Correctional Facilities and the New Hampshire Hospital

Tests of individuals convicted and confined to a New Hampshire correctional facility or committed to New Hampshire hospital, pursuant to RSA 141-F:5 IV, shall be conducted in accordance with the written policies and procedures of the facility and the following:

(a) The facility shall maintain a confidential record kept in accordance with RSA 141-F:8 for the collection of specimens;

(b) The confidential record shall include the following:

(1) The name of the person from whom the specimen was taken;

(2) The name and address of the licensed physician, or person authorized by the physician who collected the specimen; and

(3) The date the specimen was collected;

(c) All specimens shall be tested by the New Hampshire department of health and human services, public health laboratories or other laboratories, businesses or organizations which test human blood, tissue, or other samples as part of their operations;

(d) A record of the number of tests performed on specimens received shall be maintained for at least 4 years; and

(e) A record of the number of tests that were positive or indeterminate shall be maintained for at least 4 years.

History

• #4637, eff 6-19-89; EXPIRED: 6-19-95
• #6563, eff 8-21-97; ss and moved by #8355; eff 5-24-05 (from He-P 305.04), EXPIRED: 5-24-13

N.H. Code Admin. R. Ann. He-P 305.06 Standards for Performing HIV Testing

(a) This section shall apply to any New Hampshire laboratory or other such business or organization which offers, or engages in, the performance of tests to detect or quantify antibody to, or antigen of, HIV in human body fluids or tissues.

(b) A laboratory or other such business or organization which offers to test, or engages in testing, to detect or quantify antibody to, or antigen of, HIV shall comply with the provisions for consent in RSA 141-F:5 and the exceptions thereunder.

(c) Any purposeful violation of the requirements set forth in these rules shall be subject to enforcement under RSA 141-F:11.

(d) All laboratories, public or private, or other such businesses or organizations shall use only analytic procedures that are FDA approved and in compliance with CLIA, as found in 42CFR Part 493, and which include but are not limited to the following:

(1) The manufacturer’s testing insert kit for all initial and confirmatory testing; and

(2) The performance of external controls.

(e) No laboratories or other such businesses or organizations shall report any reactive or indeterminate screening test result prior to the performance of a confirmatory test as defined by the manufacturer’s testing kit package insert, except:

(1) When the test is being conducted by a blood transfusion center or tissue procurer for the purpose of determining the medical acceptability of a blood, organ or tissue donor;

(2) When the physician who ordered the test specifically attests that he/she needs the initial test result to provide optimal emergency diagnosis and/or emergency treatment to the individual; or

(3) When the reactive or indeterminate screening test result is obtained using a FDA-approved rapid testing technology and such test result is reported as a screening test result that must be subjected to a confirmatory test.

(f) Reports of tests on all HIV specimens shall be kept confidential in accordance with RSA 141-F: 7 and RSA 141-F: 8;

(g) Laboratories or other such businesses or organizations shall use the following record protocol:

(1) A record of the number of tests performed on specimens received shall be maintained for at least 4 years;

(2) A record of the number of tests that were positive or indeterminate shall be maintained for at least 4 years; and

(3) Records of tests on all HIV specimens shall be kept confidential in accordance with RSA 141-F:7 and RSA 141-F:8.

History

• #8355; eff 5-24-05 (from He-P 305.05), EXPIRED: 5-24-13

Part He-P 307 Immunization Registry

N.H. Code Admin. R. Ann. He-P 307.01 Purpose

These rules implement the procedures of the department pursuant to RSA 141-C:20-f relative to the establishment and maintenance of a New Hampshire immunization registry (registry) for children and adults to aid, coordinate, and promote effective and cost-efficient disease prevention and control efforts. The information contained in the registry shall be used for the following purposes:

(a) To remind registrants to receive all required immunizations in a timely manner by providing access to the registrant’s immunization record and to provide registrants with information about recommended immunizations;

(b) To ensure appropriate management and use of immunizations distributed by the department; and

(c) To control communicable diseases by assisting in the identification of individuals who require immediate immunization in the event of a disease outbreak.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by 14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.02 Definitions

(a) “Administering health care provider” means a health care provider whose medical focus is limited to completing a screening checklist for contraindications and administering an immunization.

(b) “Authorized user” means a person or entity which is authorized to enter information into or access certain information contained in the registry, including:

(1) Administering, current, and former health care providers;

(2) Health care providers;

(3) Schools;

(4) Licensed child care agencies;

(5) The department’s division of public health services; and

(6) Designated individuals of (1)-(5) above.

(c) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or their designee.

(d) “Current health care provider” means a health care provider who the patient has chosen for ongoing health care and who maintains a complete medical history of the patient.

(e) “Department” means the New Hampshire department of health and human services.

(f) “Former health care provider” means a health care provider that is no longer a patient’s current health care provider.

(g) “Health care provider” means “health care provider” as defined in RSA 141-C:2, X-a. namely, “any licensed person who or entity which provides health care services, including but not limited to, hospitals, medical clinics and offices, clinical laboratories, physicians, naturopaths, chiropractors, pharmacists, dentists, registered or other nurses, and nurse practitioners, paramedics, and emergency medical technicians.” This term also includes other immunization providers.

(h) “Immunization” means “immunization” as defined in RSA 141-C:2, XI-a, namely, “inoculation with a specific antigen to promote antibody formation in the body” or “immunizing agent” as defined in RSA 141-C:2, XI-b namely, “a vaccine, antitoxin, or other substance used to increase a person's immunity to a disease.”

(i) “Immunization event” means an immunization or immunoglobulin administration, exemption, refusal as defined in (s) below, or adverse reaction.

(j) “Managed care organization” means an entity which offers a managed care plan, as defined in RSA 420-J:3, XXV, namely, “a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with, or employed by the health carrier.”

(k) “New Hampshire immunization registry (registry)” means a single repository of accurate, complete, and current immunization records to aid, coordinate, and promote effective and cost-efficient disease prevention and control efforts for New Hampshire residents.

(l) “Opt-in” means the process an individual follows to elect to participate in the registry and, after which, one’s personal data will be provided to the registry.

(m) “Opt-out” means the process an individual follows to elect not to participate in the registry and, after which, one’s personal data will not be provided to the registry.

(n) “Patient” means an adult individual or minor child who receives an immunization or other health care services in New Hampshire.

(o) “Personal data” means a registrant’s name, date of birth, race, ethnicity, gender, address, contact information, immunization information, and immunization events.

(p) “Public health purpose” means a population-based activity or individual effort primarily aimed at the prevention of injury, disease, or premature mortality, or the promotion of health in the community.

(q) “Read-only rights” means the ability of the data to be accessed but not entered or modified.

(r) “Read/write rights” means the ability of the data to be accessed, entered, or modified.

(s) “Refusal” means the act of not receiving an immunization on a particular day or at a particular medical appointment, for such reasons as, wanting to delay the immunization to another time, not wanting a particular immunization at that time, behavioral or medical issues at the time of immunization, or a religious exemption from a particular immunization. This term does not include refusal to participate in the registry.

(t) “Registrant” means the patient who did not opt-out of the registry prior to the statutory change, effective July 1, 2023, who has opted-in to the registry, or who has not withdrawn from the registry.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.03 Establishment and Maintenance of the Immunization Registry

The department shall implement and maintain a computerized immunization registry as established in RSA 141-C:20-f in compliance with all applicable state statutes and federal laws and regulations.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.04 Authorized User Access to the Registry

(a) The following authorized users, and their designated individuals, shall have read/write rights to the registry:

(1) Administering, current, and former health care providers; and

(2) The department’s division of public health services.

(b) The following authorized users, and their designated individuals, shall have read-only rights to the registry:

(1) Health care providers who are not listed in (a)(1) above;

(2) Schools, only for named individuals in their care;

(3) Licensed child care agencies, only for named individuals in their care; and

(4) Local public health entities, which are administered by the cities of Manchester and Nashua, New Hampshire.

(c) Access to the registry for all entities in (a) and (b) above, except (a)(2) and (b)(4) shall be limited to patients in their care.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.05 Content and Submission of Immunization Event Reports

(a) For each patient who, after being given the opportunity to opt-in or opt-out of participating in the registry in accordance with He-P 307.06, and who has explicitly provided written or electronic consent to opt-in, shall have all immunization events reported, unless exempted under He-P 307.05(c)(3), to the registry within 7 business days of the event through an electronic interface or manual data entry at https://nhiis-prod.dhhs.nh.gov/nhiis/Login.aspx by a participating administering or current health care provider when a state or federally supplied immunization is administered.

(b) For each immunization event where a state or federal supplied immunization was administered to a registrant, administering or current health care providers who are participating in the registry shall report to the registry such data listed in the Centers for Disease Control and Prevention’s (CDC), “Core Data Elements for an Immunization Information History”, listed in the functional standards document at https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html and in Appendix B in HL7 Version 2.5.1: Implementation Guide for Immunization Messaging Release 1.5 (October 2018) found at https://repository.immregistries.org/files/resources/5bef530428317/hl7_2_5_1_release_1_5__2018_update.pdf , available as noted in Appendix A.

(c) For each immunization event, administering or current health care providers who are participating in the registry shall also report to the registry the following types of registrant information:

(1) The registrant’s insurer information as held by the administering or current health care provider;

(2) Any doses of immunization(s) previously administered to the registrant by the health care provider that may not have been previously reported to the registry for which there is documentation;

(3) Any doses of immunization previously administered to the registrant by another health care provider that may not have been previously reported to the registry for which there is documentation provided unless the administering or current health care provider cannot manually or electronically transmit this information to the New Hampshire Immunization Information System (NHIIS); and

(4) Date of death, if applicable and if known.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.06 Procedures for Patients to Opt-In or Opt-Out of the Registry

(a) No patient, or the patient’s parent or guardian if the patient is a minor, shall be required to participate in the immunization registry.

(b) No patient’s personal data shall be entered into the registry without that patient, or the patient’s parent or guardian if the patient is a minor, being given the opportunity to opt-in or opt-out of the registry and providing written or electronic consent.

(c) No health care provider shall provide to the registry the name of, or any immunization information relating to, any patient who opts out of participating in the registry.

(d) A health care provider shall not provide information relating to immunizations contained in a former patient’s medical record without that patient, or the patient’s parent or guardian if the patient is a minor, first requesting that such information be reported to the registry.

(e) A patient, or the patient’s parent or guardian if the patient is a minor, shall be provided an opportunity to opt-in or opt out of the registry as follows:

(1) At the time of immunization by an administering health care provider who is participating in the registry, unless the provider is able to confirm documentation of prior opt-in or opt-out in the patient’s medical record; or

(2) Prior to or at a face-to-face encounter with a current health care provider by the current health care provider who is participating in the registry, unless the provider is able to confirm documentation of prior opt-in or opt-out in the patient’s medical record.

(f) In all cases described in (e) above, the opportunity to opt-in or opt-out of the registry shall be provided in writing in a clear, succinct, and conspicuous manner, in simple language, and in a form, style, and size easily readable by the average adult.

(g) The provider shall maintain documentation, in the patient’s medical record, of providing the opportunity to opt-in or opt-out of the registry as well as the written or electronic consent given by any patient, or the patient’s parent or guardian, if the patient is a minor, who has elected to opt-in to the registry.

(h) In all cases described in (e) above, the provider shall inform and educate the patient about the registry and ensure patient understanding of the following:

(1) Participation in the New Hampshire immunization registry is voluntary;

(2) Immunization information for registrants may be consolidated and used by authorized NHIIS users such as their health care provider, school nurse, licensed child care provider, or NH division of public health to provide notice about upcoming immunizations, overdue immunizations or identification of recommended immunization in the event of a disease outbreak;

(3) The decision to opt-in or opt-out of the New Hampshire immunization registry shall not prevent them from receiving immunizations;

(4) Individuals may reverse their decision at any time by notifying their current health care provider(s);

(5) Individuals may remove all existing information from NHIIS by submitting a “New Hampshire Immunization Information System (NHIIS) Withdrawal Form” to their health care provider or by mailing or faxing a notarized “New Hampshire Immunization Information (NHIIS) Withdrawal Form” to:

Department of Health and Human Services

Division of Public Health Services

NH Immunization Program

29 Hazen Drive

Concord, NH 03301-6504

Attn: Registry Admin

Fax: (603) 696-3226

(6) An individual’s immunization information will not be released to the New Hampshire immunization registry unless they have provided explicit electronic or written consent; and

(7) The NHIIS may exchange immunization information with other state or territory Immunization Information Systems (IIS). In the event that an immunization record exists for individuals who participates in another state’s or territory’s registry, by choosing to participate they allow the transfer of their immunization record from another state or territory into the NHIIS. In the event that the registrant receives medical treatment that would have prompted retrieval of the registrant’s immunization record or immunization in another state or territory or there is a change of residence to another state or territory, by choosing to participate, they allow the transfer of their immunization record from the NHIIS to be exchanged with that other state’s or territory’s IIS.

(i) If the opportunity to opt-in or opt-out of the registry is provided by a current health care provider prior to a face-to-face encounter with the current health care provider, as described in (e)(2) above, that provider shall send a written communication to the patient, or the patient’s parent or guardian if the patient is a minor, which meets the requirements in (f) above in form and substance, which is individually directed, and in which opting-in or opting out is the focus of the communication.

(j) In the event a patient or the patient’s parent or guardian if the patient is a minor, changes their decision from opt-in to opt-out or vice versa, the registrant, or the registrant’s parent or guardian if the registrant is a minor, shall follow the process as described in He-P 307.09.

(k) An administering or current health care provider who is participating in the registry, including the physicians and nurses in the administering or current health care provider’s professional practice or medical group, shall not be required to provide notice of the opportunity to opt-in or opt-out of the registry to the same patient, or the patient’s parent or guardian if the patient is a minor, more than once unless evidence of prior opt-in or opt-out cannot be confirmed via patient medical records.

(l) An administering or current health care provider who is participating in the registry, including the physicians and nurses in the administering or current health care provider’s professional practice or medical group, shall not be required to obtain explicit written or electronic consent to send personal data to the registry for any patient, or the patient’s parent or guardian if the patient is a minor, if the healthcare provider has documentation in the medical record of an opportunity to opt-out prior to July 1, 2023 and did not elect to opt-out unless there is a change to the registrant’s decision to opt-in or opt-out to the registry.

(m) Nothing in this rule shall relieve the patient, or the patient’s parent or guardian if the patient is a minor, who chooses to opt-out of participation in the registry, from the obligation to comply with current immunization requirements set forth in RSA 141-C:20-a or He-P 301.14.

(n) Nothing in this rule shall relieve the provider from the obligation to maintain a record of immunization within the practice’s patient’s medical record in accordance with Med 501.02(f)(8) and other state or federal regulations.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.07 Procedures

for Patients to Withdraw from Participation in the Registry.

(a) A patient, or the patient’s parent or guardian if the patient is a minor, may withdraw from participation in the registry at any time, including the removal of information contained in the registry, as follows:

(1) The patient, or the patient’s parent or guardian if the patient is a minor, shall complete the vaccine recipient information section of the “New Hampshire Immunization Information System (NHIIS) Withdrawal Form” (March 2023) and acknowledge that:

“I understand that this withdrawal from participation in the registry will not prevent me or my child from receiving immunizations/vaccinations.

I understand withdrawing will delete all existing vaccine information within the NHIIS for myself or for my child. This is a permanent deletion that cannot be undone.

I understand that I may reverse my decision by completing a “Reverse Previous Decision not to Participate in the New Hampshire Immunization/Vaccination Registry” (3/2016) form with my current healthcare provider.

I understand that it is my responsibility to inform my other health care providers of my decision to withdraw from the registry so that no future immunization/vaccination information is reported to the NHIIS.

Patients who choose to withdraw from participation in the registry are not relieved from the obligation to comply with current immunization requirements set forth in RSA 141-C:20-a and He-P 301.14.” ;

(2) The patient, or the patient’s parent or guardian if the patient is a minor, shall obtain signature of a health care provider or a public notary on the “New Hampshire Immunization Information System (NHIIS) Withdrawal Form” (March 2023);

(3) The patient, or the patient’s parent or guardian if the patient is a minor, or health care provider in (2) above shall fax or mail the completed “New Hampshire Immunization Information System (NHIIS) Withdrawal Form” (March 2023) to the department; and

(4) The department shall remove all patient information from the registry.

(b) If a patient, or the patient’s parent or guardian if the patient is a minor, requests withdrawal from participation in accordance with (a) or (b) above, then no information relating to the patient shall remain in the registry, and no record of the transaction, including the request itself, shall be kept by either the department or the health care provider.

(c) It shall be the responsibility of the patient, or the patient’s parent or guardian if the patient is a minor, to inform his or her other health care providers of his or her decision to withdraw from participation in the registry. In order to ensure that no future immunization/vaccination information is reported to the registry, such patient, or the patient’s parent or guardian if the patient is a minor, shall complete a “Choose not to Participate in the New Hampshire Immunization/Vaccination Registry” form (3/16 edition) with each of the patient’s current and administering health care providers who are participating in the registry.

(d) Nothing in this rule shall relieve the patient, or the patient’s parent or guardian if the patient is a minor, who chooses to remove his or her information from the registry, from the obligation to comply with current immunization/vaccination requirements set forth in RSA 141-C:20-a or He-P 301.14.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.08 Procedures for Patients to Review and Correct Information Contained in the Registry

(a) A patient, or the patient’s parent or guardian if the patient is a minor, may review and correct information contained in the registry by making a request through their health care provider who is participating in the registry or through the department in accordance with this section.

(b) A request under (a) above for a registry record review to the department shall be via the completion and submission of a “New Hampshire Immunization Information System (NHIIS) Request for Immunization Record” (June 2024) that includes the signature of the patient or the patient’s parent or guardian if the patient is a minor.

(c) If the above signature is that of a guardian or if there has been a legal name change, a copy of the appropriate legal documentation shall be submitted before the records are released.

(d) Upon receipt of a complete request in (b) above, the department shall provide the patient, or the patient’s parent or guardian if the patient is a minor, a copy of the requested record or statement that there is no associated record by mail.

(e) A request under (a) above for a registry record review to a health care provider who is participating in the registry shall be by a method to be determined by the health care provider.

(f) A record of the transaction described in (b) and (e) above, including the request itself, shall be maintained by the department or the health care provider to ensure that the department or the health care provider are in compliance with federal HIPAA record retention requirements.

(g) A request to correct information contained in the registry shall be as follows:

(1) A patient, or a patient’s parent or guardian if the patient is a minor, shall:

a. Complete the “New Hampshire Immunization Information System Correction to NHIIS Immunization Record” form (June 2024), available on the department’s web site at https://www.dhhs.nh.gov/programs-services/disease-prevention/immunizations/nh-immunization-information-system/nhiis-1 or at the office of the current health care provider who is participating in the registry;

b. Return the completed form to the current health care provider who is participating in the registry or to the department via fax or mail listed in He-P 307.06(h)(5);

c. If the completed form is being returned to the department, include a copy of the following supporting documentation for the information requested to be corrected:

1. For verification of requestor identity, the form signed by a notary public or a copy of a valid state issued photo ID or passport;

2. For proof of parent, a copy of the minors birth certificate;

3. Documentation of immunization received, if a dose needs to be corrected, added, or deleted;

4. A copy of legal court documentation, if there has been a legal name change or as proof of guardianship for minors or medial proxy; and

5. A copy of other legal documents, if applicable;

(2) If the completed form is being returned to a current health care provider who is participating in the registry, the provider shall confirm validity of identification and any correction(s) being requested prior to performing any NHIIS correction;

(3) Upon receipt of the materials in (1) above, and upon verification of information requested to be corrected, the entity who received the “New Hampshire Immunization Information System Correction to NHIIS Immunization Record” form (June 2024) shall make any such corrections or updates to the patient’s record within 7 business days;

(4) Only the corrected information shall remain in the registry; and

(5) A record of the transaction in described in (1) through (3) above, including the request itself, shall be maintained by the entity who received the “New Hampshire Immunization Information System Correction to NHIIS Immunization Record” form (June 2024), in accordance with HIPAA record retention requirements.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.09 Procedures for Patients to Reverse Decision to Opt-in or Opt Out of the Registry

(a) A patient, or the patient’s parent or guardian if the patient is a minor, may reverse the decision to opt-in or opt-out of participation in the registry at any time by informing each of their administering health care providers who participate in the registry of their decision to reverse their opt-in or opt-out status.

(b) The provider shall document the patient’s, or the patient’s parent or guardian if the patient is a minor, reversal of decision and explicit consent to opt-in, if applicable, in the patient’s medical record.

(c) The provider shall ensure that past, current, and future immunization information is or is not further reported to the registry in accordance with the patient’s change in opt-in or opt-out status.

(d) If a patient, or the patient’s parent or guardian if the patient is a minor, reverses their decision and opts-out of the registry, they may withdraw their information from the registry, pursuant to He-P 307.07.

History

• #6830, INTERIM, eff 8-14-98, EXPIRED: 12-12-98
• #6941, eff 1-30-99, EXPIRED: 1-30-07
• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.10 Requests for Registry Data for Research or Other Purposes

(a) Only de-identified data from the registry shall be released by the department for research purposes.

(b) Release of aggregated statistical data shall not include direct-identifiers, as defined by HIPAA and in accordance with RSA 91-A:10, that would allow constructive identification of individuals. The cell size shall not be released in any document where the numbers of counts are between 1 and 4.

(c) A “New Hampshire Immunization Program Request for Non-Confidential Data” form (June 2024) shall be completed by the researcher, submitted to the division’s immunization section, and approved before any data shall be released.

(d) The completed “New Hampshire Immunization Program Request for Non-Confidential Data” form shall be mailed or faxed to:

Department of Health and Human Services

Division of Public Health Services

Immunization Section – Data Request

29 Hazen Drive

Concord, NH 03301-6504

Fax: (603) 271-3850

(e) If the request is not complete, the department shall notify the applicant in writing within 10 business days of receiving the request specifying any information or supporting documentation required to be submitted before the request can be processed.

(f) If after written notice in (e) above the applicant fails to provide the missing information or supporting documentation, within 30 days of such notice, the application shall be considered incomplete and shall not be processed.

(g) Persons fraudulently requesting data shall be subject to penalty for unsworn falsifications in accordance with RSA 641:3.

(h) The department shall approve applications for the use of registry data if:

(1) The application is complete; and

(2) It is determined that the study, if carried out according to the request submitted, will serve a public health purpose as defined in He-P 307.02(p).

(i) The department shall deny an application when it has been determined that one or more of the requirements of (h) above have not been met.

History

• #12163, eff 5-1-17; ss by #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.11 Exchange of Registrant Immunization Records

(a) The department may enter, pursuant to (b) below, into data sharing agreements with other jurisdiction’s immunization information systems (IIS) in order to ensure a complete immunization record for all registrants for the purposes as outlined in RSA 141-C:20-f, I and V and He-P 307.01, and for other purposes as allowable under HIPAA and state and federal laws.

(b) Registrant immunization information may be exchanged with another jurisdiction’s IIS in order to create a complete vaccination record for the following purposes:

(1) To create a single repository of accurate, complete, and current immunization records to aid, coordinate, and promote effective and cost-efficient disease prevention and control efforts;

(2) To ensure that registrants receive all recommended immunizations in a timely manner by providing access to the registrant’s immunization record and to provide registrants with information about recommended immunizations;

(3) To improve immunization rates by facilitating notice to registrants of overdue or upcoming immunizations; and

(4) To control communicable diseases by assisting in the identification of individuals who require immediate immunization in the event of a disease outbreak.

History

• #14010, eff 6-27-24

N.H. Code Admin. R. Ann. He-P 307.12 Procedures for Managed Care Organizations to Obtain Summary Statistics of Immunization Information on Members

The department shall provide annual summary statistics of immunization information to managed care organizations.

History

• #12163, eff 5-1-17; ss by #14010, eff 6-27-24 (from He-P 307.11)

Part He-P 308 Financial Assistance to Partially Fund Towns or Cities for Mosquito Control Activities - Expired

N.H. Code Admin. R. Ann. He-P 308.01 Purpose

Statutory Authority: RSA 141-C:6, XXII, RSA 141-C:24

The purpose of this part is to set forth the procedures for administration and distribution of funds directed toward mosquito control activities as established in RSA 141-C:25 and establishment of mosquito control districts.

History

• #8683, EMERGENCY RULE, eff 7-17-06, EXPIRED: 1-13-07
• #8799, eff 1-19-07; ss by #9173, eff 6-7-08, EXPIRED: 6-7-16

N.H. Code Admin. R. Ann. He-P 308.02 Definitions

(a) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Eligible costs” means costs incurred by a town, city, or mosquito control district:

(1) During the same calendar year, prior to or following the declaration of a public health threat; and

(2) For mosquito control activities aimed at reducing the public health threat.

(d) “Mosquito control” means activities targeting the abatement of mosquitoes through the application of pesticides aimed at mosquito larvae (larvicide) and adult mosquitoes (adulticide).

(e) “Mosquito control district (MCD)” means contiguous municipalities that work together for the purpose of applying for a special permit and/or partial funding pursuant to RSA 141-C:24.

(f) “Mosquito control fund” means a fund, established pursuant to RSA 141-C:25, to assist cities, towns, and MCDs by providing funding for the purpose of offsetting the costs of mosquito control activities including, but not limited to, the purchase and application of chemical pesticides.

(g) “Mosquito control plan” means a written document prepared by a town, city, or MCD that describes preventive and response actions for reducing human mosquito-borne disease.

(h) “Special permit” means a special permit obtained in accordance with Pes 505, Pes 506, and/or Pes 604.

(i) “Public health threat” means a condition declared by the commissioner, in consultation with the Centers for Disease Control and Prevention and with concurrence of the governor, that warrants expedited mosquito control activities within a city, town, or MCD, and which is based on local factors per RSA 141-C:25, III(a).

History

• #8683, EMERGENCY RULE, eff 7-17-06, EXPIRED: 1-13-07
• #8799, eff 1-19-07; ss by #9173, eff 6-7-08; amd by #9303, eff 10-25-08, EXPIRED: 6-7-16

N.H. Code Admin. R. Ann. He-P 308.03 Mosquito Control Districts

: Contiguous municipalities that establish mosquito control districts for the purposes of applying for moneys from the mosquito control fund shall be eligible for financial assistance if the district is established pursuant to RSA 430:13 and meets the requirements set forth in He-P 308.05.

History

• #8683, EMERGENCY RULE, eff 7-17-06, EXPIRED: 1-13-07
• #8799, eff 1-19-07; ss by #9173, eff 6-7-08, EXPIRED: 6-7-16

N.H. Code Admin. R. Ann. He-P 308.04 Application for Financial Assistance to Partially Fund Towns, Cities, or MCD’s Mosquito Control Activities

(a) A town, city, or MCD desiring to apply for financial assistance for mosquito control activities shall submit the following documents to the department:

(1) The completed application form, “Application for Financial Assistance to Partially Fund Towns, Cities, or MCD’s Activities”; and

(2) A copy of the town, city, or MCD’s mosquito control plan, which shall include at a minimum:

a. A list of pesticides, including their active ingredient(s), to be applied and methods by which these pesticides will be applied to ensure the application is performed in a safe and proper manner, if the town is requesting financial assistance for the treatment of mosquitoes with pesticides;

b. A description of the safeguards in place to protect the health of the public, wildlife, and resources within the state;

c. A description of a comprehensive public awareness campaign geared toward prevention and designed to educate the public about the health risks associated with mosquitoes;

d. A description of surveillance activities employed to detect a mosquito-borne public health threat; and

e. A description of appropriate mosquito control methods.

(b) The public awareness campaign described in (a)(2)c. above shall address, at a minimum:

(1) The potential severe human illness associated with bites from infected mosquitoes;

(2) Measures the public can take to reduce mosquito-breeding locations on their property and in their community; and

(3) Measures to prevent mosquito bites through the use of effective repellant, types of clothing, and altered activity schedules during times of peak mosquito biting.

(c) The “Application for Financial Assistance to Partially Fund Towns, Cities, or MCD’s Activities” shall be signed by the individual filing the application, or, for MCDs, by a representative from each incorporated town or city belonging to that particular MCD.

(d) The “Application for Financial Assistance to Partially Fund Towns, Cities, or MCD’s Activities” may be obtained by contacting:

The Arboviral Surveillance Program

The Department of Health and Human Services

Division of Public Health Services

(603) 271-4496

(e) The applicant shall mail or hand-deliver the above-listed documents to:

Arboviral Surveillance Coordinator

The Department of Health and Human Services

Division of Public Health Services

29 Hazen Drive

Concord, NH 03301-6504

History

• #8683, EMERGENCY RULE, eff 7-17-06, EXPIRED: 1-13-07
• #8799, eff 1-19-07; ss by #9173, eff 6-7-08 (from He-P 308.03), EXPIRED: 6-7-16

N.H. Code Admin. R. Ann. He-P 308.05 Eligibility

(a) The town, city, or MCD shall be eligible to receive funds for mosquito control activities if the following criteria have been met:

(1) The commissioner, in consultation with the Centers for Disease Control and Prevention and with concurrence of the governor, has declared a public health threat within a given city, town, or MCD based on local factors per RSA 141-C:25, III(a);

(2) The commissioner, after consultation with the Centers for Disease Control and Prevention, has determined mosquito control activities are appropriate to mitigate the public health threat based on local factors per RSA 141-C:25, III(a); and

(3) The town, city, or MCD that is requesting financial assistance:

a. Holds a current special permit, approved in accordance with Pes 505, Pes 506, and/or Pes 604;

b. Completes and submits an application no later than December 1st of the calendar year in which expenses were incurred, along with other required documentation, to the department, as described in He-P 308.04; and

c. Requests funding for mosquito control activities aimed to address a public health threat of a mosquito-borne disease and not for nuisance mosquito control activities.

(b) “Nuisance mosquito control” means mosquito control activities which are not aimed at a declared public health threat.

(c) The amount of funding requested through the application shall be no more than 25% of the total eligible costs of mosquito control activities directed at a public threat.

History

• #8683, EMERGENCY RULE, eff 7-17-06, EXPIRED: 1-13-07
• #8799, eff 1-19-07; ss by #9173, eff 6-7-08 (from He-P 308.04), EXPIRED: 6-7-16

N.H. Code Admin. R. Ann. He-P 308.06 Approval for Towns, Cities, or MCDs to Receive Funds for Mosquito Control Activities

(a) The commissioner shall base the decision as to whether to grant the funding request, and, if the request is granted, the amount of funding to be provided, on the following criteria:

(1) The nature and degree of the declared threat to the public health;

(2) The mosquito control activities proposed by the city, town, or MCD;

(3) Funding from the mosquito control fund shall not exceed 25% of the total eligible costs of mosquito control activities; and

(4) Funding is available through the appropriation under RSA 141-C:25.

(b) If an application is approved, the department shall notify the applicant in writing of the approval, and the amount of funding approved, within 30 working days of December 1st.

(c) If an application is denied, the department shall notify the applicant in writing of the reason for the denial within 30 working days of December 1st.

(d) Applications shall be received by the department by December 1st of the calendar year for which expenses were incurred.

History

• #9173, eff 6-7-08 (from He-P 308.05), EXPIRED: 6-7-16

Part He-P 309 Healthcare associated Infections reporting

N.H. Code Admin. R. Ann. He-P 309.01 Definitions

Revision Note:

Document #13282, effective 10-23-21, was an interim rule that amended He-P 309.01 titled “Definitions” and He-P 309.02 titled “Reporting Requirements”.

Document #13282 also repealed He-P 309.05 titled “Central Line Insertion Practices (CLIP)” and renumbered, but did not readopt, He-P 309.06 through He-P 309.13 as He-P 309.05 through He-P 309.12 as indicated in the source notes. The interim rule was scheduled to expire 4-21-22 except for the repeal of He-P 309.05, which was permanent. The prior filings affecting He-P 309.05 included the following documents:

#9851, eff 1-14-11

#10079, eff 1-26-12

#12943, eff 12-11-19

Before the interim rule expired, Document #13351, effective 3-19-22, readopted with amendments He-P 309.01, He-P 309.02, and He-P 309.10, which was formerly titled “Surgical Antimicrobial Prophylaxis and Intravenous Antimicrobial Administration” and was now re-titled as “Intravenous Antimicrobial Administration”.

(a) “Ambulatory surgical center” means “ambulatory surgical center” as defined in He-P 812.03(i) and licensed in accordance with RSA 151 and He-P 812. The term “ambulatory surgical center” includes “ambulatory surgical facility” as used in RSA 151:33.

(b) “Assisted living residence” means “assisted living residence” as defined in RSA 161-J:2, II.

(c) “Catheter-associated urinary tract infections (CAUTI)” means urinary tract infections that are associated with having a catheter as defined by the National Healthcare Safety Network (NHSN) in the material incorporated by reference in He-P 309.03(a).

(d) “Central line” means one of the following types of intravascular catheter that terminates at or close to the heart, or in one of the great vessels that is used for infusion, withdrawal of blood, or hemodynamic monitoring:

(1) A permanent central line, including:

a. Tunneled catheters;

b. Tunneled dialysis catheters; and

c. Implanted catheters;

(2) A temporary central line or a non-tunneled, non-implanted catheter; and

(3) An umbilical catheter, which is a vascular catheter inserted through the umbilical artery or vein in a neonate.

(e) “Centers for Medicare and Medicaid Services (CMS)” means the federal agency within the U.S. Department of Health and Human Services that administers the Medicare and Medicaid programs.

(f) “Central line related bloodstream infections (CLABSI)” means central line-associated blood stream infections, or a bloodstream infection that is associated with having a central line as defined by NHSN in He-P 309.04(a).

(g) “Department” means the New Hampshire department of health and human services.

(h) “End stage renal disease dialysis center (ESRDDC)” means “end stage renal disease dialysis center” as defined in He-P 811.03(r) and licensed in accordance with RSA 151 and He-P 811. The term includes “end-stage renal dialysis center” as used in RSA 151:33.

(i) “Healthcare associated infection (HAI)” means an infection that a patient acquires during the course of receiving treatment for another condition within a healthcare setting.

(j) “Healthcare personnel (HCP)” means all facility personnel, including but not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students, trainees, volunteers, and contractual staff not employed by the healthcare facility, such as clerical, dietary, housekeeping, and maintenance staff regardless of clinical responsibility or patient contact.

(k) “Hospital” means “hospital” as defined in RSA 151:2, I(a).

(l) “Influenza vaccination rates” means the proportion of persons that received influenza vaccine.

(m) “Inpatient census” means the average number of inpatients per year for each hospital, which shall be determined by the total number of admissions per year.

(n) “Intravenous (IV) antimicrobial start” means administration starts of all intravenous antibiotics or antifungals.

(o) “LabID event” means a positive laboratory test result for Clostridioides difficile toxin A, toxin B, or both, or any detection of toxin-producing Clostridioides difficile organisms by culture or other laboratory means on an unformed stool specimen that conforms to the container, when tested through methods such as molecular assays, include polymerase chain reaction (PCR), toxin assays, including enzyme immunoassay (EIA), or both.

(p) “Measure” means any infection or process measure reported by a hospital pursuant to RSA 151:33, II and III and as described in He-P 309.02(a) and (b), and any infection or process measure reported by an ambulatory surgical center pursuant to RSA 151:33, II-a and III and as described in He-P 309.02(c) and (d).

(q) “National Healthcare Safety Network (NHSN)” means the web-based surveillance system for healthcare-associated infection surveillance maintained by the Centers for Disease Control and Prevention.

(r) “New Hampshire veterans’ home” means “home” as defined in Ve-H 102.03 and licensed in accordance with RSA 119:1 and Ve-H 100-400. This term includes “veterans’ home” as used in RSA 151:33.

(s) “Nursing home” means “nursing home” as defined in He-P 803.03(az) and licensed in accordance with RSA 151 and He-P 803.

(t) “Residential care facility” means “residential health care facility” as defined in He-P 805.03(bj) and licensed in accordance with RSA 151 and He-P 805. This term also includes “assisted living residence-residential care (ALR-RC)”.

(u) “Specialty hospital” means a psychiatric or rehabilitation hospital as defined in He-P 802.

(v) “Supported residential health care facility (SRHCF)” means “supported residential health care facility” as defined in He-P 805.03(bu).

(w) “Surgical antimicrobial prophylaxis” means administration of antibiotics in relation to a surgical procedure as defined by CMS in He-P 309.07(a).

(x) “Surgical wound infections” means surgical site infections (SSI), or an infection that is associated with a surgical procedure, as defined by NHSN in He-P 309.06(a).

(y) “Vascular access site infection” means an infection that is associated with having a dialysis access site.

History

• #9851, eff 1-14-11; ss by #10079, eff 1-26-12; amd by #10344, eff 5-22-13; ss by #12943, eff 12-11-19; amd by #13282, INTERIM, eff 10-23-21; ss by #13351, eff 3-19-22 (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.02 Reporting Requirements

(a) In accordance with RSA 151:33, II, all hospitals shall identify, track, and report infections, including:

(1) Catheter-associated urinary tract infections;

(2) Central line related bloodstream infections; and

(3) Surgical wound infections.

(b) All hospitals shall provide to the department Clostridioides difficile infection (CDI) labID event data, if available.

(c) Hospitals shall also identify, track, and report process measures including:

(1) Coverage rates of influenza vaccination for health care personnel and patients or residents; and

(2) Antimicrobial use data, if available.

(d) In accordance with RSA 151:33, II-a, all ambulatory surgical centers shall identify, track, and report surgical wound infections.

(e) Ambulatory surgical centers shall also identify, track, and report on the following:

(1) Surgical antimicrobial prophylaxis administered intravenously; and

(2) Coverage rates of influenza vaccination for health care personnel.

(f) In accordance with RSA 151:33, II-b, all end-stage renal dialysis centers shall identify, track, and report dialysis events, including:

(1) Positive blood cultures; and

(2) Vascular access site infections.

(g) End stage renal dialysis centers shall also identify, track, and report on the following:

(1) Intravenous antimicrobial start time; and

(2) Coverage rates of influenza vaccination of health care personnel.

(h) In accordance with RSA 151:33, II-c, the New Hampshire veterans’ home and all nursing homes, residential care facilities, and assisted living facilities shall identify, track, and report coverage rates of influenza vaccination of health care personnel.

History

• #9851, eff 1-14-11; ss by #10079, eff 1-26-12; ss by #12943, eff 12-11-19; amd by #13282, INTERIM, eff 10-23-21; ss by #13351, eff 3-19-22 (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.03 Catheter-Associated Urinary Tract Infections (CAUTI)

(a) Hospitals shall comply with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “Catheter-Associated Urinary Tract Infection (CAUTI) Event” (January 2019 edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf, when submitting CAUTI data.

(b) Hospitals shall monitor all adult and pediatric intensive care units for CAUTI events all 12 calendar months, and shall report data on CAUTI events quarterly via NHSN.

(c) Hospitals shall provide data within 60 days of the close of each quarter to NHSN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

(d) Specialty hospitals, ESRD centers, residential care facilities, assisted living residences, nursing homes, and veterans’ homes shall not be required to report CAUTI.

History

• #10079, eff 1-26-12; ss by #12943, eff 12-11-19

N.H. Code Admin. R. Ann. He-P 309.04 Central Line-Associated Blood Stream Infections (CLABSI)

(a) Hospitals shall comply with the United States Centers for Disease Control and Prevention National Healthcare Safety Network, “Central Line Bloodstream Infection (CLABSI) Event”, (January 2019 Edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf, when submitting CLABSI data.

(b) Hospitals shall monitor all adult, pediatric, and neonatal intensive care units for CLABSI events all 12 calendar months, and shall report data on CLABSI events quarterly via NHSN.

(c) Hospitals shall provide data within 60 days of the close of each quarter to NHSN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

(d) Specialty hospitals, ESRD centers, residential care facilities, assisted living residences, nursing homes, and veterans’ homes shall not be required to report CLABSI.

History

• #9851, eff 1-14-11; amd by #10079, eff 1-26-12 (from He-P 309.03); ss by #12943, eff 12-11-19

N.H. Code Admin. R. Ann. He-P 309.05 Surgical Site Infections (SSI)

(a) Hospitals and ambulatory surgical centers shall comply with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “Surgical Site Infection (SSI) Event” (January 2019 edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf, when submitting SSI data.

(b) Hospitals shall report on the following NHSN operative procedures:

(1) Abdominal hysterectomy;

(2) Coronary artery bypass graft surgery for chest incision and donor site;

(3) Colon surgery for incision, resection, or anastomosis of the large intestine; and

(4) Knee arthroplasty.

(c) Ambulatory surgical centers shall report on the following NHSN operative procedures:

(1) Breast surgery;

(2) Hernia repair surgery; and

(3) Open reduction of fracture surgery.

(d) Hospitals and ambulatory surgical centers shall monitor for the specified SSI events above all 12 calendar months, and shall report data on SSI events quarterly via NHSN.

(e) Hospitals and ambulatory surgical centers shall provide data within 60 days of the close of each quarter to NHSN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

History

• #9851, eff 1-14-11; ss by #10079, eff 1-26-12 (from He-P 309.05); ss by #12943, eff 12-11-19; renumbered by #13282, INTERIM (formerly He-P 309.06) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.06 Clostridioides Difficile

Infections (CDI).

(a) Hospitals shall comply with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “Multidrug-Resistant Organism & Clostridioides difficile Infection (MDRO/CDI) Module” (January 2019 edition), available as noted in Appendix A at https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf, when submitting CDI labID event data, if such data is available.

(b) Hospitals shall monitor for CDI events all 12 calendar months and shall report data on CDI events quarterly via NHSN.

(c) Hospitals shall provide data within 60 days of the close of each quarter to NSHN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

History

• #12943, eff 12-11-19; renumbered by #13282, INTERIM (formerly He-P 309.07) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.07 Antimicrobial Use Data

(a) Hospitals shall report antimicrobial use data annually on April 30th or earlier for the previous year if such data is available.

(b) If such data is available, hospitals with antimicrobial use data shall report by either or both of the following:

(1) Sending antimicrobial use data by complying with United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “Antimicrobial Use and Resistance (AUR) Module” (January 2019 edition), available as noted in Appendix A at https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf; or

(2) Completing the “Days of Therapy (DOT) Reporting Sheet” and returning it to the department via:

a. Email, as an attachment, to haiprogram@dhhs.nh.gov;

b. Fax to (603) 271-0545; or

c. Mail to:

Healthcare Associated Infections Surveillance Program

Bureau of Disease Control

Division of Public Health Services

Department of Health and Human Services

29 Hazen Drive

Concord, NH 03301

(c) Hospitals reporting antimicrobial use data through the “Days of Therapy (DOT) Reporting Sheet” form shall include the following information on the form:

(1) Name of person completing the form;

(2) Name of facility;

(3) Email address of person completing the form;

(4) Telephone number of person completing the form;

(5) Total number of patient days during the reporting period;

(6) Class of antibiotic administered, specified as intravenous or oral;

(7) Days of therapy by each antibiotic administered; and

(8) Any other desired comments.

History

• #12943, eff 12-11-19; renumbered by #13282, INTERIM (formerly He-P 309.09) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.08 Vascular Access Site Infections (VASI)

(a) End stage renal dialysis centers shall comply with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “End Stage Renal Dialysis (ESRD) Event” protocol (January 2019 edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf, when submitting ESRD data.

(b) End stage renal dialysis centers shall report on the following NHSN vascular access site infections:

(1) Bloodstream infection (BSI);

(2) Local access site infection (LASI);

(3) Access-related bloodstream infection (ARBSI); and

(4) Vascular access infection (VAI);

(c) End stage renal dialysis centers shall monitor for VASI events all 12 calendar months and shall report on VASI events quarterly via NHSN.

(d) End stage renal dialysis centers shall provide data within 60 days of the close of each quarter to NHSN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

History

• #12943, eff 12-11-19; renumbered by #13282, INTERIM (formerly He-P 309.09) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.09 Positive Blood Cultures

(a) End stage renal dialysis centers shall comply with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “End Stage Renal Dialysis (ESRD) Event” protocol, (January 2019 edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf, when submitting ESRD data.

(b) End stage renal dialysis centers shall report positive blood cultures.

(c) End stage renal dialysis centers shall monitor for positive blood cultures all 12 calendar months and shall report data on positive blood cultures quarterly via NHSN.

(d) End stage renal dialysis centers shall provide data within 60 days of the close of each quarter to NHSN, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

History

• #12943, eff 12-11-19; renumbered by #13282, INTERIM (formerly He-P 309.10) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.10 Intravenous Antimicrobial Administration

(a) End stage renal dialysis centers shall, when submitting ESRD data, report intravenous antimicrobial administration by complying with the United States Centers for Disease Control and Prevention, National Healthcare Safety Network, “End Stage Renal Dialysis (ESRD) Event” protocol (January 2022 edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf.

(b) In addition to the reporting requirements identified in (a) above, end stage renal dialysis centers shall submit ESRD data within 60 days of the close of each quarter, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

(c) Ambulatory surgical centers shall report the list of procedures during which the patient received intravenous prophylactic antibiotic to the department on the “Intravenous Antibiotic Reporting Form” (November 2019) within 60 days of the close of each quarter, as follows:

(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before May 30th;

(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before August 29th;

(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before November 29th; and

(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or before March 1st of the following calendar year.

(d) The department shall contact all ambulatory surgery centers via email no later than March 15 of each year, and provide the survey, as well as a pdf copy.

(e) Ambulatory surgery centers shall either:

(1) Complete the survey; or

(2) Complete the pdf version of the survey and return to the department via:

a. Email, as an email attachment, to haiprogram@dhhs.nh.gov;

b. Fax, at (603) 271-0545; or

c. Mail, to:

Healthcare Associated Infections Surveillance Program

Bureau of Disease Control

Division of Public Health Services

Department of Health and Human Services

29 Hazen Drive

Concord, NH 03301

(f) Ambulatory surgery centers shall report the following measures on the “Intravenous Antibiotic Reporting Form” (November 2019):

(1) Facility name;

(2) Unique patient identification number;

(3) Date of the surgery or procedure;

(4) Type of procedure using codes as defined by the World Health Organization’s “International Classification of Diseases (ICD)” (11th Revision), available as noted in Appendix B;

(5) Type of prophylactic antibiotic;

(6) Time of the start of the intravenous antibiotic was included; and

(7) Time of the start of the incision.

(g) Specialty hospitals shall not be required to report surgical antimicrobial prophylaxis data and intravenous antimicrobial administration.

(h) Residential care facilities, assisted living residences, nursing homes, and the veterans’ home shall not be required to report surgical antimicrobial prophylaxis data and intravenous antimicrobial administration.

History

• #9851, eff 1-14-11; amd by #10079, eff 1-26-12 (from He-P 309.06); ss by #12943, eff 12-11-19 (formerly He-P 309.07); renumbered by #13282, INTERIM (formerly He-P 309.11); ss by #13351, eff 3-19-22 (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.11 Influenza Vaccination Rates

(a) Hospitals and specialty hospitals shall report staff and patient vaccination rates annually on or before April 30th for the previous influenza season via the “Flu Survey- Hospital” as described in (g) below.

(b) Assisted living residences and residential care facilities shall report staff and resident vaccination rates annually on or before April 30th for the previous influenza season via the “Flu Survey- Assisted Living” as described in (h) below.

(c) Nursing homes and the New Hampshire veterans’ home shall report staff and resident vaccination rates annually on or before April 30th for the previous influenza season via the “Flu Survey-LTC &VA” as described in (h) below.

(d) Ambulatory surgical centers and end stage renal dialysis centers shall report staff vaccinations rates annually on or before April 30th for the previous flu season via the “Flu Survey for ASC and End Stage Rental Dialysis Centers” as described in (i) below.

(e) The department shall contact hospitals, specialty hospitals, residential care facilities, assisted living facilities, nursing homes, the New Hampshire veterans’ home, ambulatory surgical centers, and end stage renal dialysis centers each year on or before April 1st, and provide an online link to the survey, as well as a pdf copy.

(f) Hospitals, specialty hospitals, residential care facilities, assisted living residences, nursing homes, the New Hampshire veterans’ home, ambulatory surgical centers and end stage renal dialysis centers shall either:

(1) Complete the survey via the survey link; or

(2) Complete the pdf version of the survey and return to the department via:

a. Email, as an email attachment to haiprogram@dhhs.nh.gov;

b. Fax, to (603) 271-0545; or

c. Mail, to:

Healthcare Associated Infections Program

Bureau of Disease Control

Division of Public Health Services

Department of Health and Human Services

29 Hazen Drive

Concord, NH 03301

(g) Hospitals and specialty hospitals shall report the following information:

(1) Hospital contact information, to include the following:

a. Facility name;

b. Name of person completing the survey;

c. Professional title of person completing the survey;

d. Email address of person completing the survey; and

e. Telephone number of the person completing the survey;

(2) Number of patients admitted to the hospital during the reporting season, separated by:

a. Total number of patient admissions; and

b. Total number of patient admissions excluding readmissions;

(3) Number of patients immunized against seasonal influenza;

(4) Number of patients not immunized against seasonal influenza;

(5) Number of patients admitted that have been immunized against pneumococcal disease;

(6) Number of healthcare personnel who worked or volunteered at the facility during the reporting period;

(7) Number of staff immunized against seasonal influenza during the reporting season;

(8) Number of staff not immunized against seasonal influenza during the reporting season;

(9) Of the staff not immunized, the number who did not receive influenza vaccine for the following reasons:

a. Medical contraindications;

b. Religious;

c. Personal or philosophical; or

d. Unknown;

(10) The extent to which the facility has a seasonal influenza vaccination policy, indicated as:

a. A policy is in place;

b. A policy is not in place but being considered;

c. A policy is not in place and is not being considered; or

d. Other;

(11) For facilities that have a seasonal influenza vaccination policy, the reasons for exemption, indicated as:

a. Medical;

b. Religious;

c. Personal or philosophical; or

d. Other;

(12) For facilities that have a seasonal influenza vaccination policy, the requirements for staff with an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Receiving verbal or written education, or both; or

c. Other;

(13) For facilities that have a seasonal influenza vaccination policy, the potential consequences for unvaccinated staff without an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Progressive discipline, up to and including termination;

c. Receiving verbal or written education, or both; or

d. Other;

(14) For facilities that have a season influenza vaccination policy, the number of noncompliant staff that were that were:

a. Temporarily suspended;

b. Resigned; or

c. Terminated;

(15) Whether or not the facility offers high-dose influenza vaccine; and

(16) Any other comments the facility would like to share.

(h) Assisted living residences, residential care facilities, nursing homes, and the New Hampshire veterans’ home shall report the following information:

(1) Facility contact information:

a. Facility name;

b. The name of the person completing the survey;

c. The professional title of the person completing the survey;

d. The email address of the person completing the survey;

e. The telephone number of the person completing the survey;

f. The facility’s license number; and

g. The facility’s street address and city name;

(2) The total number of residents or attendees of the facility during the reporting season;

(3) Number of residents or attendees immunized against influenza;

(4) Number of residents or attendees not immunized against influenza;

(5) Number of residents or attendees that have ever received a pneumococcal disease vaccination;

(6) The number of healthcare personnel who worked or volunteered at the facility during the reporting season;

(7) The number of facility staff immunized against influenza for the reporting season;

(8) The number of facility staff not immunized against influenza for the reporting season;

(9) Of the staff not immunized, the number who did not receive influenza vaccine for the following reasons:

a. Medical contraindications;

b. Religious;

c. Personal or philosophical; or

d. Unknown;

(10) The extent to which the facility has a seasonal influenza policy, indicated as:

a. A policy is currently in place;

b. A policy is not in place but is being considered;

c. A policy is not in place and is not being considered; or

d. Other;

(11) For those facilities that have an influenza vaccination policy, the acceptable reasons for exemption, indicated as:

a. Medical;

b. Religious;

c. Personal or philosophical; or

d. Other;

(12) For those facilities that have an influenza vaccination policy, the requirements for staff with an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Receiving verbal or written education, or both; or

c. Other;

(13) For those facilities that have an influenza vaccination policy, the potential consequences for unvaccinated staff without an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Progressive discipline, up to and including termination;

c. Receive verbal or written education, or both; or

d. Other;

(14) For those facilities that have an influenza policy, the number of noncompliant staff that were:

a. Temporarily suspended;

b. Resigned; or

c. Terminated;

(15) Whether or not the facility offered high-dose influenza vaccine; and

(16) Any other comments the facility would like to share.

(i) Ambulatory surgery centers and end-stage renal dialysis centers shall report the following information:

(1) Facility contact information:

a. Facility name;

b. The name of the person completing the survey;

c. The professional title of the person completing the survey;

d. The email address of the person completing the survey; and

e. The telephone number of the person completing the survey;

(2) Number of healthcare personnel who worked or volunteered at the facility during the reporting period;

(3) The number of healthcare personnel immunized against influenza for the reporting season;

(4) The number of healthcare personnel not immunized against influenza for the reporting season;

(5) Of the staff not immunized, the number who did not receive influenza vaccine for the following reasons:

a. Medical contraindications;

b. Religious;

c. Personal or philosophical; or

d. Unknown;

(6) The extent to which the facility has a seasonal influenza policy, indicated as:

a. A policy is currently in place;

b. A policy is not in place but is being considered;

c. A policy is not in place and is not being considered; or

d. Other;

(7) For those facilities that have an influenza vaccination policy, the acceptable reasons for exemption, indicated as:

a. Medical;

b. Religious;

c. Personal or philosophical; or

d. Other;

(8) For those facilities that have an influenza vaccination policy, the requirements for staff with an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Receiving verbal or written education, or both; or

c. Other;

(9) For those facilities that have an influenza vaccination policy, the potential consequences for unvaccinated staff without an acceptable reason for exemption, indicated as:

a. The wearing of a mask;

b. Progressive discipline, up to and including termination;

c. Receiving verbal or written education, or both; or

d. Other;

(10) For those facilities that have an influenza policy, the number of noncompliant staff that were:

a. Temporarily suspended;

b. Resigned; or

c. Terminated;

(11) Total number of procedures performed at the facility within the past calendar year; and

(12) Any other desired comments the facility would like to share.

History

• #9851, eff 1-14-11; amd by #10079, eff 1-26-12 (from He-P 309.07); ss by #12943, eff 12-11-19 (formerly He-P 309.08); renumbered by #13282, INTERIM (formerly He-P 309.12) (see Revision Note at part heading for He-P 309)

N.H. Code Admin. R. Ann. He-P 309.12 Fees

Pursuant to RSA 151:36, the department shall assess a fee to hospitals, ambulatory surgical centers, and end stage renal dialysis centers that are required to report under RSA 151:33 to support the program’s approved annual operating budget and which shall be proportional to the total number of measures reported by all hospitals, ambulatory surgical centers, and end stage renal dialysis, as follows:

(a) The base amount for the hospitals’ portion of the annual operating budget shall be proportional to the total number of measures reported, as described by the reporting categories in He-P 309.02(a) through (c), by all hospitals in the state;

(b) Of that base amount stated in (a) above, each hospital shall pay a fee based on the appropriate fee category for that hospital;

(c) There shall be 5 proportional fee categories based on the hospital’s number of beds, which shall total the base amount of payment that is required by hospitals;

(d) The fee categories and the proportional rates of the budgeted amounts for hospitals shall be as follows:

(1) Specialty hospitals at 0.900%;

(2) Less than 25 beds at 2.500%;

(3) 25-199 beds at 4.500%;

(4) 200-299 beds at 5.240%; and

(5) 300 beds or more at 5.880%;

(e) The number of beds attributed to each hospital shall be the number of beds for which the hospital is licensed by the department’s bureau of health facilities administration, in accordance with He-P 802, at the time the fees are assessed;

(f) All ambulatory surgical centers shall report the number of procedures for the previous calendar year to the department by email to HAIprogram@dhhs.nh.gov on or before March 1st of the following year;

(g) The base amount for the ambulatory surgical centers’ portion of the annual operating budget shall be proportional to the total number of measures reported, as described by the reporting categories in He-P 309.02(c) and (d), by all ambulatory surgical centers in the state;

(h) Of that base amount stated in (g) above, each ambulatory surgical center shall pay a fee based on the appropriate category for that ambulatory surgical center;

(i) There shall be 3 proportional fee categories based on the range of procedures performed annually at an ambulatory surgical center, which shall total the base amount of payment that is required by ambulatory surgical centers;

(j) The proportional fee categories and the total percentage of the budget for that category shall be:

(1) No operative procedures at 20%;

(2) 1–1,499 operative procedures annually at 35%; and

(3) More than 1,500 operative procedures annually at 45%;

(k) The total proportion of the budget for that procedure fee category shall be split equally among all facilities that fall within that category;

(l) The base amount for the end stage renal dialysis center portion of the annual operating budget shall be proportional to the total number of measures reported, as described by the reporting categories in He-P 309.02(a) and (b), by all end stage regnal dialysis centers in the state;

(m) Of that base amount stated in (l) above, each end stage renal dialysis center fee is based on a flat fee for all end stage renal dialysis;

(n) The department shall notify hospitals, ambulatory surgical centers, and end stage renal dialysis centers the fee assessed to them upon passage of the program’s operating budget and then annually each year of the biennium;

(o) A hospital or ambulatory surgical center that is not licensed during the entire base year but is licensed at the time the fees are assessed shall pay the lowest fee category for that year; and

(p) Hospitals, ambulatory surgical centers, and end stage renal dialysis center shall send the fee for the annual amount to the department within 30 days after notification.

History

• #9851, eff 1-14-11; ss by #10344, eff 5-22-13); ss by #12943, eff 12-11-19 (formerly He-P 309.09); renumbered by #13282, INTERIM (formerly He-P 309.13) (see Revision Note at part heading for He-P 309)

Part He-P 311 Rules for Temporary Acute Care Centers Located Within a Hospital

N.H. Code Admin. R. Ann. He-P 311.01 Purpose

The purpose of these rules is to set forth the requirements to establish and operate temporary acute care centers located within a hospital pursuant to RSA 141-C:26, and thereby ensure, through basic standards, the health and safety of individuals in a temporary acute care center located within a hospital.

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.02 Scope

This part shall apply to any person, agency, partnership, corporation, government entity, association, or other legal entity operating a temporary acute care center. Any facility established under this section shall be exempt from the provisions of RSA 151, except as otherwise required herein.

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.03 Definitions

As used in this part, unless the context indicates otherwise, the following terms have the following meanings:

(a) “Centers for Medicare and Medicaid Services (CMS)” means the United States Department of Health and Human Services Centers for Medicare and Medicaid Services;

(b) “Commissioner” means the commissioner of the New Hampshire department of health and human services;

(c) “Department” means the New Hampshire department of health and human services; and

(d) “Temporary acute care center” means a facility established for the purpose of the delivery of acute medical services to persons who would normally require admission to an acute care hospital, when there is a public health incident as defined in RSA 508:17-a, II(c) and when the acute care hospitals in the area do not have the physical and human resources necessary to meet the demand or anticipated demand for medical care.

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.04 Establishment

A temporary acute care center shall only be established with the authorization of the commissioner, following the written approval of the governor, for a temporary duration when there is a public health incident as defined in RSA 508:17-a, II(c) and when the acute care hospitals in the area do not have the physical and human resources necessary to meet the demand or anticipated demand for medical care to persons who would normally require admission to an acute care hospital.

History

• #13304, EMERGENCY RULE, eff 12-10-21, EXPIRED: 6-8-22
• #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.05 Duties and Responsibilities

(a) The temporary acute care center shall comply with these rules and all applicable CMS regulations, in consideration of any waivers or flexibilities allowable and approved by CMS, under 42 CFR 482 and 42 CFR 485 in effect throughout the duration of the operation of the temporary acute care center, including, but not limited to:

(1) Facility and staffing requirements;

(2) Screening and admission criteria;

(3) Payment and reimbursements;

(4) Clinical standards;

(5) Recordkeeping;

(6) Patient rights; and

(7) Discharge criteria.

(b) The temporary acute care center shall comply with all provisions of RSA 151:21, except when the health or safety of the individual or other patients would be endangered.

(c) If notified by CMS that the temporary acute care center is out of compliance with (a) above to the extent that the health or safety of individuals are in jeopardy, the department shall withdraw the temporary acute care center’s designation.

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.06 Payment and Reimbursement

The temporary acute care center shall follow its established procedures for the billing of services rendered.

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

N.H. Code Admin. R. Ann. He-P 311.07 Immunity

For the purposes of immunity, actions taken pursuant to this section shall be considered an emergency management function under RSA 21-P:41, I.

Appendix A

Documents Incorporated by Reference

Rule

Title

Publisher, How to Obtain, Cost

He-P 301.02(e)(2)

NH Local Implementation Guide for Electronic Laboratory Reporting using HL7, 2.5.1, 7/31/2014.

Available as an on-line document free of charge at www.dhhs.nh.gov/dphs/bphsi/documents/elrguide

He-P 301.03(i)(1)

NH Local Implementation Guide for Syndromic Surveillance Reporting, Version 1.07, 2/15/15.

Available as an on-line document free of charge at www.nh.gov/dphs.

He-P 301.04

Healthcare Infection Control Practices Advisory Committee 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007.

Available as an on-line document free of charge at www.cdc.gov/hicpac.

He-P 301.04

Healthcare Infection Control Practices Advisory Committee, Management of Multi-drug Resistant Organisms in Healthcare Settings, HICPAC Advisory Committee. October 2006.

Available as an on-line document free of charge at www.cdc.gov/hicpac/mdroGuidelines2006.

He-P 301.11(c)(5)

US Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents.

Available free of charge at: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.

He-P 301.14

Recommended Immunization Schedules for Persons Aged 0-18 years- US 2016 by Centers for Disease Control and Prevention (CDC) and as approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

Available on line free of charge at www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.

He-P 304.01(m)

“Chapter III, Standards for Tumor Inclusion and Reportability” Table 2. “NAACCR Layout Version 15: “Comparison of Reportable Cancers” “NPCR Requirements.” (Thornton ML, (ed)). “Standards for Cancer Registry Operations”/Volume II: “Data Standards and Data Dictionary, Record Layout” Version 15, 19^th ed. (Posted October 2014, Revised February 27, 2015), Springfield, Ill.: North American Association of Central Cancer Registries, (NAACCR).

Available online at no cost at www.naaccr.org.

He-M 304.02(b) and (g)

North American Association of Central Cancer Registries (NAACCR), “Standard for Cancer Registries, Volume II”/“Data Standard and Data Dictionary”, 19^th (ed.), “Record Layout Version 15”, Implementation: January 1, 2015, Edited by Monica Thornton, Revised February 2015.

Available online at no cost at www.naaccr.org.

He-M 304.02(b) and (g)

“Standards for Cancer Registries” Volume V: “Pathology Laboratory Electronic Reporting, Version 4.0.”Klein Wt., Havener L. (eds.) Springfield (IL); North American Association of Central Cancer Registries, Inc., April, 2011.

Available online at no cost at www.naaccr.org.

He-M 304.02(b) and (g)

National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control, “Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries” HL7 Clinical Document Architecture (CDA) Release 1.1 (March, 2014).

Available online at no cost at http://cdc.gov/cancer/npcr/meaningful_use.html.

He-M 304.07(d)(7)

Surveillance, Epidemiology and End Results Program (SEER) “Case Finding List, Current List”, ICD-10-CM-(FY 2015-October 1, 2015-September 30, 2016.

Available online at no cost at http://seer.cancer.gov/tools/casefinding.

He-P 307.05(b)

Centers for Disease Control and Prevention’s, “Core Data Elements for Immunization Information Systems, listed in the functional standards document and in Appendix B in HL7 Version 2.5.1: Implementation Guide for Immunization Messaging Release 1.5” (October 2018)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html; or

https://repository.immregistries.org/files/resources/5bef530428317/hl7_2_5_1_release_1_5__2018_update.pdf

He-P 309.03(a)

United States Centers for Disease Control and Prevention, National Healthcare Safety Network’s, “Catheter-Associated Urinary Tract Infection (CAUTI) Event” (January 2019 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

He-P 309.04(a)

United States Centers for Disease Control and Prevention, National Healthcare Safety Network’s, “Central Line Bloodstream Infection (CLABSI) Event” (January 2019 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

He-P 309.05(b)

United States Centers for Disease Control and Prevention, National Healthcare Safety Network’s, “Central Line Insertion Practices (CLIP) Adherence Monitoring” (January 2019 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

http://www.cdc.gov/nhsn/PDFs/pscManual/5psc_CLIPcurrent.pdf

He-P 309.06(a)

United States Center for Disease Control and Prevention, National Healthcare Safety Network’s, “Surgical Site Infection (SSI) Event” (January 2019 Edition).

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf

He-P 309.07(a)

United States Center for Disease Control and Prevention, National Healthcare Safety Network’s, “Multidrug-Resistant Organism and Clostridiodes difficile Infection (MDRO/CDI) Module” (January 2019 Edition).

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf

He-P 309.08(b)(1)

United States Center for Disease Control and Prevention, National Healthcare Safety Network’s, “Antimicrobial Use and Resistance (AUR) Module” (January 2019 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf

He-P 309.09(a); He-P 309.10(a); and He-P 309.11(e)

United States Center for Disease Control and Prevention, National Healthcare Safety Network’s, “End Stage Renal Dialysis (ESRD) Event” (February 2018 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free to the Public

The incorporated document is available at:

http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf

He-P 309.11(j)

World Health Organization’s “International Classification of Diseases” (11th Revision)

Publisher: World Health Organization

Cost: Free to the Public

The incorporated document is available at: https://icd.who.int/en

APPENDIX B

RULE

RSA/FEDERAL CITATION

He-P 301.01

RSA 141-C:2

He-P 301.02

RSA 141-C:6, I , RSA 141-C:7; RSA 141-C:8

He-P 301.03

RSA 141-C:6, I; RSA 141-C:7

He-P 301.04

RSA 141-C:11-15

He-P 301.05

RSA 141-C:11-15

He-P 301.06

RSA 132:6; RSA 132:10-b

He-P 301.07

RSA 141-C:3, RSA 141-C:9

He-P 301.08

RSA 141-C:10

He-P 301.09

RSA 141-C:16-a

He-P 301.10

RSA 141-C:17; RSA 141-C:17-a

He-P 301.11

RSA 141-C:2, IV, RSA 141-C:3, III

He-P 301.11(b), (c) intro., (c)(3), (c)(4), (g) intro., (g)(1) intro., and (g)(1)d.

RSA 141-C:2, VI, RSA 141-C:3, III, RSA 141-C:4, X.,

RSA 141-C:15, IV

He-P 301.12

RSA 141-C:11, RSA 141-C:12

He-P 301.13

RSA 141-C:20-a through RSA 141-C:20-e

He-P 301.14

RSA 141C:20-a thru e

He-P 301.15

RSA 141C:20-a thru e

He-P 301.16

RSA 141-C:6, XI

He-P 301.17(c) intro., (c)(4), (e), (h) intro., (h)(3), (h)(5) intro., (h)(5)e., and (o)

RSA 141-C:15, III

He-P 304.01

RSA 141-B:2

He-P 304.02

RSA 141-B:7; RSA 141-B:8, II, RSA 141-B:10

He-P 304.03

RSA 141-B:7; RSA 141-B:8, II, RSA 141-B:10

He-P 304.04

RSA 141-B:7; RSA 141-B:8, II, RSA 141-B:10

He-P 304.05

RSA 141-B:7; RSA 141-B:8, II, RSA 141-B:10

He-P 304.06

RSA 141-B:7; RSA 141-B:8, II, RSA 141-B:10

He-P 304.07

RSA 141-B:8, III; RSA 141-B:8, IV; RSA 141-B:9,

42 USC 280e(c)(2)(D)(viii)

He-P 304.08

RSA-141-B:8, III; RSA 141-B:9; 45 CFR 164,

45 CFR164.502, 45 CFR 164.506, 45 CFR 164.512

He-P 304.09

RSA 141-B:8, III, RSA 141-B:9

He-P 304.10

RSA 141-B:8, III, RSA 141-B:9

He-P-305.01

RSA 541-A:7

He-P 305.02

RSA 151:2

He-P 305.03

RSA 141-F:6

He-P 305.04

RSA 141-F:5 through F:7

He-P 305.05

RSA 141-F:5, IV

He-P 305.06

RSA 141-F:7

He-P 307.01 – H-P 307.06

RSA 141-C:20-f

He-P 307.07

RSA 141-C:20-f, III; RSA 141-C:20-f, IIII-a

He-P 307.08 -307.11

He-P 307.01 – 307.06; RSA 141-C:20-f

He-P 308.01

RSA 141-C:25, I, RSA 430:13

He-P 308.02

RSA 141-C:24, RSA 141-C:25, IV, as amended by Chapter Law 73 of the 2008 Session

He-P 308.03

RSA 141-C:24, RSA 430:13

He-P 308.04

RSA 141-C:25, III, RSA 141-C:25, IV

He-P 308.05

RSA 141-C:25, III, RSA 141-C:25, IV, RSA 141-C:25, V

He-P 308.06

RSA 141-C:25, III, (b)

He-P 309.01

RSA 151:32

He-P 309.02

RSA 151:33; RSA 151:35

He-P 309.03

RSA 151:33: I, II(a)(2), III, IV, V; RSA 151:35

He-P 309.04

RSA 151:33: I, II(a)(1), IV, V; RSA 151:35

He-P 309.05

RSA 151:33: I, II(b)(1), IV, V; RSA 151:35

He-P 309.06

RSA 151:33: I, II(a)(3), II-a(a), IV, V; RSA 151:35

He-P 309.07

RSA 151:33: I, III, IV; RSA 151:35

He-P 309.08

RSA 151:33:I, III, IV; RSA 151:35

He-P 309.09

RSA 151:33, II-b (b), IV, RSA 151:35

He-P 309.10

RSA 151:33, I, II-a (b), IV and, V, RSA 151:35

He-P 309.11

RSA 151:33, I, II-a (b), IV, V, RSA 151:35

He-P 309.12

RSA 151-:33, I, II-a (c) IV, V, RSA 151:35

He-P 309.13

RSA 151:36

He-P 311.01

RSA 141-C:26

He-P 311.02

RSA 141-C:26

He-P 311.03

RSA 141-C:26

He-P 311.04

RSA 141-C:26

He-P 311.05

RSA 141-C:26

He-P 311.06

RSA 141-C:26

He-P 311.07

RSA 141-C:26

History

• #13304, EMERGENCY RULE, eff 12-10-21; ss by #13380-A, eff 5-25-22

Chapter He-P 400 Health Care Providers

Part He-P 401 Quality Assurance in Physician Practices

N.H. Code Admin. R. Ann. He-P 401.01 Purpose

The purpose of this rule is to promote greater patient safety in the delivery of health care and to reduce medical errors by encouraging physicians to improve quality of care through effective and continuing quality assurance programs.

History

• #7694, eff 6-4-02; ss by #9719, eff 6-4-10

N.H. Code Admin. R. Ann. He-P 401.02 Scope

This part shall apply to physician practices as defined by RSA 329:29-a.

History

• #7694, eff 6-4-02; ss by #9719, eff 6-4-10

N.H. Code Admin. R. Ann. He-P 401.03 Quality Assurance

Physician practices may develop and implement a quality assurance program to monitor, evaluate and improve the quality and appropriateness of the care provided to patients, so that important problems and trends in the delivery of care are identified and steps are taken to correct problems and to take advantage of opportunities to improve care.

History

• #7694, eff 6-4-02; ss by #9719, eff 6-4-10

N.H. Code Admin. R. Ann. He-P 401.04 Quality Assurance Committee

(a) All physician practices choosing to implement a quality assurance program shall establish a quality assurance committee.

(b) The quality assurance committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the way in which the information being monitored will be evaluated and measured;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions and initiate changes to improve quality of care;

(7) Evaluate the effectiveness of the corrective actions;

(8) Ensure that quality control logs are maintained for any required laboratory controls and proficiency testing;

(9) Ensure that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturers directions; and

(10) Review such areas as:

a. Infection surveillance;

b. Drug usage evaluation;

c. Morbidity;

d. Risk assessment;

e. Mortality;

f. Environmental safety;

g. Monitoring of staff quality control practices in each service provided; and

h. Physician and staff education, training and evaluation.

(c) The size and composition of the quality assurance committee shall be as follows:

(1) The quality assurance committee shall consist of at least one representative from each specialty area provided by the practice;

(2) One person may represent more than one specialty provided the person is trained and qualified to represent each specialty;

(3) When a matter under consideration by the committee involves a particular specialty, a member representing that specialty shall participate in the committee's proceedings;

(4) The quality assurance committee shall consist of at least 3 physicians;

(5) To comply with (4) above, physician practices consisting of fewer than 3 physicians shall, while maintaining patient confidentiality, associate with other physician practices so that a total of at least 3 physicians are members of the committee; and

(6) Physician practices consisting of 3 or more physicians may associate with other physician practices in a quality assurance program and committee provided patient confidentiality is protected.

(d) The quality assurance committee shall meet at least quarterly.

(e) The quality assurance committee shall generate dated written minutes after each meeting, including information on:

(1) Member attendance;

(2) Indicators reviewed at the present meeting;

(3) Conclusions of the committee;

(4) Recommendations for corrective action, if any; and

(5) Indicators to be reviewed at the next meeting.

(f) Documentation of all quality assurance activities shall be maintained on-site by the physician practice for at least 2 years.

(g) In accordance with RSA 329:29-a records related to the activities of the quality assurance program shall be confidential and privileged.

Appendix

Rule

Specific State Statute which the Rule Implements

He-P 401.01

RSA 329:29-a, I (b)

He-P 401.02

RSA 329:29-a, I (a)-(b)

He-P 401.03

RSA 329:29-a, I (b)

He-P 401.04

RSA 329:29-a, I-II

History

• #7694, eff 6-4-02; ss by #9719, eff 6-4-10

Chapter He-P 600 Certification of Other Qualified Agencies

Part He-P 601 Certified Other Qualified Agencies

N.H. Code Admin. R. Ann. He-P 601.01 Purpose

Statutory Authority: New Hampshire RSA 161-I:7

The purpose of this chapter is to set forth the procedures and requirements for operating as an other qualified agency pursuant to RSA 161-I.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.02 Scope

This chapter shall apply to all other qualified agencies operating in the state of New Hampshire regarding the provision of personal care services, including agencies providing consumer-directed services or both agency-directed and consumer directed services, reimbursed through the medicaid program.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.03 Definitions

(a) “Agency-directed” means personal care services for which the agency is responsible for identifying, training, supervising, evaluating, and terminating the personal care service provider.

(b) “Alternative format” means a method of making written communications more accessible to individuals with vision impairments, including, but not limited to, large print or Braille.

(c) “Applicant” means an agency seeking to be certified as an other qualified agency pursuant to RSA 161-I.

(d) “Case manager” means an individual employed by, or contracted with, a case management agency who:

(1) Meets the qualifications described in He-E 805.06;

(2) Is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the provision of services included in the comprehensive care plan; and

(3) Does not have a conflict of interest.

(e) “Choices for Independence (CFI)” means a system of long-term services and supports (LTSS) provided under Section 1915(c) of the Social Security Act.

(f) “Chronic illness” means an illness, which has one or more of the following characteristics:

(1) Is permanent;

(2) Leaves residual disability;

(3) Is caused by non-reversible, pathological alteration; or

(4) Requires special training of the individual for rehabilitation.

(g) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(h) “Complaint” means:

(1) Any allegation or assertion that a right of an individual has been violated;

(2) Any allegation or assertion that an individual has been abused, neglected, or exploited by an employee of, or a volunteer or consultant for, a facility, provider, or program; or

(3) Any allegation or assertion that the department or a facility, agency, or service provider has acted in an illegal or unjust manner with respect to an individual or category of individuals.

(i) “Comprehensive care plan” means an individualized person-centered plan described in He-E 805.05(c) that is:

(1) The result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the individual;

(2) Developed by the individual’s case manager; and

(3) An integrated plan of all the individual’s services.

(j) “Consumer-directed services” means personal care services under which the individual or his or her representative is responsible for:

(1) Participating in the development of the individual’s service plan;

(2) Selecting the individual’s personal care services worker;

(3) Setting the terms and conditions of work;

(4) Training, supervising, and evaluating the personal care services worker; and

(5) Terminating his or her relationship with the personal care services worker.

(k) “Department” means the New Hampshire department of health and human services.

(l) “Incident” means an occurrence or event that interrupts normal procedure, including a serious injury or other event threatening the health or safety of an individual or staff.

(m) “Individual” means any person receiving personal care services under these rules.

(n) “Individual’s bill of rights” means a written statement of the rights and responsibilities of an individual receiving personal care services from an other qualified agency.

(o) “Intermediary services” means an array of fiscal and supportive services to facilitate the delivery of consumer-directed services, including:

(1) Fiscal management services including but not limited to:

a. Computing tax withholdings;

b. Filing and depositing employment taxes;

c. Preparing and disbursing payroll checks;

d. Verifying time worked by employees;

e. Processing and paying non-labor related invoices such as printing, copying, and postage costs related to providing fiscal management services;

f. Processing criminal background checks on prospective workers;

g. Overseeing the verification worker’s citizenship/legal alien status; and

h. Generating standardized reports depending on program design; and

(2) Supportive services including but not limited to:

a. Skills advocacy training for the eligible consumer or representative;

b. Assistance with recruiting, screening, hiring, and training personal care service providers;

c. Creating and maintaining work registries;

d. Assessing and reassessing service needs;

e. Counseling and support; and

f. Monitoring of customer satisfaction.

(p) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 161-I, He-P 601, or other applicable laws or rules.

(q) “Other qualified agency (OQA)” means an entity certified in accordance with He-E 601 to offer personal care services and/or intermediary services.

(r) “Personal care services” means non-medical, hands-on services that assist eligible individuals to maintain themselves in a community setting.

(s) “Personal care service worker” means a person who is employed by other qualified agencies and who is:

(1) Selected by the eligible individual, his or her representatives, or the agency; and

(2) Anyone other than the individual’s legally responsible relative, as defined in RSA 161-I:2, VIII, case manager, or personal care services representative.

(t) “Person-centered” means that the individual or his or her authorized representative or caregiver is the center of the system of care and the individual’s needs and preferences drive the care and services provided.

(u) “Person-centered planning” means a process for planning and supporting an individual receiving personal care services that builds upon the individual’s capacity to engage in activities that promote community life and honors the individual’s preferences, choices, and abilities, and which involves families, friends, and professionals as the individual desires or requires.

(v) “Registered nurse” means an individual who holds a current license to practice registered nursing as defined in RSA 326-B:2, XI.

(w) “Representative” means a person:

(1) Chosen by:

a. The individual or his or her legal guardian; or

b. A person granted power of attorney by the individual;

(2) Deemed appropriate by the department to act on behalf of the individual; and

(3) Who:

a. Is not the personal care services worker;

b. Does not have a financial relationship with a home health agency or other qualified agency providing intermediary services to the individual; and

c. Is not the individual’s case manager.

(x) “Universal precautions” means a set of precautions designed to prevent transmission of blood borne pathogens when providing first aid or health care.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.04 Personal Care Services

(a) Personal care services shall be provided by personal care service workers in accordance with these rules.

(b) Personal care services shall include the following services:

(1) Hands-on assistance with activities of daily living necessary to carry out daily self-care activities such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, bathing, and continence, or cuing an individual to perform a task;

(2) Under the direction of the individual, assistance with self-administration of oral or topical medication as prescribed, to include:

a. Reminding the individual regarding the timing and dosage of the medication, and to take his or her medication as written on the medication container;

b. Placing the medication container within reach of the individual;

c. Assisting the individual with opening the medication container;

d. Assisting the individual by steadying shaking hands; and

e. Observing the individual take the medication and recording the same in the individual’s record;

(3) Accompanying the individual in the community when:

a. The assistance of the personal care worker is required for the individual to access necessary services; and

b. The need for re-direction or direct assistance, or both, is required;

(4) When non-medical transportation services are authorized, hands-on assistance at the authorized destination when the comprehensive care plan documents that this assistance is required at the destination; and

(5) General household tasks, limited to the following:

a. Laundering the individual’s personal clothing items, towels, and bedding;

b. Light cleaning limited to the individual’s bedroom, bathroom, mobility, and medical devices, and common living spaces;

c. When the individual lives alone, light cleaning of the kitchen, entry way areas, and common living spaces, in order to maintain a safe environment;

d. Errands for necessary tasks identified in the comprehensive care plan; and

e. Preparing non-communal meals and snacks, unless for multiple CFI individuals, including cleaning the food preparation area after the food is served.

(c) Personal care services shall not include:

(1) For the purpose of transportation only, when no other assistance is required;

(2) When provided in any of the following settings:

a. A residential care facility;

b. A hospital;

c. A nursing facility;

d. A rehabilitation facility; and

e. An adult family care home.

(4) When provided by any of the following individuals:

a. The individual’s personal care services representative;

b. The individual’s agent acting under a designated power of attorney pursuant to RSA 564-E; or

c. The individual’s legal guardian.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.05 Application Requirements

(a) Each applicant shall complete and submit an application entitled Form 3720 “Request for Certification of Other Qualified Agency” (May 2025) verifying the following:

“I verify that the information provided in this application is accurate to the best of my knowledge. Neither the executive director or if applicable the executive officers have been named as the perpetrator in a founded determination of abuse, neglect, or exploitation following a protective investigation conducted by the department pursuant to RSA 161-F: 42-57, or following a similar investigation conducted by another state. I affirm my programs are in compliance with RSA 161-I, He-P 601, including the requirement for criminal record checks for all personal care workers, and other applicable laws and rules. I understand that providing false information shall be grounds for denial, suspension, or revocation of a certification.”

(b) Along with Form 3720 “Request for Certification of Other Qualified Agencies”, each applicant shall submit the following:

a. For program design and program administration, policies and procedures:

1. A description of the OQA program goals and objectives and how it supports consumer directed care;

2. A description of the OQA policy regarding intake and admission and/or exclusion criteria;

3. An explanation of how the agency will ensure that individuals will have choice over his/her personal care worker(s) and indicate if an individual will be able to choose the individual’s personal care worker other than from the agency’s own pool of workers;

4. An indication if the agency will allow individuals who have a legal representative to participate in the program;

5. An explanation of what supports or education are offered to each individual on how to manage the individual’s care and management of the individual’s personal care worker;

6. A description of how an individual’s plan of care is designed including who is involved in developing the plan and how the OQA monitors its use, such as face to face interviews with the individual, and how BAAS case managers are involved;

7. Specification of any other monitoring process(s) the agency uses or plans to use for ensuring the quality of personal care services such as individual satisfaction surveys. If available, include samples of the tools used to collect this information;

8. A description of the annual OQA program evaluation plan indicating measurable goals and objectives and how progress will be measured;

9. A current, dated organizational chart of the OQA program illustrating lines of authority, responsibility/communication, and staff assignment, including date, staff names, and position titles;

10. A description of the policies for programmatic access related to the American with Disabilities Act, for example, alternative formats, and include the program’s web address;

11. A description of and a copy of the written confidentiality policy;

12. A description of and a copy of the agency’s policies and procedures for screening potential staff members including the procedures for conducting criminal history checks and BAAS state central registry checks on potential personal care workers;

13. An explanation of what customer service system procedures the agency currently utilized or what the agency plans to utilize, to include a toll-free number for individuals, the hours the toll-free number is staffed, and if the agency has a messaging service, and the procedures that are in place for returning calls; and

14. An indication of how the agency informs each individual of the individual’s rights and responsibilities for participating in the program, and include a copy of the written rights and responsibilities, grievance procedures, and service-termination policies you provide to each individual; and

b. For staffing, supervision, and training:

1. A copy of the staff orientation plan including for certified personal care workers;

2. A description of the policies regarding staff supervision provided to personal care workers by the OQA;

3. The OQA program job descriptions that delineate the roles and responsibilities for the executive director and the director of personal care services;

4. An indication of how the agency informs each personal care worker of their rights and responsibilities and include a copy of the written rights and responsibilities, grievance procedures, and service termination policies the OQA provides to each personal care worker;

5. Identification of how the OQA informs the individual and the individual’s worker about how to report incidences to the state according to the requirements of the state’s adult protection and the department’s ombudsman’s program laws and indicate if the agency would like pamphlets on the adult protection law to provide to individuals;

6. An explanation of the process for resolving incidences and/or reporting incidences to the state according to the requirements of the state’s adult protection laws. Indicate if you keep a record of incidences.

7. A copy of the emergency back-up plan the agency provides to individuals in the event a personal care worker fails to report to work and how the agency informs the individual of these procedures. Indicate if the agency has a worker registry that the individual may access to find a substitute worker;

8. A description on how training is provided to the individuals employed by your agency to provide personal care services and include what the qualifications of the person(s) providing the training and the type and frequency of ongoing training provided;

9. Details on the schedule for regular in service OQA staff training for OQA staff including an indication of:

i. If the OQA provides additional/ongoing training to caregivers, if the OQA determines additional training is needed; or

ii. If the OQA routinely provides additional training, and if so how often is the additional training provided; and

10. A copy of the training manual, workbook, or other written training instructions.

(c) For initial certification, each applicant shall submit the following documents to the department:

(1) A document demonstrating financial viability in one of the following forms:

a. The most recent financial statement or annual report;

b. The most recent financial audit;

c. A letter from an accountant indicating financial viability of the agency; or

d. A letter from a financial institution demonstrating financial solvency of the agency;

(2) Current proof of authorization from the secretary of state to do business in New Hampshire; and

(3) A copy of the Internal Revenue Service (IRS­) notice that includes the organization’s federal employer identification number.

(d) An OQA applying for renewal of certification shall submit:

(1) The information described above in (a) through (c) within 90 days of the expiration of the current certification;

(2) A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 601.16, if applicable; and

(3) If requested by the department, any documentation related to plans of correction developed and implemented pursuant to He-P 601.08.

(e) If information required in (a) through (c) above are incomplete or missing, the department shall notify the applicant.

(f) The applicant shall provide the missing information to the department within 10 days of being notified of an incomplete application or missing supporting documentation.

(g) The department shall process the applications in accordance with RSA 541-A:29.

(h) Applications shall be denied in accordance with He-P 601.06.

(i) If an initial or renewal application is denied, the applicant or OQA shall not provide personal care services.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11 (paras (b)-(h)), EXPIRED: 3-29-19; #9898-B, eff 3-29-11 (para (a)); ss by #13115, eff 10-1-20; ss by #14257, EXRF, eff 5-28-25, EXPIRES: 5-28-35

N.H. Code Admin. R. Ann. He-P 601.06 Denial of Certification Applications

(a) The department shall deny an application for an initial or renewal certification if:

(1) After being notified of and given an opportunity to supply missing information, the applicant does not meet the requirements of He-P 601.05;

(2) Any representative or employee of the applicant, OQA, or the agency’s executive director is named as the perpetrator in a founded determination of abuse, neglect, or exploitation following a protective investigation conducted by the department pursuant to RSA 161-F:42-57, or following a similar investigation conducted by another state;

(3) Any representative or employee of the applicant knowingly provides materially false information to the department;

(4) Any representative or employee of the applicant fails to provide to the department the documents required by this rule;

(5) Any representative or employee of the applicant is found to be in violation of any provision of RSA 161-I, He-P 60, 1 or other applicable laws or rules;

(6) Any representative, or employee of the applicant is found to be permitting, aiding, or abetting the commission of any unlawful act;

(7) Any employee of the applicant, including personal care services workers has an administrative finding or criminal conviction as described in He-P 601.11, unless a waiver is granted; or

(8) The department finds that an applicant for a new certification, or the agency at the time of renewal of certification, is not in compliance with RSA 161-I, He-P 601 or other applicable laws or rules.

(b) Any applicant aggrieved by the denial of an application may request an adjudicative proceeding in accordance with He-P 601.15.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.07 Certification

(a) All certificates issued in accordance with He-P 601 shall be non-transferable.

(b) Certificates issued to applicants shall indicate:

(1) The effective date of the certification;

(2) The expiration date of the certification;

(3) The certification number; and

(4) The name of the OQA.

(c) A OQA shall inform the department, in writing, within 30 days of terminating the provision of personal care services for CFI.

(d) A certification shall be valid on the date of issuance and expire the following year on the last day of the month in which it was issued.

(e) If a OQA fails to submit a complete application for renewal, in accordance with He-P 601.05, the certificate shall expire.

(f) Any OQA whose certification has expired without the OQA having submitted a complete application for renewal pursuant to He-P 601.05 above shall be treated as an applicant for a new certification.

(g) If the OQA is applying for renewal of its current certificate and the certificate expires, the OQA shall apply for an initial certification, and the certificate issued shall not be retroactive to the expiration of the expired certification.

(h) When there is a change of ownership of an OQA certified under He-P 601, the new owner shall submit the following to the department at least 30 days prior to the change of ownership:

(1) A written request for a new certification, containing:

a. The reason for requesting the certification;

b. The name of the OQA as it appears on the current certificate;

c. The name of the new OQA that will appear on the new certification; and

d. The date upon which the change of ownership will take effect;

(2) A completed application form and supporting documents described in He-P 601.05;

(3) A document confirming the agency’s financial viability in one of the following forms:

a. The most recent financial statement or annual report;

b. The most recent financial audit;

c. A letter from an accountant indicating the financial solvency of the new owner of the OQA; or

d. A letter from a financial institution demonstrating the financial solvency of the new owner of the OQA;

(4) A copy of any certificate of amendment of organizational filings issued by the New Hampshire secretary of state, if applicable;

(5) A copy of the IRS notice that includes the new owner’s federal employer identification number; and

(6) A letter from the current OQA owner, containing:

a. An acknowledgment of the impending change of ownership; and

b. The date when the change of ownership will become final.

(i) When a certificate is lost, destroyed, or damaged, the OQA shall request a replacement certificate in writing from the department within 10 days of discovering the loss.

(j) Any certification that is replaced due to a change in name or ownership shall expire on the same day as the old certification.

(k) The department shall conduct announced or unannounced on site inspections, as necessary, of the OQA.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.08 Plans of Correction

(a) If the department finds the OQA is not in compliance with these rules, the department shall issue a written report including:

(1) The name and address of the physical location of the OQA;

(2) A listing of all rules with which the OQA failed to comply; and

(3) Evidence supporting the finding of non-compliance with each identified rule.

(b) Within 21 days of the date of issuance of the report the OQA shall submit either:

(1) A written plan of correction; or

(2) Information as to why each deficiency did not exist.

(c) The department shall evaluate the information submitted in (b) above and render a written decision concerning:

(1) The merits of the plan of correction, if one is submitted; or

(2) Whether a written plan of correction is necessary, if a plan was not submitted.

(d) The plan of correction submitted in accordance with (b)(1) above shall specify:

(1) How the OQA has corrected or intends to correct and prevent the occurrence of each deficiency; and

(2) The date by which each deficiency will be corrected.

(e) The department shall issue a certificate if it determines that the plan of correction:

(1) Addresses each identified deficiency in a manner which achieves full compliance with rules cited in the report in (a) above;

(2) Does not create a new violation of statute or rule as a result of its implementation; and

(3) States a completion date.

(f) The department shall reject a plan of correction that fails to comply with (e) above.

(g) If the proposed plan of correction is rejected, the department shall notify the OQA in writing of the reason(s) for rejection.

(h) Within 21 days of the date of the written notice under (g) above, the OQA shall submit a revised plan of correction that:

(1) Includes proposed alternatives that address the reason(s) for rejection; and

(2) Is reviewed in accordance with (e) above.

(i) If the revised plan of correction is rejected, the department shall deny the certification request.

(j) The OQA shall submit written documentation to the department that verifies the implementation of the accepted plan of correction.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.09 Revocation of Certification

(a) The department shall revoke a certification, following written notice pursuant to (b) below and opportunity for a hearing pursuant to He-C 200, due to any of the following reasons:

(1) Any founded report of abuse, neglect, or exploitation of an individual by an OQA staff person or personal care services worker, if:

a. Such abuse, neglect, or exploitation is reported on the state registry of abuse, neglect, and exploitation in accordance with RSA 161:F-49;

b. Such person(s) continues to have contact with the individual; and

c. Such finding has not received a waiver;

(2) Unless a waiver is granted, any OQA employee or personal care services worker, who has an administrative finding or criminal conviction as described in He-P 601.11;

(3) The OQA fails to perform criminal background checks on pursuant to He-P 601.11;

(4) An applicant or a licensee violated RSA 161-I or He-P 601 in a manner which poses a risk of harm to a client’s health, safety or well-being;

(5) The OQA or any representative or employee of the OQA provides materially false or misleading information to the department;

(6) The OQA fails to permit or interferes with any inspection or investigation conducted by the department;

(7) The OQA fails to provide required documents to the department; or

(8) At an inspection, the OQA is not in compliance with these rules or other applicable rules.

(b) Certification shall be revoked upon the written notice by the department to the OQA stating the specific rule(s) with which the OQA does not comply.

(c) Any OQA aggrieved by the revocation of the certificate may request an adjudicative proceeding in accordance with He-P 601.15.

(d) The revocation shall not become final until the period for requesting an adjudicative proceeding has expired or, if the OQA requests an adjudicative proceeding, until such time as the administrative appeals unit issues a decision upholding the department’s action.

(e) A OQA shall not accept additional individuals if a notice of revocation of certification has been issued.

(f) Any applicant, OQA, or executive director who has had a certification revoked, shall be prohibited from applying for a new or renewed certification for a period of 5 years.

(g) If an OQA’s certification has been revoked the OQA shall:

(1) Notify the individual, his or her representative, and the individual’s case manager;

(2) Notify OQA employees; and

(3) Discontinue operation immediately.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.10 Duties and Responsibilities of Other Qualified Agencies

An OQA shall:

(a) Provide personal care services and/or intermediary services or both as defined in He-P 601.03;

(b) Monitor and ensure the quality of personal care services and/or intermediary services provided to individuals;

(c) Develop and implement a written person-centered plan that will guide the provision of personal care services, as follows:

(1) The person-centered plan shall be developed in conjunction with the individual and the individual’s representative, if any;

(2) The OQA shall communicate with the individual’s case manager in order to ensure the person-centered plan is consistent with and addresses the applicable service needs identified in the comprehensive care plan; and

(3) The person-centered plan shall contain:

a. A description of the individual’s needs and the scope of personal care services;

b. The dates upon which service will begin and end;

c. The frequency of the service(s);

d. Information on the individual’s health condition, medications, and frequency, allergies, and special dietary needs;

e. The anticipated goals and outcomes of service provision; and

f. A description of an individualized contingency plan that addresses unexpected situations that could jeopardize the individual’s health or welfare, and which:

1. Identifies alternative resources in the event that normally scheduled personal care service providers are unavailable; and

2. Addresses special evacuation needs that require notification of the local emergency responders;

(d) Forward a copy of the person-centered plan in (c) above to the case manager, upon the completion or revision of the plan, and document the date it was sent;

(e) Describe the roles and responsibilities of individuals, representatives, OQA providers and personal care service workers under the agency-directed and consumer-directed personal care services options, as applicable;

(f) Notify individuals of his or her rights and responsibilities including:

(1) The right to select their own personal care service worker:

(2) The process for referring the individual’s selected personal care service worker to the OQA for hire; and

(3) The OQA’s criteria for selecting or not selecting the personal care service worker chosen by the individual;

(g) Develop and implement a system for receiving and processing complaints including:

(1) A complaint and appeal process;

(2) Referrals to the department’s ombudsman program in accordance with RSA 161-F:10-19; and

(3) Reports made in accordance with RSA 161-F:46;

(h) Prepare and distribute person-centered plans, both initial and revised, to individuals and representatives upon request;

(i) Prepare and maintain a policies and procedures manual that contains:

(1) Written policies and procedures for all operational tasks performed and services provided by the agency including agency-directed or consumer-directed personal care services or both;

(2) A confidentiality policy;

(3) A drug free work place statement;

(4) A prohibition of sexual harassment statement;

(5) An individual site and home safety checklist;

(6) A universal precautions policy; and

(7) A proper lifting techniques and body mechanics policy;

(j) Develop and maintain a system for customer service and for the provision of personal care services, including:

(1) A toll-free number by which individuals can access OQA customer services including a statement of the OQA’s business hours and appropriate staff contacts;

(2) A system for returning all calls received during and after regular business hours and prior to the close of the next business day after receipt, respectively;

(3) A system for tracking communications with and complaints/grievances from individuals and for resolving issues in an effective manner;

(4) A communication access plan for the provision of communication access for clients with limited English proficiency, deafness or hearing loss, vision loss, or speech impairments; and

(5) The availability of alternative communication formats;

(k) Establish terms and conditions of employment;

(l) Ensure that the personal care service worker is able to meet the needs of the individual to be served;

(m) Prior to employment, conduct and document:

(1) A criminal background check pursuant to RSA 161-I:6-a, and He-P 601.11; and

(2) A NH central registry check pursuant to RSA 161-F:49;

(n) Prior to personal care service workers providing services to an individual:

(1) Have evidence of a 2-step tuberculosis testing, mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(2) Allow the personal care service worker to begin providing services if the TB test results are negative for the first step, and the personal care service worker is awaiting the results of the second step of the TB test; and

(3) Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis;

(o) Complete reference checks for potential personal care service workers if requested by the individual in writing via letter, e-mail, or fax;

(p) Provide information to individuals or their representatives about employing a consumer-directed personal care service worker including, but not limited to:

(1) Techniques for interviewing and screening personal care service workers;

(2) Preparing interview questions;

(3) How to schedule and conduct an interview with a prospective personal care services worker;

(4) The process for referring selected personal care service workers to the OQA for hire;

(5) The process for informing candidates that they have not been selected for employment; and

(6) Techniques for supervising personal care service workers;

(q) Develop a process for receiving and reviewing completed personal care service worker applications;

(r) Develop a personal care service worker’s employment package including but not limited to:

(1) A personal care service worker’s handbook;

(2) An employment application;

(3) INS Form I-9, Verification of Citizenship and Alien Status, with instructions and completed example;

(4) IRS Form W-4, Employee’s Withholding Allowance Certificate with instructions and completed example;

(5) IRS Notice 797, Possible Federal Tax Refund Due to the Earned Income Credit (EIC);

(6) The hiring criteria and requirements used by the OQA for rejecting a personal care service worker for employment who was recruited and referred by an individual;

(7) A confidentiality policy;

(8) A drug free work place statement;

(9) A statement on the prohibition of sexual harassment statement;

(10) A statement signed by the individual or the representative and the personal care service workers stating that the worker has the necessary knowledge, skills, and experience to meet the individual’s personal care services needs;

(11) The agreement form signed by every individual or representative agreeing to abide by OQA policies and procedures;

(12) Payroll pay days schedule that the personal care service worker’s paychecks are issued; and

(13) The payroll schedule illustrating when verification of the personal care service worker’s time worked are to be completed;

(s) Develop and maintain a system for collecting and verifying the following information:

(1) The name and address of the individual receiving personal care services;

(2) The name of the personal care service worker;

(3) The day of the week, date, and amount of time spent providing each occurrence of personal care services; and

(4) The total number of units of service provided during the time period documented;

(t) Include the following on paper timesheets when they are used:

(1) The signature of the individual receiving or directing the personal care services indicating that the service was provided in accordance with the care plan, and to the individual’s satisfaction; and

(2) The signature or equivalent evidence/verification of the personal care service worker indicating that the information provided is accurate and signifying that the employee understands that falsification of information provided could lead to prosecution;

(u) Develop and implement a process for distributing personal care service worker’s payroll checks, ensuring that:

(1) The OQA is in compliance with federal and state minimum wage and overtime laws;

(2) Only approved hours are reimbursed; and

(3) The OQA has the option of paying workers via direct deposit or mailing paychecks to workers’ homes;

(v) Assist individuals and representatives to develop of an emergency back-up plan in the event that the personal care service worker fails to report for work;

(w) Implement procedures for:

(1) Comparing the information verified in (s) above with the individual’s person-centered plan described in (c);

(2) Notifying the individual or representative when information regarding the time worked does not reconcile and facilitating the resolution of issues before payroll is processed;

(3) The evaluation of the personal care service worker performance; and

(4) The termination of a personal care service worker;

(x) For OQAs that offer consumer-directed personal care services, develop and maintain a personal care service worker registry that individuals and representatives can access when recruiting their personal care service workers;

(y) Ensure that:

(1) Individuals or their representatives train their consumer-directed personal care service workers; and

(2) Workers providing consumer-directed personal care services can access other training opportunities as deemed necessary by the individual or their representative receiving services;

(z) Provide orientation to personal care service workers that includes but is not limited to:

(1) Agency policies and processes including those dealing with confidentiality;

(2) The individual’s bill of rights;

(3) Mandated adult protective services (APS) reporting;

(4) Health insurance portability and accountability act (HIPAA) basics;

(5) Blood-borne pathogens and universal precautions; and

(6) Basic lifting techniques;

(aa) Conduct skills training at the agency or individual’s home, including a description of the skills training topics available;

(ab) Develop techniques for orienting and training personal care service workers and document the training provided;

(ac) Report to the appropriate authority any individual who is suspected of being abused, neglected, exploited, or self-neglecting, in accordance with the adult protection law, RSA 161-F:46;

(ad) Initiate action to maintain the OQA in full compliance at all times with the health and safety requirements contained in applicable federal, state and local laws, rules, regulations, and ordinances;

(ae) Possess and maintain written proof of insurance coverage as required by applicable state or local laws and rules;

(af) Comply with the department’s quality assurance procedures in accordance with RSA 126-A:4, IV and these rules;

(ag) Identify, report, and manage:

(1) Personal care service worker-related injuries;

(2) Individual’s injuries; and

(3) General incidence reporting;

(ah) Maintain and make available safety information, including, but not limited to:

(1) An individual site and home safety checklist;

(2) Procedures for identifying and reporting personal care service worker’s injuries;

(3) Procedures for addressing emergencies;

(4) Emergency contact people and telephone numbers to contact at the OQA; and

(5) Procedures regarding universal precautions and safe lifting techniques;

(ai) Establish a disaster recovery plan for computer files that addresses:

(1) The estimated time for the return to operation; and

(2) The accuracy of software and data at return to operation;

(aj) Ensure all personnel utilize universal precautions as defined in He-P 601.03(w); and

(ak) Comply with and make available upon request any licensing or certification requirements required by applicable federal, state, or local laws and/or rules.

New #13115, eff 10-1-20

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11; amd by #9959, eff 7-26-11 (para (n)); EXPIRED 3-19-19 in paras (a)-(m) and (o)-(ak); EXPIRED 7-26-19 in para (n)

N.H. Code Admin. R. Ann. He-P 601.11 Personnel Requirements

(a) OQAs shall employ the following:

(1) An executive director;

(2) A director of personal care services;

(3) Professional staff adequate to provide consumer-directed programs and guidance to individuals receiving personal care services; and

(4) Personal care service workers.

(b) The executive director and director of personal care services shall:

(1) Be at least 21 years of age; and

(2) Be able to demonstrate knowledge regarding the philosophy and application of consumer-direction to personal care services.

(c) If the OQA has a change in its executive director, the OQA shall notify the department in writing of the change no later than 90 days after the employment start date of the new executive director.

(d) The new executive director shall meet the requirements in (b) above.

(e) Each staff member or personal care service worker shall:

(1) Be at least 17 years of age;

(2) Be found by the OQA executive director or his or her designee to have the knowledge and skills necessary to successfully perform the tasks necessary to meet the needs of the individual receiving services.

(f) For all new hires prior to employment, the OQA shall:

(1) Verify the person’s qualifications; and

(2) Verify that the person is not listed on the BAAS state registry pursuant to RSA 161-F:49 or does not have a finding of abuse, neglect, or exploitation following a similar investigation conducted by another state.

(g) For potential employees whose scope of employment will include the provision of services in an individual’s home or otherwise involves direct contact with an individual, the following shall apply:

(1) The OQA shall obtain and review a criminal conviction record check in accordance with RSA 161-I:6-a; and

(2) Without a waiver granted in accordance with He-P 601.16 the OQA shall not make a final offer of employment if the person has been convicted of a felony.

(h) Waivers of (g)(2) above shall be effective for the length of the person’s employment, unless additional convictions occur.

(i) For employees hired prior to the 2020 effective date of these rules who have a conviction described in (g)(2), the OQA shall submit waiver requests in accordance with He-P 601.16 no later than the expiration date of the OQA’s current certification.

(j) For personal care service workers with a misdemeanor conviction, prior to the initiation of services to each individual served, the OQA shall:

(1) Disclose to the individual or his or her representative the personal care service worker’s conviction and discuss the impact of the individual’s selection on the provision of services, including the following:

a. Whether or not the conviction poses a threat to the health and safety of the individual;

b. What safeguards will be in place to maintain the health and safety of the individual, if the personal care service worker were to provide services; and

c. Whether or not the individual consents to the personal care service worker providing services, after being so informed; and

(2) Maintain the following in the service record:

a. Documentation of the date on which the conviction was discussed with the individual or his or her representative as described in (1) above;

b. The steps taken to implement the safeguards described in (1)b. above; and

c. A signed statement from the individual indicating that he or she has been informed of the conviction as describe in (1) above and consents to the personal care service worker providing services.

(k) All personnel shall sign separate statements indicating whether or not that they:

(1) Have had a felony conviction in this or any other state;

(2) Have been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a client;

(3) Have had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; and

(4) Understand they are required to report any administrative finding or criminal conviction to the OQA during the duration of their employment.

(l) All personnel shall report any administrative finding or felony or misdemeanor criminal conviction to the OQA during the duration of their employment.

(m) All professional staff hired by the OQA shall be licensed or registered as required by applicable state or federal laws.

(n) The executive director shall carry out all of the policies and procedures of the OQA.

(o) The executive director, president, or CEO shall be responsible for:

(1) Administering agency management and fiscal matters;

(2) Implementing the goals and objectives of the agency;

(3) Implementing all written policies and procedures of the certified other qualified agency;

(4) Employing and terminating staff, in conjunction with individuals receiving consumer-directed personal care services;

(5) Designating, in writing, a staff member who is responsible for administering the agency in the absence of the executive director;

(6) Planning, organizing, and directing activities that may be delegated;

(7) Appointing the director of personal care services; and

(8) Ensuring the accuracy of informational materials and activities.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.12 Documentation, Recordkeeping and Reporting

(a) Personnel records shall be maintained by the OQA for all employees.

(b) Each employee’s personnel record shall include the following:

(1) The name, address, and telephone number of the employee;

(2) The employee’s qualification for the position, including, as applicable, education, training, and his or her referral for hire by an individual;

(3) The employee’s prior work experience and employment references;

(4) Proof of age;

(5) A copy of a valid photo identification;

(6) A completed INS Form I-9 Verification of Citizenship and Alien Status, if applicable;

(7) Copies of all required federal and state employment tax and insurance related forms;

(8) A signed verification by the employee that he or she has received a copy of the OQA’s policy setting forth the rights and responsibilities of individuals served and the rights and responsibilities of the employee;

(9) A statement signed by the employee and the consumer receiving the personal care services or the consumer’s representative that the employee has the skills and experience and has received orientation by the agency and training sufficient to meet the needs of the individual;

(10) A signed statement in accordance with He-P 601.11(k);

(11) A record of all training received; and

(12) Documentation of completed criminal background check pursuant to RSA 161-I:6-a and central registry check pursuant to RSA 161-F:49.

(c) The OQA shall ensure that all records are legible, current, and accurate.

(d) Personnel records shall be retained for 7 years after discharge of a personal care service worker.

(e) The OQA shall arrange for the storage and retrieval of personnel records in the event that the OQA ceases operation.

(f) Personnel records shall be maintained in a confidential manner as follows:

(1) Active and archived personnel records shall be maintained in a locked, metal container, room, or cabinet at the organization;

(2) Individual personnel records shall not contain information pertaining to other employees;

(3) Access to personnel files shall be limited as authorized by federal, state, or local law or regulations;

(4) Personnel files shall be readily available to any persons authorized to review such records including the department during any complaint investigation; and

(5) Computerized files shall be protected by access restrictions.

(g) Service records for each individual shall be maintained by the certified OQA for all services provided to individuals.

(h) Service records shall include, but not be limited to:

(1) The individual’s name, address, telephone number, and date of birth;

(2) If the individual has designated a representative, the representative’s name, date of birth, relationship to the individual, address, and phone number, when applicable;

(3) An emergency contact name, the contact’s relationship to the individual, address and telephone number;

(4) The name of individual’s case manager and his or her contact information;

(5) Medicaid and other insurance information, as applicable;

(6) A copy of the individual’s person-centered plan and all updates;

(7) The names of the individual’s back-up personal care service worker(s) and back-up plan;

(8) The personal care service-related training provided to each personal care service worker by the individual or his or her representative;

(9) Copies of payroll summary reports;

(10) Documentation of all assessments of the individual that are conducted by the OQA;

(11) Documentation of all communications with the individual and with the individual’s case manager;

(12) Documentation of the information required in He-P 601.11(j)(2) including the implementation of safeguards in accordance with He-P 601.11(j)(2)b., if applicable;

(13) A signed acknowledgement of receipt of the individual’s bill of rights signed by the individual or his or her representative;

(14) A signed acknowledgement of the individual or the representative’s receipt of the manual as described in (e) above;

(15) Documentation of the personal care services provided in accordance with He-P 601.10(s); and

(16) Documentation of termination of services including:

a. The date of discharge;

b. The health and functional status of the individual at discharge;

c. Discharge planning information;

d. Any discharge referrals which have been made; and

e. Reason for discharge.

(i) Service records for each individual shall be maintained as follows:

(1) The OQA shall ensure that all individuals’ service records are legible, current and accurate;

(2) Individuals’ service records shall be retained for 7 years after discharge of an individual;

(3) An OQA shall arrange for storage and access as needed of individuals’ service records in the event the OQA ceases operation;

(4) Individuals’ service records shall be maintained in a confidential manner including the following:

a. Separate individual service records shall be maintained for each individual receiving personal care services and shall contain all information required in (h) above;

b. Service records shall be retained at the OQA;

c. Service records shall be maintained in accordance with the HIPAA;

d. An OQA shall develop and implement a policy that shall determine the method by which written release of information contained in the individual’s service record shall occur;

e. All files shall be accessible only to the staff designated by the OQA director and protected by federal, state, or local law or regulation;

f. Except to the extent prohibited by the requirement in (4)e. above, each service record shall be readily available to the professional staff, health care worker, and any persons legally authorized to review such records ; and

g. An OQA shall provide the individual with a copy of his or her service record upon receipt of the request from that individual;

(5) An OQA shall have a system in place and a policy and procedure for preparing and distributing billing summary reports to individuals or representatives for each billing period; and

(6) Copies of each report, specified in (5) above, shall be kept in the individual’s service record;

(7) The billing summary report shall include, but not be limited to:

a. The individual’s name, address and telephone number;

b. The individual’s Medicaid identification number, when applicable;

c. The name of the individual’s case manager and his or her telephone number;

d. The billing period;

e. The total hours per week and hours per day of personal care services rendered;

f. The total number of billing units;

g. The billing rate per hour; and

h. The total amount billed per week.

(j) The OQA shall maintain the original versions of each employee’s properly executed time sheets or records demonstrating electronic documentation of the employee’s time worked;

(k) The OQA shall make available to the department the individual’s service records and related documents necessary for the purposes of verification of compliance with the scope, duration, and intent of the department’s support plan developed for the individual.

(l) The OQA shall not engage in falsification of any documents or records related to individuals’ personal care service provision and billing.

(m) Each OQA shall post the following documents in an area of the premises that is conspicuous and open to individuals and the general public:

(1) The agency’s current certificate;

(2) All investigation reports issued by the department and other relevant regulatory agencies for the previous 12 months;

(3) Any notice of a pending hearing or order pertaining to the certified other qualified agency that has been issued by the department or a court during the previous 24 months;

(4) A copy of the individual’s bill of rights as defined in He-P 601.03 (n);

(5) A copy of the OQA’s policies and procedures relative to the implementation of the individual’s bill of rights and responsibilities;

(6) A copy of the OQA’s complaint procedure; and

(7) A notice stating that complaints regarding the OQA may be submitted to:

Department of Health and Human Services

Bureau of Adult and Aging Services

129 Pleasant St. Concord, NH 03301

1-800-351-1888, ext. 7857 or (603) 271-9212.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.13 Representative

(a) The individual, his or her legal guardian, or a person granted power of attorney by the individual may designate a representative to act on the individual’s behalf:

(1) When directing personal care services being provided; and

(2) Under the following conditions:

a. The persons named below shall not serve as representatives for purposes of personal care services:

1. The personal care worker providing the services;

2. The individual’s case manager; and

3. Anyone having a financial relationship with any agency providing personal care services or intermediary services to the individual; and

b. The personal care representative shall be designated through a written document signed by the individual or his or her legal guardian or by the person granted power of attorney, and a witness, stating that:

1. The personal care representative’s role only applies to decisions made regarding the personal care services described in this rule;

2. The appointment of a personal care representative can be revoked at any time by either party; and

3. The responsibilities of the personal care representative shall be to:

(i) Have weekly face-to-face contact with the individual and the personal care worker;

(ii) Have monthly contact with the CFI case manager concerning personal care services;

(iii) Ensure that the personal care worker is taking the individual’s care preferences into consideration; and

(iv) Communicate concerns or satisfaction to the other qualified agency regarding the personal care worker, when appropriate.

(b) An OQA shall have written policies and procedures for:

(1) Verifying that each individual’s representative meets department requirements;

(2) Obtaining from the individual or his or her guardian or his or her power of attorney the representative’s name, address, telephone number, and scope of authority;

(3) Collecting and keeping current a copy of the written document, signed by the individual or his or her guardian or his or her power of attorney stating the information included in section (a)(2)b. above;

(4) Communicating with the individual’s representative issues and their satisfaction with the personal care services being received by the individual; and

(5) Obtaining from the individual or his or her guardian or from his or her power of attorney any changes in representation within 30 days of the date that the change occurs and keeping this information current.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.14 Monitoring the Quality of Services

(a) An OQA shall comply with the department’s quality assurance procedures in accordance with RSA 126-A:4, IV and these rules.

(b) OQAs providing personal care services shall:

(1) Develop a quality assurance program which shall assess patterns and trends of activities which affect the quality of care and the application of the philosophy of consumer-direction; and

(2) Initiate action to develop or modify currently existing agency policies to assure that an optimum quality of care and the level of consumer choice whereby an individual shall have the option to receive personal care services, including agency-directed or consumer-directed services or both, through a home health agency or an other qualified agency and direction for all individuals receiving personal care services.

(c) An OQA shall ensure that an appropriate staff member, other than the personal care worker:

(1) Conducts by mail individual and representative satisfaction surveys that shall be:

a. Available in alternative formats upon request;

b. Mailed within 60 days of when the agency began serving the individual or representative; and

c. Conducted on an annual basis after the initial survey;

(2) Conducts satisfaction surveys with individuals who have representatives based on the schedule outlined in (1)a. and b. above; and

(3) Verifies if the person-centered plans are being carried out by comparing documentation of provided services with services required in the person-centered plan in addition to (1) and (2) above.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.15 Appeals

(a) The department shall notify applicants or OQA of the department’s decision to deny or revoke a certification of the right to request an administrative appeal in accordance with RSA 541-A and He-C 200.

(b) If an applicant or OQA fails to request an administrative appeal in writing within 30 days of the date of the notice, the action of the department shall become final.

(c) Administrative appeals under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(d) Further appeals of department decisions under this section shall be governed by RSA 541.

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.16 Waivers

(a) Applicants or OQA seeking waivers of specific rules requirements in He-P 601 shall submit written requests for waivers to the commissioner.

(b) The written request for a waiver shall include:

(1) Identification of the specific section of the rule for which a waiver is being sought;

(2) A full explanation of why the applicant or OQA believes the waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or the OQA; and

(4) The period of time for which the waiver is sought, which shall be no longer than 12 months after the waiver request date, except as allowed by He-P 601.11(h).

(c) A request for a waiver shall be granted only if the commissioner of the department determines that the alternative proposed by the applicant or OQA:

(1) Meets the objective or intent of the rule; and

(2) Either:

a. Does not negatively impact the health or safety of the individuals being served by the OQA; or

b. Is administrative in nature and does not affect the quality of care provided to individuals.

(d) All waivers, except as allowed by He-P 601.11(h), shall expire on the same day as the certificate or 12 months after the request, whichever is sooner.

(e) The OQA’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which the waiver was sought.

(f) Waivers shall not be transferable.

(g) If a OQA wishes to extend the waiver beyond the period of time in (d) above , the OQA shall apply for a new waiver at least 60 days prior to the expiration of the existing waiver by submitting the information required by (b) above.

(h) The request to extend a waiver shall be subject to (b) through (g) above.

Appendix A: Incorporation by Reference

History

• (See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11, EXPIRED: 3-29-19
• #13115, eff 10-1-20

N.H. Code Admin. R. Ann. He-P 601.10 Certification of Other Qualified Agencies

(n)(3) Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition) Publisher: Centers for Disease Control and Prevention Cost: Free of Charge The incorporated document is available at: https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

Appendix B

Rule

Specific State Statute which the Rule Implements

He-P 601.01-601.02

RSA 161-I:1

He-P 601.03

RSA 161-I:2

He-P 601.03(a)

RSA 151:2-b, IV

He-P 601.04

RSA 161-I:7

He-P 601.05

RSA 541-A:29; RSA 161-I:7

He-P 601.06-601.09

RSA 161-I:7

He-P 601.10

RSA 161-I:6; RSA 161-I:6-a; RSA 161-I:7

He-P 601.11

RSA 161-I:5; RSA 161-I:7

He-P 601.12

RSA 161-I:7,I(e)

He-P 601.13

RSA 161-I:4,II & 7,IV

He-P 601.14

RSA 161-I:7

He-P 601.15

RSA 541-A:16, I(b)

He-P 601.16

RSA 541-A:22,IV

Chapter He-P 800 Residential Care and Health Facility Rules

Part He-P 801 General Requirements for All Facilities

N.H. Code Admin. R. Ann. He-P 801.01 Residential Care and Health Facility Rules

• EXPIRED

History

• #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; amd by #5933, eff 12-8-94; amd by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99, paragraph (r) EXPIRED: 12-8-00

N.H. Code Admin. R. Ann. He-P 801.02 Residential Care and Health Facility Rules

– He-P 801.06 - EXPIRED

History

• #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

N.H. Code Admin. R. Ann. He-P 801.07 Residential Care and Health Facility Rules

• EXPIRED

History

• #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; amd by #5933, eff 12-8-94; amd by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99, paragraphs (b) through (e) EXPIRED: 12-8-00

N.H. Code Admin. R. Ann. He-P 801.08 Residential Care and Health Facility Rules

– He-P 801.26 - EXPIRED

History

• #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

Part He-P 802 Rules for Hospitals and Special Health Care Services

N.H. Code Admin. R. Ann. He-P 802.01 Purpose

The purpose of this part is to set forth the licensing requirements for all hospitals pursuant to RSA 151:2, I(a) and the special health care services offered by hospitals pursuant to RSA 151:2-e.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34

N.H. Code Admin. R. Ann. He-P 802.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a hospital, except:

(a) All facilities listed in RSA 151:2, II(a)-(i); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

History

• #2044, eff 6-3-82; amd by #2793, eff 8-2-84; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34

N.H. Code Admin. R. Ann. He-P 802.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) “Acute care hospital” means a hospital that provides inpatient medical care and other related services for surgery, acute medical conditions, or injuries usually for a short term illness or condition.

(d) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(e) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, pursuant to RSA 318-B and RSA 326-B.

(f) “Administrator” means the person responsible for the management of the licensed premises and who reports to and is accountable to the governing body.

(g) “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services. This term also includes “admitted”.

(h) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. The term “advance directive” includes living wills, durable powers of attorney for health care, or surrogate decision makers in accordance with RSA 137-J.

(i) “Adverse event” means a consequence of care that results in an undesired outcome which may or may not have been preventable, and which is listed in RSA 151:38.

(j) “Affiliated parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, and captive or affiliated insurance companies. This term includes “related parties”.

(k) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA 137-J:34-37.

(l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a hospital pursuant to RSA 151:2, I(a) or provide a special health care service pursuant to RSA 151:2-e.

(m) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 802, or other applicable federal or state requirements.

(n) “Cardiac catheterization laboratory services” mean those cardiac catheterization procedures that are performed in a cardiac catheterization laboratory, including diagnostic and interventional cardiac catheterization procedures.

(o) “Care plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, and the patient’s guardian or agent, if any, as a result of the assessment process for the provision of care and services. This term includes “treatment plan”.

(p) “Change of ownership” means a change in the controlling interest of an established hospital or provider of special health care services to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(q) “Chemical restraint” means a drug or medication used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.

(r) “Commissioner” means the commissioner of the department of health and human services or their designee.

(s) “Controlling interest” means greater than 50% ownership interest.

(t) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

(u) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(v) “Days” means calendar days unless otherwise specified in the rule.

(w) “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151 or He-P 802.

(x) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post-test to the training provided.

(y) “Department” means the department of health and human services, at 129 Pleasant St, Concord, NH 03301.

(z) “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(aa) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee needs to take to correct identified deficiencies.

(ab) “Dietitian” means a person who is licensed under RSA 326-H.

(ac) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ad) “Elopement” means an event in which a patient who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away, escapes, or otherwise leaves the facility unsupervised, unnoticed, or prior to their scheduled discharge.

(ae) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(af) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ag) “Emergency psychiatric services” means those services available on a 24-hour basis when a patient needs immediate treatment for psychiatric health concerns.

(ah) “Emergency services” means those services rendered in accordance with RSA 151:2-g and includes emergency medical treatment of both physical and behavioral health concerns.

(ai) “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(aj) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license or suspension of a license in response to non-compliance RSA 151 or He-P 802.

(ak) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes “fixtures”.

(al) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(am) “Facility” means “facility” as defined in RSA 151:19, II, including the part of the hospital where special health care services are rendered in accordance with RSA 151:2-e.

(an) “Freestanding hospital emergency facility (FHEF)” means a hospital geographically separate from the parent hospital, which is owned or operated, directly or indirectly, by the parent hospital and which provides emergency acute care identical to those services provided by the parent hospital.

(ao) “Good cause” means any circumstances beyond a person’s control that prevents that person from taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(ap) “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(aq) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

(ar) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).

(as) “Hospital” means “hospital” as defined in RSA 151:2, I(a).

(at) “Incident command system (ICS)” means a standardized on-scene emergency management

system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(au) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.

(av) “Infectious waste” means those items specified by Env-Sw 904.

(aw) “Informed consent” means the decision by a person, their guardian or agent, or surrogate decision-maker, to agree to a proposed course of treatment, after the person, their guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about the risks and benefits of the treatment and available alternatives, needed to make the decision competently.

(ax) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(ay) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 802 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 802.

(az) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 802, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.

(ba) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(bb) “Licensed premises” means the building, or portion thereof, that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(bc) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(bd) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(be) “Locked unit” means a locked, secured, or alarmed hospital or units within a hospital, or anklets, bracelets, or similar devices that cause a door to close automatically and lock when approached, thereby preventing a patient from freely exiting the hospital or unit within.

(bf) “Long term care hospital (LTCH)” means a hospital certified as an acute care hospital by CMS that provides a broad spectrum of clinical services to acutely ill and medically complex patients, other than a rehabilitation, psychiatric, substance use disorder, intermediate care facility, or skilled nursing facility service, that has an average length of inpatient stay greater than 25 days and that meets the long-term care hospital patient level criteria issued by CMS.

(bg) “Material adverse impact” means “material adverse impact” as defined in RSA 151:4-a, I (b).

(bh) “Medical director” means a physician licensed in New Hampshire pursuant to RSA 329, who is responsible for the implementation of patient care policies and the coordination of medical care in the hospital.

(bi) “Medical staff” means those physicians and other licensed practitioners permitted by law and licensee policies to provide patient care services independently within their scope of practice.

(bj) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(bk) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.

(bl) “Megavoltage radiation therapy equipment” means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues. The term includes, but is not limited to, Cobalt-60 and linear accelerator machines.

(bm) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. This term does not include repair or replacement of interior finishes.

(bn) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any patient. For the purposes of this definition, minimum means that the hospital provides stabilizing treatment to all patients until the patient has been physically transferred from the hospital.

(bo) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bp) “Nursing care” means the provision or oversight of a patient’s physical, mental, or emotional condition or diagnosis by a nurse, that if not monitored on a routine basis by a nurse, would or could result in physical or mental harm to a patient.

(bq) “Open heart surgery (OHS)” means open surgical procedures on the heart muscle, valves, coronary arteries, or other heart structures, including coronary artery bypass graft surgery.

(br) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bs) “Owner” means a person, organization, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of or title to, a license.

(bt) “Parent hospital” means the hospital which owns and operates a freestanding hospital emergency facility.

(bu) “Patient” means any person admitted to or in any way receiving care, services, or both from a hospital licensed in accordance with RSA 151 and He-P 802.

(bv) “Patient record” means a separate file maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 802 and all documentation as required by other federal and state requirements.

(bw) “Patient rights” means the privileges and responsibilities possessed by each patient pursuant to RSA 151:21.

(bx) “Patient’s personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in, a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.” This term includes “personal representative”.

(by) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(bz) “Personal care” means personal care services that are non-medical, hands-on services provided to a patient including, but not limited to, assistance with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the patient to take medications.

(ca) “Personnel” means an individual who is employed by, a volunteer of, or an independent contractor of the hospital who provides services to patients.

(cb) “Physical restraint” means any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move their arms, legs, body, or head freely.

(cc) “Physician” means medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329.

(cd) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified deficiencies with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(ce) “Primary interventional cardiac catheterization” means those catheter-based procedures that involve modification of the coronary arterial system under emergency conditions.

(cf) “Pro re nata (PRN) medication” means medication administered as circumstances might require in accordance with licensed practitioner’s orders.

(cg) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(ch) “Protective care” means the provision of patient monitoring services, including but not limited to:

(1) Knowledge of patient whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(ci) “Psychiatric hospital” means a:

(1) Hospital that has been verified by CMS as an inpatient psychiatric hospital; or

(2) Hospital designated by CMS to provide psychiatric services in a distinct part unit.

(cj) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(ck) “Radiographic images” means x-rays or other images which are either on film, paper, or stored electronically.

(cl) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cm) “Rehabilitation” means any of the following undertaken in an existing building:

(1) Addition;

(2) Modification;

(3) Reconstruction;

(4) Renovation; and

(5) Repair.

(cn) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(co) “Rehabilitation hospital” means a:

(1) Hospital that has been certified by CMS as an inpatient rehabilitation hospital; or

(2) Hospital designated by CMS to provide comprehensive physical rehabilitation services in a distinct part unit.

(cp) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cq) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.

(cr) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

(cs) “Service area” means “service area” as defined in RSA 151:4-a, I (c).

(ct) “Special health care service” means cardiac catheterization laboratory services, open heart surgery, or coronary artery bypass graft surgery, or treatment using megavoltage radiation therapy equipment.

(cu) “State building code” means “state building code” as defined in RSA 155-A:I, IV.

(cv) “State fire code” means “state fire code” as defined in RSA 153:1, VI-a as amended by rules adopted pursuant to RSA 153:5.

(cw) “State monitoring” means the placement of individuals by the department to monitor the operation and conditions of the facility.

(cx) “Surgery” means a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedures.

(cy) “Swing beds” means beds within a hospital or critical access hospital participating in Medicare that are approved by the CMS for the provision of a skilled level of care.

(cz) “Volunteer” means an unpaid person who assists with the provision of services such as personal care services, food services, entertainment, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34

N.H. Code Admin. R. Ann. He-P 802.04 Notice to Critical Access Hospitals

(a) Prior to submitting an application for licensure in accordance with He-P 802.05, a proposed facility shall comply with the requirements of RSA 151:4-a, II, and send written notification of its intent to submit an application for licensure as a hospital, or special health care service, via certified mail to the department and to the chief executive officer of all critical access hospitals with a primary physical location within a 15 mile radius of the proposed hospital, or special health care service.

(b) The written notification required in (a) above shall contain the following:

(1) The name of the person or entity seeking to establish the proposed hospital, or special health care service;

(2) The proposed physical location of the facility; and

(3) The scope of services for the facility.

(c) Upon receipt of the written notification in (a) above, the chief executive officer of the critical access hospital(s) shall have 30 days to file a written objection with the department.

(d) The written objection in (c) above shall contain the following:

(1) The critical access hospital’s detailed basis for the objection to the proposed facility to include:

a. If the proposed facility will have a material adverse impact on the critical access hospital’s operations; and

b. How the proposed facility will impact the health care services, in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

(2) Proof that the objection was sent via certified mail to the proposed individual or entity seeking to establish the proposed facility.

(e) Upon receipt of an objection meeting the requirements of (d) above, from a critical access hospital located within a 15 mile radius of a proposed hospital, or special health care service, the department shall send a letter to the proposed facility informing them of the:

(1) Objection and the reason for the objection; and

(2) Opportunity to submit a written response to the objection, which shall include at a minimum:

a. Any information regarding the objection that might be relevant to the determination of material adverse impact; and

b. How the proposed facility will not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources.

(f) The department shall provide the names of 3 independent contractors, retained by the department through a competitive procurement process, to the critical access hospital and proposed facility for their consideration.

(g) The independent contractors proposed in (f) above shall be experts in the provision of health care services and skilled in determining how utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources could be impacted by the proposed facility.

(h) If, after proposing 3 independent contractors, the critical access hospital and proposed facility cannot agree on an independent contractor within 30 days of the proposal by the department, the department shall designate the independent contractor to perform the assessment and create the expert report.

(i) Within 30 days of the selection of the independent contractor in accordance with (f) and (h) above, the department shall send a letter to the selected independent contractor requesting their services. This letter shall include:

(1) A request to engage the independent contractor’s services to perform the assessment and create the expert report as required in RSA 151:4-a, II(b);

(2) A summary of the requirements for the content of the expert report, to include:

a. How the proposed project might or might not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

b. A summary of public comments received in accordance with (q) below shall be taken into consideration in completing the assessment;

(3) The contact information for the proposed facility and chief executive officer of the critical access hospital(s) raising the objection(s);

(4) The objection and response along with any other documentation received by the department relative to this transaction; and

(5) A deadline for completion of the expert report, which shall be no later than 90 days from retention of the expert unless an extension is granted by the department in accordance with (s) below. Such an extension shall not exceed 30 days.

(j) Upon selection of the independent contractor, the department shall notify the proposed facility and critical access hospital of the selected independent contractor.

(k) The independent contractor shall invoice the proposed facility and critical access hospital the cost of any fees associated with the retention and work to be completed. The fees shall be shared equally between the proposed facility and the critical access hospital.

(l) Invoices shall be paid for in advance of any services performed in accordance with RSA 151:4-a, II(b)(6).

(m) Payment of the proposed facility’s and critical access hospital’s portion of the advance retainer for the independent contractor shall be paid within 5 business days.

(n) If the proposed facility fails to make payment in accordance with (m) above, it shall forfeit its right to submit an application for licensure.

(o) If the critical access hospital fails to make payment in accordance with (m) above, it shall forfeit its right to object and the proposed facility shall be allowed to apply for licensure.

(p) In accordance with RSA 151:4-a, II(b), the proposed facility and critical access hospital shall provide any information requested by the independent contractor to complete its report in accordance with the following:

(1) Information obtained at the request of the independent contractor shall not be considered confidential under RSA 151:13, unless the department determines that it should be exempt from disclosure under RSA 91-A:5;

(2) The proposed facility and critical access hospital shall provide the information within a reasonable time, as determined by the independent contractor, based on the scope of work of the project and the expected time to review said documentation, so that the independent contractor may finish its report in the required 90 day time period;

(3) If the proposed facility fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to submit an application for licensure; and

(4) If the critical access hospital fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to object and the proposed facility shall be allowed to apply for licensure.

(q) Within 30 days of retention of the independent contractor, the department shall publish a notice on the department’s website to notify the public of the proposed health care facility and solicit public comment for a period of at least 7 days.

(r) All public comments received in (q) above shall be provided to and considered by the independent contractor for use in the analysis.

(s) Within 90 days of retention of the independent contractor, the report as described in RSA 151:4-a, II(b) and (i)(1)-(2) above, shall be submitted to the department, unless an extension is granted by the department in accordance with the following:

(1) The department shall grant an extension for good cause;

(2) Good cause shall be determined by the department and a finding of good cause shall require the independent contractor to show why the report cannot be completed within the 90 days and that the extension is not a result of the proposed health care facility or critical access hospitals failure to comply with the rules; and

(3) Such an extension shall not exceed 30 days.

(t) Within 10 days of receipt of the expert report, the department shall provide a copy of the report to the proposed facility and critical access hospital.

(u) If the report finds that the proposed facility will have a material adverse impact, then the proposed health care facility shall not be allowed to apply for licensure.

(v) If the report finds that the proposed facility will not have a material adverse impact, then the proposed facility may proceed with application for licensure.

(w) The person or entity seeking to establish the proposed facility and the critical access hospital(s) shall have the right to request a rehearing by the commissioner, pursuant to RSA 541:3.

(x) The result of the rehearing may be appealed by petition to the NH Supreme Court, pursuant to RSA 541:6.

(y) If the proposed facility chooses to move forward with the licensing process prior to all appeal rights being exhausted, the proposed facility shall do so at its own risk and shall not hold the critical access hospital or the department liable for any costs incurred.

(z) The appellant shall bear all costs of the state in connection with any rehearing or petition for appeal, including the state’s attorneys’ fees.

History

• #14081, eff 9-25-24, EXPIRES: 9-25-34

N.H. Code Admin. R. Ann. He-P 802.05 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (August 2025), signed by the owner or 2 of the corporate officers, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”; and

b. For any facility required to comply with RSA 151:4-a:

“I affirm that I have complied with RSA 151:4-a and a determination is on file with the department that finds the proposed health care facility shall be allowed to apply for licensure.”;

(2) A floor plan of the prospective hospital;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) List of affiliated or related parties;

(5) The applicable fee in accordance with RSA 151:5, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the name and qualifications of the administrator and medical director;

(7) Copies of applicable licenses, certificates, or both, for the administrator and medical director;

(8) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code and local fire ordinances for a health care facility; and

b. For a building under construction, the written approvals required by (a) above shall be submitted at the time of the application based on the local official’s review of the building plans and their final inspection upon completion of the construction project;

(9) If the hospital uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if public water supply is used, a copy of a water bill;

(10) A written statement from the applicant, proposed licensee, administrator, and medical director stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient in this or any other state;

c. Do not have any permanent restraining or protective orders against the applicant, licensee, or administrator; and

d. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person in this or any other state;

(11) If any of the items in (10) above have occurred, the individual shall include a detailed explanation of the circumstances surrounding the occurrences;

(12) The results of a criminal records check for the applicant(s), licensee if different than the applicant, administrator, and medical director that shall include a criminal history from the state of New Hampshire;

(13) The results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director: and

(14) Any waiver requests, if applicable.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

(c) If a hospital has not previously performed a special health care service but plans to do so, the hospital shall complete a new application including all of the above application requirements and any information required under He-P 802.39, He-P 802.40, and He-P 802.41.

(d) A previously operating special health care service, which means a special health care service as defined by RSA 151:2-e, II that was being offered by a hospital prior to July 1, 2016 and has continued to be offered since July 1, 2016, shall not require additional licensure separate from the hospital license but shall still comply with RSA 151 and all applicable He-P 802 provisions.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.04)

N.H. Code Admin. R. Ann. He-P 802.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by RSA 151 and He-P 802.05(a) have been received.

(b) Following both a clinical and life safety code inspection, a license and license certificate shall be issued to the applicant if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 802.10.

(c) If an application does not contain all of the items required by He-P 802.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(d) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(e) Licensing fees shall not be transferable to any other application(s).

(f) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 802.14 if it determines that the applicant, proposed licensee, medical director, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable.

(h) A written notification of denial, pursuant to He-P 802.14(b), shall be sent to an applicant applying for an initial license, if it has been determined by the inspection in He-P 802.10(b)(1) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 802.

(i) A written notification of denial, pursuant to He-P 802.14(b), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.05)

N.H. Code Admin. R. Ann. He-P 802.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 802.05(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The materials required by He-P 802.05(a)(1) and (5);

(2) The current license number;

(3) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 802.11(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 802.18(e)(2); and

(5) A copy of any temporary, new, or exceptions or variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5 and Saf-C 6005.

(c) In addition to (b) above, if a private water supply is used, documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 802.10, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151, He-P 802, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if deficiencies were cited at the renewal inspection.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall not operate.

(f) If a licensee fails to submit an application for renewal prior to the expiration of the license and continues to operate:

(1) The licensee shall be considered an initial licensee and shall follow all application requirements set forth for an initial license pursuant to He-P 802.05; and

(2) The licensee shall be subject to a fine in accordance with He-P 802.14(d).

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.06)

N.H. Code Admin. R. Ann. He-P 802.08 Hospital Construction, Modifications, or Structural Alterations

(a) As required by RSA 151:6, any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicant’s own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building code, state laws and rules, and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2022 edition), as applicable, available as noted in Appendix A.

(i) Exceptions to the FGI guidelines above shall be granted by the state fire marshal.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 802.10 prior to its use.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.07)

N.H. Code Admin. R. Ann. He-P 802.09 Requirements for Organizational Changes

(a) The licensee shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Capacity; or

(6) Affiliated or related parties.

(b) When there is a change in the name, the licensee shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(c) The licensee shall complete and submit a new application and obtain a new license prior to operating, for:

(1) A change in ownership; or

(2) A change in the physical location.

(d) When there is a change in address without a change in location, the licensee shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(e) In accordance with 802.19(b) when there is to be a change in the listed services, prior to providing the additional services, the hospital shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, will be made to the physical environment.

(f) An inspection by the department shall be conducted prior to operation when there are changes in the following:

(1) Ownership, unless the current licensee has no outstanding administrative actions in process and there will be no changes made by the new owner in the scope of services provided;

(2) The physical location;

(3) A change in the licensing classification;

(4) A change that places the facility under a different life safety code occupancy chapter; or

(5) An increase in the number of beds beyond what is authorized under the license.

(g) A revised license shall be issued for any of the following:

(1) A change in name;

(2) A change of administrator or medical director;

(3) An increase in the number of beds beyond what is authorized under the license;

(4) A change in the address without a change in physical location; or

(5) When a waiver has been granted.

(h) The licensee shall inform the department in writing no later than 30 days prior to a change in

administrator or medical director, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal records check for the new administrator or medical director that shall include a criminal history from the state of New Hampshire;

(4) The results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director; and

(5) A statement, which shall be signed at the time the initial offer of employment, contract, or engagement and then annually thereafter, stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient in this or any other state; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person in this or any other state.

(i) Upon review of the materials submitted in accordance with He-P 802.09(h), the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 802.17(b) and He-P 802.17(c) respectively.

(j) If the department determines that the new administrator or medical director does not meet the qualifications for the position as specified in (i) above, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(k) The licensee shall inform the department in writing via e-mail, fax, or mail of any change in the licensee’s e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the facility.

(l) A restructuring of an established hospital that does not result in a transfer of the controlling interest of the licensee, but which might result in a change in the name of the licensee or corporation, shall not constitute a change in ownership.

(m) If a licensee chooses to cease the operation of the hospital or special health care service, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.08)

N.H. Code Admin. R. Ann. He-P 802.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 802, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the licensee; and

(3) Any records required by RSA 151 and He-P 802.

(b) The department shall conduct a clinical and life safety code inspection to determine full compliance with RSA 151 and He-P 802, to include a clinical and a life safety inspection, prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 802.09(f)(1);

(3) A change in the licensee’s physical location;

(4) An increase in the number of beds beyond what is authorized under the license;

(5) Occupation of space after construction, modifications, or structural alterations; or

(6) The renewal of a license, if not deemed under RSA 151:5-b.

(c) In addition to (b) above, the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A deficiency report or notice to correct shall be issued when, as a result of any inspection, the department determines that the licensee is in violation of any of the provisions of He-P 802, RSA 151, or any applicable state or federal law, administrative rule, or code.

(e) If deficiencies were cited, the licensee shall submit a POC, in accordance with He-P 802.13(c) within 21 days of the date on the letter that transmits the inspection report.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.09)

N.H. Code Admin. R. Ann. He-P 802.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 802 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not have the potential to negatively impact the health or safety of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.10)

N.H. Code Admin. R. Ann. He-P 802.12 Complaints

(a) The department shall investigate a complaint against a licensed, non-CMS certified hospital when there is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 802.

(b) The bureau of licensing and certification shall refer for investigation to the department’s health facilities administration-certification unit or to the accrediting organization, as appropriate, any complaint against a CMS certified hospital that meets the following conditions:

(1) There is sufficient specific information to determine that if the allegation(s) were proven to be true, a violation would be determined to exist of the applicable requirements at 42 CFR 482, 42 CFR 485, 42 CFR 489, or the CMS, “Life Safety Code & Health Care Facilities Code Requirements" https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/LSC, as available and noted in Appendix A; and

(2) Investigations shall be conducted in accordance with CMS Publication #100-07, “State Operations Manual”, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984, including Chapter 5-Complaint Procedures, and applicable appendices, as available and noted in Appendix A.

(c) For complaints alleging violations of RSA 151 or He-P 802, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if deficiencies were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of alleged violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 802.13(c) if the inspection results in deficiencies being cited.

(d) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including:

(1) Requests for additional information from the complainant;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant and have probative value;

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value; and

(5) Any other relevant investigative techniques.

(e) For complaints regarding an unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of inspection;

b. The reasons for the inspection; and

c. Whether or not the inspection resulted in a determination that the services being provided require licensing under RSA 151;

(2) The owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (1) above to respond to a finding that they are operating without a license or submit a completed application for a license in accordance with RSA 151:7-a, II;

(3) If the owner of an unlicensed hospital does not comply with (2) above, or if the department does not agree with the owner’s response, the department shall:

a. Issue a written warning to immediately comply with RSA 151 and He-P 802; and

b. Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III; and

(4) Any person or entity who fails to comply after receiving a warning, as described in (3)a. above, shall be subject to an action by the department for injunctive relief under RSA 151:17. Whether or not the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 802, or other applicable laws.

(f) Complaint investigation files shall:

(1) Be confidential in accordance with RSA 151:13;

(2) Not be disclosed publicly; and

(3) Be released by the department on written request only:

a. To the department of justice when relevant to a specific investigation;

b. To law enforcement when relevant to a specific criminal investigation;

c. When a court of competent jurisdiction orders the department to release such information; or

d. In connection with any adjudicative proceedings relative to the licensee.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.11)

N.H. Code Admin. R. Ann. He-P 802.13 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 802, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions on a licensee;

(4) Imposing fines upon an unlicensed individual, applicant, or licensee in accordance with (f) below; or

(5) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each deficiency in which the licensee is not in compliance with RSA 151 or He-P 802; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a notice of deficiencies, the licensee shall submit a written POC for each item, written in the appropriate place on the statement of findings or notice to correct detailing:

a. How the licensee intends to correct each deficiency;

b. What measures will be put in place, or what system changes will be made to ensure that the deficiency does not recur, including how the measures are evaluated for effectiveness;

c. The date by which each deficiency shall be corrected; and

d. The position(s) of the employee(s) responsible for the corrective action;

(2) The licensee shall submit the POC in (c)(1) above to the department within 21 days of the date on the letter that transmitted the inspection report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means to develop and submit the POC within the 21-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of the patients, personnel, or visitors will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 802;

b. Addresses all deficiencies and deficient practices as cited in the inspection report;

c. Prevents a new violation of RSA 151 or He-P 802 as a result of the implementation of the POC;

d. Identifies the position(s) of the employee(s) responsible for the corrective action; and

e. Specifies the date upon which the deficiencies will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either verbally or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the waiver;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department, or is not submitted in accordance with this section, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 802.14(d)(13);

(9) Following the date of completion specified by the licensee in the POC, the department shall verify the implementation of any POC by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented as verified by (6) above, the licensee shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine as appropriate, in accordance with He-P 802.14(d)(13).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, deficiencies were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If, at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine:

(3) Deny an application for a renewal of a license in accordance with He-P 802.14; or

(4) Revoke the license in accordance with He-P 802.14.

(f) The department shall offer an opportunity for informal dispute resolution to any licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the licensee or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the licensee of the determination.

(i) The deadline to submit a POC in accordance with (c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(k) An informal dispute resolution shall not be available for any licensee against whom the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring if it determines that repeated poor compliance or the conditions of the facility might negatively impact the health, safety, or well-bring of patients.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.12)

N.H. Code Admin. R. Ann. He-P 802.14 Enforcement Actions and Hearings

(a) As specified in this section, the department shall take the following enforcement actions for violation of RSA 151, He-P 802, or other applicable licensing rules:

(1) Issue a warning;

(2) Impose a fine in accordance with (e) below;

(3) Deny the application for a renewal of a license in accordance with (c) and (d) below;

(4) Immediately suspend a license; or

(5) Revoke the license in accordance with (c) and (d) below.

(b) Prior to taking enforcement action against an applicant, or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the deficiency has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(c) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 802, which poses a risk of harm to a patient’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay a fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information on an application, an applicant or licensee fails to submit an application that meets the requirements of He-P 802.05;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 802.13(c) and (d);

(7) A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 802.13(c)(5) and has not submitted a revised POC as required by He-P 802.13(c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 802 for the same violations within the last 5 inspections;

(9) A licensee, its corporate officers, or its board members has had a license revoked and submits an application during the 5-year prohibition period specified in (l) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premises are not in compliance with RSA 151 or He-P 802;

(11) Unless a waiver has been granted, the department makes a determination that the administrator, licensee, medical director, or applicant has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet all of the qualifications for the positions under circumstances in which the department has not granted a waiver; or

(13) The applicant, administrator, licensee, or medical director has had a license revoked by any division of the department 5 years prior to the application.

(d) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2 or RSA 151:2-e, the fine shall be $2,000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, RSA 151:2-e, and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed provider, or a licensee shall be $2,000.00;

(3) For advertising services or otherwise representing that the facility has a license to provide services it is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

(4) For a failure to transfer a patient whose needs exceeds the services or programs provided by the licensee in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For admission of a patient whose needs exceed the services or programs authorized by the license classification, in violation of RSA 151:5-a, II, and He-P 802.19, the fine for a licensee shall be $1,000.00;

(6) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 802.12, He-P 802.14, or He-P 802.15, the fine shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 802.07(b), the fine shall be $500.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 802.09(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 802.09(a)(2), the fine shall be $500.00;

(10) For a failure to notify the department of a change in e-mail address as required by He-P 802.09(m), the fine for a licensee shall be $100.00;

(11) For a failure to allow access by the department to the licensee’s premises, programs, services, patients, or records, in violation of He-P 802.10(a), the fine for an unlicensed individual or licensee shall be $2,000.00;

(12) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 802.09(k), the fine for a licensee shall be $100.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, in violation of He-P 802.13(c)(2) or (c)(5), the fine for a licensee shall be $500.00 unless an extension has been granted by the department;

(14) For a failure to implement or maintain corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 802.13(c), the fine for a licensee shall be $1,000.00;

(15) For a failure to establish, implement, or comply with all policies generated by the licensee as required under this rule, the fine for a licensee shall be $1,000.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 802.19, the fine for a licensee shall be $500.00;

(17) For exceeding the maximum number of patients or beds licensed by the department, in violation of He-P 802.15(ah), the fine for a licensee shall be $500.00 per day;

(18) For providing false or misleading information or documentation to the department contained on an application or on any records required to be maintained for licensing, in violation of He-P 802.15(h), the fine shall be $1,000.00 per offense;

(19) For a failure to meet the needs of the patient, in violation of He-P 802.15(k)(1), the fine for a licensee shall be $1,000.00 per patient;

(20) For employing, contracting with, or engaging an administrator, medical director, or personnel who do not meet the qualifications for the position in violation of He-P 802.17(b)(1), He-P 802.17(c), and He-P 802.03(cj), respectively, or under circumstances where the department has not granted a waiver in accordance with He-P 802.11, the fine for a licensee shall be $500.00;

(21) For placing a patient in a room that has not been approved or licensed by the department, unless authorized by the department, such as during an emergency, in violation of He-P 802.28, the fine for a licensee shall be $500.00;

(22) For failure to report an adverse event as required by He-P 802.16, the fine for a licensee shall be $2,000.00 per occurrence;

(23) For failure to report infections and process measures as identified and required by He-P 802.23, the fine for a licensee shall be $1,000.00 per occurrence;

(24) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 802.08(a), the fine for a licensed facility shall be $500.00;

(25) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(26) For failing to comply with any provision of He-P 802 where a patient’s health, safety, or well-being is placed in jeopardy, the fine shall be $1,000;

(27) When an inspection determines that a violation of RSA 151 or He-P 802 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same deficiency is cited within 2 years of the original deficiency, the fine for a licensee shall be double the initial fine, but not to exceed $1,000.00; and

b. If the same deficiency is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the fine, but not to exceed $2,000.00; and

(28) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 802 shall constitute a separate violation and shall be fined in accordance with He-P 802.13(f). If the applicant or licensee is making good faith efforts to comply with He-P 802, the department shall not issue a daily fine.

(e) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(f) An applicant, licensee, or unlicensed entity shall have 10 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(g) If a written request for a hearing is not made pursuant to (f) above, the action of the department shall become final.

(h) The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of patients when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(i) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 802 is achieved.

(j) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(k) RSA 541 shall govern further appeals of department decisions under this section.

(l) When a hospital’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years, if the enforcement action specifically pertained to their role and actions or inactions in the hospital.

(m) The 5-year period referenced in (l) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(n) Notwithstanding (l) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has reasonable information or evidence that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 802.

(o) If a licensee, applicant, administrator, or others are circumventing (l) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(p) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 802.

History

• #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.13)

N.H. Code Admin. R. Ann. He-P 802.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, and:

(1) For Medicare Certified Hospitals (Acute), CMS federal regulation at 42 CFR Part 482;

(2) For Medicare Certified Critical Access Hospitals (CAH), CMS federal regulations at 42 CFR Part 485;

(3) For Medicare Certified Psychiatric Hospitals, CMS federal regulations at 42 CFR Part 482;

(4) For Medicare Certified Rehabilitation Hospitals, CMS federal regulations at 42 CFR Part 482;

(5) For Medicare Certified Hospitals with Prospective Payment System Units for Psych, Rehab, or LTCH, CMS federal regulations at 42 CFR Part 412; and

(6) For any newly licensed and certified hospital not specified as an acute, rehab, psych, or CAH hospital, all applicable CMS federal regulations for that hospital’s particular designation.

(b) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

(c) The licensee shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion, that apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(d) The written policy in (c) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion

prevention policy.

(e) The licensee shall define, in writing, the scope and type of services to be provided by the hospital, which shall include, at a minimum, the required services listed in He-P 802.19.

(f) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the licensee.

(g) In accordance with RSA 151:2-i, the licensee shall complete and implement an operational plan for the recognition and management of patients with dementia or delirium. The licensee shall keep the plan on file and make the plan available to the department of health and human services, bureau of licensing and certification upon request.

(h) All policies and procedures shall be reviewed per licensee policy.

(i) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(j) The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

(k) Except for the requirements of RSA 151:4, III(a)(5), the licensee shall not:

(1) Advertise or otherwise represent itself as operating a hospital or providing a special health care service, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(l) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(m) Licensees shall:

(1) Meet the needs of the patients during those hours that the patients are in the care of the licensee;

(2) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the hospital or special health care service;

(3) Appoint an administrator;

(4) Verify the qualifications of all personnel;

(5) Provide sufficient numbers of qualified personnel to meet the needs of patients during all hours of operation;

(6) Provide sufficient supplies, equipment, and lighting to meet the needs of the patients; and

(7) Implement any POC that has been accepted by the department.

(n) The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

(1) Has a guardian appointed by a court;

(2) Has a durable power of attorney or surrogate for health care that has been activated; or

(3) Is an un-emancipated minor.

(o) The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted pursuant to RSA 153:1, VI-a.

(p) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007 edition), available as noted in Appendix A.

(q) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(r) The licensee shall implement measures to ensure the safety and stabilizing treatment of patients who are assessed as an elopement risk or danger to self or others.

(s) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 802.10(b), for the previous 12 months;

(3) A copy of the patients’ bill of rights;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted by calling 1-800-852-3345 x 9499 or in writing, to the:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street, Concord, NH 03301; and

(6) The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

(t) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 802 as authorized by RSA 151:6 and RSA 151:6-a.

(u) Licensees shall, in accordance with He-P 802.16:

(1) Report all adverse events to the department;

(2) Submit additional information if required by the department; and

(3) Report the event to other agencies as required by law.

(v) The licensee shall immediately notify the local police department, the guardian, and agent if any, when a patient, who has been assessed or is known as being a danger to self or others, has an unexplained absence after the licensee has searched the building and the grounds of the hospital.

(w) A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of the patient record pursuant to the provisions of RSA 151:21, X.

(x) All records required by law or He-P 802 shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(y) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

(3) Systems to prevent tampering with information pertaining to patients and personnel.

(z) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(aa) The licensee shall provide cleaning and maintenance services, as needed to protect patients, personnel, and the public.

(ab) The building housing the licensed facility shall comply with all state and local:

(1) Health requirements;

(2) Building ordinances;

(3) Fire ordinances; and

(4) Zoning ordinances.

(ac) Smoking shall be prohibited in the licensed facility as required by RSA 155:66, I(b).

(ad) If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

(ae) If the licensee holds or manages a patient’s funds or possessions, the licensee shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other patients, or other household members.

(af) The licensee shall have written policies on the proper completion of an involuntary emergency admission certificate for those in need of mental health treatment that:

(1) Comply with RSA 135-C:27-33 and He-M 613; and

(2) Detail the medical screening examination and stabilizing treatment provided to patients with mental health needs.

(ag) The licensee shall require all staff including volunteers, consulting doctors, and students in contact with patients to wear a form of identification which readily discloses the licensure status, if any, staff position, and at a minimum, the first name as required per RSA 151:3-b.

(ah) The licensee shall not exceed the maximum number of patients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(ai) If the licensee offers animal assisted services the licensee shall develop and implement policies and procedures to include but not be limited to, the following:

(1) Therapy animals should be in good health and up-to-date with recommended immunizations and prophylactic medications, for example, heartworm prevention, as determined by a licensed veterinarian based on local needs and recommendations;

(2) Regular re-evaluation of the animal's health and behavior status;

(3) Animals should be routinely screened for enteric parasites or have evidence of a recently completed antihelminthic regimen;

(4) Animals should be free of ectoparasites for example, fleas and ticks, and should have no sutures, open wounds, or obvious dermatologic lesions that could be associated with bacterial, fungal, or viral infections or parasitic infestations;

(5) Prohibit incorporating young animals, for example, those aged less than 1 year, in therapy programs due to unpredictable behavior and elimination control;

(6) Animals shall be clean and well-groomed;

(7) The visits shall be supervised by persons who know the animals and their behavior. Animal handlers shall be trained in these activities and receive site-specific orientation to ensure that they work efficiently with the staff in the specific health-care environment; and

(8) Strict enforcement of hand-hygiene measures for example, using either soap and water or an alcohol-based hand rub, for all patients, staff, and residents after handling the animals.

History

• #2144, eff 9-28-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.14)

N.H. Code Admin. R. Ann. He-P 802.16 Adverse Event Reporting

(a) Pursuant to RSA 151:38, the administrator or designee shall report to the department the following adverse events:

(1) Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx, as available as noted in Appendix A; and

(2) The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker's intentional unsafe act.

(b) An act by hospital or ambulatory surgery center staff resulting in an infection or disease shall be considered to be purposefully unsafe if it meets the following criteria:

(1) There was an intentional act or reckless behavior;

(2) No reasonable person with similar qualifications, training, and experience would have acted the same way under similar circumstances; and

(3) There were no extenuating circumstances that could justify the act.

(c) If the licensee suspects an adverse event occurred, the administrator or designee shall send a report to the department in electronic or paper format, within 15 working days after discovery of the event, including:

(1) Licensee information;

(2) Patient information;

(3) Event information; and

(4) Type of occurrence as listed in (a) above.

(d) For events reported in (a) above, the licensee shall, within 60 days after discovery of the event, provide the department:

(1) An analysis that includes the type of harm and contributing factors; and

(2) A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the licensee determines that one is not required.

(e) If the licensee suspects that it received a patient from a sending hospital that was subject to an adverse event, then the receiving administrator or designee shall notify the sending hospital’s administrator or designee and the department. The department shall inform the sending hospital that a report is required in accordance with (a) above.

(f) Upon receipt of a report of an adverse event, the department shall:

(1) Acknowledge receipt of the event and review the information for completeness;

(2) Review the corrective action plan for system changes that reduce the risk repeat of similar adverse events;

(3) Communicate specific concerns to the licensee if the department does not find the corrective action plan credible;

(4) Track and analyze adverse events for trends and underlying system problems; and

(5) Provide information and make referrals to other state agencies as appropriate.

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.15)

N.H. Code Admin. R. Ann. He-P 802.17 Organization and Administration

(a) Each licensee shall have a governing body whose duties shall include:

(1) Management and control of the operation of the hospital;

(2) Assessment and improvement of the quality of care and services;

(3) Appointment of the administrator;

(4) Adoption of hospital by-laws defining responsibilities for the operation of the hospital, and establishment of medical staff;

(5) Approval of medical staff by-laws as described in (e)(2) below, defining the medical staff responsibilities;

(6) Responsibility for management of the overall operation and fiscal viability of the hospital;

(7) Responsibility for determination of the qualifications for appointment for all personnel; and

(8) Ensuring compliance with all relevant health and safety requirements of federal, state, and local laws, rules, and regulations.

(b) Each hospital shall have a full-time administrator who:

(1) Has a master’s degree from an accredited institution and at least 4 years of experience working in a health-related field or has a bachelor’s degree from an accredited institution and at least 8 years of experience working in a health-related field; and

(2) Shall be responsible to the governing body for the daily management and operation of the hospital and any special health care services offered by the hospital including:

a. Management and fiscal matters;

b. Implementing the by-laws adopted by the governing body;

c. The employment and termination of personnel necessary for the efficient operation of the hospital;

d. The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the hospital and any special health care services offered by the hospital in the absence of the administrator;

e. Attendance at meetings of the governing body, medical staff, and personnel, to serve as a liaison to the governing body;

f. The planning, organizing, and directing of such other activities as may be delegated by the governing body;

g. The delegation of responsibility to subordinates as appropriate; and

h. Ensuring development and implementation of all policies and procedures on:

1. Patient’s rights as required by RSA 151:19-21;

2. Advanced directives as required by RSA 137-J;

3. Discharge planning as required by RSA 151:26;

4. Organ and tissue donor identification and procurement;

5. Withholding of resuscitative services from patients pursuant to RSA 137-J; and

6. Adverse event reporting.

(c) Each hospital shall have a full-time medical director who is qualified to practice medicine and licensed in the state of New Hampshire and has at least 5-years’ experience as a physician in a hospital setting.

(d) Each hospital shall have medical staff in accordance with the by-laws adopted under (a)(4) above.

(e) The medical staff shall be responsible for:

(1) Appointment of an executive committee made up of members of the medical staff which shall make recommendations directly to the governing body with regard to:

a. The process by which physicians or other licensed practitioners shall be admitted to practice for the licensee;

b. Evaluation of individuals seeking medical staff membership;

c. Delineation of what clinical privilege includes;

d. The organization of the quality assessment and improvement activities of the medical staff; and

e. The appointment of a medical director who meets the qualifications of (c) above;

(2) Development of medical staff by-laws and policies in conjunction with the governing body which shall establish a mechanism for self-governance by the medical staff and accountability to the governing body;

(3) Monitoring and evaluation of the quality of patient care and patient care services in the hospital including:

a. Monitoring of medication use and review of pharmacy activity in the hospital;

b. Review of patient record quality;

c. Review of blood use in the hospital; and

d. Review of other functions such as risk management, infection control, disaster planning, hospital safety, and utilization review; and

(4) Identifying and making available education programs designed to maintain the medical staff’s expertise in areas related to the services provided in the hospital.

(f) There shall be a full-time director of nursing services who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and:

(1) Is an RN with a bachelor’s and a master’s degree from an accredited institution;

(2) Is an RN with a bachelor’s degree and at least 4 years of relevant experience; or

(3) Is an RN with a minimum of 8 years of relevant experience.

(g) The director of nursing services shall be responsible for:

(1) Establishment of standards of nursing practice used in the hospital;

(2) Ensuring that the admission process and patient assessment process coordinates patient requirements for nursing care with available nursing resources;

(3) Participating with the governing body, administrator, and medical staff to improve the quality of nursing care at the hospital;

(4) Nursing care as authorized by the nurse practice act and according to RSA 326; and

(5) Nutritional monitoring.

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.16)

N.H. Code Admin. R. Ann. He-P 802.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified staff are present in the facility to meet the needs of patients at all times.

(b) For all applicants for employment, for all volunteers, or for all independent contractors who will provide direct care or personal care services to patients, the licensee shall:

(1) Obtain and review a criminal records check which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (c) below;

(3) Verify the qualifications of all applicants prior to employment; and

(4) Verify that the applicant is not on the “List of Excluded Individuals/Entities”, maintained by the U.S. Department of Health and Human Services Office of Inspector General.

(c) Unless a waiver is granted in accordance with He-P 802.11 and (e) below, the licensee shall not employ, contract, or engage an individual if that individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(d) If the licensee discovers that an individual meets one of the criteria in (c) above and that individual is already employed, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the individual; or

(2) Request a waiver of (c) above.

(e) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if the department determines that the person poses a threat to the health, safety, or well-being of a patient; or

(2) Grant a waiver pursuant to He-P 802.11 if the department determines that the person does not pose a current threat to the health, safety, or well-being of a patients(s).

(f) The licensee shall check the names of the persons in (b) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, the NH board of nursing, nursing assistant registry, maintained pursuant to RSA 326-B:26 and 42 CFR 483.156, and the medical technician registry, maintained pursuant to RSA 328-I prior to employing, contracting with, or engaging them.

(g) The licensee shall:

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS;

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry; and

(3) Only employ, contract with, or engage medical technicians who are listed on the medical technician registry.

(h) In lieu of (b) and (f) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) and (f) above and are allowable under (c) and (g) above.

(i) Prior to having contact with patients or food, all personnel shall:

(1) Receive a tour of the employee’s work environment relative to their position;

(2) Receive a copy of the job description for the position containing:

a. Duties and responsibilities of the position;

b. Physical requirements of the position; and

c. Education and experience requirements of the position;

(3) Meet the educational and physical qualifications of the position as listed in their job description;

(4) Be licensed, registered, or certified as required by state statute and as applicable;

(5) Receive an orientation within the first 3 days of work or prior to the assumption of duties that includes:

a. The licensee’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The procedures for food safety for personnel involved in preparation, serving, and storing of food;

c. The licensee’s infection control program;

d. The licensee’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency;

e. Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

f. The recognition and management of patients with dementia or delirium, in accordance with the licensee’s operational plan developed pursuant to He-P 802.15(e);

(6) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(7) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

(8) Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

(9) Comply with all public health guidelines with requirements for infectious disease reporting and management.

(j) All personnel shall complete a mandatory annual in-service education, which includes a review of the licensee’s:

(1) Policies and procedures required under He-P 802;

(2) Infection control program;

(3) Education program on fire and emergency procedures;

(4) Mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29; and

(5) Operational plan regarding the recognition and management of patients with dementia or delirium, pursuant to He-P 802.15(g).

(k) Personnel who have direct contact with patients who have a history of TB or a positive laboratory and antigen testing shall have a symptomatology screen of a TB test.

(l) Current and complete personnel files shall be maintained and stored in a secure and confidential manner at the hospital.

(m) The licensee shall maintain a separate employee file which shall include, at a minimum, the following:

(1) A completed application for employment or a resume;

(2) A signed statement acknowledging the receipt of the licensee’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A signed and dated job description;

(4) A record of satisfactory completion of the orientation program required by (i)(5) above;

(5) A copy of each current New Hampshire license, registration, or certification in health care field and CPR certification, if applicable;

(6) Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) A record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee as required by (j) above;

(8) Documentation of any performance reviews conducted;

(9) Information as to the general content and length of all continuing education or educational programs attended;

(10) A statement, which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a patient in this or any other state; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person in this or any other state;

(11) A copy of the results of a criminal records check;

(12) Documentation that the individual or entity is not on the “List of Excluded Individuals/Entities”, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

(13) The results of the registry check in (f) above.

(n) The licensee shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients, as follows:

(1) For volunteers, the information in (m)(1), (3), (4), (6), and (8)-(12) above; and

(2) For independent contractors, the information in (m)(3), (4), (6), and (8)-(12), except that the letter in (h) above may be substituted for (m)(11) and (13).

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.17)

N.H. Code Admin. R. Ann. He-P 802.19 Required Services

(a) Each licensee shall provide the services that have been disclosed on its application and have been approved for by the department, or are required by state or federal law.

(b) If the licensee wishes to provide services other than the ones it is already licensed to provide, the licensee shall submit a letter of intent to provide the additional services, prior to providing the new service(s), to the department which includes:

(1) A listing of the additional services to be provided;

(2) The physical resources, personnel, and competency necessary to provide the additional services;

(3) Floor plans describing change(s) or architectural plans if structural changes are involved;

(4) The date the hospital wishes to start such services; and

(5) Documentation of compliance with RSA 151 and He-P 802.

(c) If the licensee wishes to provide a special health care service, the licensee shall complete the requirements of He-P 802.05(a) through (c).

(d) Each licensee shall ensure the availability of competent and sufficient personnel, with the required skills and experience, to provide the services in (a) and (b) above, including personnel able to provide services for both physical and behavioral health concerns.

(e) The licensee shall have a policy governing CPR.

(f) The licensee shall establish health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the patient is at the hospital that includes:

(1) Monitoring the patient’s functioning, safety, and whereabouts; and

(2) Emergency response and crisis intervention.

(g) The licensee shall have social services available to the patient and patient’s family, which shall be provided by a social worker with at least a bachelor’s degree in social work or human services and includes:

(1) The compilation of a social history and conducting patient psychosocial assessments;

(2) The provision of emotional support to patients and families or caregivers as needed;

(3) Assistance with the patient’s adaptation to the hospital and involvement in the plan of care; and

(4) Advocacy for the patient’s human and civil rights and responsibilities.

(h) The licensee shall complete discharge planning on all patients admitted to the hospital including the provision of written instructions to the patient, agent, or guardian.

(i) Discharge planning shall include, as applicable:

(1) The patient’s medication needs upon discharge;

(2) The need for medical equipment, special diets, or potential food-drug interactions;

(3) The need for further placement in another health care setting;

(4) The need for home health services upon discharge; and

(5) Discharge instructions and education shall be provided to the patient in writing.

(j) All laboratories operated by the licensee shall be in compliance with He-P 808, He-P 817, and CMS 42 CFR Part 493 – Laboratory Requirements.

(k) Pharmacies shall be in compliance with RSA 318 and RSA 318-B and shall employ or contract with a pharmacist who is licensed to practice pharmacy in the state of New Hampshire.

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.18)

N.H. Code Admin. R. Ann. He-P 802.20 Patient Management

(a) Admission procedures shall include:

(1) Completion of a health assessment and medical evaluation in accordance with the licensee’s policy which shall be documented for each patient accepted for care and treatment;

(2) Provision of information concerning patient rights in a language the patient can understand, which might require a translator;

(3) Provision of information in a clear concise manner to enable the patient to make appropriate treatment decisions;

(4) Collection of specific patient medical and social history information as required by the licensee’s policy including information concerning advanced directives or alternative decision makers; and

(5) Development of a treatment plan.

(b) Discharge documentation shall include:

(1) The date and time of discharge;

(2) The status of the patient at the time of discharge; and

(3) Any discharge planning or referrals that have been conducted for the patient.

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.19)

N.H. Code Admin. R. Ann. He-P 802.21 Patient Records

(a) The licensee shall maintain a legible, current, and accurate record for each patient based on the services provided by the licensee.

(b) Patient records shall include, at a minimum:

(1) Identification data including the patient’s:

a. Name;

b. Home address;

c. Home telephone number;

d. Name, address, and telephone number for an emergency contact person;

e. Date of birth;

f. Guardian or agent as applicable; and

g. Admitting diagnosis;

(2) A signed acknowledgment of receipt of patient bill of rights by the patient, guardian, agent, or surrogate decision maker;

(3) A record of a health examination by a licensed practitioner;

(4) Orders of all medications, treatments, and therapeutic diets;

(5) Documentation of all services provided including progress notes by:

a. Nursing personnel;

b. Physicians; and

c. Other health professionals authorized by state law;

(6) Orders and results of any laboratory, x-rays, consultations, or other diagnostic tests;

(7) The patient’s health insurance information;

(8) The consent for release of information signed by the patient, guardian, or agent, if any;

(9) The medication record;

(10) Documentation of any accident or injuries occurring while in the care of the facility;

(11) Documentation of a patient’s refusal of any care or services; and

(12) Transfer or discharge documentation including planning, referrals, and notification to the patient and guardian or agent if any.

(c) Patient records shall be available to authorized personnel and any other person authorized by law or rule to review such records.

(d) Patient records shall be retained, accessible, and stored in an area inaccessible to those who do not have authorized access to such records.

(e) The licensee shall create a policy to determine the method by which release of information from patient records shall occur.

(f) Patient records shall be safeguarded against loss or unauthorized use by implementation of appropriate use, handling, and storage procedures.

(g) Patient records shall be retained 7 years after discharge of a patient, and in the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

(h) The licensee shall arrange for the storage of and access to medical records for 7 years in the event the hospital ceases operation.

(i) Electronic records shall be maintained according to current HIPAA regulations.

History

• #5846, eff 6-22-94, EXPIRED: 6-22-00
• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.20)

N.H. Code Admin. R. Ann. He-P 802.22 Medication Services

(a) All medications shall be made available to the patient in accordance with the orders of a licensed practitioner or other professional with prescriptive powers.

(b) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for use at the hospital;

(2) Reorder medications for use at the hospital; and

(3) Receive and record new medication orders.

(c) Each medication order shall include the following information:

(1) The patient’s name;

(2) The medication name, strength, prescribed dose, and route of administration;

(3) The frequency of administration;

(4) For PRN doses, the indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that have such maximum doses;

(5) For titration orders, the medication name, route, initial rate of infusion, for example the dose per unit of time, incremental units to which the rate or dose can be changed, the maximum rate or dose of infusion, and the objective clinical measure to be used to guide changes; and

(6) The dated and timed authentication of the ordering practitioner.

(d) All licensees shall comply with RSA 318, RSA 318-B, and the rules adopted thereunder regarding the handling, storage, labeling, ordering, and destruction of medications.

(e) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized by a licensed practitioner and indicated, in the medication record, the date the dose or the discontinuance occurred.

(f) Health care professionals, within their scope of practice, can accept telephone orders for medications, treatments, and therapeutic diets and shall document and authenticate to telephone orders in the patient’s electronic medical record.

(g) The transcribed order in (e) above shall be counter-signed by the authorized prescriber within 48 hours of receipt or as soon as possible but no longer than 30 days.

(h) No medications shall be given to or taken by a patient until a written order is received, except as allowed by (f) above or in emergent or urgent situations, to address immediate patient care needs if a verbal order is given by an authorized prescriber.

(i) Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (h) above.

(j) All over-the-counter medications shall have a signed practitioner’s order specifying that the patient may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(k) All bulk medication at the hospital shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use. This shall not apply to unit-of-use packaging.

(l) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(m) The licensee shall maintain a written record for each medication taken by a patient at the facility that contains the following information:

(1) Any allergies or adverse reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;

(5) For PRN medications, the reason the patient required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(n) The licensee shall report to the patient’s licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient’s record the reaction, the error, and date, time, and person notified.

(o) The therapeutic use of cannabis by patients who are qualifying patients possessing a registry identification card may be permitted at a hospital as long as:

(1) The licensee develops, maintains, and implements a general policy relative to patient use of cannabis at the licensed premises, including storage, security, and administration; and

(2) The smoking of cannabis is not permitted on the licensed premises.

History

• #9580, eff 10-24-09; amd by #9851, eff 1-14-11; amd by #10079, eff 1-26-12; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.21)

N.H. Code Admin. R. Ann. He-P 802.23 Infection Control

(a) The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

(5) Reporting of infectious and communicable diseases as required by He-P 301;

(6) Evaluating and revising the infection control program in accordance with current CDC recommended actions;

(7) Maintenance of a sanitary physical environment; and

(8) Infection control policies specific to each department.

(c) Education on the infection control program shall be completed by all personnel on an annual basis and address the:

(1) Cause of infections;

(2) Effect of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, saliva, or droplets, shall not work in food service or provide direct care in any capacity without personal protective equipment until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to patients or work in food services until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the personnel member receives tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable and durable bandage with secure edges.

(h) The licensee shall immunize all consenting patients for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

(i) The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

(j) The licensee shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

(k) The administrator shall appoint an infection control officer who shall:

(1) Receive reports of communicable and infectious diseases; and

(2) Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

(l) The licensee shall have a policy requiring personnel to make a report to the infection control officer if they suspect that a personnel member, including themself, or patient has a communicable disease.

(m) The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.21); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.22)

N.H. Code Admin. R. Ann. He-P 802.24 Quality Assurance and Performance Improvement

(a) The licensee shall develop and implement a quality assurance and performance improvement program (QAPI) that reviews policies and services and maximizes quality by preventing and correcting identified problems.

(b) As part of its QAPI, an interdisciplinary quality assurance and performance improvement committee shall be created and required to:

(1) Meet at least quarterly to evaluate quality assurance and performance improvement activities;

(2) Generate dated, written minutes for each meeting;

(3) Maintain all QAPI activities, including minutes of meetings, for at least 2 years from the date the record was created; and

(4) Make recommendations to the governing body to improve the quality of care.

(c) QAPI activities shall include:

(1) Review of patterns and trends of activities which affect the quality of care;

(2) Ensuring that quality control logs are maintained for any laboratory controls and proficiency testing required;

(3) Ensuring that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer's recommendations or code requirements;

(4) Ensuring that the medical staff monitoring and evaluating patient care recommendations referenced in He-P 802.17(e)(3), are considered by the full quality assessment and improvement committee; and

(5) Reviewing and making recommendations for improvement in areas such as:

a. Infection surveillance;

b. Drug usage evaluation;

c. Morbidity;

d. Risk assessment;

e. Mortality;

f. Environmental safety;

g. Monitoring of quality control practices in each service; and

h. Adverse events in accordance with He-P 802.16.

(d) For each QAPI activity, the committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the licensee; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.22); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.23)

N.H. Code Admin. R. Ann. He-P 802.25 Food Services

(a) The licensee shall provide food services that:

(1) Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as noted in Appendix A;

(2) Provide for the nutritional needs of each patient;

(3) Provide substitutions if a patient declines the items offered;

(4) Provide patients’ diets that are supervised by a dietitian;

(5) Provide diets that are in accordance with the orders of patients’ licensed practitioners;

(6) Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

(7) Provide food and drink to the patients that is:

a. Safe for human consumption and free of spoilage or other contamination;

b. Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

c. Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination; and

d. Labeled, dated, stored, and served in a manner appropriate to maintain proper food temperatures.

(b) Each patient shall be offered at least 3 meals in each 24-hour period unless contraindicated by the patient’s medical condition.

(c) Snacks shall be available between meals unless contraindicated by the patient’s medical condition.

(d) The licensee shall provide therapeutic diets to patients only as directed by a licensed practitioner or other professional with prescriptive authority.

(e) The use of outdated, unlabeled food, or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

(f) All work surfaces, food services equipment, dishes, utensils, and glassware shall be in good repair, cleaned and sanitized after each use, and properly stored.

(g) Soiled linen and trash shall not be transported through food preparation areas and shall be kept in an impervious container.

(h) All hospital personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

(i) Regularly scheduled training programs including sanitation and safety shall be made available to personnel. Information as to the content and length of this training shall be documented and kept in personnel records.

(j) A current therapeutic diet manual approved by the dietician and medical staff shall be readily available to all medical, nursing, and food service personnel.

(k) The licensee shall have written policies and procedures to address the following:

(1) Availability of a diet manual and therapeutic diet menus to meet patients’ nutritional needs;

(2) Frequency of meals served;

(3) System for diet ordering and patient trays deliveries;

(4) Accommodation of non-routine occurrences such as parenteral nutrition, total parenteral nutrition, peripheral parenteral nutrition, change in diet orders, early and late trays, and nutritional supplements;

(5) Integration of the food and dietetic service into the licensee’s QAPI and infection control programs;

(6) Guidelines for acceptable hygiene practices of food service personnel; and

(7) Guidelines for kitchen sanitation.

(l) The licensee shall have a full-time employee who:

(1) Serves as director of the food and dietetic services;

(2) Is responsible for daily management of dietary services; and

(3) Is qualified by experience or training.

(m) The licensee shall employ or contract with a qualified dietician to supervise the nutritional aspects of patient care.

(n) If the dietician does not work full-time, and when the dietician is not available, the licensee shall make adequate provisions for dietary consultation that meets the needs of the patients.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.24)

N.H. Code Admin. R. Ann. He-P 802.26 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed premises.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the patients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the FGI’s “Guidelines for Design and Construction of Hospitals” (2022 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A, and summarized as follows:

(1) One hundred and five to 120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

(2) One hundred and twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, and may be by separate booster, unless a chemical rinse is provided; and

(3) One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

(f) All patient bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous waste, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and program supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and therapy animals.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service area shall be covered at all times, except during food preparation and subsequent clean-up.

(m) The following requirements shall be met for laundry services:

(1) The laundry room shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Cleaning supplies shall be stored in dust-free and moisture-free storage areas or containers.

(p) Any hospital that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.23); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.25)

N.H. Code Admin. R. Ann. He-P 802.27 Physical Environment

(a) The licensed premises shall be maintained so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(b) The licensee shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Maintain the premises in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

(3) Keep the premises free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within a hospital including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit during the day if patient(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Any heating device other than a central plan shall be designed and installed so that:

(1) Combustible material cannot be ignited by the device or its appurtenances;

(2) If fuel-fired, such heating devices comply with the following:

a. They shall be chimney or vent connected;

b. They shall take air for combustion directly from outside; and

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(3) Any heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(g) Unvented fuel-fired heaters shall not be used in any hospital.

(h) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code pursuant to RSA 155-A.

(i) Screens shall be provided for doors and windows that are left open to the outside.

(j) Doors that are self-closing and remain closed when not in use are exempt from the requirement in (i) above.

(k) The licensee shall have a telephone to which the patients have access.

(l) Toilet and bathing facilities shall be provided to meet patient needs in relation to the number and acuity of the patients.

(m) Separate toilets with hand washing sinks shall be provided for personnel and visitors.

(n) All toilets shall be vented out-of-doors.

(o) Each bathroom shall be equipped with:

(1) Soap dispensers;

(2) Paper towels or a hand-drying device providing heated air; and

(3) Hot and cold running water.

(p) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(q) All hand-washing facilities shall be provided with hot and cold running water.

(r) All bathroom and closet doors must either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

(s) The licensee shall comply with all state and local codes and ordinances for:

(1) Zoning;

(2) Building;

(3) Health;

(4) Fire;

(5) Waste disposal; and

(6) Water.

(t) The hospital shall be accessible at all times of the year.

(u) The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel, and the public.

(v) Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

(w) Doors shall be of such width as to permit removal of hospital beds and meet the state fire and building code.

(x) Corridors in patient occupied areas shall be wide enough to permit passage of 2 hospital beds, in addition to complying with NFPA 101 for means of egress.

(y) Ventilation shall be provided throughout the entire hospital and, whenever necessary, mechanical means such as fans shall be provided to remove excessive heat, moisture, objectionable odors, dust, or explosive or toxic gases.

(z) There shall be an emergency generator system to provide power pursuant to the following, as adopted by the state fire code:

(1) The electrical systems chapter of NFPA 99, health care facilities code; and

(2) The standard for emergency and standby power systems, NFPA 110.

(aa) Waste water shall be disposed of through a system which meets the requirements of RSA 485:1-A and Env-Wq 1000. Sink drains which have no connection to sanitary sewers or septic systems and similar methods of disposal above ground shall be strictly prohibited.

(ab) Facilities shall provide for prompt cleaning of bedpans, urinals, and other utensils.

(ac) Any locked door providing egress from a patient room or means of egress within a hospital shall meet the requirements of the health care occupancy chapter of NFPA 101, as adopted by the state fire code.

(ad) Delayed egress doors on locked units shall be equipped with locking devices, which shall:

(1) Unlock upon actuation of the automatic fire detection and sprinkler system; and

(2) Unlock upon loss of power.

(ae) A system for sterilization of equipment and supplies shall be provided which shall be checked for effective sterilization in accordance with the manufacturer’s recommendation and the results of these quality control tests shall be documented.

(af) Sterile supplies and equipment shall be stored in a manner that protects from contamination and follows manufacturer’s recommendations.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.24); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.26)

N.H. Code Admin. R. Ann. He-P 802.28 Patient Care Units and Patient Rooms

(a) There shall be a nurse’s station for each patient care unit.

(b) There shall be a utility room for every patient care unit with work and storage space and equipment for cleaning and sterilizing utensils as appropriate.

(c) Patient rooms in which patients shall be housed for more than 24 hours shall be outside rooms and shall not be located below grade unless they are dry, well ventilated, and have window space equivalent to or greater than 8% of the room’s square footage.

(d) There shall be a minimum of 3 feet of clear aisle space leading from the side of any patient bed to the room door.

(e) As stated in the FGI’s “Guidelines for Design and Construction of Hospitals” (2022 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A, patient rooms shall comply as follows:

(1) For multiple bed rooms:

a. Medical and surgical rooms shall have 120 square feet per patient;

b. Critical care units shall have 200 square feet per patient; and

c. Intermediate care units shall have 150 square feet per patient;

(2) For single rooms:

a. Medical and surgical rooms shall have 100 square feet;

b. Critical care units shall have 200 square feet; and

c. Intermediate care units shall have 120 square feet;

(3) For pediatric nursery, to minimize the possibility of cross infection, with the exception of pediatric critical care units, each nursery room serving pediatric patients shall contain no more than 8 bassinets. Each bassinet shall have a minimum clear floor area of 40 square feet;

(4) For pediatric rooms, requirements shall be the same as for adult beds due to the size variation and the need to change from cribs to beds and beds to cribs; and

(5) For newborn ICU, there shall be 120 square feet per bassinet excluding sinks and aisles.

(f) Each patient room, except for nursery beds, shall be served with a patient call station equipped for two-way voice communication. For psychiatric units and psychiatric hospitals, this shall be optional.

(g) In addition to the FGI’s “Guidelines for Design and Construction of Hospitals” (2022 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available and noted in Appendix A, the call systems shall meet the requirements of UL 1069 Standard for Hospital Signaling and Nurse Call Equipment. Use of alternate technologies that meet the requirements of UL 1069, including radio frequency systems, shall be permitted for call systems.

(h) All medication in each nursing unit shall be clearly labeled and stored in a lighted area or cabinet which is either locked or under constant observation.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.25); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.27)

N.H. Code Admin. R. Ann. He-P 802.29 Life Safety and Fire Safety Procedures

(a) All hospitals shall meet the appropriate chapter of NFPA 101, the appropriate chapters of the state fire code pursuant to RSA 153:5 and the appropriate chapters of the state building code.

(b) The administrator or designee shall appoint a safety committee which shall include representatives from administration, clinical services, and support services.

(c) The safety committee shall:

(1) Appoint a safety officer who shall:

a. Inspect the premises at least semi-annually to assure that all safety precautions are met; and

b. Report to the safety committee any findings noted during the inspections;

(2) Develop or approve written policies and procedures covering all matters of safety and fire protection and an emergency response plan, including:

a. The emergency procedures required by the emergency response plan shall include, but not be limited to, evacuation routes, emergency notification numbers, and emergency instructions and shall be available in locations accessible to personnel and visitors; and

b. The fire safety plan shall provide for the following:

1. Use of alarms;

2. Transmission of alarm to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation; and

9. Extinguishment of the fire;

(3) Ensure that the fire safety and evacuation plans are available to all supervisory personnel;

(4) Ensure that all employees receive in-service biennial training to clarify their responsibilities in carrying out the emergency plan;

(5) Ensure the required plan shall be readily available at all times in the telephone operator’s location or at the security center; and

(6) Conduct fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

a. Infirm or bedridden patients shall not be required to be moved during drills to safety areas or to the exterior of the building;

b. Drills shall be conducted quarterly on each shift to familiarize hospital personnel with the signals and emergency action required under varied conditions; and

c. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded or plain language announcement may be used instead of audible alarms.

(d) The licensee shall notify the department and local fire department when a required sprinkler or fire alarm system is out of service for more than 4 hours in a 24-hour period.

(e) The licensee shall be evacuated or an approved dedicated fire watch shall be provided for all parties left unprotected by the shutdown until the sprinkler or alarm system has been returned to service.

(f) If a facility loses fire sprinkler coverage for more than 10 hours a fire watch shall be instituted pursuant to NFPA.

(g) If a facility loses fire alarm coverage for more than 8 hours a fire watch shall be instituted pursuant to NFPA.

(h) The licensee shall notify the department when the emergency power has been utilized for 6 or more hours due to power outage.

(i) If there is an incident including, but not limited to, fire, or toxic fumes including smoke that requires the evacuation of the hospital all or in part, the hospital shall notify the department immediately by phone and within 72 hours in writing.

(j) A full follow-up written report on the incident shall be completed and submitted to the department when the investigation has been conducted and completed, including what the incident was, action taken, injuries or deaths, or both, that occurred during incident including during evacuation, emergency procedures followed, notification of emergency services including local fire departments, and the corrective actions taken.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.26); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.28)

N.H. Code Admin. R. Ann. He-P 802.30 Emergency Preparedness

Each facility shall comply with all applicable federal, state, and local emergency preparedness requirements including 42 CFR 482.15.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.29)

N.H. Code Admin. R. Ann. He-P 802.31 Psychiatric Units

The following shall apply if the hospital has a distinct psychiatric unit:

(a) The psychiatric unit shall have a clinical director, service chief, or equivalent that meets the training and experience requirements for examination by the American Board of Psychiatry and Neurology, or the American Osteopathic Board of Neurology and Psychiatry;

(b) The psychiatric unit shall have a director of nursing services who shall be:

(1) A registered nurse (RN) currently licensed in New Hampshire who has a master’s degree or its equivalent in psychiatric and mental health nursing; or

(2) An RN with a bachelor’s degree and a minimum of 3 years of experience in the care of the mentally ill and to include one year in a nursing management position;

(c) Admission procedures to the psychiatric unit shall include, in addition to those specified in He-P 802.20(a):

(1) A psychiatric diagnosis;

(2) An admitting diagnosis including any concurrent disease; and

(3) Completion of a psychosocial assessment and family history as appropriate;

(d) The psychiatric unit shall provide emergency psychiatric services on a 24 hour per day basis, 7 days per week;

(e) The hospital shall perform a psychiatric evaluation as soon as practicable but no longer than 24 hours after admission on each patient admitted to the psychiatric unit including:

(1) Medical history;

(2) Present mental status;

(3) Notation about the onset of symptoms and circumstances leading to admission and admitting diagnosis;

(4) An estimate of the patient’s intellectual functioning, memory functioning, and orientation;

(5) An evaluation of the patient’s use or abuse of alcohol or drugs, as appropriate; and

(6) When indicated, a neurological examination;

(f) The hospital shall require that each patient have an individual treatment plan which includes:

(1) The diagnosis;

(2) An inventory of the patient’s strengths and weaknesses which would enable the patient to function in a normal situation;

(3) Treatment goals;

(4) The specific treatment modalities used based on the strengths and weaknesses demonstrated by the patient;

(5) The responsibilities of each treatment team member; and

(6) Documentation as to the specific therapeutic activities the patient shall participate in during the patient’s hospitalization;

(g) The psychiatric unit shall provide therapeutic activities which are:

(1) Appropriate to the needs and interests of the patients;

(2) Directed toward restoring the patient’s physical and psychosocial functioning; and

(3) In accordance with the treatment plan in (f) above;

(h) Progress notes shall be recorded in the patient’s medical record by all personnel involved in carrying out the individual treatment plan for each patient;

(i) In the psychiatric unit where patients might be a hazard to themselves or others, all glazing, both interior and exterior, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

(j) There shall be at least one seclusion room per every 24 beds or fraction thereof on each psychiatric unit;

(k) Seclusion rooms, if used as a treatment modality, shall:

(1) Where restraining patients is provided, have a maximum clear floor area of at least 60 square feet with a minimum wall length of 7 feet and a maximum wall length of 11 feet;

(2) Be accessed by an anteroom or vestibule that also provides access to a toilet room. The doors to the anteroom and the toilet room shall be a minimum of 3 feet 8 inches wide;

(3) Be for only one patient;

(4) Have doors that permit staff observation of patients through a view panel, while also maintaining provisions for patient privacy. The view panel shall be fixed glazing with polycarbonate or laminate on inside of glazing;

(5) Be under constant observation, which may include video monitoring, when being used;

(6) Be constructed to prevent patient hiding, escape, injury, or suicide;

(7) Be constructed of materials that are of a type acceptable to the local authority having jurisdiction and the state regulatory agency when the interior of the seclusion treatment room is padded with combustible materials;

(8) Not contain outside corners or edges;

(9) Have the ability to be locked as applicable;

(10) Not have electrical switches and receptacles within the rooms; and

(11) Have doors that swing out;

(l) The room(s) shall be appropriately located for direct nursing observation;

(m) Forensic units shall have security vestibules or sally ports at the unit entrance;

(n) Care and supervision of child psychiatric patients shall be separate and distinct from adult psychiatric patients;

(o) Patient room areas with beds or cribs shall be at least 100 square feet for single-bed rooms, 80 square feet per bed and 60 square feet per crib in multiple-bed rooms;

(p) Geriatric, Alzheimer’s, and other dementia units patient room areas shall be at least 120 square feet in single bedrooms and 200 square feet in multiple-bed rooms;

(q) Maximum room capacity shall be 2 patients;

(r) A visitor room for patients to meet with friends or family with a minimum floor space of 100 square feet shall be provided;

(s) A quiet room shall be provided for a patient who needs to be alone for a short period of time but does not require a seclusion room. Such a room shall be a minimum of 80 square feet. A group therapy room may be combined with this space if the unit accommodates not more than 12 patients and when at least 225 square feet of enclosed private space is available for group therapy activities;

(t) When door closers are required, they shall be mounted on the public side of the door rather than the private patient side of the door and whenever possible they should be within view of a nurse workstation;

(u) Door hinges shall be designed to minimize points for hanging;

(v) Door lever handles shall point downward when in the latched positions. All hardware shall have tamper-resistant fasteners;

(w) All window glazing, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

(x) Clothing rods or hooks, if present, shall be designed to minimize the opportunity for patients to cause injury;

(y) Drawer pulls shall be of the recessed type to eliminate the possibility of use as a tie-off point;

(z) Special design considerations for injury and suicide prevention shall be given to shower, bath, toilet, and sink hardware and accessories, including grab bars and toilet paper holders;

(aa) Grab bars shall be required in 10 percent of the private or semi-private patient toilet rooms. Where grab bars are provided, they shall be of a removable type and the space between the bar and the wall shall be filled to prevent a cord being tied around it for hanging;

(ab) The following shall not be permitted:

(1) Towel bars;

(2) Shower curtain rods; and

(3) Lever handles;

(ac) In private patient bathrooms, the ceiling shall be of the tamper-resistive type or of sufficient height to prevent patient access;

(ad) In patient bedrooms where acoustical ceilings are permitted, the ceiling shall be secured or of sufficient height to prevent patient access;

(ae) In private patient bathrooms, any plumbing, piping, ductwork, or other potentially hazardous elements shall be concealed above a ceiling;

(af) In patient bedrooms and bathrooms, ceiling access panels shall be secured or of sufficient height to prevent patient access;

(ag) In patient bedrooms and bathrooms, ventilation grilles shall be secured and have small perforations to eliminate their use as tie-off point or shall be of sufficient height to prevent patient access;

(ah) In unsupervised patient areas, sprinkler heads shall be recessed or of a design to minimize patient access;

(ai) In private patient bathrooms, air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type;

(aj) Electronic surveillance systems shall not be required in psychiatric nursing units, but if provided for the safety of the residents, any devices in resident areas shall be mounted in a tamper-resistance enclosure that is unobtrusive; and

(ak) A nurse-call system shall meet the requirements of UL 1069 Standard for Hospital Signaling and Nurse Call Equipment. Use of alternate technologies that meet the requirements of UL 1069, including radio frequency systems, shall be permitted for call systems and shall have tamper-resistant fasteners.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.33); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.30)

N.H. Code Admin. R. Ann. He-P 802.32 Obstetrics

If a hospital provides the services of obstetrics, then:

(a) The unit shall be exclusively designed for maternity patients and their newborn infants, except that gynecological patients, with no communicable diseases, may be admitted when the need exists only as determined by hospital policy;

(b) The department head shall be, at a minimum, a registered nurse with education, training, and experience in obstetric nursing;

(c) A pediatrician or family practitioner shall direct the medical care of newborn infants;

(d) Personnel assigned to the unit shall be free of infections and shall not be assigned to care for any other patients who might present a hazard of cross-infection;

(e) The unit shall employ or contract with nurses qualified by obstetrical education, training, and experience and in numbers adequate to meet the needs of each patient;

(f) The unit shall be physically separate and arranged to prevent traffic from other areas of the hospital to pass through the unit;

(g) The unit shall have facilities for the following functions:

(1) Antepartum care for patient stabilization;

(2) Fetal diagnostic testing such as amniocentesis, ultrasound, oxytocin stress tests, and non-stress tests;

(3) Labor observation and evaluation;

(4) Labor;

(5) Delivery;

(6) Postpartum care; and

(7) Neonatal care;

(h) The functions listed in (g) above may be combined in a single room or separated into separate service areas;

(i) If the functions listed in (g) above are in separate areas, the following shall apply:

(1) Labor rooms shall include toilet and hand washing facilities in or immediately adjacent to the room;

(2) Delivery rooms shall be in close proximity to the labor rooms;

(3) Drugs and equipment necessary for emergency treatment of mother and infant shall be available in the delivery room;

(4) Occupancy in rooms for postpartum care shall be limited to 2 patients; and

(5) Lavatories shall be either in the room or available without accessing a general corridor;

(j) If the functions listed in (g) above are combined, the rooms shall include the following:

(1) Each room shall be equipped for all types of deliveries except Cesarean section births or any delivery requiring general anesthesia;

(2) Each combined function room shall have a toilet and shower room attached;

(3) Lavatories shall contain facilities for hand washing, and infant bathing; and

(4) Each combined function room shall have windows;

(k) Care of infants who have shown no complications shall be provided either in a newborn nursery area or in the mother’s room;

(l) If nursery care is provided:

(1) Each newborn nursery room shall contain no more than 16 infant stations. When a rooming in program is used, the total number of bassinets in these units may be reduced, but the newborn nursery shall not be omitted in its entirety from any hospital that includes delivery services;

(2) The hospital shall maintain a continuing care nursery for hospitals that provide continuing care for infants requiring close observation, such as, low birth-weight babies who are not ill but require more hours of nursing than normal neonates, the minimum of 120 square feet per infant station;

(3) Labor and delivery room(s) shall have a minimum clear floor area of 340 square foot with a minimum clear dimension of 13 feet. This shall include an infant stabilization and resuscitation space with a minimum clear floor area of at least 40 square feet. Each labor and delivery room shall be for single occupancy; and

(4) Cesarean or delivery room(s) shall have minimum clear floor area of 440 square feet with a minimum dimension of 16 feet. This shall include an infant resuscitation space with a minimum clear floor area of at least 80 square feet;

(m) The number of bassinets shall exceed the number of obstetrical beds by 25% and, if intensive neonatal care is provided, the number of bassinets shall be increased by an additional 10%;

(n) Emergency equipment for resuscitation shall be readily available and in operable condition;

(o) Equipment for care of at risk infants shall be available;

(p) The unit shall have the ability to provide isolation for infants with contagious diseases or infections; and

(q) Care of infants, either born in the unit or transported to the unit immediately after birth, shall include:

(1) Use of a prophylactic in the infant’s eyes in accordance with RSA 132:6; and

(2) Provision for accurate identification of infants.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.28); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.31)

N.H. Code Admin. R. Ann. He-P 802.33 Radiology and Radiation Services

If a hospital provides radiology, nuclear medicine, and therapeutic radiation services, then:

(a) The chief of radiology shall be a medical radiologist or a consulting medical radiologist;

(b) There shall be diagnostic x-ray facilities, providing a complete service, consisting of radiographic and fluoroscopic equipment;

(c) There shall be adequate toilet and dressing rooms for patients;

(d) Diagnostic x-ray and radiation therapy equipment shall be registered and radioactive material shall be licensed, in accordance with RSA 125-F, and shall meet all applicable requirements of He-P 4000;

(e) The technical staff employed by the radiology department shall perform the service as assigned by the medical radiologist for diagnostic uses of radiation, and by the radiation oncologist for the therapeutic uses of radiation, and in accordance with He-P 4000;

(f) The chief of radiology shall establish procedures necessary to assure the safe and proper use of all x-ray equipment and diagnostic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment;

(g) The medical director of radiation oncology shall establish procedures necessary to assure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment; and

(h) A radiation oncologist or therapeutic radiologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.29); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.32)

N.H. Code Admin. R. Ann. He-P 802.34 Surgical Services

(a) Hospitals which provide surgical services shall determine the scope of surgical services that shall be performed in the surgical suite.

(b) The hospital shall determine the types of anesthesia that shall be utilized for each type of surgical procedure and assure its availability in the surgical suite.

(c) The surgical suite shall be a separate unit, physically set apart from all other departments.

(d) The surgical suite shall contain the following:

(1) At least one operating room equipped for general operating use within the scope of surgical services determined by the hospital in accordance with (a) above;

(2) Facilities for sterilization, scrubbing, and clean-up separate from the operating room;

(3) Clean or sterile, and soiled or decontamination rooms which shall be separate and distinct;

(4) Appropriate storage space for sterile supplies, instruments, anesthesia, and medications;

(5) Emergency lighting;

(6) Adequate ventilation, including air exchanges, humidity and temperature which shall meet the requirements of the ANSI/ASHRAE/ASHE Standard 170-2017: Ventilation of Health Care Facilities as referenced in the FGI’s “Guidelines for Design and Construction of Hospitals” (2022 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A, including but not limited to, operating rooms, sterile supply, clean, and decontamination rooms; and

(7) Space routinely used for administering inhalation anesthesia and inhalation analgesia which shall be served by a scavenging system to vent waste gases with the air supply at or near the ceiling and return or exhaust air inlets near the floor level.

(e) The nursing director of the surgical suite shall be a registered nurse with education, training, and experience in surgical nursing techniques.

(f) The anesthesiologist shall be qualified in anesthesiology in accordance with the medical staff bylaws of the hospital.

(g) The chief of surgical service shall be board certified in surgery.

(h) The surgical suite shall not be used for childbirth except for Caesarian section procedures.

(i) Except in emergencies, no operation shall be performed until:

(1) The patient has had a physical examination and medical history completed;

(2) Any indicated laboratory and x-ray examinations have been completed; and

(3) The preoperative diagnosis has been recorded in the patient’s record.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.30); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.33)

N.H. Code Admin. R. Ann. He-P 802.35 Emergency Services

(a) Hospitals shall provide emergency services overseen by a medical director of emergency services who shall be certified by the American Board of Emergency Medicine (ABEM) in emergency medicine or the equivalent osteopathic board, be eligible to sit for the examination in emergency medicine, or have equivalent training or experience in emergency medicine in accordance with the American College of Emergency Physicians (ACEP) “Emergency Department Planning and Resource Guidelines,” (2021 edition), available as noted in Appendix A.

(b) An emergency department shall offer comprehensive emergency care to all individuals regardless of ability to pay 24 hours a day with at least one physician experienced in emergency care in the emergency care area or immediately available within the hospital.

(c) An emergency department shall employ or contract with licensed practitioners in the field of psychiatry, psychology, or other medical practitioners recognized by the board of medicine to have the knowledge and expertise to treat individuals in need of emergency mental health treatment to meet the mental health needs of individuals who present in the emergency department for mental health treatment.

(d) The nursing director of the emergency services shall be a registered nurse who is qualified by education, training, and experience to supervise the provision of emergency nursing services.

(e) The emergency department shall contain:

(1) Appropriate access from ambulance unloading area to facilitate easy transfer of patients;

(2) A waiting area for families of patients who are being treated or for patients waiting to be seen;

(3) Treatment rooms for the care of emergency patients that are equipped to provide treatment of life-threatening conditions; and

(4) Treatment areas which provide privacy for patient treatment without compromising patient care.

(f) Emergency service policies and procedures shall be developed regarding assessment and treatment by physicians and other personnel.

(g) The hospital shall develop a procedure for reporting suspected or alleged cases of child or adult abuse and neglect and emergency service personnel shall be trained in this procedure.

(h) Documentation of care provided in the emergency service department shall include the following information:

(1) A record of the emergency care provided; and

(2) A record of any emergency care provided prior to the patient’s arrival in the emergency room.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.31); amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.34)

N.H. Code Admin. R. Ann. He-P 802.36 Critical Access Hospital

A critical access hospital (CAH), as defined in He-P 802.03(t), shall meet the criteria set forth in He-P 802, except as follows:

(a) A CAH may obtain swing-bed approval to provide post-hospital skilled nursing facility-level care in inpatient beds, which shall not be counted in the 96-hour calculation;

(b) A CAH may contract with a licensed hospice to provide hospice care;

(c) The CAH may dedicate beds to the hospice, but the beds shall be counted toward the 25-bed maximum;

(d) The hospice patient shall not be included in the calculation of the 96-hour annual average length of stay;

(e) The hospice patient may be admitted to the CAH for any care involved in their treatment plan or for respite care;

(f) In addition to the 25-inpatient CAH beds, a CAH may also operate a psychiatric or a rehabilitation distinct part unit of up to 10 beds each;

(g) A CAH shall notify the department when it receives CAH status;

(h) The department shall issue a license to a CAH, which shall designate the number of staffed beds, up to the maximum allowed under critical access;

(i) The CAH shall be exempt from He-P 802.34(f) and instead may have a certified registered nurse anesthetist;

(j) If a CAH wishes to change its critical access status, the hospital shall notify the department;

(k) The CAH shall be exempt from He-P 802.35(a) and (c); and

(l) The CAH shall be exempt from He-P 802.17(c) and instead may have a medical director, as defined in He-P 802.03(bh), who is employed less than full time.

History

• #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18
• #13166, eff 1-28-21 (formerly He-P 802.32); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.35)

N.H. Code Admin. R. Ann. He-P 802.37 Psychiatric Hospital

(a) A psychiatric hospital, as defined in He-P 802.03(ci), shall meet the criteria set forth in He-P 802, including He-P 802.28.

(b) Each psychiatric hospital shall have a full time administrator who meets the qualifications for an administrator as defined in He-P 802.17(b) and shall be responsible to the governing body for the daily management and operation of the hospital which, in addition to those responsibilities defined in He-P 802.17(b), shall include ensuring development and implementation of hospital policies and procedures on:

(1) Voluntary and involuntary emergency admission; and

(2) Seclusion and restraints.

(c) Psychiatric hospitals shall be exempt from He-P 802.17(e) and (f) and He-P 802.32.

History

• #13166, eff 1-28-21 (formerly He-P 802.33); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.36)

N.H. Code Admin. R. Ann. He-P 802.38 Rehabilitation Hospital

(a) A rehabilitation hospital, as defined in He-P 802.03(co), shall meet the criteria set forth in He-P 802 and:

(1) Each rehabilitation hospital shall have a full time administrator who meets the qualifications for an administrator as specified in He-P 802.17(b)(1)-(2) and is responsible to the governing body for the daily management and operation of the hospital including those responsibilities specified in He-P 802.17(b); and

(2) Shall have personnel requirements that include:

a. A director of nursing services who shall be exempt from He-P 802.17(e) and (f) and instead:

1. Be a registered nurse currently licensed in New Hampshire; and

2. Possess at least a bachelor’s degree with 3 years’ experience in the provision of comprehensive physical rehabilitation services; and

b. A medical director of rehabilitation services who shall:

1. Be a medical doctor or doctor of osteopathic medicine licensed in the state of New Hampshire;

2. Provide services to the facility or unit and its inpatients for at least 20 hours per week; and

3. Meet one of the following requirements:

(i) Be board-certified by either the American Board of Physical Medicine and Rehabilitation or the American Society of Neurorehabilitation; or

(ii) Have at least 2 years of training or experience in the medical management of inpatients requiring rehabilitative services.

(b) In addition to the requirements in He-P 802.18, rehabilitation hospitals shall have available the services of:

(1) An occupational therapist licensed by the state of New Hampshire;

(2) A physical therapist licensed by the state of New Hampshire;

(3) A speech-language pathologist licensed by the state of New Hampshire;

(4) A respiratory therapist licensed by the state of New Hampshire;

(5) A psychologist licensed by the state of New Hampshire;

(6) An orthotist or prosthetist;

(7) A rehabilitation nurse with education, training, and experience in rehabilitation nursing and licensed by the state of New Hampshire; and

(8) Other nursing personnel and aides educated and trained to provide services as instructed by the physician.

(c) Rehabilitation hospitals that accommodate inpatients shall comply with the following construction requirements:

(1) The state fire code;

(2) The state building code; and

(3) The FGI’s “Guidelines for Design and Construction of Hospitals” (2022 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A.

(d) Minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules shall be 140 square feet in single-bed rooms and 125 square feet per bed in multiple-bed rooms.

(e) Maximum occupancy shall be 2 beds per room.

(f) A training unit shall be provided for teaching daily living activities, which includes:

(1) A bedroom;

(2) A full bathroom in addition to other toilet and bathing requirements;

(3) A kitchen; and

(4) Space for training stairs.

(g) Space requirements for the exercise area shall be designed to permit access to all equipment and be sized to accommodate equipment for physical therapy.

(h) In addition to He-P 802.24, quality assurance, a rehabilitation hospital shall establish and maintain a comprehensive, ongoing, facility-wide quality assurance program which involves assessment of all quality assurance activities conducted in the provision of its health care and rehabilitation program and services at all levels which includes no less than:

(1) Assessment of rehabilitation outcomes using measures currently adopted by CMS for rehabilitation hospitals; and

(2) A mechanism to assure the utilization of systematic data collection based on valid samples of the total patient population to measure performance and patient results, and to make recommendations to physicians and centers of needed changes.

(i) Rehabilitation hospitals shall be exempt from He-P 802.35.

History

• #13166, eff 1-28-21 (formerly He-P 802.34); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.37)

N.H. Code Admin. R. Ann. He-P 802.39 Freestanding Hospital Emergency Facility

(a) A freestanding hospital emergency facility (FHEF), as defined in He-P 802.03(an), shall be governed by the same regulations as a general hospital with the following additions:

(1) Each FHEF shall be owned and operated by a licensed parent general hospital, that participates in Medicare; and

(2) Each FHEF shall document how the needs of patients will be met during hours when the FHEF is not in operation.

(b) Each FHEF shall have a full-time administrator who may also be the administrator of the parent hospital and who:

(1) Meets the requirements for an administrator as defined in He-P 802.17(b)(1)-(2); and

(2) Shall be responsible to the parent hospital administrator or governing body for the daily management and operation of the hospital which shall act as liaison to the parent hospital for the patients and personnel of the FHEF, in addition to those responsibilities defined in He-P 802.17(b).

(c) The FHEF medical staff shall be members of the parent hospital in accordance with the parent hospital by-laws.

(d) The FHEF shall have a medical director of emergency services.

(e) The medical director of emergency services shall meet the requirements set forth in He-P 802.34(a) and (b).

(f) The director of nursing services shall, in lieu of the requirements in He-P 802.17(e) and (f):

(1) Be part of the parent hospital’s single organized nursing services;

(2) Be at least a registered nurse currently licensed in New Hampshire;

(3) Have a bachelor’s degree in nursing or related field; and

(4) Hold a current certificate in advanced cardiac life support from the American Heart Association and be an emergency nurse certified by the Board of Certification for Emergency Nursing.

(g) Each FHEF shall provide the services disclosed under He-P 802.19(a).

(h) An existing parent hospital shall be responsible for providing information required in He-P 802.19(b)(1)-(5) as applicable.

(i) The FHEF shall offer comprehensive emergency care 24 hours a day, 7 days a week.

(j) The FHEF shall have at least one physician experienced in emergency care present in the emergency care area or able to be present within 5 minutes during the entire hours of operation.

(k) Emergency service policies and procedures regarding assessment and treatment by physicians and other personnel shall be developed by the parent hospital and followed by the FHEF.

(l) The parent hospital’s procedure to handle suspected or alleged cases of child or adult abuse or neglect and emergency service shall be utilized by the FHEF and the personnel shall be trained in this procedure.

(m) Patients who require hospital admission shall be evaluated and stabilized prior to transfer to the parent hospital or hospital of the patient’s choice.

(n) Patients who are treated and released from the FHEF shall be discharged and treated in accordance with He-P 802.19(h).

(o) A medical record shall be maintained and kept active for each patient admitted to the freestanding hospital emergency facility and shall be subject to all rules under He-P 802.20, and in the event of transfer to a hospital, copies of the record of the medical assessment and notes about treatments given shall be transferred with the patient while the original record shall be maintained in the FHEF.

(p) An emergency laboratory shall be available to the FHEF during all hours of operation.

History

• #13166, eff 1-28-21 (formerly He-P 802.35); ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.38)

N.H. Code Admin. R. Ann. He-P 802.40 Cardiac Catheterization Services

(a) If cardiac catheterization services have not been provided by the hospital previously, no licensee shall offer cardiac catheterization services without a special health care service license.

(b) In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide cardiac catheterization services, regardless of whether the licensee holds a special health care license.

(c) Cardiac catheterization laboratory services shall only be provided on the campus of a licensed hospital.

(d) Licensed hospitals providing interventional cardiac catheterization laboratory services without on-site open-heart surgery shall secure and maintain a formal transfer agreement with a hospital performing open heart surgery.

(e) Licensed hospitals providing elective interventional cardiac catheterization laboratories shall also provide primary interventional cardiac catheterization laboratory services within 12 months of commencement of elective interventional cardiac catheterization laboratory services.

(f) Licensed hospitals providing primary interventional cardiac catheterization services shall meet the procedure volume requirements of 150 cardiac catheterization procedures of any kind at the licensed location on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any 12-month period.

(g) Cardiac catheterization laboratories performing only diagnostic catheterization procedures and not interventional catheterization procedures shall not have any minimum volume requirements.

(h) Hospitals providing cardiac catheterization laboratory services shall include cardiac catheterization laboratory services in the hospital’s quality assurance plan to objectively and systematically monitor patient care.

(i) The quality assurance plan referenced in (h) above shall:

(1) Contain patient selection criteria by procedures;

(2) Contain formal transfer agreements and emergency protocols for transfer to another facility which:

a. Specify the protocol for transfer to another facility; and

b. Include the signature of both hospitals and be dated within the past 12 months of submission with the application;

(3) Describe the mentoring program for licensed physicians, which shall include operator volume requirements; and

(4) Describe the process of review and outcomes analysis for patients who have been transferred without compromising the statutory confidentiality protection of the hospital’s quality assurance program.

(j) All licensees performing cardiac catheterization laboratory services shall be accredited by a recognized accrediting agency for the provision of cardiac catheterization laboratory services.

(k) If the licensee is newly providing cardiac catheterization services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (j) above.

(l) Staffing for cardiac catheterization laboratory services shall be in accordance with the accrediting agency’s accepted staffing requirements.

(m) Cardiac catheterization laboratory services shall be directed and staffed by a board certified cardiologist with training and experience, which meets or exceeds the requirements of ACCF/AHA/SCAI’s “2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures” (July 2013), available as noted in Appendix A.

History

• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.39)

N.H. Code Admin. R. Ann. He-P 802.41 Open Heart Surgery Services

(a) If open heart surgery services have not been provided by the hospital previously, no licensee shall offer open heart surgery services without a special health care service license.

(b) In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide open heart surgery services, regardless of whether the licensee holds a special health care license.

(c) Open heart surgery services shall be available and accessible on-site 24 hours per day, 7 days per week, for emergency purposes.

(d) All licensees performing open heart surgery services shall be accredited by a recognized accrediting agency for the provision of open heart surgery services.

(e) If the licensee is newly providing open heart surgery services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (d) above.

(f) Staffing for open heart surgery services shall be in accordance with the accrediting agency’s accepted staffing requirements.

(g) Each open heart surgery program shall provide, at a minimum, the following:

(1) A total of 4 segregated or private beds for cardiac care in an ICU;

(2) A telemetry unit proximate to the ICU;

(3) An acute renal dialysis service;

(4) A cardiac rehabilitation service;

(5) A minimum of 2 operating rooms equipped and available as needed for open heart surgery;

(6) An in-house cardiac catheterization service; and

(7) An available and accessible supply of blood and platelets, through an in-house supply or through affiliation with an established blood bank network.

(h) The licensee shall establish and maintain:

(1) A quality assurance plan that includes:

a. An outline of utilization, or peer review and control programs, or both; and

b. An annual review of the morbidity and mortality rates and other indicators of patient outcomes, compared with regional or national averages;

(2) Protocols governing transfers, admissions, and discharges of open-heart surgery patients; and

(3) The following protocols that shall be annually reviewed:

a. A list of indications and contraindications to govern patient selection for open heart surgery;

b. Guidelines governing the admission of open heart surgery patients to the intensive care, coronary care, and progressive care units, and discharge from these units; and

c. Mechanisms for follow-up surveillance of discharged patients.

(i) Licensee’s providing open heart surgery shall subscribe, for the purpose of external quality review, to a confidential data registry.

(j) The licensee shall have the appropriate equipment to adequately perform open-heart surgery as required by the accrediting agency.

(k) Each licensee performing open heart surgery shall perform 150 open heart surgery cases on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any 12-month period.

History

• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.40)

N.H. Code Admin. R. Ann. He-P 802.42 Megavoltage Radiation Therapy Services

(a) If megavoltage radiation therapy services have not been provided by the hospital previously, no licensee shall offer megavoltage radiation therapy services without a special health care service license.

(b) In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide megavoltage radiation therapy services, regardless of whether the licensee holds a special health care license.

(c) The licensee shall appoint a chief of radiation oncology who shall be certified in radiation oncology and responsible for:

(1) Overseeing the services provided to ensure safe and quality care;

(2) Ensuring personnel are qualified to perform megavoltage radiation therapy services in accordance with He-P 4000; and

(3) Establishing procedures necessary to ensure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment.

(d) A radiation oncologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000.

(e) A licensee providing treatment on megavoltage radiation therapy equipment shall ensure the provision of a comprehensive coordinated care plan which may include:

(1) Clinical oncology services, including chemotherapy and surgical treatment of tumors and follow-up capabilities;

(2) Services of a tumor registry;

(3) Services of a simulation capability and dose computation equipment;

(4) Services of a pathology laboratory;

(5) Services of a physics laboratory;

(6) Computerized tomography or magnetic resonance imaging capability;

(7) Social work and counseling;

(8) Brachytherapy or a referral arrangement for provision of the service;

(9) Nutrition and dietary consultation; and

(10) In-house capabilities encompassing the full range of radiation therapy modalities, including megavoltage equipment and superficial treatment equipment and systemic therapy or referral arrangements for the provision of these services.

(f) All licensees performing megavoltage radiation services shall be accredited by a recognized accrediting agency for the provision of megavoltage radiation therapy services.

(g) If the licensee is newly providing megavoltage radiation therapy services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (f) above.

(h) Staffing for megavoltage radiation therapy services shall be in accordance with the accrediting agency’s accepted staffing requirements.

(i) No licensee shall provide megavoltage radiation therapy services unless the program will treat a minimum of 200 patients on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any 12-month period for cognitive planning process codes.

(j) Any licensee holding a special health care service license to provide megavoltage radiation therapy services not on hospital premises shall adopt protocols for the transportation of patients for the provision of necessary support and emergency services, which shall include a written agreement for the acceptance and transfer of patients needing such emergency care, with the nearest acute care hospital or any acute care hospital within 30 minutes travel time.

History

• #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.41)

N.H. Code Admin. R. Ann. He-P 802.43 Long Term Care Hospitals

A LTCH, as defined in He-P 802.03(bf), shall be governed by the same regulations as a general hospital with the following additions:

(a) The hospital shall have an average Medicare inpatient length of stay of greater than 25 days pursuant to Section 114(e) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added section 1886(m) of the Act, and codified the provisions of the BBA and BIPA in paragraph (1) of that subsection;

(b) Applicants for a proposed LTCH shall provide a staffing plan that includes licensed professionals who provide services to the LTCH’s patients as:

(1) Employees;

(2) Under contract; or

(3) As members of the LTCH’s organized medical staff; and

(c) The hospital shall provide sufficient numbers of qualified personnel to meet the needs of patients in the LTCH during all hours of operation.

History

• #14081, eff 9-25-24, EXPIRES: 9-25-34

Part He-P 803 New Hampshire Nursing Home Rules

N.H. Code Admin. R. Ann. He-P 803.01 Purpose

The purpose of this part is to set forth the classification of and licensing requirements for nursing home facilities pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(3).

History

• #2191, eff 11-25-82; amd by #2640, eff 3-7-84; ss by #3193, eff 1-28-86; amd by #4232, eff 2-23-87; amd by #4349, eff 12-28-87; amd by #4517, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5644, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association or other legal entity operating a nursing home, except:

(a) All facilities listed in RSA 151:2, II(a)-(h); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of residents;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to residents; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving residents without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrator” means the person responsible for the management of the licensed premises, who is licensed by the state of New Hampshire pursuant to RSA 151, and who reports to and is accountable to the governing body.

(f) “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(g) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

(h) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies, or other companies as the commissioner shall decide.

(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA-J:34-37.

(j) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a nursing home pursuant to RSA 151.

(k) “Area of non-compliance” means any action or failure to act that cause(s) a licensee to be out of compliance with RSA 151, He-P 803, or other applicable federal and state requirements.

(l) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the resident to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

(m) “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the resident, and the resident’s guardian, agent, or personal representative, if any, as a result of the assessment process, for the provision of care and services to a resident.

(n) “Certified nursing home” means a nursing home that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 803.

(o) “Change of ownership” means change in the controlling interest of an established nursing home to an individual or successor business entity.

(p) “Chemical restraint” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.

(q) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(r) “Core services” means those minimal services to be provided to any resident that must be included in the basic rate.

(s) “Critical incident stress management (CISM)” means an adaptive, short-term psychological

helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(t) “Days” means calendar days, unless otherwise specified.

(u) “Department” means the New Hampshire department of health and human services.

(v) “Direct care” means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(w) “Direct care personnel” means any person providing direct care to a resident.

(x) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(y) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).

(z) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

(aa) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(ab) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ac) “Equipment” means “any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services”, not to include portable refrigerators. This term includes fixtures.

(ad) “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

(ae) “Facility” means “facility” as defined in RSA 151:19, II.

(af) “Governing body” means a group of designated person(s) that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(ag) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the resident’s person and/or estate.

(ah) “Health care occupancy” means an occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical, or mental disability, or because of security measures not under the occupant’s control.

(ai) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(aj) “Infectious waste” means those items specified by Env-Sw 904.

(ak) “Informed consent” means the decision by a resident, his or her guardian or agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(al) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(am) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 803 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 803.

(an) “License” means the document issued by the department to an applicant at the start of operation as a nursing home which authorizes operation as a nursing home in accordance with RSA 151 and He-P 803, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date and the license number.

(ao) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the nursing home is licensed for.

(ap) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(aq) “Licensed premises” means the building or buildings that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(ar) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(as) “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(at) “Mechanical restraint” means a device designed to prohibit a resident’s free movement, including full bed rails, gates that prohibit a resident’s free movement throughout the living areas of a unit, half doors that prohibit a residents free movement throughout the living areas of a unit, geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will, wrist or ankle restraints, vests or pelvic restraints, or other similar devices that prevent a resident’s free movement.

(au) “Medical director” means a physician licensed in New Hampshire pursuant to RSA 329 or 326-B, who is responsible for the implementation of resident care policies and the coordination of medical care in the facility.

(av) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(aw) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(ax) “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health and safety of any resident.

(ay) “Nursing care” means the provision or oversight of a resident’s physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.

(az) “Nursing home(s)” means a place which provides for 2 or more persons basic domiciliary services, including board, room, and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.

(ba) “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

(bb) “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bc) “Over-the-counter medications” means non-prescription medications.

(bd) “Owner” means a person or organization who has controlling interest in the nursing home.

(be) “Patient or resident rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

(bf) “Personal representative” means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

(bg) “Personnel” means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a resident(s).

(bh) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the resident’s freedom of movement.

(bi) “Physician” means a medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329, or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bj) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bk) “Pro re nata (PRN) medication” means medication administered as circumstances may require in accordance with licensed practitioner’s orders.

(bl) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bm) “Protective care” means the provision of resident monitoring services, including but not limited to:

(1) Knowledge of resident whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(bn) “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(bo) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bp) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(bq) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(br) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(bs) “Resident” means any individual residing in and receiving care from a nursing home licensed in accordance with RSA 151 and all other federal and state requirements.

(bt) “Resident record” means documents maintained for each resident receiving care and services, which includes all documentation required by RSA 151, He-P 803, and all documentation compiled relative to the resident as required by other federal and state requirements.

(bu) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(bv) “Significant change” means a decline or improvement in a resident’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident’s health status; and

(3) Requires interdisciplinary review and/or revision of the care plan.

(bw) “State monitoring” means the placement of individuals by the department at a nursing home to monitor the operation and conditions of the facility.

(bx) “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease or clinical conditions.

(by) “Unusual incident” means an occurrence of any of the following while the resident is either in the nursing home or in the care of nursing home personnel:

(1) The unanticipated death of a resident that is not related to their diagnosis or underlying condition;

(2) An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and that has resulted in an injury that requires treatment in an emergency room or by a licensed practitioner; or

(3) An elopement from the nursing home or other circumstances that resulted in the notification and/or involvement of law enforcement or safety officials.

(bz) “Underwriters Laboratories (UL) listed” means that a product has been confirmed safe for use by a the global safety certification company UL.

(ca) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (March 2019), signed by the applicant or 2 of the corporate officers, affirming to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

b. For any nursing home to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any nursing home to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical assess hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) A floor plan of the prospective nursing home;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) List of affiliated or related parties;

(5) The applicable fee in accordance with RSA 151:5, IV, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the qualifications of the nursing home administrator;

(7) Copies of licenses for the nursing home administrator;

(8) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the health care chapter of the Life Safety Code 101 and the Uniform Fire Code, NFPA 1, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final onsite inspection of the construction project;

(9) If the nursing home uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill;

(10) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, medical director, administrator, and any officer, director, shareholder, or general or limited partner thereof, as applicable;

(11) The previous 5 years of regulatory compliance history of the prospective licensee in providing long term care in New Hampshire, including by compliance with applicable statutes and regulations governing the operation of long term care facilities;

(12) The previous 5 years of regulatory compliance history of the prospective licensee in providing long term care in states other than New Hampshire, if any, including compliance with the applicable statutes and regulations governing the operation of long term care facilities in said states; and

(13) Any waiver requests if applicable.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #9856-B, eff 1-26-11; ss by #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 803.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 803.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 803.

(f) Unless a waiver has been granted, the department shall deny a licensing request after reviewing the information in He-P 803.04(a)(9) above if it determines that the applicant, proposed licensee or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety or well-being of residents.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 803.04(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The materials required by He-P 803.04(a)(1) and (5);

(2) The current license number;

(3) A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 803.10(f), if applicable; and

(4) A statement identifying any variances applied for or granted by the state fire marshal.

(d) In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

(e) Following an inspection, as described in He-P 803.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) and (d) above as applicable, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 803 at the renewal inspection.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.07 Nursing Home Construction, Alterations or Renovations

(a) At least 60 days prior to initiating construction, the nursing home shall provide to the department notice and stamped architectural, sprinkler, and fire alarm plans drawn to scale for any of the following including but not limited to:

(1) A new building;

(2) An addition or renovation to an existing building;

(3) Structural alterations to any resident area;

(4) Alterations that require approval from local or state authorities; and

(5) Alterations that might affect compliance with the health and safety, fire or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

(b) The department shall review plans for construction, renovation or structural alterations of a nursing home for compliance with all applicable sections of RSA 151 and He-P 803 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

(c) Department approval shall not be required prior to initiating construction, renovations or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

(d) The nursing home shall comply with all applicable licensing rules when undertaking construction, renovations or structural alterations.

(e) A licensee or applicant constructing, renovating, or structurally altering a building shall comply with the following:

(1) Saf-C 6000 and the state fire code under RSA 153:1, VI-a, including, but not limited to, NFPA 1 and NFPA 101 and as amended in Saf-FMO 300 by the fire marshal with the board of fire control and ratified by the general court pursuant to RSA 153:5;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) The Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

(f) All nursing homes newly constructed or undergoing modification after the 2019 effective date of He-P 803 shall comply with the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

(g) Where renovation or structural alteration work is done within an existing facility, all such work shall comply, insofar as practical, with applicable sections of the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

(h) The department’s health facilities administration shall be the authority having jurisdiction for the application of the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A, and shall negotiate compliance and grant waivers in accordance with He-P 803.10 as appropriate.

(i) Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless otherwise specified.

(j) The completed building shall be subject to an inspection pursuant to He-P 803.09 prior to its use.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.08 Nursing Home Requirements for Organizational Changes

(a) The nursing home shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Capacity; or

(6) Affiliated parties or related parties.

(b) When there is a change in the name, the nursing home shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(c) The nursing home shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in the number of residents beyond what is authorized under the current license.

(d) When there is a change in address without a change in location the nursing home shall provide the department with a copy of the notification from the local, state or federal agency that requires the change.

(e) The nursing home shall inform the department in writing as soon as possible prior to a change in administrator and provide the department with the following:

(1) The information specified in He-P 803.04(a)(9) if not currently employed by the licensee; and

(2) Copies of applicable licenses for the new administrator.

(f) An inspection by the department shall be conducted prior to operation when there are changes in the following:

(1) Ownership, unless the current licensee has no outstanding administrative actions in process and there will be no changes made by the new owner in the scope of services provided;

(2) The physical location; or

(3) An increase in the number of residents beyond what is authorized under the current license.

(g) A new license and license certificate shall be issued for a change in ownership or a change in physical location.

(h) A revised license and license certificate shall be issued for changes in the nursing home’s name.

(i) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in the number of residents from what is authorized under the current license; or

(3) When a waiver has been granted.

(j) Licenses issued under (f)(1) above shall expire on the date the license issued to the previous owner would have expired.

(k) The licensee shall return the previous license to the division within 10 days of the nursing home changing its ownership, physical location, address or name.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 803, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the nursing home; and

(3) Any records required by RSA 151 and He-P 803.

(b) The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 803, to include a clinical and a life safety inspection, prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 803.08(f)(1);

(3) A change in the licensee’s physical location;

(4) A relocation within the facility or an increase in the number of beds beyond what is authorized under the current license;

(5) Occupation of space after construction, renovations or structural alterations; or

(6) The renewal of a license for non-certified nursing homes.

(c) In addition to (b) above, the department shall verify the implementation of any POC accepted or issued by the department.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 803 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought; and

(4) The period of time for which the waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not have the potential to negatively impact the health or safety of the residents; and

(3) Does not negatively affect the quality of resident services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(2) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 803.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the nursing home, or the alleged unlicensed individual or entity;

(2) The name, address and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 803.

(c) Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including:

(1) Requests for additional information from the complainant or the licensee;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For the nursing home, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of alleged violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 803, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 803.12(c).

(e) For the unlicensed individual or entity the department shall provide written notification to the owner or person responsible that includes:

(1) The date of inspection;

(2) The reasons for the inspection; and

(3) Whether or not the inspection resulted in a determination that the services being provided require licensing under RSA 151:2, I(e)(2).

(f) The owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (f) above to respond to a finding that they are operating without a license or submit a completed application for a license in accordance with RSA 151:7-a, II.

(g) If the owner of an unlicensed nursing home does not comply with (g) above, or if the department does not agree with the owner’s response, the department shall:

(1) Issue a written warning to immediately comply with RSA 151 and He-P 803; and

(2) Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III.

(h) Any person or entity who fails to comply after receiving a warning, as described in (h) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

(i) The fact that the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 803, or other applicable laws.

(j) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 803, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC;

(2) Imposing a directed POC upon a licensee;

(3) Imposing fines upon an unlicensed individual, applicant or licensee;

(4) Immediate suspension of a license; or

(5) Revocation of a license.

(b) When fines are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area of non-compliance;

(2) Identifies the specific remedy(s) that has been proposed; and

(3) Provides the licensee with the following information:

a. The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the fine becoming final; and

b. The automatic reduction of a fine by 25% if the licensee waives the right to a hearing, the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a notice of areas of non-compliance, the licensee shall submit a POC detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur; and

c. The date by which each area of non-compliance shall be corrected;

(2) The licensee shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the inspection report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a resident will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 803;

b. Addresses all areas of non-compliance and deficient practices as cited in the inspection report;

c. Prevents a new violation of RSA 151 or He-P 803 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 -day period but has been unable to do so; and

2. The department determines that the health, safety or well- being of a resident will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 803.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with (f)(12) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and employees;

(2) A revised POC is not submitted within 14 days of the written notification from the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license; or

(4) Revoke or suspend the license in accordance with He-P 803.13.

(f) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2 the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

(4) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 803.11(g), the fine shall be $500.00;

(5) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 803.06(b), the fine shall be $100.00;

(6) For a failure to notify the department prior to a change of ownership, in violation of He-P 803.08(a)(1), the fine shall be $500.00;

(7) For a failure to notify the department prior to a change in the physical location, in violation of He-P 803.08(a)(2), the fine shall be $500.00;

(8) For a refusal to allow access by the department to the nursing home’s premises, programs, services or records, in violation of He-P 803.09(a), the fine for an applicant, individual, or licensee shall be $2000.00;

(9) For refusal to cooperate with the inspection or investigation conducted by the department the fine shall be $ 2000.00;

(10) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 803.12(c)(2) or (5)(b), the fine for a licensee shall be $100.00 unless an extension has been granted by the department;

(11) For a failure to implement any POC that has been accepted or issued by the department, in violation of He-P 803.12(c)(8), the fine for a licensee shall be $1000.00;

(12) For a failure to establish, implement, or comply with licensee policies, after being notified in writing by the department of the need to establish, implement or comply with licensee policies, as required by He-P 803.14(c), the fine for a licensee shall be $500.00;

(13) For a failure to provide services or programs required by the licensing classification and specified by He-P 803.14(b), the fine for a licensee shall be $500.00;

(14) For exceeding the maximum number of residents, in violation of He-P 803.14(k), the fine for a licensee shall be $500.00;

(15) For moving a current resident to an unlicensed space prior to approval from the department, the fine for a licensee shall be $500.00;

(16) For falsification of information contained on an application or of any records required to be maintained for licensing, in violation of He-P 803.14(f), the fine shall be $500.00 per offense;

(17) For a failure to meet the needs of the resident, in violation of He-P 803.14(i)(1), the fine for a licensee shall be $500.00;

(18) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 803.17(b)(1) and 803.18(d)(3), the fine for a licensee shall be $500.00;

(19) For failure to report an unusual incident as required by He-P 803.14(t), the fine for a licensee shall be $500.00 per occurrence;

(20) For failure to submit architectural sprinkler and fire alarm plans or drawings, when applicable, prior to undertaking construction or renovation of a proposed and or licensed facility in violation of He-P 803.07(a), the fine shall be $500.00;

(21) When an inspection determines that a violation of RSA 151 or He-P 803 has the potential to jeopardize the health, safety or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the initial fine, but not to exceed $2000.00; and

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the fine, but not to exceed $2000.00;

(22) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 803 shall constitute a separate violation and shall be fined in accordance with He-P 803.12(f); and

(23) If the applicant or licensee is making good faith efforts to comply with the violations of the provisions of RSA 151 or He-P 803, the department shall not issue a daily fine.

(g) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.13 Enforcement Actions and Hearings

(a) At the time of imposing a fine, or denying, revoking or suspending a license, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department; and

(3) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 803, which violations have the potential to harm a resident’s health, safety or well-being;

(2) An applicant or a licensee has failed to pay a fine imposed under administrative remedies;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 803.04;

(5) An applicant, licensee or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 803.12(c), (d), and (e);

(7) The licensee is cited a third time under RSA 151 or He-P 803 for the same violations within the last 5 inspections;

(8) A licensee, including corporation officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

(9) Upon inspection, the applicant’s premises is not in compliance with RSA 151 or He-P 803;

(10) The department makes a determination that one or more of the factors in He-P 803.05(f) is true; or

(11) The applicant or licensee fails to employ a qualified administrator.

(c) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(d) If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

(e) The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of residents when it finds that the health, safety or welfare of residents is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(f) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 803 is achieved.

(g) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(h) When a nursing home’s license has been denied or revoked, the applicant or licensee shall not be eligible to reapply for a license for 5 years, and the action shall be reported to the New Hampshire nursing home administrator licensing board for investigation and review of the administrator’s role if any.

(i) The 5 year period referenced in (h) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(j) Notwithstanding (h) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 803.

(k) RSA 541 shall govern further appeals of department decisions under this section.

(l) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 803.

(m) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with a area of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(n) The informal dispute resolution shall be requested in writing by the applicant, licensee or program director no later than 14 days from the date the statement of findings was issued by the department.

(o) The department shall review the evidence presented and provide a written notice to the applicant or licensee of its decision.

(p) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

(b) The licensee shall define, in writing, the scope and type of services to be provided by the nursing home, which shall include, at a minimum, the core services listed in He-P 803.15(d).

(c) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the nursing home.

(d) All policies and procedures shall be reviewed per licensee policy.

(e) The licensee shall assess and monitor the quality of care and service provided to residents on an ongoing basis.

(f) The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

(g) The nursing home shall not:

(1) Advertise or otherwise represent itself as operating a nursing home, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) Licensees shall:

(1) Meet the needs of the residents during those hours that the residents are in the care of the nursing home;

(2) Initiate action to maintain the nursing home in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the nursing home;

(4) Appoint an administrator who shall meet the requirements of He-P 803.17(b)(1);

(5) Appoint a medical director who shall meet the requirements of He-P 803.17(a);

(6) Verify the qualifications of all personnel;

(7) Provide sufficient numbers of personnel who are present in the nursing home and are qualified to meet the needs of residents during all hours of operation;

(8) Provide the nursing home with sufficient supplies, equipment, and lighting to meet the needs of the residents;

(9) Implement any POC that has been accepted by the department; and

(10) Comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(j) The licensee shall consider all residents to be competent and capable of making health care decisions unless the resident:

(1) Has a guardian appointed by a court of competent jurisdiction;

(2) Has a durable power of attorney for health care that has been activated; or

(3) Is an un-emancipated minor.

(k) The licensee shall not exceed the number of occupants authorized by NFPA 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and identified on the licensing certificate.

(l) If the licensee accepts a resident who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the residents, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

(m) The licensee shall report all positive tuberculosis test results for employees to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(n) The licensee shall implement measures to ensure the safety of residents who are assessed as an elopement risk or danger to self or others.

(o) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 803.09(b), for the previous 12 months;

(3) A copy of the patients’ bill of rights;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the nursing home website if available; and

(6) The licensee’s floor plan for fire safety, evacuation and emergencies identifying the location of, and access to all fire exits.

(p) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(q) A licensee shall, upon request, provide a resident or the resident’s guardian or agent, if any, with a copy of his or her resident record pursuant to the provisions of RSA 151:21, X.

(r) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and employees that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to residents and personnel; and

(3) Systems to prevent tampering with information pertaining to residents and personnel.

(s) Accidents, injuries, and unusual incidents shall be documented, including:

(1) The date and time of the occurrence;

(2) A description of the occurrence, including identification of injuries, if applicable;

(3) The actions taken;

(4) The signature of the person documenting the occurrence; and

(5) If medical intervention was required, the date and time that the emergency contact person and guardian or agent, if any, and the licensed practitioner were notified.

(t) For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property the licensee shall :

(1) Notify the department by faxing a notice to 603 271-5574 within 24 hours from the time the reportable incident, allegation of abuse, neglect, mistreatment, or misappropriation becomes known, that an investigation is in progress containing the following information:

a. The nursing home name;

b. A description of the incident including identification of injuries, if applicable;

c. The name of resident;

d. The date and time of the incident;

e. If medical intervention was required, and if so, please provide:

1. Who the medical intervention was provided by;

2. The date the medical intervention was provided; and

3. The time the medical intervention was provided; and

f. When the practitioner and the resident representative was notified, if applicable; and

(2) Within 5 days, submit a completed investigation report to the department containing the following information:

a. All items referenced in (1) above;

b. The names and results of interview(s) with all personnel, resident(s), or other individuals involved in the unusual incident, including all applicable statement signatures; and

c. The action taken by the licensee in direct response to the unusual incident(s), including any and all follow-up;

(3) Immediately notify the local police department, the department, guardian, agent or personal representative, if any, when a resident, has eloped, after the licensee has searched the building and the grounds of the nursing home; and

(4) Submit additional information, if required by the department, to support the incident report referenced in (t)(2) above.

(u) The licensee shall provide cleaning and maintenance services, as needed to protect residents, employees, and the public.

(v) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(w) Smoking shall be prohibited in the nursing home per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

(x) If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other residents.

(y) At the time of admission the licensee shall give a resident and the resident’s guardian, agent, or personal representative, a listing of all known applicable charges and identify what care and services are included in the charge.

(z) The licensee shall give a resident 30 days written notice for an increase in the cost or fees for any nursing home services.

(aa) Except as required to protect the health, safety, and well-being of the resident or other residents, prior to a resident room or bed location change, the licensee shall:

(1) Provide written notice to the resident and/or the resident’s guardian or agent, as applicable, including:

a. The reason for the change;

b. The effective date of the change; and

c. The location to which the resident is being moved;

(2) Provide verbal notice to the resident and/or the resident’s guardian or agent, as applicable, including performing the following:

a. Learning the resident’s preferences and taking them into account when discussing changes of rooms or roommates and the timing of such changes;

b. Explaining to the resident the reason for the move; and

c. Providing the opportunity to see the new location, meet the new roommate, and ask questions about the move;

(3) For a resident who is receiving a new roommate, give that resident as much notice and information about the new person as possible, while maintaining confidentiality regarding medical information; and

(4) Document all information contained in (1)-(3) above in the resident record.

(ab) The licensee shall develop and follow policies and procedures regarding resident room or bed location changes.

(ac) Following the death of a roommate, the licensee shall facilitate the provision of social services for the resident as needed.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.15 Required Services

(a) The licensee shall provide administrative services which include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the nursing home;

(2) Meets the requirements of He-P 803.17(b)(1); and

(3) Delegates, in writing, an alternate onsite, qualified designee who shall assume the responsibilities of the administrator in his or her absence.

(b) Prior to or upon the time of admission, the licensee shall provide the resident a written copy of the admission agreement, except in the case of an emergency admission where the written agreement shall be given as soon as practicable.

(c) In addition to (b) above, at the time of admission, the licensee shall provide a written copy to the resident and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions packet including the following information:

a. The basic daily, weekly, or monthly rate;

b. A list of the core services required by He-P 803.14(b);

c. Information regarding the timing and frequency of cost of care increases;

d. The nursing home’s house rules;

e. The grounds for transfer or discharge and termination of the agreement, pursuant to RSA 151:21, V;

f. The nursing home’s policy for resident discharge planning;

g. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The nursing home’s responsibility for arranging services; and

3. The fee and payment for services, if known; and

h. Information regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the resident and provided on the nursing home premises;

5. Handling of resident funds pursuant to RSA 151:24 and He-P 803.14(y);

6. Bed hold, in compliance with RSA 151:25;

7. Storage and loss of the resident’s personal property;

8. Smoking;

9. Roommates; and

10. The licensee’s policy regarding the use of restraints;

(2) A copy of the patients’ bill of rights under RSA 151:21 and the nursing home’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5);

(4) The nursing home’s policy and procedure for handling reports of abuse, neglect or exploitation, which shall be in accordance with RSA 161-F:46 and RSA 169-C:29;

(5) Information on accessing the long-term care ombudsman; and

(6) Information on advanced directives.

(d) The licensee shall provide the following core services:

(1) Services of a licensed nurse provided 24 hours a day;

(2) Services of an RN provided at least 8 hours within a 24-hour period;

(3) Emergency response and crisis intervention;

(4) Medication services in accordance with He-P 803.16;

(5) Food services in accordance with He-P 803.20;

(6) Housekeeping, laundry and maintenance services;

(7) On-site activities and/or access to community activities designed to meet the individual interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents; and

(8) Assistance in arranging medical and dental appointments, including arranging transportation to and from such appointments and reminding the residents of the appointments.

(e) The licensee shall:

(1) Make available basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper;

(2) Identify in the admission packet the cost, if any, of basic supplies for which there will be a charge; and

(3) Not be required to pay for a specific brand of the supplies referenced in (1) above.

(f) At the time of a resident’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions, treatments, diet, c, and any other pertinent interventions to maintain the residents health and safety needs .

(g) The licensee shall have each resident seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. During this visit a health examination shall be completed and documented.

(h) The health examination referenced in (g) above shall include in the medical record:

(1) Diagnoses, if any;

(2) Medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies; and

(7) Dietary needs.

(i) Assessments utilizing the 3.0 version of the Centers for Medicare and Medicaid Services Resident Assessment Instrument (RAI) including the minimum data set (MDS) with care area assessment (CAA) shall be completed on each resident as follows:

(1) A comprehensive MDS shall be completed within 14 days after admission;

(2) A comprehensive MDS shall be repeated annually or after any significant change, as defined in He-P 803.03(bw); and

(3) A quarterly MDS shall be completed at least every 3 months.

(j) The care plan portion of the RAI shall be developed within 14 days of the MDS and revised based on needs identified by the MDS.

(k) An initial nursing care plan shall be initiated upon admission and completed within 48 hours of the resident’s admission.

(l) The nursing care plan shall:

(1) Be updated following the completion of each future assessment in (i) above;

(2) Be made available to personnel who assist residents in the implementation of the plan; and

(3) Address the needs identified by (h) and (i) above.

(m) Nursing notes shall be written as per the licensee’s policy, and appropriate to resident condition, resident change in condition, and in accordance with professional standards.

(n) Pursuant to RSA 151:21, IX, residents shall be free from chemical and physical restraints except when they are authorized in writing by a licensed practitioner for a specific and limited time necessary to protect the resident or others from injury, or as permitted by the CMS conditions of participation, or as allowed by (o) below and He-P 803.21(d).

(o) Pursuant to RSA 151:21, IX, in an emergency, physical restraints may be authorized by the personnel designated in (p)(3) below in order to protect the resident or others from injury, and such action shall be promptly reported to the resident’s physician and documented in the resident’s clinical record.

(p) The nursing home shall have written policies and procedures for implementing physical, chemical, and mechanical restraints, including:

(1) What type of emergency restraints may be used;

(2) When restraints may be used;

(3) What professional personnel may authorize the use of restraints;

(4) The documentation of their use in the resident record including the physician order as applicable;

(5) How the licensee plans for reduction of restraint use for any resident requiring restraints;

(6) Initial personnel training and subsequent education and training required to demonstrate competence related to the use of physical, chemical and mechanical restraints;

(7) The least restrictive to the most restrictive method to be utilized to control a resident’s behavior; and

(8) That the training shall be conducted by individuals who are qualified by education, training, and experience.

(q) A resident may refuse all care and services.

(r) When a resident refuses care or services that could result in a threat to their health, safety or well-being, or that of others, the licensee or their designee shall:

(1) Inform the resident and guardian of the potential results of their refusal;

(2) Notify the licensed practitioner of the resident’s refusal of care;

(3) Notify the agent, as applicable, unless the resident objects; and

(4) Document in the resident’s record a pattern of refusal of care and the resident’s reason for the refusal, if known, including education to the resident of the risk of refusal.

(s) The licensee shall provide the following information to emergency medical personnel in the event of an emergency transfer to another medical facility.

(1) Full name and the name the resident prefers, if different;

(2) Name, address and telephone number of the resident’s next of kin, guardian, or agent, if any;

(3) Diagnosis, as applicable;

(4) Medications, as applicable, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives; and

(10) Any other pertinent information not specified in (1)-(9) above.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.16 Medication Services

(a) All medications shall be administered in accordance with the orders of the licensed practitioner.

(b) Medications, treatments and diets ordered by the licensed practitioner shall be made available to the resident within 24 hours of the order, or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the nursing home;

(2) Reorder medications for use at the nursing home; and

(3) Receive and record new medication orders.

(d) For each prescription medication being taken by a resident, the licensee shall maintain one of the following:

(1) The original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

(2) A copy of the original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers.

(e) Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

(1) The resident’s name:

(2) The medication name, strength, and prescribed dose and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated original or electronic signature of the ordering practitioner.

(f) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s order and labeled with the resident’s name.

(g) The label of all medication containers maintained in the nursing home shall match the current orders of the licensed practitioner and include the expiration date of the medication unless authorized by (aa) below.

(h) Except as allowed by (f) above and (i) below, only a pharmacist shall make changes to prescription medication container labels.

(i) When the licensed practitioner changes the dose of a medication and personnel of the nursing home are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the nursing home’s written procedure, indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(j) Any change or discontinuation of medications taken at the nursing home shall be pursuant to an order from a licensed practitioner or other professional with prescriptive powers.

(k) The licensee shall require that all telephone orders for medications, treatments, and diets are immediately transcribed and signed by the individual receiving the order.

(l) The transcribed order in (k) above shall be counter-signed by the authorized provider within 30 days of receipt or next visit but not to exceed 60 days.

(m) The licensee shall obtain an order from a licensed practitioner for all over-the-counter medications.

(n) The medication storage area shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

(3) Equipped to maintain medication at the proper temperature per manufacturer’s requirements.

(o) All medications at the nursing home shall be kept in the original containers or packaging and properly closed after each use.

(p) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(q) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the nursing home, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(r) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(s) All contaminated, expired or discontinued medication shall be destroyed within 90 days of the expiration date, the end date of a licensed practitioner’s orders or the date the medication becomes contaminated, whichever occurs first.

(t) Controlled drugs shall be destroyed only in accordance with state law.

(u) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(v) If a resident is going to be absent from the nursing home at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication shall be given to the person responsible for the resident while the resident is away from the nursing home.

(w) Upon discharge or transfer, the licensee may make the resident’s current medications available to the resident and the guardian or agent, if any.

(x) An order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(y) The licensee shall maintain a written record for each resident for each medication taken by the resident at the nursing home that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials and job title of the person who administers, supervises, or assists the resident taking medication;

(5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(z) Stock medications shall only be accessed and administered by the licensed nurse or any other professional authorized by state or federal regulation pursuant to a licensed practitioner’s order.

(aa) A nursing home shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.02 under circumstances where the nursing home:

(1) Has a director of nursing who is a registered nurse (RN) licensed in accordance with RSA 326-B; and

(2) Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

(ab) The licensee shall develop and implement a system for reporting to the director of nursing or designee within 24 hours after any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications.

(ac) The written documentation of the report in (ab) above shall be maintained in the resident’s record.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.17 Organization and Administration

(a) Each nursing home shall have a medical director who is a licensed physician in the state of New Hampshire.

(b) Each nursing home shall have a full time, onsite administrator who:

(1) Is licensed pursuant to RSA 151-A:2; and

(2) Shall be responsible for the daily management and operation of the nursing home including:

a. Management and fiscal matters;

b. The employment and termination of managers and personnel necessary for the efficient operation of the nursing home;

c. The designation of an onsite alternate, in writing, who shall be responsible for the daily management and operation of the nursing home in the absence of the administrator;

d. Ensuring development and implementation of nursing home policies and procedures on:

1. Patient’s rights as required by RSA 151:20;

2. Advanced directives and DNR orders as required by RSA 137-J;

3. Discharge planning as required by RSA 151:26; and

4. Unusual incident reporting;

e. Monitoring and evaluating the quality of resident care and resident care services in the nursing home pursuant to He-P 803.24; and

f. Identifying and making available education programs designed to maintain the personnel’s expertise in areas related to the services provided in the nursing home.

(c) There shall be a full time director of nursing services who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN with at least 2 years relevant experience in resident care.

(d) The director of nursing services shall be responsible for:

(1) Establishment of standards of nursing practice used in the nursing home;

(2) Ensuring that the admission process and resident assessment process coordinates resident requirements for nursing care with available nursing resources;

(3) Participating with the administrator and personnel to improve the quality of nursing care at the nursing home;

(4) Nursing care as authorized by the nurse practice act and according to RSA 326;

(5) The overall health and safety of residents; and

(6) Maintaining written personnel schedules, which shall be retained on-site for a period of at least 90 days and which include:

a. At least one licensed nurse in the facility 24 hours a day;

b. At least one registered nurse, for 8 consecutive hours a day 7 days a week; and

c. Nursing assistants who have been verified in accordance with the New Hampshire board of nursing.

(e) The director of nursing services shall enure compliance with all dementia training requirements pursuant to RSA 151:48-50 including continuing education.

(f) Such continuing education shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

(2) A minimum of 4 hours of ongoing training each calendar year.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.18 Personnel

(a) The licensee shall develop a job description for each position at the nursing home containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Education and experience requirements of the position.

(b) All direct care personnel shall be at least 18 years of age unless they are:

(1) A student in a New Hampshire board of nursing approved nursing or nursing assistant program;

(2) A nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(3) Part of an established educational program working under the supervision of a nurse.

(c) For all new hires, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

(2) Verify the qualifications and licenses, as applicable, of all applicants prior to employment; and

(3) Verify that the applicant is not on the List of Excluded Individuals and Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General per 42 USC 1320-a7, or on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

(d) Unless a waiver is granted in accordance with He-P 803.10 and (f) below, the licensee shall not make a final offer of employment for any position if the individual:

(1) Has been convicted of any felony in this or any other known state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other known state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(e) If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(f) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

(g) The licensee shall not employ, contract with, or engage, any person in (c) above who is listed on the BEAS state registry unless a waiver is granted by BEAS.

(h) In lieu of (c) and (g) above, the licensee may accept from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) above.

(i) All employees shall:

(1) Meet the educational and physical qualifications of the position as listed in their job description;

(2) Not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department;

(3) Be licensed, registered or certified as required by state statute and as applicable;

(4) Receive an orientation within the first 3 days of work prior to the assumption of duties that includes:

a. The nursing home’s policies on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities, policies, procedures, and guidelines, of the position they were hired for;

c. The nursing home’s infection control program;

d. The nursing home’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

e. Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

(5) Complete a mandatory annual in-service education, which includes a review of the nursing home’s:

a. Policies and procedures on patient rights and responsibilities and abuse or neglect;

b. Infection control;

c. Education program on fire and emergency procedures; and

d. Mandatory reporting requirements.

(j) Prior to having contact with residents, employees shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

(3) Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

(4) Comply with all public health guidelines with regard to the requirements for communicable infectious disease reporting pursuant to He-P 301.

(k) All licensees using the services of independent contractors as direct care personnel shall ensure and document that the independent clinical contractors have:

(1) Been oriented in accordance with (i)(4) above;

(2) Documented results of all infectious disease testing shall comply as required by (j) (1)-(4) above;

(3) Licenses that are current and valid; and

(4) A written agreement that describes the services that will be provided.

(l) Current, separate and complete employee files shall be maintained and stored in a secure and confidential manner at the nursing home.

(m) The employee file shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the nursing home’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) A record of satisfactory completion of the orientation program required by (i)(4) above and any required annual continuing education, if any;

(5) Verification of current New Hampshire license, registration or certification in health care field and CPR certification, if applicable;

(6) Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Documentation of annual in-service education as required by (i)(5) above;

(8) A statement, which shall be signed at the time the initial offer of employment is made and then annually thereafter, stating that he or she:

a. Does not have a felony conviction in this or any other state;

b. Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety, or well-being of a resident; and

c. Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person;

(9) Documentation of the criminal records check, except for persons licensed by the NH board of nursing pursuant to RSA 326-B as allowed by RSA 151:2-d, VI; and

(10) Documentation that the individual or entity is not on the List of Excluded Individuals and Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General per 42 USC 1320-a7, or on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

(n) An individual need not re-disclose any of the matters in (m)(8) and (m)(9) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.19 Resident Records

(a) The licensee shall maintain a legible, current and accurate record for each resident based on services provided at the nursing home.

(b) At a minimum, resident records shall contain the following:

(1) A copy of the resident’s admission agreement and all documents required by He-P 803.15(c);

(2) Identification data, including:

a. Vital information including the resident’s name, date of birth, and marital status;

b. Resident’s religious preference, if known;

c. Resident’s veteran status if known; and

d. Name, address and telephone number of an emergency contact person;

(3) The name and telephone number of the resident’s licensed practitioner(s);

(4) Resident’s health insurance information;

(5) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(6) A record of the health examination(s) in accordance with He-P 803.15(h);

(7) Written, dated and signed orders for the following:

a. All medications, treatments and special diets; and

b. Laboratory services and consultations;

(8) Results of any laboratory tests, or consultations;

(9) All assessments and care plans, and documentation that the resident and the guardian or agent, if any, have been given the opportunity or has participated in the development of the care plan;

(10) Documentation of informed consent;

(11) All admission and progress notes;

(12) Documentation of any alteration in the resident’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including practitioner notification;

(13) Documentation of any medical or specialized care;

(14) Documentation of unusual incidents;

(15) The consent for release of information signed by the resident, guardian or agent, if any;

(16) Discharge planning and referrals as applicable;

(17) Transfer or discharge documentation, including notification to the resident, guardian, or agent, if any, of transfer or discharge;

(18) Room change documentation, including notification to the resident, guardian, or agent, if any, and if applicable;

(19) The medication record as required by He-P 803.16(y) and (ac);

(20) Documentation of a resident’s refusal of any care or services; and

(21) Code status.

(c) Resident records and resident information shall be kept confidential and only provided in accordance with law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

(e) Resident records shall be available to health care workers and any other person authorized by law or rule to review such records.

(f) When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

(g) Records shall be retained for 7 years after discharge, except for records of Medicaid residents, which shall be retained for 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6-year period, whichever is longer.

(h) The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the nursing home ceases operation.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.20 Food Services

(a) The licensee shall provide food services that:

(1) Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as noted in Appendix A;

(2) Provide the nutritional needs of each resident;

(3) Meet the special dietary needs associated with health or medical conditions for each resident as identified by the health examination required by He-P 803.15(h);

(4) Include provision of a food service manager who shall;

a. Be responsible for the day to day operation of the kitchen;

b. Have knowledge of the nutritional requirements for residents and of the planning and preparation of prescribed diets; and

c. Have all the required competencies as per the licensee’s policy;

(5) Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

(6) Include dining facilities that have eating areas sufficient in size to provide seating for at least 50% of the licensed capacity.

(b) Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident’s care plan.

(c) Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident’s care plan.

(d) If a resident refuses the item(s) on the menu, a substitute shall be offered.

(e) Menus, including beverages for regular and therapeutic diets, shall be planned and written for at least 2 weeks in advance of serving.

(f) Each day’s menu shall be posted in a place accessible to food service personnel and residents.

(g) A listing of the diet orders and allowed foods for each resident shall be available to personnel.

(h) A dated record of menus as served shall be maintained for at least 3 months.

(i) The licensee shall provide therapeutic diets to residents only as directed by a licensed practitioner or other professional with prescriptive authority.

(j) Residents requiring therapeutic diets shall have an assessment of nutritional status by a qualified dietitian or dietary technician at least quarterly and with any significant weight loss or weight gain.

(k) If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record along with education relating to non-compliance with prescribed diet, and notify the resident’s licensed practitioner.

(l) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods maintained on the premises for the average daily census and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Enough drinking water for a 3-day period.

(m) All food and drink provided to the residents shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

(3) Served at the proper temperatures;

(4) Labeled, dated and stored at proper temperatures; and

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

(n) The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

(o) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(p) All work surfaces shall be cleaned and sanitized after each use.

(q) All dishes, utensils and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(r) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(s) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(t) Garbage or trash in the kitchen area shall be placed in lined containers with covers.

(u) All nursing home personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

(v) Regularly scheduled training programs including sanitation and safety shall be made available to personnel. Information as to the content and length of this training shall be documented and kept in employee records.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.21 Restraints

(a) For CMS certified nursing homes, the use of restraints shall be permitted as allowed by 42 CFR 483.12(a).

(b) For all other facilities, the requirements in (c) through (g) shall apply.

(c) When physical restraints are used, the following requirements shall be met:

(1) Physical restraints shall be used only after less restrictive measures have been found to be ineffective to protect the resident or others from harm;

(2) Except as allowed in (d) below, physical restraints shall be ordered for a specified and limited time by a licensed practitioner; and

(3) The order for the physical restraints in (2) above may be verbal and shall:

a. Be obtained by a licensed nurse before the physical restraint is administered; and

b. Be followed with the licensed practitioner’s signature within 14 days.

(d) In an emergency situation, physical restraints may be authorized by a professional staff member designated by the licensee in accordance with established policy and procedure under He-P 803.15(p)(3) as follows:

(1) The designated staff member shall promptly report the restraint use and the resident’s behavior to the resident’s licensed practitioner; and

(2) The designated staff member shall document the use of restraints in the resident’s clinical record, in accordance with (g) below.

(e) When chemical restraints are used, the following requirements shall be met:

(1) Chemical restraints shall be used only after less restrictive measures have been found to be ineffective to protect the resident or others from harm;

(2) Chemical restraints shall be ordered for a specified and limited time by a licensed practitioner;

(3) The order for the chemical restraints can be verbal and shall:

a. Be obtained by a licensed nurse before the chemical restraint is administered; and

b. Be followed with the licensed practitioner’s signature within 14 days;

(4) Medication used as a chemical restraint may only be administered by a licensed nurse or licensed practitioner;

(5) Standing orders for medications utilized as chemical restraints shall be prohibited; and

(6) It shall be the responsibility of the licensed nurse or licensed practitioner administering the chemical restraint to document the administration of the medication and the effects as specified in He-P 803.16(y) and (ac).

(f) When mechanical restraints are used, the following requirements shall be met:

(1) Mechanical restraints shall be used only when less restrictive measures have been found to be ineffective in protecting the resident or others from harm;

(2) Mechanical restraints shall be ordered for a specific and limited time by a licensed practitioner and the order shall include:

a. The type of restraint to be used;

b. The reason for the restraint; and

c. The time intervals at which the licensee’s personnel shall check the resident’s well-being and the placement and position of the restraint;

(3) Standing orders for the use of mechanical restraints shall be prohibited;

(4) Mechanical restraints shall not be applied in a manner that impedes circulation; and

(5) Locked, secured or alarmed doors or elevators, or units within a nursing home, anklets, bracelets and similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the nursing home or unit within shall not be considered restraints provided they meet the requirements of the applicable building and fire safety codes and are documented in the care plan.

(g) The use of all restraints shall be documented in the resident’s clinical record according to the licensee’s policy, including:

(1) The behavior and actions of the resident that necessitated the use of a restraint;

(2) The authorization given to restrain the resident;

(3) The type of restraint used;

(4) The length of time the resident was restrained;

(5) The effects of the restraint on the resident;

(6) The report to the resident’s licensed practitioner and all actions taken; and

(7) Any orders from the resident’s licensed practitioner.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.22 Resident Transfer or Discharge

Transfers and discharges shall be done in accordance with RSA 151:26.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.23 Infection Control

(a) The licensee shall appoint a person to be in charge of and develop and implement an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

(b) The infection control program shall include documented procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

(3) The management of residents with infectious or contagious diseases or illnesses;

(4) The handling, transport and disposal of those items identified as infectious waste in Env-Sw 103.28;

(5) Reporting of infectious and communicable diseases as required by He-P 301; and

(6) Maintenance of a sanitary physical environment.

(c) The infection control education program shall:

(1) Be completed by all new and current employees of the -licensee on an annual basis; and

(2) Address the:

a. Cause of infections;

b. Effect of infections;

c. Transmission of infections; and

d. Prevention and containment of infections.

(d) Direct care personnel or employees infected with a disease or illness transmissible through food, saliva, fomites or droplets, shall not work in food service or provide direct care without personal protection equipment to prevent disease transmission until they are no longer contagious as determined by a licensed practitioner.

(e) Direct care personnel or employees infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected as determined by a licensed practitioner.

(f) Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Employees with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable bandage with secure edges.

(h) The licensee shall immunize all consenting residents for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.24 Quality Improvement

(a) The nursing home shall establish an interdisciplinary quality improvement committee which:

(1) Shall have a minimum of 3 members, including the medical director, an individual representing nursing and an individual representing administration;

(2) Shall meet at least quarterly to evaluate quality improvement activities; and

(3) Shall make recommendations to the administrator to improve the quality of care.

(b) The quality improvement committee shall be responsible for:

(1) Determining the information to be monitored;

(2) Determining the frequency with which information will be reviewed;

(3) Determining the indicators that will apply to the information being monitored;

(4) Evaluating the information that is gathered;

(5) Determining the action that is necessary to correct identified problems;

(6) Recommending corrective actions to the licensee; and

(7) Evaluating the effectiveness of the corrective actions and determine additional corrective actions as applicable.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.25 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed nursing home premises.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the residents.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, Table 2.5-1” (2018 edition), available as noted in Appendix A, , and summarized as follows:

(1) Seventy-120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures, Where sinks are used primarily for hot water and are served by a single pipe supplying tempered water, it shall not exceed 80 degrees Fahrenheit;

(2) One hundred forty degrees Fahrenheit for dietary areas, except that provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, which may be by separate booster, unless a chemical rinse is provided; and

(3) One hundred sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a process which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures as specified by the manufacturer.

(f) All resident bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

(g) Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications and program supplies, and to prohibit access by residents.

(h) Toxic materials shall not be used in a way that contaminates food, equipment or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and nursing home pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service area shall have covers and shall remain closed except when in use.

(m) The following requirements shall be met for laundry services:

(1) Dirty laundry shall not be permitted to contaminate kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing that are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Cleaning supplies shall be stored in dust-free and moisture-free storage areas.

(p) Any nursing home that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified as required by the department of environmental services shall notify the department upon receipt of notice of a failed water test.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19

N.H. Code Admin. R. Ann. He-P 803.26 Physical Environment

(a) The licensed premises shall be maintained so as to provide for the health, safety, well-being, and comfort of residents and personnel, including reasonable accommodations for residents and personnel with mobility limitations.

(b) Equipment providing heat within a nursing home including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit during the day if residents are present and 65 degrees Fahrenheit at night; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(2) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Any heating device other than a central plant shall be designed and installed so that:

(1) Combustible material cannot be ignited by the device or its appurtenances;

(2) If fuel-fired, such heating devices comply with the following:

a. They shall be chimney or vent connected;

b. They shall take air for combustion directly from outside; and

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(3) The heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(f) Unvented fuel-fired heaters shall not be used in any nursing home.

(g) Plumbing shall be sized, installed, and maintained in accordance with the provisions of the International Plumbing Code, as specified in the State Building Code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

(h) Screens shall be provided for doors and windows that are left open to the outside.

(i) Doors that are self-closing and remain closed when not in use are exempt from the requirement in (h) above.

(j) The nursing home shall have a telephone to which the residents have access.

(k) The number of sinks and toilets shall be in a ratio of one for every 6 individuals, unless personnel have separate bathroom facilities not used by residents.

(l) Each bathroom shall be equipped with:

(1) A soap dispenser;

(2) Paper towels or a hand-drying device providing heated air;

(3) Hot and cold running water; and

(4) A door that either slides or swings, not a folding door or curtain.

(m) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(n) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(o) Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(p) There shall be at least 100 square feet in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom, exclusive of space required for closets, wardrobes and toilet facilities.

(q) Each bedroom shall:

(1) Contain no more than 2 beds if constructed after the 2011 adoption of these rules;

(2) Have its own separate entry to permit the resident to reach his/her bedroom without passing through the room of another resident;

(3) Have a side hinge door and not a folding or sliding door or a curtain unless it meets specific exceptions allowed by the codes referenced in He-P 803.07(e);

(4) Not be used simultaneously for other purposes; and

(5) Be separated from halls, corridors and other rooms by floor to ceiling walls.

(r) The licensee shall provide the following for the residents’ use, as needed:

(1) A bed appropriate to the needs of the resident;

(2) A mattress that complies with the state fire code and codes adopted by reference pursuant to RSA 153:I, VI-a, and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5;

(3) Clean linens, blankets and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) A light;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades, or curtains that provide privacy.

(s) A resident may refuse any of the items in (r) above with appropriate documentation.

(t) The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others.

(u) The licensee shall provide the following rooms to meet the needs of residents:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of seating at least 50% of the residents.

(v) Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

(w) Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

(x) If the nursing home admits residents under the age of 18, each age group shall have separate and distinct units.

(y) If the nursing home admits residents between the age of 10 and 17 years, each gender shall have separate and distinct units.

(z) The nursing home shall comply with all state and local codes and ordinances for:

(1) Zoning;

(2) Building;

(3) Health;

(4) Fire;

(5) Waste disposal; and

(6) Water.

(aa) The nursing home shall be accessible at all times of the year.

(ab) The nursing home shall provide housekeeping and maintenance adequate to protect residents, personnel and the public.

(ac) Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

(ad) Ventilation shall be provided throughout the entire nursing home and, whenever necessary, mechanical means such as fans shall be provided to remove excessive heat, moisture, objectionable odors, dust, or explosive or toxic gases.

(ae) There shall be a secondary power source to provide emergency power pursuant to the Electrical Systems chapter of NFPA 99, Health Care Facilities Code, and The Standard for Emergency and Standby Power Systems, NFPA 110, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(af) Waste water shall be disposed of through a system which meets the requirements of RSA 485:1-A and Env-Wq 1000. Sink drains which have no connection to sanitary sewers or septic systems and similar methods of disposal above ground shall be strictly prohibited.

(ag) Facilities shall provide for prompt cleaning of bedpans, urinals, and other utensils.

(ah) Any locked door providing egress from a resident room and/or means of egress within a nursing home shall meet the requirements of the Health Care Occupancy chapter of NFPA 101, Life Safety Code, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(ai) Special locking devices including delayed egress devices, shall meet the requirements of NFPA 101, the Life Safety Code, which shall:

(1) Unlock upon actuation of the automatic fire detection and or suppression system; and

(2) Unlock upon loss of power.

(aj) No more than one such device in (ai) above shall be located in any egress path of travel.

(ak) Sterile supplies and equipment shall not be mixed with unsterile supplies.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.27 Emergency and Fire Safety

(a) The administration of the licensed facility shall have, in effect and available to all supervisory personnel, written copies of a plan for the protection of all persons in the event of fire, including:

(1) Evacuation to areas of refuge;

(2) All personnel shall be periodically, at least annually if no changes are made to the plan, be instructed and kept informed with respect to their duties under this written plan. Copies of this plan shall be readily available at all times in a central location, example, reception area, nurses station, or security center;

(3) The emergency procedures required by the emergency response plan shall include, but are not limited to, evacuation routes, emergency notification numbers, and emergency instructions and shall be posted in locations accessible to personnel and visitors;

(4) The nursing home fire safety plan shall provide for the following:

a. Use of alarms;

b. Transmission of alarm to fire department;

c. Emergency phone call to fire department;

d. Response to alarms;

e. Isolation of fire;

f. Evacuation of immediate area;

g. Evacuation of smoke compartment;

h. Preparation of floors and building for evacuation; and

i. Extinguishment of the fire;

(5) Ensuring that the fire safety and evacuation plans are available to all supervisory personnel;

(6) Ensuring that all employees receive in-service annual training to clarify their responsibilities in carrying out the emergency plan;

(7) The required plan shall be readily available at all times;

(8) Conducting fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

a. Infirm, bedridden, or cognitively impaired residents shall not be required to be moved during drills to safety areas or to the exterior of the building;

b. Drills shall be conducted quarterly on each shift to familiarize nursing home personnel with the signals and emergency action required under varied conditions; and

c. When drills are conducted between 9:00 p.m./2100 hours and 6:00 A.M./0600 hours, a coded announcement may be used instead of audible alarms;

(9) Facilities shall complete a written record of fire drills and include the following:

a. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

b. The location of exits used;

c. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

d. The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

e. The name and title of the person conducting the drill;

f. A list of problems and issues encountered during the drill;

g. A list of improvements and resolution to the issues encountered during the fire drill; and

h. The names of all staff members participating in the drill; and

(10) Written records of the fire drills that shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(b) All nursing homes shall have:

(1) At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10;

(2) Be manually inspected when initially placed in service;

(3) Be inspected either manually or by means of an electronic monitoring device/system at intervals not exceeding 31 days;

(4) Be inspected at least once per calendar month; and

(5) Documentation of manual fire extinguisher inspections that shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation. Documentation of electronically monitored fire extinguishers shall be provided to the department within 2 business days of the completion of the inspection or investigation.

(c) All nursing homes shall meet the health care chapter of NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(d) Extension cords shall be prohibited except as allowed in accordance with NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(e) Immediately following any fire or emergency, such as a gas incident, terrorism, or other threatening condition, the licensee shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

(f) The written notification in (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any damage;

(3) A description of events preceding and following the incident;

(4) The name of any employee or resident who was evacuated as a result of the incident, if applicable;

(5) The name of any employee or resident who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(g) Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code including but not limited to:

(1) Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

a. Minimum distance of 6.1 m or 20 ft;

b. Minimum distance of 1.5 m or 5 ft if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

c. A gas cabinet constructed per NFPA 30, Flammable and Combustible Liquids Code, or NFPA 55, Compressed Gases and Cryogenics Fluids Code, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

(2) Cylinders shall be protected from damage by means of the following specific procedures:

a. Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

b. Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

c. Cylinders shall be protected from tampering by unauthorized individuals;

d. Cylinders or cylinder valves shall not be repaired, painted, or altered;

e. Safety relief devices in valves or cylinders shall not be tampered with;

f. Valve outlets clogged with ice shall be thawed with warm, not boiling water;

g. A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

h. Sparks and flame shall be kept away from cylinders;

i. Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

j. Large cylindersexceeding size E and containers larger than 45 kg or100 lb weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

k. Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

l. Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

(3) Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

a. Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

b. Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

c. Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

d. The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

e. Oxygen shall be referred to by its proper name, “oxygen”, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

f. Oxygen shall not be used as a substitute for compressed air;

g. The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

h. Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels/tags used for indicating cylinder status such as full, in use, or empty;

i. The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

j. Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, heat ducts;

k. Very cold cylinders or containers shall be handled with care to avoid injury;

l. A precautionary sign, readable from a distance of 1.5 m or 5 ft, shall be displayed on each door or gate of the storage room or enclosure; and

m. The sign shall include the following wording as a minimum:

CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING

(h) If the licensee has chosen to allow smoking under He-P 803.14(w), an outside location or a room used only for smoking shall be provided which:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non-combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act and He-P 1900.

History

• #9856-A, eff 1-26-11, EXPIRED: 1-26-19
• #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
• #12860, eff 8-28-19; ss by #13246, eff 8-4-21

N.H. Code Admin. R. Ann. He-P 803.28 Emergency Preparedness

(a) Each licensee shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the licensee’s administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the -licensee;

(11) Conduct a facility-wide –walk-through and review, to include the property that the licensee is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least annually;

(12) Include the licensee’s response to both short-term and long-term interruptions in the availability of utility service during the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations, to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation, to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(14) Include the management of residents, particularly with respect to physical and clinical issues to include:

a. Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the licensee is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(f) The licensee shall conduct and document with a detailed log, including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the -licensee’s plan and who is not involved in the exercise;

(2) Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the licensee’s improvement plan.

(g) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Potable water for a 3-day period.

(h) Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

(1) Assumptions for calculations of food and water supplies including maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

(2) Storage location(s); and

(3) Back-up supplies.

History

• #12860, eff 8-28-19

Part He-P 804 Assisted Living Residence–residential Care Licensing

N.H. Code Admin. R. Ann. He-P 804.01 Purpose

REVISION NOTE:

Document #13368, effective 4-19-22, readopted with amendments the “Care Assessment for Residential Services Tool” form pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c. The form is incorporated by reference in He-P 804.16(d) which requires the assisted living residence–residential care (ALR-RC) facility to assess each resident’s needs using the “Care Assessment for Residential Services Tool” form otherwise called the “CARES Tool”. Document #13368 contained only the amended form, giving it a new effective date, and updated the revision date on the form from the “January 2022 edition” to the “April 2022 edition.”

The prior filing affecting He-P 804.16 was Document #13339, effective 1-29-22, and the effective date of the rule remained unchanged by Document #13368. Since Document #13368 updated the revision date on the form from “(January 2022 edition)” to the “(April 2022 edition)”, the revision date was subsequently updated editorially in He-P 804.16(d).

The purpose of this part is to set forth the classification of and licensing requirements for assisted living residence–residential care (ALR-RC) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(1).

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an assisted living residence at the residential care level pursuant to RSA 151:9, VII(a)(1), except:

(a) All entities which are owned or operated by the state of New Hampshire;

(b) Residential care facilities authorized and inspected by the United States Department of Veterans Affairs which provide services to 3 or fewer individuals; and

(c) Any home where the total number of licensed or certified beds does not exceed 3 when all the residents receive services:

(1) Under a current New Hampshire division for children, youth, and families license pursuant to RSA 170-E:27 and 31; or

(2) In a certified community residence pursuant to RSA 126-A:20.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, ss by #9835, eff 12-18-10; ss by #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a resident;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a resident; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a resident without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 804.

(f) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

(g) “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(h) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA-J:34-37.

(j) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ALR-RC pursuant to RSA 151:2, I(e).

(k) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 804, or other federal or state requirements.

(l) “Assessment” means an evaluation of the resident to determine the care and services that are needed.

(m) “Assisted living residence–residential care (ALR-RC)” means a long term care residence providing personal care at the residential care level pursuant to RSA 151:9, VII(a)(1).

(n) “Care assessment for residential services (CARES) tool” means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I.

(o) “Care plan” means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(p) “Change of ownership” means the transfer of the controlling interest of an established ALR-RC to any individual, agency, partnership, corporation, government entity, association or other legal entity.

(q) “Chemical restraints” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.

(r) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(s) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(t) “Core services” means those minimal services to be provided to any resident by the licensee that are included in the basic rate.

(u) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(v) “Days” means calendar days unless otherwise specified in the rule.

(w) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

(x) “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

(y) “Direct care” means hands-on care and services provided to a resident, including but not limited to medical, nursing, psychological, or rehabilitatitive treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(z) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(aa) “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

(ab) “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ac) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away or otherwise leaves a caregiving facility or environment unsupervised or unnoticed, without the knowledge of the licensee’s personnel.

(ad) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ae) “Employee” means anyone employed by the ALR-RC and for whom the ALR-RC has direct supervisory authority.

(af) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 804.

(ag) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(ah) “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

(ai) “Facility” means “facility” as defined in RSA 151:19, II.

(aj) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident’s health care and other personal needs.

(ak) “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s or occupants control.

(al) “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents, who have resided at the licensed premises for more than 30 days.

(am) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(an) “Infectious waste” means those items specified by Env-Sw 103.28.

(ao) “Informed consent” means the decision by a resident, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(ap) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(aq) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 804 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 804.

(ar) “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of disease.

(as) “License” means the document issued by the department or licensee of an ALR-RC which authorizes operation in accordance with RSA 151 and He-P 804, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number.

(at) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the ALR-RC is licensed.

(au) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(av) “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(aw) “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151.

(ax) “Licensing classification” means the specific category of services authorized by a license.

(ay) “Life safety code” means the standards, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(az) “Mechanical restraint” means locked or secured ALR-RCs or units within an ALR-RC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ALR-RC or unit within.

(ba) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(bb) “Mobile” means capable of moving from place to place, with or without assistive devices, without the assistance of others.

(bc) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bd) “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.

(be) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bf) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a resident.

(bg) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bh) “Over-the-counter medications” means non-prescription medications.

(bi) “Patient rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

(bj) “Personal care” means personal care services that are non-medical, hands-on services provided to a resident including, but not limited to, assistance with ADL’s.

(bk) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

(bl) “Personnel” means individual(s), either paid or volunteer, who provide direct or indirect care or services, or both, to a resident(s).

(bm) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

(bn) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bo) “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

(1) A lancing or finger stick device to get a blood specimen;

(2) A test strip or reagents to apply a specimen to for testing; or

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

c. A Cholesterol meter.

(bp) “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of patient care.

(bq) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(br) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bs) “Protective care” means the provision of resident monitoring services, including but not limited to:

(1) Knowledge of resident whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(bt) “Qualified personnel” means personnel that have been trained to and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bu) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(bv) “Renovation” means the replacement in type or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(bw) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintain such materials, elements, equipment, or fixtures in good or sound condition.

(bx) “Reportable incident” means an occurrence of any of the following while the resident is either in the ALR-RC or in the care of ALR-RC personnel:

(1) The unanticipated death of the resident;

(2) An injury to a resident, that is potentially due to abuse or neglect; or

(3) The elopement or unexplained absence of a resident from the ALR-RC.

(by) “Resident” means any person admitted to or in any way receiving care, services, or both from a facility licensed in accordance with RSA 151 and He-P 804.

(bz) “Residential board and care occupancy,” means “residential board and care occupancy” as defined in NFPA 101 of the state fire code, namely “ an occupancy used for lodging and boarding of 4 or more residents not related by blood or marriage to the owners or operators for the purpose of providing personal care services.”

(ca) “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 804, and as required by other federal or state laws.

(cb) “Respite care” means the admission of a person from his or her primary residence to an ALR-RC, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care.

(cc) “Self administration of medication with assistance” means the resident takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

(cd) “Self administration of medication without assistance” means the resident takes his or her own medication(s) without the assistance of personnel, including prompting.

(ce) “Self-directed medication administration” means a resident, who has a physical limitation that prohibits him or her from self administration of medication, with or without assistance, directs personnel to physically assist in the medication process which does not include assisting with injections or filling insulin syringes.

(cf) “Self evacuate” means the resident can initiate and complete movement from any location in the ALR-RC to an exit without assistance from personnel other than verbal or physical prompting.

(cg) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(ch) “Significant change”. means a decline or improvement in a resident’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident’s health status; and

(3) Requires interdisciplinary review or revision of the care plan.

(ci) “State monitoring” means the placement of individuals by the department at an ALR-RC to monitor the operation and conditions of the facility.

(cj) “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

(ck) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(cl) “Unexplained absence” means an incident involving a resident leaving the premises of the ALR-RC without the knowledge of the ALR-RC personnel in a manner that is contrary to their normal routine.

(cm) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.04 License Application Submission

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License, or Special Health Care Services,” (January 2022), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

(2) A floor plan of the prospective ALR-RC;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee, in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the qualifications of the ALR-RC administrator;

(6) Copies of applicable licenses for the ALR-RC administrator;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300 , including, at a minimum, the One and Two Family Dwelling chapter or the Residential Board and Care chapter of the life safety code, and local fire ordinances applicable for an assisted living residence–residential care; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(8) If the ALR-RC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, or Env-DW 704.02, or if a public water supply, a copy of a water bill; and

(9) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and household members.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 804.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 804.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 804.13(b) if, it determines that the applicant, administrator, or a household member:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the following:

(1) A copy of the ALR-RC’s admission agreement; and

(2) A copy of the ALR-RC’s standard disclosure form.

(g) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 804.

(h) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(i) A written notification of denial, pursuant to He-P 804.13(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (g) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 804.

(j) A written notification of denial, pursuant to He-P 804.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire one year from the date of issuance unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 804.04(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 804.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 804.18(g)(2); and

(4) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

(d) In addition to to He-P 804.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(e) Following an inspection as described in He-P 804.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by He-P 804.06(b) and (c), as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 804 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

(f) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 804.04 and shall be subject to a fine in accordance with He-P 804.14(c)(7).

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.07 ALR-RC New Construction and Existing Rehabilitation

(a) For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 804 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) Department approval shall not be required prior to initiating construction, renovations, or structural

alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own

risk.

(g) The ALR-RC shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

(h) A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

(1) The state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300, including but not limited to at a minimum:

a. For 3 residents or fewer, the One and Two Family Dwelling chapter of the life safety code; and

b. For 4 residents or more, the Residential Board and Care Occupancy chapter of the life safety code;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) The FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A; and

(i) All ALR-RCs newly constructed or rehabilitated after the 2022 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, (2018 edition), as applicable, available as noted in Appendix A.

(j) Where rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, (2018 edition) available as noted in Appendix A.

(k) The department’s bureau of health facilities administration shall be the authority having jurisdiction for the requirements in (h)-(j) above and shall negotiate compliance and grant waivers in accordance with He-P 804.10 as appropriate.

(l) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

(m) Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(n) Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

(o) The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 804.09 prior to its use.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.08 ALR-RC Requirements for Organizational or Service Changes

(a) The ALR-RC shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds authorized under the current license; or

(6) Services.

(b) The ALR-RC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in number of beds authorized under the current license; or

(4) A change in services.

(c) When there is a change in the address without a change in location, the ALR-RC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the ALR-RC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department;

(2) The physical location;

(3) An increase in the number of beds or residents authorized under the curerent license;

(4) A change in licensing classification; or

(5) A change that places the facility under a different life safety code occupancy chapter.

(f) A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

(g) A revised license and license certificate shall be issued for a change in the ALR-RC name or a change in address without a change in physical location.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) An increase or decrease in the number of beds;

(3) A change in the scope of services provided; or

(4) When a waiver has been granted in accordance with He-P 804.10.

(i) The ALR-RC shall inform the department in writing when there is a change in administrator no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) Copies of applicable licenses for the new administrator; and

(3) The results of a criminal background check from the NH department of safety for the new administrator;

(4) The results of the criminal attestation as described in He-P 804.18(w); and

(5) The results of the bureau of elderly and adult services (BEAS) registry check per He-P 804.18(h).

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 804.18(i) and (k).

(k) If the department determines that the new administrator does not meet the qualifications, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(l) When there is to be a change in the services provided, the ALF-RC shall provide the department with a description of the service change and, where applicable, identify what additional personnel shall be hired and their qualifications, how the new services shall be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

(m) The department shall review the information submitted under (l) above and determine if the added services can be provided under the ALR-RC’s current license.

(n) The ALR-RC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(o) A restructuring of an established ALR-RC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) If a licensee chooses to cease operation of an ALR-RC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 804, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the ALR-RC; and

(3) Any records required by RSA 151 and He-P 804.

(b) The department shall conduct a clinical and life safety code inspection, as necessary, to determine full compliance with RSA 151 and He-P 804 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 804.08(e)(1);

(3) A change in the physical location of the ALR-RC;

(4) A change in the licensing classification;

(5) An increase in the number of beds;

(6) Occupation of space after construction, renovations, or alterations; or

(7) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department as part of an annual inspection or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ALR-RC is in violation of any of the provisions of He-P 804, RSA 151, or other federal or state requirement.

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 804.12(c), within 21 days of the date on the letter that transmits the inspection report.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 804 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought if less than permanent.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the residents; and

(3) Does not negatively affect the quality of resident services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 804.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the ALR-RC, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 804.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed ALR-RC, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 804.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a written response to the findings prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, which results in a determination that the services being provided require licensing under RSA 151, the department shall issue a written warning, to the owner or person responsible, requiring compliance with RSA 151 and He-P 804;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 804.13(c)(6).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 804, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each finding;

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 804;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 804 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 804.12(d) and a fine in accordance with He-P 804.13(c)(13);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 804.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 804.13(c)(14) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine in accordance with He-P 804.13(c);

(3) Deny the application for a renewal of a license in accordance with He-P 804.13(b); or

(3) Revoke the license in accordance with He-P 804.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of residents; or

(2) The presence of conditions in the ALR-RC that negatively impact the health, safety, or well-being of residents.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 804 which poses a risk of harm to the health, safety, or well-being of a resident;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 804.04;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 804.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 804.12(c)(5) and has not submitted a revised POC in accordance with He-P 804.12(c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 804 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 804;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a resident whose needs exceed the services or programs provided by the ALR-RC, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For admission of a resident whose needs at the time of admission exceed the services or programs authorized by the ALR-RC licensing classification, in violation of RSA 151:5-a, II, and He-P 804.15(a), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 804.11(e)(5), the fine for an unlicensed provider or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 804.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 804.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 804.08(a)(2), the fine for a licensee shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address as required by He-P 804.08(n), the fine for a licensee shall be $100.00;

(11) For a failure to allow access by the department to the ALR-RC’s premises, programs, services, or records, in violation of He-P 804.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(12) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 804.08(i), the fine for a licensee shall be $100.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 804.12(c)(2) and (5), the fine for a licensee shall be $500.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 804.12(c)(11) & (e) the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement, or comply with licensee policies, as required by He-P 804.14(b) and He-P 804.19(e), the fine for a licensee shall be $500.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 804.14(c), the fine for a licensee shall be $500.00;

(17) For exceeding the licensed capacity, in violation of He-P 804.14(n), the fine for a licensee shall be $500.00 per day;

(18) For providing false or misleading information or documentation, in violation of He-P 804.14(t), the fine for an applicant or licensee shall be $1000.00 per offense;

(19) For a failure to meet the needs of a resident or residents, as described in He-P 804.15(a), the fine for a licensee shall be $500.00 per resident;

(20) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 804.18(e)-(f), under circumstances where the department has not granted a waiver in accordance with He-P 804.10, the fine for a licensee shall be $500.00;

(21) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 815.09(a), the fine shall be $2000.00;

(22) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 804.07(a), the fine for a licensed facility shall be $500.00;

(23) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 804.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(24) When an inspection determines that a violation of RSA 151 or He-P 804 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

(25) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 804 shall constitute a separate violation and shall be subject to fines in accordance with He-P 804.13(c) provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 804, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) The department shall impose state monitoring under the following conditions:

(1) Repeated poor compliance on the part of the facility in areas that might impact the health, safety or well-being of residents; or

(2) Concern that the conditions in the ALR-RC have the potential to worsen.

(f) An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(g) If a written request for a hearing is not made pursuant to (f) above, the action of the department shall become final.

(h) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a resident is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

(i) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 804 is achieved.

(j) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(k) When an ALR-RC’s license has been denied or revoked, the applicant, family member, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

(l) RSA 541 shall govern further appeals of department decisions under this section.

(m) The 5-year period referenced in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(n) Notwithstanding (m) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 804.

(o) If the department has reasonable information or evidence that a licensee, applicant, administrator, or other individuals are circumventing rule (k) above by applying for a license through an agent or another person and will retain ownership, management authority, or both, the department shall deny the application.

(p) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 804.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(b) The licensee shall have written policies and procedures to include:

(1) The rights and responsibilities of admitted residents in accordance with the paitents’ bill of rights under RSA 151:20, II;

(2) The policies described in He-P 804.14(r), He-P 804.16(c)(11), and He-P 804.19(e); and

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(c) The licensee shall provide the following core services:

(1) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding:

a. The residents’ functioning, safety, and whereabouts; and

b. The residents’ health status, including the provision of intervention as necessary or required;

(2) Emergency response and crisis intervention;

(3) Assistance with taking and ordering medications as needed;

(4) The provision of 3 nutritious meals and snacks in accordance with He-P 804.21 unless the resident chooses other options according to their admission agreement;

(5) Housekeeping, laundry, and maintenance services in accordance with the admission agreement;

(6) The availability of activities, for which the facility shall make reasonable accommodation for residents with disabilities, to include, but not be limited to, television, radio, internet, games, newspapers, visitors, and music, designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the admission agreement;

(7) Assistance in arranging medical and dental appointments, which shall include assistance in arranging transportation to and from such appointments and reminding the residents of the appointments; and

(8) Supervision of residents when required to offset cognitive deficits that may pose a risk to self or others if the resident is not supervised.

(d) The licensee shall have a system to regularly identify the ALR-RC’s daily census, including times when a resident is absent from the ALR-RC.

(e) The licensee shall assist with arranging transportation to community activities, as available, designed to meet the individual interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents.

(f) The licensee shall:

(1) Make available basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper. Such basic supplies shall be included in the basic rate except that there may be an additional charge for specific brands or items required to meet individual residents’ needs or requests;

(2) Identify in the admission agreement the cost, if any, of basic supplies or other services for which there will be a charge;

(3) Ensure that all personnel have received the training necessary to be qualified personnel to include demonstrated competency in the training given with documentation maintained in the employee file;

(4) Comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education that shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

a. A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

b. A minimum of 4 hours of ongoing training each calendar year.

(5) Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known; and

(6) Have a clearly identified policy for CPR that includes the following:

a. If CPR is not performed, the policy shall include a statement that 911 shall be called in an emergency;

b. If CPR is performed, there shall be either at least one person on duty per shift who is certified to perform CPR or an AED available for use; and

c. This policy shall be signed by each resident and their guardian, agent, or personal representative, if any, and be located in the resident’s file with their admission agreement.

(g) The licensee shall educate personnel about the needs and services required by the residents under their care and document such education to include demonstrated competancies.

(h) Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX.

(i) As soon as is practicable and in no case longer than 24 hours after the use of a physical or chemical restraint, the resident’s licensed practitioner, guardian, agent, or personal representative, if any, and the department shall be notified of the use of such restraints.

(j) The use of mechanical restraints, limited to locked or secured ALR-RCs, or units within an ALR-RC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ALR-RC or unit within as permitted by the state fire code, shall be allowed.

(k) Notwithstanding (j) above, the following methods of mechanical restraints shall be prohibited:

(1) Full bed rails;

(2) Gates, if they prohibit a resident’s free movement throughout the living areas of the ALR-RC;

(3) Half doors, if they prohibit a resident’s free movement throughout the living areas of the ALR-RC;

(4) Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will;

(5) Wrist or ankle restraints;

(6) Vests or pelvic restraints; and

(7) Other similar devices that prevent a resident’s free movement.

(l) For reportable incidents, the licensee shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 271-4968 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

a. The ALR-RC name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of resident(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. When the resident’s guardian, agent, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident;

j. The date and time the resident’s licensed practitioner was notified, if applicable; and

k. The date the facility performed the investigation required by (1) above;

(3) As soon as practicable, notify the guardian, agent, or personal representative, if any;

(4) As soon as practicable, notify the local police department, the department, and the guardian, agent, or personal representative, if any, when a resident has an elopement or unexplained absence and the licensee has searched the building and the grounds of the ALR-RC without finding the resident; and

(5) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(m) The licensee shall comply with the requirements of RSA 151:19-30.

(n) The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

(o) The licensee shall give a resident and the resident’s guardian, agent, or personal representative, as applicable, written notice of the following:

(1) For an increase in the cost or fees for any ALR-RC services, 30 days advance notice shall be required except for residents receiving Medicaid whose financial liability is determined by the state’s standard of need, or residents funded by the department’s choices for independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs; or

(2) For an involuntary change in room or bed location, the facility shall make reasonable accommodation of individual needs and preferences and give 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the resident or other residents, in such case the notice shall be as soon as practicable.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a conspicuous area accessible to residents, employees, and visitors:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports for the last 12 months in accordance with He-P 804.09(d) and He-P 804.11(d);

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to The Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

(5) The licensee’s evacuation floor plan identifying the location of, and access to, all fire exits.

(q) The licensee shall determine whether smoking will be allowed at the ALR-RC.

(r) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68, and RSA 155:69 and He-P 804.26(f).

(s) If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.

(t) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

(u) The licensee shall not advertise or otherwise represent themselves as having a license to provide services that they are not licensed to provide.

(v) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(w) The licensee shall develop quality assurance plans and policies that evaluate:

(1) The quality of care and services provided to residents;

(2) Compliance with RSA 151 and He-P 804;

(3) The effectiveness of training provided to personnel; and

(4) The effectiveness of corrective actions taken in response to statements of findings, notices to correct, and problems identified in (1)-(3) above

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.15 Resident Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria

(a) The licensee shall only admit an individual or retain a resident:

(1) Whose needs are compatible with the care, services, and programs offered by the ALR-RC and authorized by its license;

(2) Who is and remains mobile;

(3) Who can self evacuate or equivalency to safely evacuate;

(4) Whose needs can be met by the facility personnel and which needs do not prevent the resident from being able to safely evacuate, except as allowed by (b) below; and

(5) Who does not require special equipment for transfers to or from a bed or chair.

(b) Notwithstanding (a)(2)-(3) above, a resident who develops a condition that requires hospice care following admission to an ALR-RC may receive services from a New Hampshire home hospice care provider licensed under He-P 823, provided that the ALR-RC licensee can evacuate the resident without jeopardizing the other residents or personnel. In the event that the resident becomes immobile or unable to self evacuate, the licensee shall have a written plan to ensure that the resident can be evacuated 24/7 in the event of an emergency.

(c) A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

(d) The ALR-RC shall hold the resident’s bed open during a temporary absence, in accordance with RSA 151:25.

(e) The resident shall be transferred or discharged only as allowed under RSA 151:19, VII, RSA 151:21, V, or in accordance with the provisions of RSA 151:26.

(f) If a resident is to be transferred or discharged, the licensee shall develop a discharge plan that meets the resident’s needs with the input of the resident and the guardian, agent, or personal representative, if any.

(g) The most recent resident assessment tool, care plan, progress notes, and any current medication records shall accompany the resident upon transfer or discharge.

(h) If the transfer or discharge referenced in (f) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the resident as soon as possible.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of an administrator who:

(1) Is responsible for the day-to-day operations of the ALR-RC;

(2) Works no less than 35 hours per week at the ALR-RC, which may include day, evening, night, and weekend hours;

(3) Meets the requirements of He-P 804.18(k);

(4) Designates, in writing, a staff member who shall assume the responsibilities of the administrator in his or her absence; and

(5) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (3) above.

(b) At the time of application for admission, the licensee shall provide the resident and the guardian, agent, or personal representative, if any, a written copy of the residential service agreement pursuant to RSA 161-J, except that a copy of the residential service agreement shall not be required if the facility admission agreement includes all of the provisions of a residential service agreement.

(c) In addition to (b) above, at the time of admission, the licensee shall provide the resident and the guardian, agent, or personal representative, if any, and receive written verification of receipt, a written copy of the admission agreement that includes the following:

(1) The basic daily, weekly, and monthly fee;

(2) A list of the core services required by He-P 804.14(c) that are covered by the basic rate;

(3) Information regarding the timing and frequency of cost of care increases;

(4) The time period covered by the admission agreement;

(5) The criteria and acuity level that the resident must maintain in order to remain a resident at an ALR-RC in accordance with He-P 804.15(a);

(6) The ALR-RC’s house rules;

(7) The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

(8) The ALR-RC’s responsibility for resident discharge planning;

(9) Information regarding care, services, or supplies not provided in the core services, to include:

a. The availability of services;

b. The ALR-RC’s responsibility for arranging services; and

c. The fee and payment for services, if known;

(10) The licensee’s policies and procedures regarding:

a. Arranging for the provision of transportation;

b. Arranging for the provision of third party services, such as a hairdresser or cable television;

c. Monitoring third party services contracted directly by the resident and provided on the ALR-RC premises;

d. Handling of resident funds pursuant to RSA 151:24 and He-P 804.14(s);

e. Bed hold, in compliance with RSA 151:25;

f. Storage and loss of the resident’s personal property; and

g. Smoking;

(11) The licensee’s medication management services;

(12) The list of grooming and personal hygiene supplies provided by the ALR-RC as part of the basic daily, weekly, or monthly rate;

(13) A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the ALR-RC’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(14) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(a)(5);

(15) The ALR-RC’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29;

(16) Information on accessing the long-term care ombudsman;

(17) Information on advanced directives;

(18) Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both, or whether or not the facility has an AED on-site and available for use in an emergency;

(19) Information that if the facility changes its current acceptance of payment sources, it shall provide 60 days’ notice of such change; and

(20) A statement that a resident’s inability to cover the cost of care may result in discharge.

(d) The ALR-RC shall assess each resident’s needs using the “CARES Tool” (January 2022).

(e) All personnel who administer the CARES Tool shall be trained to complete the CARES Tool by the department or entities listed in RSA 151:5-a, III.

(f) The assessment described in (d) above shall:

(1) Be completed no more than 30 days prior to or within 24 hours following admission to the ALR-RC;

(2) Be completed in consultation with the resident and guardian, agent, or personal representative, if any;

(3) Be repeated every 6 months or after any significant change as defined in He-P 804.03(ch);

(4) Be signed and dated by the individual who completed the CARES Tool; and

(5) Be signed by the resident and guardian, agent, or personal representative, acknowledging that the CARES Tool was completed as directed in (2) above.

(g) If the guardian, agent, or personal representative if any is unable to sign the Cares Tool the facility shall have documented evidence that the guardian, agent, or personal representative has had an opportunity to take part in completing and reviewing the completed Cares Tool..

(h) If the CARES Tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES Tool.

(i) If the nursing assessment indicates that the resident cannot safely evacuate, the resident shall be ineligible for care and services at the ALR-RC.

(j) If the nursing assessment completed in accordance with (h) above is completed by a licensed practical nurse (LPN), the assessment shall be reviewed and co-signed by the registered nurse (RN) or physician that is supervising the LPN prior to implementation.

(k) If the Cares Tool indicates a need for a care plan, the care plan shall be:

(1) Completed within 24 hours of the initial Cares Tool and within 24 hours of the completion of all subsequent Cares Toolsexcept where a nursing assessment is required in which case, the care plan shall be completed within 24 hours following the nursing assessment;

(2) Made available to personnel who assist residents;

(3) Completed in consultation with the resident and guardian, agent, or personal representative, if any; and

(4) If the resident and guardian, agent, or personal representative, if any, are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

(l) The care plan identified in (k) above shall include on an ongoing basis:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal or objective of the plan;

(4) The action or approach to be taken;

(5) The responsible person(s) or position; and

(6) The date of reevaluation, review, or resolution.

(m) Each care plan shall be reviewed at least every 6 months to determine if:

(1) All items identified in the care plan are being met;

(2) The care plan will be continued for another 6 months; and

(3) The care plan will be revised to meet the current needs of the resident.

(n) Progress notes for each resident shall be written at least quarterly and include, at a minimum:

(1) Changes in mobility, weight, memory, skin integrity, continence, medications, behavior, and personal care needs; and

(2) A summary of visits to licensed practitioners and referrals.

(o) For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, the facility shall ensure that a discipline specific care plan:

(1) Is completed within 24 hours of the discipline specific assessment;

(2) Is completed in consultation with the resident and guardian, agent, or personal representative, if any;

(3) Is updated following the completion of all future discipline specific assessments;

(4) Is available to personnel who assist residents in the implementation of the discipline specific care plan;

(5) Addresses the needs identified in the discipline specific assessment;

(6) Includes the date the medical, nursing, or rehabilitative care or services, or hospice care need was identified;

(7) Identifies the resident goal or approach to be taken to address the medical, nursing, or rehabilitative care or services, or hospice care need;

(8) Includes the date of reevaluation of the medical, nursing, or rehabilitative care or services, or hospice care need and the name of the responsible person; and

(9) Is maintained in the resident’s record.

(p) For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, progress notes shall be written at every visit by the practitioner performing the service.

(q) At the time of a resident’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions, and therapeutic diets, as applicable.

(r) The licensee shall have each resident obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the ALR-RC.

(s) The health examination referenced in (r) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) A list of current medications including over-the-counter medications, treatments, and therapeutic diets, if applicable; and

(4) Allergies.

(t) Each resident shall have at least one health examination every 12 months by a licensed practitioner, unless the licensed practitioner determines that an annual health examination is not necessary and specifies in writing an alternative time frame, or unless the resident refuses in writing. Any such resident refusal shall be made annually.

(u) A resident may refuse all care and services.

(v) When a resident refuses care or services that could result in a threat to the resident’s health, safety, or well-being, or that of others, the licensee or personnel shall:

(1) Inform the resident of the potential consequences of their refusal;

(2) Notify the licensed practitioner and guardian, if any, of the resident’s refusal of care or services; and

(3) Document in the resident’s record the items in (1) and (2) above, the refusal of care or services, and the resident’s reason for the refusal.

(w) The licensee shall maintain an emergency data sheet, updated as needed and at a minimum at the conclusion of each RAT assessment, in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

(x) The emergency data sheet referenced in (w) above shall include:

(1) Full name and the name the resident prefers, if different;

(2) Name, address, and telephone number of the resident’s next of kin, guardian, or agent, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations to include but not be limited to physical limitations, hearing loss, visual imparement, and cognitive challenges;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives; and

(10) Any other pertinent information not specified in (1)-(9) above.

(y) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.

(z) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a point of care testing policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(aa) The licensee shall have current copies of manufacturer’s instructions and package inserts and follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, and messages, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(ab) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be incompliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

(ac) If a facility has independent living units within the same structure which are not separated by a firewall from the licensed facility, they shall be subject to the same requirements as licensed units with regard to fire and building codes, including inspections.

(ad) If ALR-RC services as defined by He-P 804.03(l) are provided by the staff of the facility to individuals in an independent living unit, the unit(s) shall be redesignated as licensed units in the ALR-RC and an application for a bed increase shall be completed as required by He-P 804.08(a)(5) and (b)(3).

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.17 Medication Services

(a) All medications shall be made available to the resident in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

(b) All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis or when indicated by a change in the resident’s condition.

(c) Medications, treatments, and therapeutic diets ordered by a licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours, or when available in accordance with the licensed practitioner’s written direction.

(d) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the ALR-RC;

(2) Reorder medications for use at the ALR-RC; and

(3) Receive and record new medication orders.

(e) Each medication order shall legibly display the following information:

(1) The resident’s name;

(2) The medication name, strength, prescribed dose, and route, if different than by mouth;

(3) The frequency of administration;

(4) The indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner as allowed by He-P 804.03(ca).

(f) Except for pharmaceutical samples, each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient, unless it is an emergency medication as allowed by (ab) below:

(1) The resident’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

(7) The expiration date of the medication(s).

(g) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee, with the resident’s name, and shall be exempt from (f)(2)-(6) above.

(h) The dosage, frequency, and route of administration on the labels of all prescription medications for each resident shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (i) below.

(i) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the ALR-RC shall indicate in writing, in the medication record, the date the dose or the discontinuance occurred.

(j) Only a pharmacist shall make changes to prescription medication container labels except as allowed by (k) below.

(k) When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

(l) Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

(m) The transcribed order in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

(n) No medications shall be given to or taken by a resident until a written order is received, except as allowed by (l) or (m) above.

(o) ALR-RCs that do not have a licensed nurse as described in (l) above on duty at the time an order for medications, treatments, or therapeutic diets are to be given shall receive said order in written form with the licensed practitioner’s signature and the date of the order.

(p) Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (o) above.

(q) All over-the-counter medications as defined by He-P 804.03(av) shall have a signed practitioner’s order specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(r) The medication storage area for medications not stored in the resident’s room shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(s) All medication at the ALR-RC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (ad)(6) below.

(t) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(u) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the ALR-RC, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(v) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(w) Except as required by (x) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

(x) Destruction of contaminated, expired, or discontinued controlled drugs shall:

(1) Be in accordance with acceptable standards of practice;

(2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

(3) Be documented in the record of the resident for whom the drug was prescribed.

(y) When a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self administration of medication without assistance.

(z) If a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken and the resident is not capable of self administration of medication without assistance, the medication container shall be given to the person responsible for the resident while the resident is away from the ALR-RC.

(aa) Upon discharge or transfer, the licensee shall make the resident’s current medications available to the resident and the guardian, agent, or personal representative, if any, and upon death of a resident, the facility shall return or destroy all remaining medications, as appropriate, and document in resident record.

(ab) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(ac) Residents shall receive their medications by one of the following methods:

(1) Self administration of medication without assistance as defined by He-P 804.03(br);

(2) Self-directed medication administration as defined by He-P 804.03(bs);

(3) Self administration of medication with assistance as defined by He-P 804.03(bq); or

(4) Administered by individuals authorized by law, including via delegation.

(ad) If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

(ae) For residents who self administer medication without assistance, the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the resident to self administer medication without assistance; and

b. Authorizing the resident to store the medications in their room;

(2) Evaluate the resident on a 6 month basis or sooner, based on a significant change in the resident, to ensure they maintain the physical and mental ability to self administer medication without assistance;

(3) Have the resident store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

(4) If a resident requests, allow the resident’s medication to be placed in a central locked storage area provided by the ALR-RC;

(5) Have a copy of the key to access the locked medication storage area in the resident’s room;

(6) Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist; and

(7) Except as provided for in (4) above, not be responsible, in any way, for management or control of the resident’s medications.

(af) The licensee shall allow the resident to self direct administration of medications if the resident:

(1) Has a physical limitation due to a diagnosis that prevents the resident from self administration of medications with or without assistance;

(2) Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self direct administration of medications;

(3) Obtains an annual written verification of the resident’s physical limitation and self-directing capabilities from the resident’s licensed practitioner and requests the ALR-RC to file the verification in their resident record; and

(4) Verbally directs personnel to:

a. Assist the resident with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

b. Assist the resident to apply, ingest, or instill the ordered dose of medication.

(ag) If a resident self administers medication with assistance, personnel shall be permitted to:

(1) Remind the resident to take the correct dose of his or her medication at the correct time;

(2) Place the medication container within reach of the resident;

(3) Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the resident’s daily medication record that they have supervised the resident taking his or her medication; and

(5) Document in the resident’s record any observed or reported side effects, adverse reactions, refusal to take medications, or medications not taken.

(ah) If a resident self administers medication with assistance, personnel shall not physically handle the medication in any manner.

(ai) Except for those residents who self administer medication without assistance, the licensee shall maintain a written record for each medication taken by a resident at the ALR-RC that contains the following information:

(1) Any allergies or adverse reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the resident taking medication;

(5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(aj) The facility shall have a written policy that incorporates the requirements listed in (ad)-(ai) for use in training and for reference by employees supervising medication administration.

(ak) Personnel who are not licensed practitioners or nurses but who assist a resident with self administration of medication with assistance or self-directed administration of medication shall, prior to providing such assistance, complete, at a minimum, a 4-hour medication assistance education program covering both prescription and non-prescription medication.

(al) A licensed nurse, licensed practitioner, or pharmacist shall teach the medication assistance education program, whether in-person or through other means such as electronic media provided it meets the requirements of (ak) above and (am) below.

(am) The medication supervision education program required by (ak) above shall include:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights relative to medication, which are:

a. The right resident;

b. The right medication;

c. The right dose;

d. Medication administered at the right time; and

e. Medication administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as antihypertensives or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(an) The administrator may accept documentation of training required by (ak) above if it was previously obtained by the applicant for employment at another licensed ALR-RC.

(ao) The licensee shall report to the resident’s licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the resident’s record the reaction, the error, and date, time, and person notified.

(ap) No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.

(aq) An ALR-RC shall have written orders from the licensed practitioner for all medications being taken by residents except for residents who have a licensed practitioner’s order to self administer medications without assistance and keep the medicine in their room.

(ar) An ALR-RC may keep non-prescription stock medications for a resident when accompanied by a licensed practicioner’s order and each resident has his or her own container for the medication.

(as) The therapeutic use of cannabis by residents who are qualifying residents possessing a registry identification card shall be permitted at an ALR-RC provided:

(1) The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or

(2) The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident.

(at) An ALR-RC that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration.

(au) An ALR-RC that designates itself as a facility caregiver according to (as)(1) above shall:

(1) Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and

(2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying residents with the therapeutic use of cannabis.

(av) An ALR-RC shall not permit the smoking of cannabis if smoking is not allowed on the ALR-RC premises.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the ALR-RC to meet the needs of residents at all times as determined by each Cares Tool.

(b) For those ALR-RCs licensed for 17 or more beds, at least one awake personnel shall be on duty at all times, including overnight, while residents are in the ALR-RC.

(c) For those ALR-RCs licensed for 16 or fewer beds, at least one awake personnel shall be on duty at all times, including overnight, while residents are in the ALR-RC, unless:

(1) There is a UL listed communication system whereby residents can contact and awaken the sleeping personnel member via an intercom or other communication system in the personnel member’s room;

(2) If the ALR-RC has residents with a history of exit seeking, the licensee has installed and maintains a functioning wander prevention system that will awaken the sleeping personnel; and

(3) All residents:

a. Require nothing more then occasional reminding or cueing;

b. Require nothing more then verbal prompting for mobility and evacuation issues;

c. Have no acute medical needs or ongoing nursing needs; and

d. Have no history of being verbally or physically abusive.

(d) For all applicants for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, and for all household members, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing; and

(2) Review the results of the criminal records check in (1) above in accordance with (e) below; and

(3) Verify the qualifications of all applicants prior to employment.

(e) Unless a waiver is granted in accordance with (g)(2) below, the licensee shall not offer employment, contract with, or engage a person in (d) above, or allow a household member to continue to reside in the residence, if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) If the information identified in (e) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

(2) Request a waiver of (e) above.

(g) If a waiver of (e) above is requested, the department shall review the information and the underlying circumstances in (e) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a resident; or

(2) Grant a waiver of (e) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

(h) The licensee shall check the names of the persons in (d) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, and against the NH board of nursing, nursing assistant registry, maintained pursuant RSA 326-B:26 and 42 CFR 483.156, prior to employing, contracting with, or engaging them, or prior to allowing or continuing to allow a household member to reside at the residence.

(i) The licensee shall not employ, contract with, engage, or allow to reside in the facility any person in (d) above who is listed on the BEAS state registry or the NH board of nursing, nursing assistant registry unless a waiver is granted by BEAS or the NH board of nursing, respectively.

(j) In lieu of (d) and (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (d) and (h) above and do not meet the criteria in (e) and (i) above.

(k) All administrators appointed after the 2022 effective date of these rules shall be at least 21 years of age and have one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and one year of experience working in a health care facility;

(2) A New Hampshire license as an RN and at least 6 months of experience working in a health care facility;

(3) An associate’s degree from an accredited institution and at least 2 years of experience working in a health care facility; or

(4) A New Hampshire license as an LPN and at least one year of experience working in a health care facility.

(l) All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the ALR-RC each annual licensing period, in accordance with (t) and (u) below.

(m) All direct care personnel shall be at least 18 years of age unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(2) Involved in an established educational program working under the supervision of a nurse.

(n) The licensee shall inform personnel of the line of authority at the ALR-RC.

(o) The licensee shall educate personnel about the needs and services required by the residents under their care.

(p) Prior to having contact with residents or food, personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(q) In lieu of (p)(1) above, independent agencies contracted by the facility or by an individual resident to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (p)(1) and (3) above before working at the ALR-RC.

(r) Prior to having contact with residents or food, personnel shall receive a tour of and orientation to the ALR-RC that includes the following:

(1) The residents’ rights in accordance with RSA 151:20;

(2) The ALR-RC’s resident complaint procedures;

(3) The duties and responsibilities of the position;

(4) The emergency medical procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 804.22;

(7) The procedures for food safety for personnel involved in preparation, serving, and storing of food; and

(8) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(s) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s resident’s rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan; and

(4) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(t) The facility administrator, licensed nurse, if available, or the administrator’s designee who has completed the 4-hour medication assistance supervision program required by He-P 804.17(ak) shall provide and document in writing, an annual review of its policies and procedures for self administration of medication without assistance, self administration of medication with assistance, and self-directed medication administration to all direct care personnel.

(u) The ALR-RC shall maintain a separate employee file for each employee, which shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the residents rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (d) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (r) above;

(7) Information as to the general content and length of all in-service or educational programs attended;

(8) Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

(9) A copy of each current driver’s license, including proof of insurance, if the employee transports residents using their own vehicle;

(10) Documentation that the required physical examinations or health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(11) The statement required by (w) below; and

(12) The results of the registry checks in (h) above.

(v) The ALR-RC shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (u)(1), (3), (4), (6), and (8)-(12) above; and

(2) For independent contractors, the information in (u)(3), (4), (6), and (8)-(12) above, except that the letter in (j) and (q) above may be substituted for (u)(4), (10), and (12) above, if applicable.

(w) All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a resident; and

(3) Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(x) An individual shall not have to re-disclose any of the matters in (w) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

(y) The licensee shall protect and store in a secure and confidential manner all records described in (u) and (v) above.

(z) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

(aa) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(ab) The ALR-RC shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(ac) The policy in (ab) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.19 Resident Records

(a) The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the ALR-RC.

(b) At a minimum, resident records shall contain the following:

(1) A copy of the resident’s residential service agreement, admission agreement, or both, as applicable, and all documents required by He-P 804.16(b) and (c);

(2) Notwithstanding (1) above, financial records may be kept in a separate file;

(3) Identification data, including:

a. The resident’s name, date of birth, and marital status;

b. If the resident is receiving respite care as described in He-P 804.20, the resident’s home address and phone number;

c. Resident’s religious preference, if known;

d. Resident’s veteran status, if known; and

e. Name, address, and telephone number of an emergency contact person;

(4) The name and telephone number of the resident’s licensed practitioner(s);

(5) If services are provided at the ALR-RC by individuals not employed by the licensee, documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, and the business address and telephone number;

(6) Resident’s health insurance information;

(7) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(8) A record of the health examination(s) in accordance with He-P 804.16 (r) - (t);

(9) Written, dated, and signed orders for the all medications, treatments, and therapeutic diets;

(10) Results of any laboratory tests, X-rays, or consultations performed at the ALR-RC;

(11) All assessments and care plans, and documentation that the resident and the guardian or agent, if any, has participated in the development of the care plan;

(12) All admission and progress notes;

(13) Documentation of any alteration in the resident’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken, including licensed practitioner notification;

(14) Documentation of medical, nursing, or other specialized care, as applicable;

(15) Documentation of reportable incidents;

(16) The consent for release of information signed by the resident, guardian, or agent, if any;

(17) Discharge planning and referrals;

(18) Transfer or discharge documentation, including notification to the resident and guardian, agent, or personal representative, if any, of involuntary room change, if applicable;

(19) The medication record as required by He-P 804.17(ai);

(20) Emergency data sheet, which contains the information required by He-P 804.16(x);

(21) Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner; and

(22) Documentation of a resident’s refusal of any care or services.

(c) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting residents, to include:

(1) That immunizations shall be provided and reported to the department’s division of public health services immunization program in accordance with RSA 151:9-b, I-V, He-P 309.02, and He-P 309.08; and

(2) The facility shall have a plan that identifies and documents, with dates, all residents that have received or declined to receive immunizations, to be included in the resident record in (b) above.

(d) Resident records and resident information shall be kept confidential and only provided in accordance with law.

(e) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

(f) When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

(g) Records shall be retained for 4 years after discharge, except that when the resident is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

(h) The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the ALR-RC ceases operation.

(i) If the facility uses an electronic record storage system, it shall provide computer access to all resident records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 804 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

(j) All resident electronic records shall have security provisions to ensure confidentiality.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.20 Respite Care in ALR-RC

(a) The licensee shall only admit an individual for respite care services when the needs of the individual are compatible with the services and programs offered by the facility as allowed by its license and the facility can meet the needs of the individual in accordance with He-P 804.15(a)-(d).

(b) When a temporary admission to an ALR-RC occurs and the individual is scheduled for a stay of no more than 30 consecutive days as agreed upon by the individual and the licensee as part of a discharge plan, the licensee shall:

(1) Obtain written verification signed by the resident, guardian or agent, if any, or personal representative, indicating they have been given a copy of the patient rights and responsibilities as required by RSA 151:20, I;

(2) Obtain a signed admission agreement listing the services that shall be provided;

(3) Be permitted to use the prescription label on the medication container as the licensed practitioner’s order provided that:

a. The medication is in the original bottle as dispensed by the pharmacy;

b. The pharmacy label has not been altered in any manner;

c. The prescription label indicates that the medication is still current; and

d. The medication container contains all the same medication or has been labeled by the pharmacy verifying that the bottle contains all the same prescription medication;

(4) Complete the CARES Tool prior to or immediately on admission to determine that the potential residents’ needs can be met by the facility;

(5) Note in the resident’s record, the resident’s allergies, if any, diagnoses, and history of wandering or unexplained absences; and

(6) Obtain copies of current advanced directives information, if available.

(c) For planned recurrent respite care the resident shall be discharged but may be readmitted using the same admission documents completed within the previous 6 months, as long as there are no identified changes in the resident’s condition or care needs except that the medication requirement in (b)(3) above shall be re-verified.

(d) If the resident exceeds the 30-day time period, the resident shall no longer be considered to be receiving respite care and:

(1) A complete admission shall occur within 72 hours; or

(2) The resident shall be discharged from the facility.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17; ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.21 Food Services

(a) The licensee shall provide food services that meet:

(1) The US Department of Agriculture’s recommended dietary allowance as specified in the “2015-2020 Dietary Guidelines for Americans,” available as noted in Appendix A;

(2) The nutritional needs of each resident; and

(3) The special dietary needs, including any therapeutic diets, associated with health or medical conditions for each resident as identified on the RAT.

(b) Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises, unless contraindicated by the resident’s care plan.

(c) There shall be no more than 14 hours between the evening meal and breakfast except if:

(1) The licensee offers snacks at bedtime;

(2) The resident agrees, in writing, to allow more than 14 hours between the evening meal and breakfast; or

(3) The resident refuses to eat a specific meal.

(d) Snacks shall be offered and made available between meals and at bedtime if not contraindicated by the resident’s care plan.

(e) If a resident refuses the item(s) on the menu, a substitute shall be offered.

(f) Each day’s menu shall be posted in a place accessible to food service personnel and residents.

(g) A dated record of menus as served shall be maintained for at least the previous 4 weeks.

(h) The licensee shall provide therapeutic diets to residents only as ordered by a licensed practitioner or other professional with prescriptive authority.

(i) If a resident has a pattern of refusing to follow a prescribed therapeutic diet, personnel shall document the reason for the refusal in the resident’s medical record and notify the resident’s licensed practitioner.

(j) All food and drink provided to residents shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and chapter 3 of the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administration, Food Code, 2013 edition, available as noted in Appendix A;

(3) Served at the proper temperatures;

(4) Labeled, dated, and stored at proper temperatures; and

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

(k) The use of expired or unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded. The dates associated with such terms as “sell by”, “use by”, or “best if used by” shall not constitute the expiration date.

(l) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(m) All work surfaces shall be non-porous and cleaned and sanitized after each use.

(n) All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(o) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(p) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(q) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(r) Garbage or trash in the kitchen area shall be placed in lined containers with covers which shall remain closed except when in use.

(s) All ALR-RC personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.22 Infection Control

(a) The ALR-RC shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of residents with infectious or communicable diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Wm 904; and

(5) The reporting of infectious and communicable diseases required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, formites, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected.

(f) Personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ALR-RC until a diagnosis of tuberculosis is excluded, or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, fitted bandage.

(h) If the ALR-RC has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.23 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times, and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the residents.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and resident supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered at all times, except during food preparation and subsequent clean-up.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and be separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas or containers.

(p) Any ALR-RC that has its own water supply and whose water has been tested and failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.24 Quality Improvement

(a) The ALR-RC shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The ALR-RC shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored:

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the ALR-RC; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

History

• #12414, eff 11-3-17

N.H. Code Admin. R. Ann. He-P 804.25 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, comfort, and privacy of resident(s) and personnel, including reasonable accommodations for residents and personnel with mobility limitations.

(b) The ALR-RC shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within an ALR-RC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following conditions are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any ALR-RC.

(g) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(h) Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(i) The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

(j) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(k) All hand-washing facilities shall be provided with hot and cold running water.

(l) Bedrooms shall have at least 100 square feet for each resident in each private bedroom and at least 80 square feet for each resident in a semi-private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities.

(m) Bedrooms in an ALR-RC licensed prior to 4/3/2008 shall:

(1) Be exempt from (l) above;

(2) Provide at least 80 square feet per resident in a private room; and

(3) Provide at least 70 square feet per resident in a semi-private room.

(n) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the resident to reach his or her bedroom without passing through the room of another resident;

(3) Have a side hinge door and not a folding or sliding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors, and other rooms by floor to ceiling walls;

(6) Be located on the same level as the bathroom facilities if the resident has impaired mobility as identified by the RAT; and

(7) If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom within 24 hours and without requiring additional construction or renovation.

(o) The licensee shall provide the following for the residents’ use, as needed:

(1) A bed appropriate to the needs of the resident;

(2) A firm mattress that complies with the state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

(3) Clean linens, blankets, and a pillow;

(4) A bureau, mirror, and bedside table;

(5) A lamp;

(6) A chair;

(7) A closet or storage space for personal belongings; and

(8) Window blinds, shades, or curtains that provide privacy.

(p) The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others and may waive any of the items in (o) above with a note signed by the resident or guardian and which note shall be placed in the resident’s file.

(q) The licensee shall provide the following rooms to meet the needs of residents:

(1) One or more living rooms or multipurpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all residents.

(r) Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

(s) Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

(t) All bathroom, bedroom, and closet doors shall either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

(u) Screens shall be provided for doors, windows, or other openings to the outside.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17 (from He-P 804.24); ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.26 Fire Safety

(a) All ALR-RCs shall meet at a minimum the following:

(1) For facilities with 3 residents or fewer, the One and Two Family Dwelling chapter of the life safety code; and

(2) For facilities with 4 residents or more, the Residential Board and Care Occupancy chapter of the life safety code.

(b) All ALR-RCs shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the ALR-RC’s electrical service, or wireless, as approved by the state fire marshal for the ALR-RC;

(2) At least one UL listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC, installed on every level of the building, and which meets the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Documentation of manual fire extinguisher inspections must be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation;

e. Documentation of electronically monitored fire extinguishers must be provided to the department within 2 business days of the completion of the inspection or investigation;

f. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

g. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) A fire safety program shall be developed and implemented to provide for the safety of residents and personnel.

(d) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) Emergency EMS transport related to pre-existing conditions.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) If the licensee has chosen to allow smoking within the ALR-RC, a designated smoking area shall be provided which:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non-combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64–77, the Indoor Smoking Act.

(g) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, or the resident’s guardian, a person with durable power of attorney (DPOA), agent, or personal representative, as appropriate at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident. Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(h) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(i) Fire drills shall be conducted as follows:

(1) For buildings constructed to the One and Two Family Dwelling chapter or the Residential Board and Care Occupancy chapter of the life safety code, the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Willing residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All ALR-RC facilities identified in (1) above shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the dark of night when a majority of residents are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the fire safety plan, and approved by the department and the local fire authority based on construction of the building, and shall provide residents with experience in egressing through all exits and means of escape;

e. Facilities shall complete a written record of fire drills that includes the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. At least annually, and whenever a resident experiences a significant change, as defined in He-P 804.03(ch), the facility shall conduct a resident Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the resident’s needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, and residents’ ability to evacuate on their own and choose an alternate exit;

h. At least annually, the facility shall review all residents’ FSES in totality to ensure that the facility can meet not only the needs of each individual resident but the resident population as a whole during a time of emergency;

i. Based on the review in h. above, if the facility is unable to meet the needs of any resident based on the FSES, the facility shall address the safety concerns through a variety of interventions such as resident discharge, additional staff, and modification to the current building; and

j. The fire drills for facilities built to the Residential Board and Care Occupancy chapter of the life safety code shall be permitted to be announced, in advance, to the residents just prior to the drill;

(2) For buildings constructed to the Health Care Occupancy chapter of the life safety code and to the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the Health Care Occupancy chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy chapter of the life safety code;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. If the facility has an approved defend or shelter in place plan, then all personnel, residents, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that residents are given the experience of evacuating to the appropriate location or exiting through all emergency exists;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

h. Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

i. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(3) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

History

• #9121, eff 4-3-08, EXPIRED: 4-3-16
• #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12414, eff 11-3-17 (from He-P 804.25); ss by #13339, eff 1-29-22

N.H. Code Admin. R. Ann. He-P 804.27 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

(12) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(14) Include the management of residents, particularly with respect to physical and clinical issues to include:

a. Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(f) The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not involved in the exercise;

(2) Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

(g) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Potable water for a 3-day period.

(h) Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

(1) Assumptions for calculations of food and water supplies including maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

(2) Storage location(s); and

(3) Back-up supplies.

History

• #12414, eff 11-3-17

Part He-P 805 Supported Residential Health Care Facility Licensing Rules

N.H. Code Admin. R. Ann. He-P 805.01 Purpose

REVISION NOTE:

Document #13368, effective 4-19-22, readopted with amendments the “Care Assessment for Residential Services Tool” form pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c. The form is incorporated by reference in He-P 805.16(d) which requires the supported residential health care facility (SRHCF) to assess each resident’s needs using the “Care Assessment for Residential Services Tool” form. Document #13368 contained only the amended form, giving it a new effective date, and updated the revision date on the form from the “January 2022 edition” to the “April 2022 edition.”

The prior filing affecting He-P 805.16 was Document #13333, effective 1-25-22, and the effective date of the rule remained unchanged by Document #13368. Since Document #13368 updated the revision date on the form from “(January 2022 edition)” to the “(April 2022 edition)”, the revision date was subsequently updated editorially in He-P 805.16(d).

The purpose of this part is to set forth the classification of and licensing requirements for supported residential health care facilities (SRHCF) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(2).

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93, EXPIRED: 7-14-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a SRHCF pursuant to RSA 151:9, VII(a)(2).

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of residents;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to residents; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving residents without their consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 805.

(f) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

(g) “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(h) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J, or a “surrogate decision-maker” in accordance with RSA 137-J:35.

(i) “Adverse drug reaction” means harm caused by a drug at normal doses.

(j) “Affiliated parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies. This term includes “related parties”.

(k) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker identified under RSA 137-J:35-37.

(l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an SRHCF pursuant to RSA 151.

(m) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 805, or other federal or state requirements.

(n) “Assessment” means an evaluation of the resident to determine the care and services that are needed.

(o) “Care assessment for residential services (CARES) tool” means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I.

(p) “Care plan” means a documented guide developed by the licensee or their personnel, in consultation with the resident or the resident’s guardian, personal representative, or agent, if any, as a result of the assessment process for the provision of care and services as required by He-P 805.16(e) - (j).

(q) “Change of ownership” means the transfer of the controlling interest of an established SRHCF to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(r) “Chemical restraints” means any drug or medication that is used as a restriction to manage a resident’s behavior or restrict the resident’s freedom of movement and is not a standard treatment or dosage for the resident’s condition.

(s) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(t) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or their designee.

(u) “Controlling interest” means greater than 50% ownership interest.

(v) “Core services” means those services provided by the licensee that are included in the basic rate.

(w) “Days” means calendar days unless otherwise specified in the rule.

(x) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to achieve a certificate of completion for a course or to pass a post-test for a training provided.

(y) “Department” means the New Hampshire department of health and human services.

(z) “Direct care” means the hands on care or services provided to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(aa) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(ab) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified areas of non-compliance.

(ac) “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

(ad) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ae) “Drug diversion” means the use of controlled substances for anything other than the intended purpose or not administered to the person to whom it was prescribed.

(af) “Elopement” means when a resident leaves the licensed premises or a safe area unsupervised or unnoticed, without the authorization of the licensee’s personnel.

(ag) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ah) “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(ai) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 805.

(aj) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(ak) “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

(al) “Facility” means “facility” as defined in RSA 151:19, II.

(am) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident’s health care and other personal needs.

(an) “Health care occupancy” means the use of a building or structure, or a portion thereof, to provide care or supervision to persons who are or are not capable of self-preservation without physical assistance.

(ao) “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days.

(ap) “Independent contractor” means an individual or business entity providing service to the licensee or its residents but not employed by the licensee.

(aq) “Infectious waste” means “infectious waste” as defined in Env-Sw 103.28 and described in Env-Sw 904.

(ar) “Informed consent” means the decision by a resident, or their guardian, personal representative, or agent, to agree to a proposed course of treatment, after they have received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(as) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(at) “Inspection” means the process used by the department to determine an applicant’s or a licensee's compliance with RSA 151, He-P 805, and all other federal and state requirements or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 805.

(au) “Laboratory” means a facility, or space within a facility, used for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease.

(av) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 805, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.

(aw) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other professional licensed by law with prescriptive powers.

(ax) “Licensed premises” means the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(ay) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(az) “Licensing classification” means the specific category of services authorized by a license.

(ba) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bb) “Mechanical restraint” means locked, secured, or alarmed SRHCFs or units within an SRHCF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within.

(bc) “Medical director” means a licensed practitioner licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a SRHCF.

(bd) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative supportive substance.

(be) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a resident’s refusal.

(bf) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include “repair” or “replacement” of interior finishes.

(bg) “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.

(bh) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety codes or rules.

(bi) “Nursing care plan” means a written guide developed by a nurse in consultation with the resident and the resident’s guardian, personal representative, or agent, that lists the interventions necessary to meet the resident’s nursing needs.

(bj) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bk) “Over-the-counter medications” means non-prescription medications.

(bl) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bm) “Patient rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21. This term includes “resident rights”.

(bn) “Patient’s personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person, other than the licensee of, an employee of, or a person having direct or indirect ownership interest, in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”. This term includes “personal representative”.

(bo) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(bp) “Personal care” means services that are non-medical, hands-on services provided to a resident including, but not limited to, assistance with activities of daily living.

(bq) “Personnel” means an individual(s), who is employed by the licensee, a volunteer, or an independent contractor who provides direct care or personal care services to a resident(s).

(br) “Physical restraint” means any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.

(bs) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bt) “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

(1) A lancing or finger stick device to get blood specimen;

(2) A test strip or reagents to apply a specimen to for testing; or

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

c. A Cholesterol meter.

(bu) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of resident care.

(bv) “Pro re nata (PRN) medication” means medication administered as circumstances might require in accordance with the licensed practitioner’s orders.

(bw) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bx) “Protective care” means the provision of resident monitoring services, including but not limited to:

(1) Knowledge of resident whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(by) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bz) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(ca) “Rehabilitation” means any of the following, as defined in this section, undertaken in an existing building:

(1) Addition;

(2) Modification;

(3) Reconstruction;

(4) Renovation; and

(5) Repair.

(cb) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(cc) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cd) “Reportable incident” means an occurrence of any of the following while the resident is either in the SRHCF or in the care of SRHCF personnel:

(1) The unanticipated death of the resident;

(2) An injury to a resident that is of a suspicious nature under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the resident;

(3) The elopement of a resident;

(4) Medication error which resulted in serious bodily injury; and

(5) Drug diversion.

(ce) “Resident” means any person admitted to or in any way receiving care, services, or both who resides in a SRHCF.

(cf) “Residential board and care” means an occupancy used for lodging and boarding of 4 or more residents, not related by blood or marriage to the owners or operators, for the purpose of providing personal care services.

(cg) “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 805 and as required by other federal and state law.

(ch) Respite care” means the admission of a person from their primary residence to an SRHCF, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care.

(ci) “Self administration of medication with assistance” means the resident takes their own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

(cj) “Self administration of medication without assistance” means an act whereby the resident takes their own medication(s) without the assistance of another person.

(ck) “Self directed medication administration” means an act whereby a resident, who has a physical limitation that prohibits them from self-administering, directs personnel to physically assist in the medication process excluding assisting with infusions, injections, or filling insulin syringes.

(cl) “Self-preservation capability” means the ability of a resident to act on an innate desire to protect oneself from harm without staff intervention.

(cm) “Serious bodily injury” means an injury involving extreme physical pain, involving substantial risk of death, involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty, or requiring medical intervention such as surgery, hospitalization, or physical

rehabilitation.

(cn) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(co) “Significant change” means a decline or improvement in a resident’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident’s health status; and

(3) Requires interdisciplinary review or revision of the care plan.

(cp) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(cq) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.

(cr) “State monitoring” means the placement of individuals by the department at an SRHCF to monitor the operation and conditions of the facility.

(cs) “Stock medication” means over-the-counter medication available for use by more than one resident.

(ct) “Supported residential health care facility (SRHCF)” means a long-term care residence providing personal assistance at the supported residential care level pursuant to RSA 151:9, VII(a)(2).

(cu) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

(cv) “Transfer” means “transfer” as defined in RSA 151:19, VII.

(cw) “Unanticipated death” means the death of a resident that is not related to their diagnosis or underlying condition.

(cx) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(cy) “Visitor” means a family member or non-related person who comes to visit one or more resident(s) temporarily, for their social well-being, amusement, or distraction.

(cz) “Volunteer” means an unpaid person who assists with food services, entertainment, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.04 Initial License Application Submission

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care, or Special Health Care Services” (August 2025), signed by the owner if a private entity, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

(2) A floor plan of the prospective SRHCF indicating the location of all rooms, number of beds in each bedroom, and fire exits;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the qualifications of the SRHCF administrator and medical director, if applicable;

(6) Copies of applicable licenses for the SRHCF administrator and medical director, if applicable;

(7) The results of a criminal records check to include results for the state of New Hampshire for the applicant(s), licensee if different than the applicant, the administrator, the medical director, if applicable, and each household member 17 years of age or older who resides at the facility, as applicable;

(8) A copy of the non-conviction attestation, as described in He-P 805.18(t), for the administrator and medical director;

(9) The results of a bureau of adult and aging services (BAAS) registry check from the bureau of adult and aging services for the administrator and medical director pursuant to He-P 805.18(e);

(10) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code and local ordinances for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of application based on the local official’s review of the building plans and again upon completion of the construction project;

(11) If the SRHCF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill;

(12) Any waiver requests, if applicable; and

(13) A list of all employees who have been previously granted waivers for criminal background check results from the department.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301;

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 805.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 805.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 805.13(c) when it determines that the applicant, licensee, administrator, or medical director:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this state or any other state;

(3) Has had a finding by the department or any other administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) Following both a clinical and life safety inspection required in He-P 805.09(b), a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 805.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 805.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 805.09(b) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 805.

(i) A written notification of denial, pursuant to He-P 805.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 805.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 805.10(f), if applicable;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 805.18(d)(2); and

(4) A copy of any temporary, new, or existing non-permanent variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 805.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by He-P 805.06(b) and (c) as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 805, and all the federal requirements, at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 805.04(a) and shall be subject to a fine in accordance with He-P 805.13(d)(7).

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.07 SRHCF Construction, Modifications, or Structural Alterations

(a) As required by RSA 151:6, any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of fire safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The plans and specifications, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicants own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building codes, state laws and rules, and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), as applicable, as available as noted in Appendix A.

(i) Applicants and licensees shall contact the state fire marshal for requests for exceptions to the FGI.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 805.09 prior to its use.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.08 SRHCF Requirements for Organizational or Service Changes

(a) The SRHCF shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds authorized under the current license; or

(6) Services.

(b) The SRHCF shall complete and submit a new application and obtain a new or revised license, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of beds authorized under the current license; or

(4) A change in services.

(c) When there is a change in address without a change in location the SRHCF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the SRHCF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department:

(2) The physical location;

(3) An increase in the number of beds or residents authorized under the current license;

(4) A change in license classification; or

(5) A change that places the facility under a different life safety code occupancy chapter.

(f) A new license shall be issued for a change in ownership, classification, or physical location.

(g) A revised license shall be issued for any of the following:

(1) A change in name;

(2) A change of administrator or medical director;

(3) An increase or decrease in the number of beds;

(4) A change in the scope of services provided; or

(5) When a waiver has been granted in accordance with He-P 805.10.

(h) The SRHCF shall inform the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal background check for the new administrator or medical director which shall include criminal history from the state of New Hampshire;

(4) The results of the non-conviction attestation as described in He-P 805.18(w); and

(5) The results of the BAAS registry check per He-P 805.18(e).

(i) Upon review of the materials submitted in accordance with (h) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 805.18(i) and (j).

(j) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

(k) When there is to be a change in the services provided, the SRHCF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

(l) The department shall review the information submitted under (k) above and determine if the added services can be provided under the SRHCF’s current license.

(m) The SRHCF shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(n) A restructuring of an established SRHCF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) If a licensee chooses to cease operation of a SRHCF, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 805, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the SRHCF; and

(3) Any records required by RSA 151 and He-P 805.

(b) The department shall conduct a clinical and life safety code inspection, as necessary, to determine full compliance with RSA 151 and He-P 805 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 805.08(e)(1);

(3) A change in the physical location of the SRHCF;

(4) A change in the licensing classification;

(5) A change in the life safety code occupancy chapter the facility is licensed under;

(6) An increase in the number of beds;

(7) Occupation of space after construction, renovations, or alterations; or

(8) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the SRHCF is in violation of any of the provisions of He-P 805, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 805, within 21 days of the date on the letter that transmits the inspection report.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 805 shall submit a written request for a waiver to the department that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought if the waiver request is not for a permanent waiver.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the residents; and

(3) Does not affect the quality of resident services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) If the request in (f) above is not received with the renewal application or at least 60 days prior to the expiration of the existing waiver, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license.

(h) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 805.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the SRHCF, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 805.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the licensee;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed SRHCF, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 805.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall have 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings or submit a completed application pursuant to He-P 805.04 prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 805, if the owner of an unlicensed SRHCF does not comply with (2) above, or if the department does not agree with the owner’s written response to the findings;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 805.13(d)(6).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 805, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a license; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151, He-P 805, or other applicable licensing rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings, or a notice to correct, the licensee shall submit its written POC for each item, detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 805;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 805 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance shall be corrected;

(4) If the POC is acceptable, the department shall issue a license or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident shall not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 805.12(d) and a fine in accordance with He-P 805.13(c)(13);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 805.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 805.13(d)(14) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine in accordance with He-P 805.13(d);

(3) Deny the application for a renewal of a license in accordance with He-P 805.13(c); or

(4) Revoke or suspend the license in accordance with He-P 805.13.

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the SRHCF in areas that impact health, safety, or well-being of residents;

(2) The presence of conditions in the SRHCF that negatively impact the health, safety, or well-being of residents; or

(3) Concern that the SRHCF is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.13 Enforcement Actions and Hearings

(a) As specified in this section, the department shall take the following enforcement actions for violation of RSA 151, He-P 805, or other applicable licensing rules:

(1) Issue a warning;

(2) Impose a fine in accordance with (d) below;

(3) Deny the application for a renewal of a license in accordance with (c) below;

(4) Immediately suspend a license; or

(5) Revoke the license in accordance with (c) below.

(b) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, II-III, as applicable, before the enforcement action becomes final.

(c) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 805 which poses a threat to a resident’s health, safety, or well-being;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, the applicant or licensee fails to submit an application that meets the requirements of He-P 805.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 805.12(c), (d), and (e);

(7) The licensee is cited a third time under RSA 151 or He-P 805 for the same violation within the last 5 inspections;

(8) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(9) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 805;

(10) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(11) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver;

(12) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application; or

(13) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 805.12(c)(5) and has not submitted a revised POC in accordance with He-P 805.12(c)(6).

(d) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

(4) For a failure to transfer a resident whose needs exceed the services or programs provided by the SRHCF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For admission of a resident whose needs exceed the services or programs authorized by the SRHCF licensing classification, in violation of RSA 151:5-a, II, and He-P 805.15(a) and (b), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 805.11(e)(5), the fine for an unlicensed provider or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 805.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 805.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 805.08(a)(2), the fine for a licensee shall be $500.00;

(10) For a failure to notify the department of a change in e-mail address as required by He-P 805.08(m), the fine for a licensee shall be $100.00;

(11) For a failure to allow access to the department to the SRHCF’s premises, programs, services, or records, in violation of He-P 805.09(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

(12) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 805.08(h), the fine for a licensee shall be $100.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 805.12(c)(2) and (6), the fine for a licensee shall be $100.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 805.12(c)(11) and (e), the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement, or comply with licensee policies, as required by He-P 805.14(l), (m), (n), (t), (w), and (x), the fine for a licensee shall be $500.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 805.14(b), the fine for a licensee shall be $500.00;

(17) For exceeding capacity, in violation of He-P 805.14(p), the fine for a licensee shall be $500.00, per day;

(18) For providing false or misleading information or documentation, in violation of He-P 805.14(u) the fine shall be of $1000.00 per offense;

(19) For a failure to meet the needs of the resident, in violation of He-P 805.15(a), the fine for a licensee shall be $500.00, per resident;

(20) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 805.18(i)-(j) and (l), under circumstances where the department has not granted a waiver in accordance with He-P 805.10, the fine for a licensee shall be $500.00;

(21) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 805.09(a), the fine shall be $2000.00;

(22) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 805.07(a), the fine for a licensed facility shall be $500.00;

(23) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, as required by He-P 805.09(b)(7), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(24) When an inspection determines that a violation of RSA 151 or He-P 805 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original deficiency the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00; and

(25) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 805 shall constitute a separate violation warranting additional fines in accordance with He-P 805.13(d), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 805, as verified by documentation or other means, the department shall not issue a daily fine.

(e) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(f) An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to appeal.

(g) If a written request is not made pursuant to (f) above, the action of the department shall become final.

(h) The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or well-being of a resident is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(i) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 805 is achieved.

(j) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(k) When a SRHCF’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director, for at least 5 years, if the enforcement action pertained to their role in the SRHCF.

(l) RSA 541 shall govern further appeals of the department decisions under this section.

(m) The 5-year period referenced in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an administrative hearing is made and a hearing is held.

(n) Notwithstanding (m) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 805.

(o) If the department has evidence that a licensee, applicant, administrator, or others are circumventing rule (k) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

(p) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 805.

History

• #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(b) The licensee shall provide the following core services:

(1) The presence of staff whenever a resident is in the facility;

(2) Health and safety services to all residents to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding:

a. The residents’ functioning, safety, and whereabouts; and

b. The residents’ health status, including the provision of intervention as necessary or required;

(3) Emergency response and crisis intervention;

(4) Assistance with taking and ordering medications as determined by a resident’s ability or inability to safely manage medications as determined by the CARES tool;

(5) The provision of 3 nutritious meals and snacks unless the resident chooses other options according to their residential service agreement;

(6) Housekeeping, laundry, and maintenance services in accordance with the residential service agreement;

(7) The availability of on-site activities, which shall include reasonable accommodation for residents with disabilities, to include, but not be limited to, television, radio, internet, games, newspapers, visitors, and music designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the residential service agreement;

(8) Assistance in arranging medical and dental appointments, including assistance in arranging transportation to and from such appointments and reminding the residents of the appointments; and

(9) Personal supervision of residents when necessary to offset cognitive deficits that might pose a risk to the safety of self or others if the resident is not supervised.

(c) The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(2):

(1) Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

(2) Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

(3) Behavioral health care services.

(d) The licensee shall develop and implement a process for determining adequate staffing levels.

(e) The process required in (d) above shall include an assessment, to be conducted at least quarterly, but more frequently if required, of the appropriateness of staffing levels to ensure:

(1) Sufficient staffing of qualified personnel to meet the resident needs as required by the CARES tool assessments and service plans on a 24-hour-per-day basis; and

(2) Sufficient staffing to respond promptly and effectively to individual resident emergencies and to respond to emergency, safety, and disaster situations affecting residents.

(f) The licensee shall:

(1) Provide basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper;

(2) Not be responsible for the cost of purchasing a specific brand of product at a resident’s request;

(3) Ensure that sufficient numbers of qualified personnel are present in the SRHCF to meet the needs of residents at all times;

(4) Ensure that demonstrated competencies required by the “qualified personnel” referenced in (e)(1) above are documented in the employee personnel file;

(5) Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known;

(6) Assist with arranging transportation to community programs, such as religious services and cultural, social, educational, and recreational activities according to the availability of such services in the surrounding communities; and

(7) Require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.

(g) The use of chemical or physical restraints as defined under He-P 805.03(r) and (br), respectively, shall only be permitted as allowed by RSA 151:21.

(h) As soon as is practicable, but no longer than 24 hours after the use of a physical or chemical restraint, the resident’s licensed practitioner, the department, and the resident’s guardian, personal representative, or agent shall be notified of the use of such restraints.

(i) The following methods of mechanical restraints shall be allowed, as permitted by the state fire code:

(1) Locked, secured, or alarmed SRHCFs or units within a SRHCF; and

(2) Anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within.

(j) The following methods of mechanical restraints shall be prohibited:

(1) Full bed rails;

(2) Gates, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;

(3) Half doors, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;

(4) Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will;

(5) Wrist or ankle restraints;

(6) Vests or pelvic restraints; or

(7) Other similar devices that prevent a resident’s free movement.

(k) For reportable incidents, the licensees shall have responsibility for:

(1) Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Submitting via fax to (603) 271-5574 the following information to the department within 48 hours of a reportable incident as defined in He-P 805.03(cd):

a. The SRHCF name and phone number;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the unusual incident;

d. The name of resident(s) involved in the reportable incident and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident;

g. If medical intervention was required, by whom and the date and time;

h. When the resident’s guardian, personal representative, agent, or emergency contact person was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the residents licensed practitioner was notified, if applicable;

(3) As soon as practicable, notifying the local police department, the department, and the guardian, personal representative, or agent when a resident has eloped and the licensee has searched the building and the grounds without finding the resident; and

(4) Notifying the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(l) The licensee shall implement policies to ensure the safety of residents who are assessed as an elopement risk to reduce the risk and define areas recognized as “safe areas” on the licensed premise.

(m) The licensee shall implement policies to ensure the safety of residents who are assessed as a danger to self or others.

(n) The licensee shall implement policies to assure the safety of all visitors.

(o) The licensee shall comply with the patient’s bill of rights as set forth in RSA 151:21.

(p) The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

(q) The licensee shall give a resident and the resident’s guardian, agent, or personal representative, as applicable, a written notice as follows:

(1) Thirty days advance notice for an increase in the cost or fees for any services except for:

a. Residents receiving medicaid whose financial liability is determined by the state’s standard of need or residents funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs; or

b. A change in the residents’ condition or service needs;

(2) For an involuntary change in room or bed location, 14 days advance notice along with reasonable accommodations of individual needs and preferences. If the change is required to protect the health, safety, and well-being of the resident or other residents, in such case the notice shall be as soon as practicable.

(r) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public and conspicuous area:

(1) The current license issued in accordance with RSA 151:5;

(2) The most recent inspection report as specified in RSA 151:6-a;

(3) A copy of the patient’s bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patients’ rights and responsibilities as required by RSA 151:20;

(5) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits; and

(6) A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints might also be made, which shall also be posted on the SRHCF website if available.

(s) The licensee shall determine the smoking status of the SRHCF.

(t) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68, RSA 155:69, and He-P 805.26(f).

(u) The licensee may hold or manage a resident’s funds or possessions only when the licensee receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.

(v) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

(w) The licensee shall develop and implement a policy for reporting to the administrator within 24 hours any observed or alleged abuse, neglect, or exploitation allegations.

(x) The licensee shall develop and implement written policies and procedures governing the operation of the SRHCF and all services provided.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.15 Resident Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria

(a) The licensee shall only admit an individual or retain a resident whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the SRHCF.

(b) If the SRHCF admits or retains an individual who:

(1) Requires lift equipment for transfers, all direct care personnel shall document in their personnel file that they have been trained in the correct operation of such equipment;

(2) Has a stage 2, 3, or 4 pressure ulcer, the licensee shall obtain the services of a nurse or other licensed health care professional, who may be a consultant, who has obtained the skills, training, and experience for the prevention of pressure sores in accordance with standards set forth by the National Pressure Ulcer Advisory Panel;

(3) Requires continuing nursing care or monitoring including but not limited to residents who are convalescing from an illness or injury and require short-term medical care, the licensee shall employ or contract for nursing personnel 24 hours per day; or

(4) Requires hospice care and the resident is no longer capable of taking medications supervised by unlicensed staff or unable to self direct the taking of medications, the licensee shall have a nurse available to meet the needs of the resident, with delays no longer than 30 minutes, during all shifts, to administer medications or shall administer medications by nurse delegation in accordance with Nur 404.

(c) A licensee shall not deny admission to any person because that person does not have a guardian or an advance directive, such as a living will or durable power of attorney for health care established in accordance with RSA 137-H or RSA 137-J.

(d) During a temporary absence the licensee shall hold the resident’s bed open in accordance with RSA 151:25.

(e) The resident shall be transferred or discharged, in accordance with RSA 151:5-a, RSA 151:19, RSA 151:21, V, and RSA 151:26.

(f) The licensee shall develop a discharge plan with the input of the resident and the guardian, personal representative, or agent.

(g) The following documents shall accompany the resident upon transfer or discharge:

(1) The most recent CARES tool as described in He-P 805.16(e), care plan, and quarterly progress notes if the resident is being transferred to another health care facility;

(2) The most recent nursing assessment, if applicable;

(3) A copy of the most recent medication administration and assistance record;

(4) A licensed practitioner’s order for transfer, if applicable; and

(5) The information data sheet.

(h) If the transfer or discharge referenced in (e) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the resident as soon as possible.

(i) If the transfer or discharge referenced in (e) above is required for life safety reasons, the facility shall make a review of the residents needs and options for meeting these needs prior to discharge.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the SRHCF;

(2) Works no less than 35 hours per week at the SRHCF, which may include day, evening, night, and weekend hours;

(3) Meets the requirements of He-P 805.18(i) or He-P 805.18(j);

(4) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their absence; and

(5) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify they meet the requirements of (3) above.

(b) At the time of application for admission, upon request and at least 24 hours prior to signing a residential service agreement, the licensee shall provide the resident, guardian, personal representative, or agent, a written copy of the residential service agreement pursuant to RSA 161-J:4, which shall include:

(1) The base rate and the cost of any available services that are not included in the base rate;

(2) A list of the core services required by He-P 805.14(b) and the list of grooming and personal hygiene supplies required by He-P 805.14(f)(1) that are included in the base rate;

(3) Information regarding the timing and frequency of cost of care increases;

(4) The policies and procedures for termination of the agreement and the time period covered by the agreement;

(5) The amount and purpose of any advance payments required by the facility;

(6) The policy for refund of advance payments;

(7) The licensee’s medication management services;

(8) Notice of the resident's rights in the event of a temporary absence from the facility, in accordance with RSA 151:25, and the resident's rights in the event of a proposed transfer or discharge from the facility, in accordance with RSA 151:26;

(9) The circumstances under which a discharge or transfer to another facility might occur, including situations in which the resident's evacuation capability and care needs would exceed what the licensee could provide, and the responsibility of the licensee in transitioning the resident to another location;

(10) A copy of the rules or policies governing resident conduct, house rules and responsibilities, and the procedures for handling resident grievances;

(11) A standard disclosure summary in the form set forth in RSA 161-J:5;

(12) A statement affirming that the proposed resident has received the residential services agreement and attached standard disclosure summary, that the resident has read it or it has been read to the resident, and that the resident understands its contents;

(13) Information regarding nursing, other health care services, or supplies and medication management services and associated costs not provided in the core services, to include:

a. The availability of services;

b. The licensee’s responsibility for arranging services; and

c. The fee and payment for services, if known;

(14) The licensee’s policy regarding:

a. Arranging for the provision of transportation;

b. Arranging for the provision of third party services, such as a hairdresser or cable television;

c. Acting as a billing agent for third party services;

d. Monitoring third party services contracted directly by the resident and provided on the premises;

e. Handling of resident funds pursuant to RSA 151:24 and He-P 805.14(u);

f. Storage and loss of the resident’s personal property;

g. Smoking;

h. Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both; and

i. Whether or not the facility has an automatic electronic defibrillator (AED) onsite and available for use in an emergency;

(15) A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the SRHCF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(16) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(a)(5);

(17) The policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169-C:29;

(18) Information on accessing the long-term care ombudsman; and

(19) Information on advance directives.

(c) Residency shall not begin unless the proposed resident, guardian, personal representative, or agent reads and signs a residential services agreement that complies with RSA 161-J.

(d) Upon signing of the agreement, the SRHCF shall give the resident and guardian, personal representative, or agent a copy of the agreement and place a copy in the resident's file.

(e) The SRHCF shall assess each resident’s needs using the “Care Assessment for Residential Services (CARES) Tool” (August 2025) which shall:

(1) Be completed no more than 30 days prior to admission to the SRHCF;

(2) Be completed in consultation with the resident, guardian, personal representative, or agent;

(3) Be repeated every 6 months or after any significant change as defined in He-P 805.03(co);

(4) Be signed and dated by the individual who completed the CARES tool; and

(5) Be signed by the resident, guardian, personal representative, or agent, acknowledging that the CARES tool was completed as directed in (2) above.

(f) All personnel who administer the CARES tool shall be trained to complete the CARES tool by the department or entities listed in RSA 151:5-a, III.

(g) If the guardian, personal representative, or agent, is unable to sign the CARES tool, the facility shall have documented evidence that the guardian, personal representative, or agent has had an opportunity to take part in completing and reviewing the completed CARES tool.

(h) If the CARES tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES tool.

(i) If the nursing assessment identified in (h) above identifies the need for a care plan it shall be:

(1) Completed within 24 hours of the nursing assessment;

(2) Made available to personnel who assist residents;

(3) Be completed in consultation with the resident and guardian, personal representative, or agent; and

(4) If the resident and guardian, personal representative, or agent are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

(j) The care plan identified in (i) above shall include on an ongoing basis:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal or objective of the plan;

(4) The action or approach to be taken;

(5) The responsible person(s) or position; and

(6) The date of reevaluation, review, or resolution.

(k) All care plans shall be reviewed at least every 6 months to determine if:

(1) The care plan will be continued for another 6 months;

(2) The care plan will be revised to meet the needs of the resident; or

(3) The care plan will be discontinued because the plan is no longer needed.

(l) Progress notes shall be written at least every 90 days and include, at a minimum:

(1) Care plan outcomes if a care plan was developed as identified by the CARES tool;

(2) The resident’s physical, functional, and mental abilities;

(3) Changes in behavior, such as eating habits, sleeping pattern, and relationships; and

(4) A summary of visits to licensed practitioners and referrals.

(m) At the time of a resident’s admission, the licensee shall obtain written and signed orders from a licensed practitioner for medications, treatment, special diet, and code status.

(n) The licensee shall have each resident obtain a health assessment by a licensed practitioner within 30 days prior to admission to the SRHCF.

(o) The health assessment referenced in (n) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) A list of current medications including over-the-counter medications, treatments, and special diets, if applicable;

(4) Allergies; and

(5) Code status.

(p) Each resident shall have at least one health assessment annually, unless the licensed practitioner determines annually that a health assessment is not necessary and specifies in writing an alternative time frame, or the resident annually refuses in writing.

(q) A resident may refuse all care and services.

(r) When a resident refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the resident of the potential results of their refusal;

(2) Notify the licensed practitioner and guardian, personal representative, or agent of the resident’s refusal of care; and

(3) Document in the resident’s record the refusal of care and the resident’s reason for the refusal.

(s) The licensee shall maintain a legible, current, and accurate information data sheet in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility which includes the following:

(1) Full name and the name the resident prefers, if different;

(2) Name, address, and telephone number of the resident’s next of kin, guardian, personal representative, or agent;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional and cognitive limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directives, if any;

(10) Code status; and

(11) Any other pertinent information not specified in (1)-(10) above.

(t) The licensee shall only perform point of care testing (POCT), that is waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(u) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate pursuant to 42 CFR Part 493.15; and

(2) Develop and implement a point of care testing policy which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(v) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(w) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in-compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.17 Medication Services

(a) All medications shall be made available and administered in accordance with the written and signed orders of the licensed practitioner.

(b) All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis.

(c) All personnel shall follow the written and signed orders of the licensed practitioner for each resident.

(d) Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours or when available as in accordance with the licensed practitioner’s written direction.

(e) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the SRHCF;

(2) Reorder medications for use at the SRHCF;

(3) Handle unavailable medications at dispensing pharmacy;

(4) Receive, record, and reconcile new medication orders; and

(5) Administer or assist with the administration of medications.

(f) Each medication order shall legibly display the following information:

(1) The resident’s name:

(2) The medication name, strength, prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for use and any special precautions or limitations for use of all medications to include the maximum allowed dose in a 24-hour period, for all pro re nata (PRN) medications; and

(5) The order from the licensed practitioner.

(g) Each prescription medication container shall legibly display the following information unless it is an emergency medication as allowed by (y) below:

(1) The resident’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all pro re nata (PRN) medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

(7) The expiration date of the medication(s).

(h) The dosage, frequency, and route of administration on the labels of all prescription medications for each resident shall be identical to the dosage, frequency, and route on the SRHCF medication record except as allowed by (i) below.

(i) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the medication record for a change or discontinuance shall indicate in writing the date the dose changed or the discontinuance occurred.

(j) Only a pharmacist shall make changes to prescription medication container labels except as allowed by (k) below.

(k) When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

(l) Only a licensed nurse shall accept telephone orders for medications, treatments, and diets, and the licensed nurse shall immediately transcribe and sign the telephone order.

(m) The transcribed order referenced in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

(n) No medications shall be given to or taken by a resident until a written order is received, except as allowed by (m) above.

(o) The medication storage area for medications not stored in the resident’s room shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each resident's medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(p) All medications, including over the counter medications, shall remain in the original containers except as authorized by (ab)(5) below.

(q) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(r) If controlled drugs, as defined by RSA 318-B, are stored in a central storage area in the facility, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(s) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(t) Except as required by (u) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders, or the medication becomes contaminated, whichever occurs first.

(u) Destruction of contaminated, expired, or discontinued controlled drugs shall:

(1) Be in accordance with acceptable standards of practice;

(2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

(3) Be documented in the record of the resident for whom the drug was prescribed.

(v) When a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self-administering without assistance, as described in (ab) below.

(w) If a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication container shall be given to the person responsible for the resident while the resident is away from the SRHCF.

(x) Upon discharge or transfer, the licensee shall make the resident’s current medications available to the resident, personal representative, guardian, or agent, and upon death of a resident, the SRHCF shall return or destroy all remaining medications, as appropriate, and document it in the resident record.

(y) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(z) Residents shall receive their medications by one of the following methods:

(1) Self-administered without assistance as allowed by (ab) below;

(2) Self-directed administration of medication as allowed by (ac) below;

(3) Self-administered with assistance as allowed by (ad) below; or

(4) Administered by individuals authorized by law.

(aa) If a nurse delegates care, including the task of medication administration, to an individual not

licensed to administer medications, the nurse and delegate shall comply with the rules of medication

delegation pursuant to Nur 404, as applicable, and RSA 326-B.

(ab) For residents who self-administer without assistance as defined in He-P 805.03(cj) the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the resident to self-administer medications without assistance; and

b. Authorizing the resident to store the medications in their room;

(2) Evaluate the resident initially and then on a 6 month basis or sooner if the resident experiences a significant change, to ensure they maintain the physical and mental ability to self-administer without assistance;

(3) Have the resident store the medication(s) in their room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

(4) Have a copy of the key to access the locked medication storage area in the resident’s room; and

(5) Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

(ac) The licensee shall allow the resident to self-direct administration of medications as defined in He-P 805.03(ck) if the resident:

(1) Has a physical limitation due to a diagnosis that prevents them from self-administration;

(2) Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self-direct administration of medications;

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the SRHCF to file the verification in their resident record; and

(4) Verbally directs personnel to:

a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting;

b. Assist the resident to apply, ingest, or instill the ordered dose of medication; and

c. Fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

(ad) If a resident self-administers medication with assistance, as defined in He-P 805.03(ci), personnel shall only:

(1) Remind the resident to take the correct dose of their medication at the correct time;

(2) Place the medication container within reach of the resident and open the container, if requested by the resident;

(3) Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the resident's daily medication record that they have observed the resident taking their medication;

(5) Document in the resident’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken; and

(6) Personnel shall not physically handle the medication in any manner.

(ae) Except for those residents who self-administer medication without assistance, the licensee shall maintain a daily medication administration record for each medication taken by the resident at the SRHCF that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the resident taking medication;

(5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication within 4 hours of consumption;

(6) Documented reason for any medication refusal or omission; and

(7) Any observed or reported side effects and adverse drug reactions.

(af) Unlicensed staff who assist a resident with self administration with assistance, self directed administration, or administration medication via nurse delegation shall complete a medication assistance education program described in (ag) below.

(ag) The medication assistance education program required by (af) above shall be taught by a licensed nurse or practitioner and include:

(1) Four hours of initial instruction;

(2) Two hours of annual continuing education;

(3) The rights of medication administration to include:

a. Right patient;

b. Right drug;

c. Right dosage;

d. Right route;

e. Right time; and

f. Right documentation;

(4) Infection control specific to medication administration and proper hand washing techniques;

(5) Documentation requirements;

(6) General categories of medications;

(7) Desired effects and potential side effects of medications;

(8) Medication precautions and interactions;

(9) Both prescription and non-prescription medications;

(10) Methods of medication administration to include demonstrations;

(11) Common abbreviations;

(12) PRN protocols; and

(13) Final exam.

(ah) The licensee shall:

(1) Accept documentation of training required by (ag) above, if previously completed by an individual; and

(2) Maintain initial and annual certificates of the medication assistance education in the personnel file.

(ai) The SRHCF shall use emergency drug kits only under circumstances where the SRHCF:

(1) Has a director of nursing who is an RN licensed in accordance with RSA 326-B; and

(2) Has a contractual agreement with a consultant pharmacist who is licensed in accordance with RSA 318.

(aj) The licensee shall document in the resident record and report any observed adverse drug reactions and side effects to the licensed practitioner and the guardian, personal representative, or agent.

(ak) The licensee shall document in the resident record and report any medication errors that cause adverse reactions that require medical intervention to the licensed practitioner and the guardian, personal representative, or agent.

(al) The licensee shall report to the department any medication error that requires medical intervention as required by He-P 805.14(k).

(am) The written documentation of the reports in (aj) and (ak) above shall be maintained in the resident’s record.

(an) No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.

(ao) Medications shall be prepared immediately prior to assisting, supervising, or administering.

(ap) Over-the-counter medications that are not labeled for a specific resident, including but not limited to pharmaceutical samples and “house stock” medications, may be kept at the SRHCF provided that these medications are only dispensed to a resident with a signed order from an authorized licensed practitioner specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(aq) The department shall order a SRHCF to obtain the routine services of a consultant pharmacist for 12 months if areas of noncompliance regarding medications, which the department determines present a potential risk to residents health, are found during any inspection or investigation.

(ar) The licensee shall develop and implement policies and procedures for each medication administration method.

(as) The therapeutic use of cannabis by residents who are qualifying residents possessing a registry identification card shall be permitted provided:

(1) The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or

(2) The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident.

(at) The facility that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration.

(au) The facility that designates itself as a facility caregiver according to (as)(1) above shall:

(1) Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and

(2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying residents with the therapeutic use of cannabis.

(av) The SRHCF shall not permit the smoking of cannabis if smoking is not allowed on the SRHCF premises.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.18 Personnel

(a) For all applicants considered for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, and for all household members, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d, which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (b) below; and

(3) Verify the qualifications prior to employment.

(b) Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment contract with, or engage a person for any position or allow a household member to continue to reside in the residence if the individual:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of the residents.

(c) If the information identified in (b) above regarding any person in (a) above is learned after the

person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee

shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person, or not permit the household

member to continue to reside in the residence; or

(2) Request a waiver of (b) above.

(d) If a waiver of (b) above is requested, the department shall review the information and the underlying circumstances in (b) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a resident(s); or

(2) Grant a waiver of (b) above if, reviewing the underlying circumstances, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

(e) Upon hire and annually thereafter, the licensee shall check the names of the persons in (a) above against the bureau of adults and aging services (BAAS) state registry maintained pursuant to RSA 161-F:49 prior to employing and continuing to employ, contracting with, or engaging them, or prior to allowing or continuing to allow a household member to reside at the residence.

(f) The licensee shall not employ, contract with, engage, or allow to reside in the facility any person in (a) above who is listed on the BAAS state registry unless a waiver is granted by BAAS.

(g) If any person in (a) above is listed on the BAAS state registry, and it is learned after the person is hired, contracted with, engaged with, or after the person becomes a household member, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

(2) Request a waiver from BAAS of (f) above.

(h) In lieu of (a) and (e) above, the licensee may accept a signed statement from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services, that the agency’s employees have complied with (a) and (e) above and do not meet the criteria in (b) and (f) above.

(i) For an SRHCF licensed for 17 or more beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and 2 years of relevant experience working in a health care setting;

(2) A New Hampshire license as an RN, with at least 2 years of relevant experience working in a health care setting;

(3) An associate’s degree from an accredited institution plus 4 years of relevant experience working in a health care setting; or

(4) A New Hampshire license as an LPN, with at least 4 years of relevant experience working in a health care setting.

(j) For an SRHCF licensed for 16 or fewer beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and one year of relevant experience working in a health care setting;

(2) A New Hampshire license as an RN, with at least one year of relevant experience working in a health care setting;

(3) An associate’s degree from an accredited institution plus 2 years of relevant experience working in a health care setting;

(4) A New Hampshire license as an LPN, with at least 2 years of relevant experience working in a health care setting; or

(5) Be a high school graduate or have a GED with 6 years of relevant experience working in a

health care setting with at least 2 of those years as direct care personnel in a long-term care setting within the last 5 years.

(k) All administrators shall obtain and document in accordance with (v)(7) and (8) below, 12 hours of continuing education related to the operation and services of the SRHCF each annual licensing period.

(l) All direct care personnel shall be at least 18 years of age unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(2) Involved in an established educational program working under the supervision of a nurse.

(m) The licensee shall inform personnel of the line of authority at the SRHCF.

(n) The licensee shall educate personnel about the needs and services required by the residents under their care.

(o) Prior to having direct care contact with residents, personnel, including volunteers and independent contractors, shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

(4) In lieu of (1) above, independent agencies contracted by the SRHCF or by an individual resident, to provide direct care or personal care services, may provide the licensee with a signed statement that their employees have complied with (1) and (3) above before working at the SRHCF.

(p) Prior to having contact with residents or food, all personnel shall receive a tour of and orientation to the facility that includes the following:

(1) The residents’ rights in accordance with RSA 151:21;

(2) The licensee’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 805.22;

(7) The procedures for food safety for personnel involved in preparation, serving, and storing of food;

(8) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29;

(9) The licensee’s policies and procedures specific to the duties and responsibilities of the staff position; and

(10) Policies and procedures for medication administration for personnel involved with supervision, assistance, or administration of medications.

(q) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s resident’s rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29;

(5) Policies and procedures for medication administration for personnel involved with supervision, assistance, or administration of medications;

(6) Procedures for food safety for personnel involved in preparation, serving, and storing of food; and

(7) The licensee’s policies and procedures specific to the duties and responsibilities of the staff position.

(r) The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49.

(s) The training required in (r) above shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial training to covered administrative staff members and covered direct service staff members within the first 90 days of hire; and

(2) A minimum of 4 hours of continuing training each calendar year.

(t) Pursuant to RSA 151:52, I(e) licensee’s seeking extensions for compliance with any specific provision of RSA 151:48, RSA 151:49, or RSA 151:50 shall submit a written request to the commissioner that includes:

(1) A full explanation of why an extension is necessary;

(2) A reasonable explanation of why the extension should be granted;

(3) The period of time for which the extension is sought; and

(4) What good faith efforts, as verified by documentation or other means, the licensee has made to comply with the requirements of RSA 151:50 but has been unable to do so.

(u) A request for extension for compliance with RSA 151:50 shall be granted if the commissioner determines that the alternative proposed does not negatively impact the health, safety, or well-being of the residents.

(v) The SRHCF shall maintain a separate employee file for each employee, which shall include the

following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that they have received a copy of and received training on the implementation of the licensee’s policy setting forth the residents rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check and BAAS state registry check;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (p) above;

(7) Information as to the general content and length of all in-service or educational programs attended;

(8) Record of satisfactory completion of all required education programs and demonstrated competencies that is signed and dated by the employee;

(9) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and

(10) The statement required by (w) below.

(w) All personnel shall sign a non-conviction attestation at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a resident in this or any other state; or

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(x) The licensee shall protect and store in a secure and confidential manner all records described in (v) above. Personnel records shall be retained for 4 years after termination.

(y) The licensee shall provide to its consenting employees annual immunizations against influenza in accordance with RSA 151:9-b.

(z) If the facility uses an electronic record storage system, it shall provide computer access to all

personnel records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 805 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

(aa) All personnel electronic records shall have security provisions to ensure confidentiality.

(ab) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, cannabis, or alcohol.

(ac) The licensee shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team and include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include, at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion as required per He-P 805.14(k); and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

(ad) The licensee shall maintain records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to residents that includes:

(1) A signed and dated job description;

(2) A record of satisfactory completion of the orientation program;

(3) Documentation that the required physical examination, or health screening, and TB test have been completed;

(4) A statement, which shall be signed at the time the initial contract or engagement is made, and then annually thereafter, stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a resident in this or any other state; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state;

(5) A copy of the criminal records check;

(6) A copy of the BAAS state registry check; and

(7) A waiver as required per (b) above, if applicable.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.19 Resident Records

(a) The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the SRHCF.

(b) At a minimum, resident records shall contain the following:

(1 A copy of the resident’s residential service agreement and standard disclosure agreement, and all documents required by He-P 805.16(b);

(2) Notwithstanding (1) above, financial records may be kept in a separate file;

(3) Identification data, including:

a. The resident’s name, date of birth, and marital status;

b. If the resident is receiving respite care as described in He-P 805.20, the resident’s home address and phone number;

c. The resident’s religious preference, if known;

d. The resident’s veteran status, if known; and

e. The name, address, and telephone number of an emergency contact person;

(4) The name and telephone number of the resident’s licensed practitioner(s);

(5) If services are provided at the SRHCF by individuals not employed by the licensee,

documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, the business address, and telephone number;

(6) The resident’s health insurance information;

(7) Copies of any executed legal orders and directives, such as guardianship orders, surrogacy orders, a durable power of attorney for healthcare, or a living will;

(8) A record of the health assessment in accordance with He-P 805.16(n) and (o);

(9) Written, dated, and signed orders for all medications, treatments, and therapeutic diets;

(10) Results of any laboratory tests, X-rays, or consultations performed at the SRHCF;

(11) All admission and progress notes;

(12) Documentation of any alteration in the resident’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including licensed practitioner and family notification;

(13) Documentation of medical, nursing, or other specialized care, if applicable;

(14) Documentation of reportable incidents;

(15) The consent for release of information signed by the resident, guardian, personal representative, or agent;

(16) Discharge planning and referrals;

(17) Transfer or discharge documentation, including notification to the resident, guardian, personal representative, or agent, and ombudsman of involuntary room change, transfer, or discharge;

(18) The medication record as required by He-P 805.17(ac)(3), (ad)(4), and (ae);

(19) Information data sheet, which contains the information required by He-P 805.16(g)(5);

(20) Documentation of nurse delegation as required by He-P 805.17(af);

(21) Documentation of any accident or injuries occurring while in the care of the SRHCF and requiring medical attention by a licensed practitioner; and

(22) Documentation of a resident’s refusal of any care or services.

(c) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting residents, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The SRHCF shall have a plan that identifies and documents, with dates, all residents that have received or declined to receive immunizations, to be included in the resident record in (b) above.

(d) Resident records and resident information shall be kept confidential and only provided in accordance with law.

(e) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

(f) When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

(g) Records shall be retained for 4 years after discharge, except that when the resident is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

(h) The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the SRHCF ceases operation.

(i) If the facility uses an electronic record storage system, it shall provide computer access to all resident records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 805 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

(j) All resident electronic records shall have security provisions to ensure confidentiality.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.20 Respite Care.

(a) The licensee shall only admit an individual for respite care services when the needs of the individual are compatible with the services and programs offered by the facility and the facility can meet the needs of the individual in accordance with He-P 805.14(e)(3).

(b) When a temporary admission to an SRHCF occurs and the individual is scheduled for a stay of no more than 30 consecutive days as agreed upon by the individual and the licensee as part of a discharge plan, the licensee shall:

(1) Obtain written verification signed by the resident, guardian, personal representative, or agent, indicating they have been given a copy of the resident rights and responsibilities as required by RSA 151:21;

(2) Obtain a signed residential service agreement listing the services that shall be provided;

(3) Obtain information regarding allergies, diagnoses, if any, and written and signed orders for medications, treatments, and special diets from the licensed practitioner;

(4) Be permitted to use the prescription label on the medication container supplied by the individual as the licensed practitioner’s order provided that:

a. The medication is in the original bottle as dispensed by the pharmacy;

b. The pharmacy label has not been altered in any manner; and

c. The prescription label indicates that the medication is still current;

(5) Complete the CARES tool prior to admission to determine that the potential

residents’ needs can be met by the facility;

(6) Note in the resident’s record any allergies, diagnoses, and history of wandering or unexplained absences; and

(7) Obtain advance directives information, if available.

(c) For planned recurrent respite care the resident shall be discharged but may be readmitted using the same admission documents completed within the previous 6 months, as long as there are no identified changes in the resident’s condition or care needs except that the medication requirement in (b)(3) above shall be re-verified.

(d) If the resident exceeds the 30-day time period, the resident shall no longer be considered to be receiving respite care and:

(1) A complete admission shall occur within 72 hours; or

(2) The resident shall be discharged from the facility.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.21 Food Services

(a) The licensee shall provide food services that:

(1) Meet the U.S. Department of Agriculture’s recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), available as noted in Appendix A;

(2) Provide the nutritional needs of each resident; and

(3) Meet the special dietary needs associated with health or medical conditions for each resident as identified on the CARES tool.

(b) Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident’s care plan.

(c) Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident’s care plan.

(d) If a resident refuses the item(s) on the menu, a substitute shall be offered.

(e) Each day’s menu shall be posted in a place accessible to food service personnel and residents.

(f) A dated record of menus as served shall be maintained for at least the previous 4 weeks.

(g) The licensee shall provide therapeutic diets to residents only as ordered by a licensed practitioner or other professional with prescriptive authority.

(h) If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record and notify the resident’s licensed practitioner.

(i) All food and drink provided to the residents shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and Chapter 3, entitled “Food”, of the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administrations’ “Food Code” (2017 Edition), available as noted in Appendix A;

(3) Served at the proper temperatures;

(4) Labeled, dated, and stored at proper temperatures;

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination; and

(6) Stored in labeled and dated containers designed for food storage, if not in the original package.

(j) The use of expired, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded. The dates associated with such terms as “sell by”, “use by”, or “best if used by” shall not constitute the expiration date.

(k) All work surfaces shall be non-porous and cleaned and sanitized after each use.

(l) All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(m) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(n) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(o) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(p) Garbage or trash in the kitchen area shall be placed in lined containers with covers which shall remain closed except when in use.

(q) All personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

(r) Regularly scheduled training programs including sanitation and safety shall be made available to food service personnel. Information as to the content and length of this training shall be documented and kept in employee records.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.22 Infection Control

(a) The SRHCF shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as noted in Appendix A;

(3) The management of residents with infectious or communicable diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

(5) The reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections;

(4) Prevention and containment of infections; and

(5) Use of standard precautions.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies, lice, pediculosis, or any communicable disease shall not provide direct care to residents or work in food services until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SRHCF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(h) If the SRHCF has an incident of an infectious diseases reported in (b)(5) above, the SRHCF shall contact the county, municipality, or state public health nurse as applicable, in which the facility is located and follow the instructions and guidance of the nurse.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.23 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to residents and staff.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked closet or cabinet, separate from food, medications, and resident supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered at all times, except during food preparation and subsequent clean-up.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

(4) Soiled linens and clothing, which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

(p) Any SRHCF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.24 Quality Improvement

(a) The SRHCF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The SRHCF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the SRHCF; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective

actions as applicable.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities, including minutes of meetings, shall be confidential in accordance with RSA 151:5-c.

History

• #14358, eff 8-28-25, EXPIRES: 8-28-35

N.H. Code Admin. R. Ann. He-P 805.25 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of resident(s) and personnel, including reasonable accommodations for residents and personnel with disabilities.

(b) The SRHCF shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed or certified under RSA 430.

(c) Equipment providing heat within an SRHCF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any SRHCF.

(g) Plumbing shall be sized, installed, and maintained in accordance with the 2021 International Plumbing Code (IPC) as adopted under the state building code, pursuant to RSA 155-A.

(h) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(i) Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(j) The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

(k) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(l) All hand-washing facilities shall be provided with hot and cold running water.

(m) In an SRHCF licensed for 16 or fewer residents, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

(n) In an SRHCF licensed for 17 or more residents, there shall be at least 100 square feet for each resident in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities.

(o) The space requirements in (m) and (n) above shall be exclusive of space required for closets, wardrobes, and bathroom.

(p) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the resident to reach their bedroom without passing through the room of another resident;

(3) Have a side hinge door and not a folding or sliding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors, and other rooms by floor to ceiling walls;

(6) Be located on the same level as the bathroom facilities, if the resident has impaired mobility as identified by the CARES tool; and

(7) If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom without requiring additional construction or renovation.

(q) The licensee shall provide the following for the residents’ use, except as requested by the resident, guardian, personal representative, or agent and documented in the resident’s record:

(1) Clean linens, blankets, and a pillow;

(2) A closet or storage space for personal belongings; and

(3) Window blinds, shades, or curtains that provide privacy.

(r) The resident may use their own personal possessions provided they do not pose a risk to the resident or others as evidenced by documented inspection for fire safety and insect infestation.

(s) The licensee shall provide the following rooms to meet the needs of residents:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all residents.

(t) Each licensee shall have an underwriters laboratories (UL) listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

(u) Lighting shall be available to allow residents to participate in activities such as reading or handicrafts.

(v) All bathroom, bedroom, and closet doors shall swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

(w) Screens shall be provided for doors, windows, and other openings to the outside.

(x) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (w) above.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.24)

N.H. Code Admin. R. Ann. He-P 805.26 Fire Safety

(a) The facility shall meet one of the following appropriate chapters and sections of the adopted state fire code and state building code:

(1) Residential board and care occupancies for facilities in which the residents are capable of self-preservation;

(2) Health care occupancy for facilities or portions of a facility in which the residents are not capable of self-preservation; or

(3) If the building is being designed as a mixed-use facility, a portion of residents are capable of self-preservation and another portion the residents are not capable of self-preservation, then the areas shall be appropriately separated into their use groups as defined under the state fire code and state building code.

(b) The facility shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the SRHCF’s electrical service, or wireless, as approved by the state fire marshal for the facility;

(2) At least one UL listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building, and which meet the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) A written emergency and fire safety program shall be developed and implemented to provide for the safety of residents and personnel.

(d) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) If the licensee has chosen to allow smoking, a designated smoking area shall be provided which has, at a minimum:

(1) A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Walls and furnishings constructed of non-combustible materials;

(3) Metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64–77.

(g) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, guardian, personal representative, or agent, at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident. Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(h) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(i) Fire drills shall be conducted as follows:

(1) For buildings constructed to the Residential Board and Care or One and Two Family Dwelling chapters of the life safety code (NFPA 101), the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All SRHCF facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when residents are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide residents with experience in egressing through all exits and means of escape;

e. Facilities shall complete a written record of fire drills that includes the following:

1. The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. The fire drills for facilities shall be permitted to be announced, in advance, to the residents just prior to the drill; and

h. Evacuation drills shall include the transmission of a fire alarm signal, and simulation of emergency fire conditions;

(2) For facilities originally constructed to meet the Health Care Occupancy chapter of the life safety code, NFPA 101 or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office, and the department to meet the Health Care Occupancy chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

e. Buildings that have a shelter in place, also known as defend in place, shall:

1. Have the plan approved by the department and their local fire official;

2. Be constructed to meet the Health Care Occupancy chapter of the life safety code; and

3. Require all personnel, residents, and visitors to evacuate to the identified assembly point during drills to ensure that residents shall be given the experience of evacuating to the appropriate location or exiting through all exists;

f. Facilities shall complete a written record of fire drills and include the following:

1. The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill;

8. The names of all staff members participating in the drill; and

9. Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

g. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(3) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

History

• #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.25)

N.H. Code Admin. R. Ann. He-P 805.27 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) The emergency management committee shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency that shall be reviewed and updated at least annually.

(d) The emergency preparedness plan in (c) above shall:

(1) Comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable;

(2) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, interruptions of any utility or services to the facility, and human-caused emergencies to include, but not be limited to, missing resident(s), bomb threat, and active shooter;

(3) Be approved by the local emergency management director or local authority having jurisdiction, and reviewed and approved by the local authority having jurisdiction when a change to the plan causes significant material difference;

(4) Be available to all personnel at all times;

(5) Be based on realistic conceptual events;

(6) Develop and implement strategies to prevent an incident that threatens life, property, and the environment of the facility to include measures to be taken to limit or control the consequences, extent, or severity or an incident that cannot be prevented;

(7) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations and essential transportation to include fuel loss, fuel spill, and fuel exposure that created a hazardous incident;

g. Medical gas and vacuum systems, if applicable;

h. Communications systems; and

i. Essential services, such as kitchen and laundry services;

(8) Include and maintain a communication plan that includes the following:

a. Names and contact information for the following:

1. Staff;

2. Entities providing services under arrangement;

3. Resident’s licensed practitioner;

4. Other nearby facilities; and

5. Volunteers;

b. Contact information for the following:

1. Federal, state, or local emergency preparedness staff;

2. The state licensing unit;

3. The office of the state long-term care ombudsman; and

4. Other sources of assistance;

c. Primary and alternate means for communication with the facility’s staff and federal, state, or local emergency management agencies;

d. A method for sharing information and medical documentation for the residents under the facility’s care, as necessary, with other health care providers to maintain the continuity of care; and

e. A means of providing information about the facility’s occupancy, needs, and its ability to provide assistance to the authority having jurisdiction;

(9) Include the management of residents, particularly with respect to physical and clinical issues to include:

a. Relocation of residents with their medical record(s) including the medicine administration record(s), as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(10) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(11) Plans for the provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, to include, but not be limited to the following:

a. Food, water, medical, and pharmaceutical supplies calculated for the maximum number of staff and residents;

b. Source of water support, either tap or commercial;

c. Expiration dates, tracking of supplies, and rotation of products;

d. Contracts and memorandums of understanding with food and water suppliers;

e. Storage location(s);

f. Back-up supplies; and

g. Alternate sources of emergency power to maintain:

1. Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;

2. Emergency lighting;

3. Fire detection, extinguishing, and alarm systems; and

4. Sewage and waste disposal; and

(12) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire radiological emergency response plan (RERP), include the required elements of the RERP.

(d) The facility shall develop and maintain emergency preparedness training for all staff, individuals providing services under arrangement, and volunteers which shall include:

(1) Initial emergency preparedness training upon hire consistent with roles and specific duties and responsibilities during an emergency;

(2) Provide emergency preparedness training at least annually;

(3) Maintain documentation of the training; and

(4) Demonstrate staff knowledge and competency of emergency procedures.

(e) The facility shall conduct and document exercises to test the emergency preparedness plan at least twice per year that includes the following:

(1) Participation in an annual full-scale exercise that is community-based. When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. If the facility experiences and documents an actual natural or man-made emergency that requires the activation of the emergency plan, the facility is exempt from engaging in another full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event;

(2) Conduct an additional annual exercise that may include, but is not limited to, the following:

a. A second full-scale exercise that is community-based or an individual, facility-based functional exercise;

b. A mock disaster drill; or

c. A tabletop exercise or workshop that is led by a facilitator that includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan; and

(3) Analyze the facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the facility's emergency plan, as needed.

History

• #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.26)

Part He-P 806 Non-Emergency Walk-in Care Centers

N.H. Code Admin. R. Ann. He-P 806.01 Purpose

The purpose of this part is to set forth the licensing requirements for all non-emergency walk-in care centers (NEWCC), whether stationary or mobile, pursuant to RSA 151:2, I(d).

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (c), (d), (m) and (s) EXPIRED: 1-13-03
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24

N.H. Code Admin. R. Ann. He-P 806.02 Scope

This part shall apply to any organization, business entity, partnership, corporation, government entity, association, or other legal entity operating a NEWCC, except:

(a) All facilities listed in RSA 151:2, II(a)-(i);

(b) Entities that provide health screening services for the purpose of risk assessment only and not for diagnosis or treatment; and

(c) Immunization clinics that are registered with the department’s division of public health services.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (c) and (d) EXPIRED 1-13-03
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24

N.H. Code Admin. R. Ann. He-P 806.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.

(b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(c) “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(d) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(e) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies.

(f) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35-37.

(g) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a NEWCC pursuant to RSA 151.

(h) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.

(i) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.

(j) “Change of ownership” means the transfer of the controlling interest of an established NEWCC to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(k) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

(l) “Commissioner” means the commissioner of the department of health and human services or their designee.

(m) “Contracted employee” means a temporary employee working under the direct supervision of the NEWCC, but employed by an outside agency.

(n) “Controlling interest” means greater than 50% ownership interest.

(o) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

(p) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(q) “Days” means calendar days unless otherwise specified in the rule.

(r) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

(s) “Department” means the New Hampshire department of health and human services.

(t) “Direct care” means hands-on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(u) “Discharge instructions” means instructions developed as a result of the assessment process in the provision of services.

(v) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions required of the licensee to correct areas of non-compliance.

(w) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes “do not attempt resuscitation order (DNAR order)”.

(x) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(y) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 806.

(z) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes “fixtures”.

(aa) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(ab) “Facility” means “facility” as defined in RSA 151:19, II.

(ac) “Good cause” means any circumstances beyond a person’s control, that the department considers to be circumstances that prevents that person from taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(ad) “Governing body” means a person or group of designated persons that appoints the administrator and is legally responsible for establishing and implementing policies regarding the management and operation of the facility.

(ae) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

(af) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).

(ag) “Health screening services” means assessment or testing performed for the purpose of assessing a patient’s risk of having a disease or condition and where the patient with an elevated risk is not diagnosed or treated but encouraged to contact a licensed provider for diagnosis and treatment as needed. This term does not include any on-site services provided by a licensed NEWCC.

(ah) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ai) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.

(aj) “Infectious waste” means those items specified by Env- Sw 103.28.

(ak) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(al) “Informed consent” means the decision by a person or their guardian, personal representative, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person, guardian, personal representative, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(am) “Inspection” means the process followed by the department to determine an applicant or a licensee’s compliance with RSA 151 and He-P 806 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151, and He-P 806.

(an) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

(ao) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 806, and includes the name of the licensee, the name of the business, the physical address, the licensing category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.

(ap) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(aq) “Licensed premises” means a physical location where care and services pursuant to He-P 806 are provided, including:

(1) The building or buildings at a site specific address; or

(2) A mobile vehicle that is registered to a site specific address.

(ar) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(as) “Licensing classification” means the specific category of services authorized by a license.

(at) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(au) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b).

(av) “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B, who is responsible for overseeing the quality of medical care and services at the NEWCC.

(aw) “Medical staff” means those physicians and other licensed practitioners permitted by law and NEWCC policies to provide patient care services within the scope of their license.

(ax) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ay) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.

(az) “Mobile NEWCC vehicle” means a vehicle capable of traveling under its own power or being towed from site to site and fully equipped to meet all the requirements specific in section He-P 806.22.

(ba) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bb) “Neglect” means an act or omission, that results or could result in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a patient.

(bc) “Non-emergency walk-in care center (NEWCC)” means a medical facility where a patient can receive medical care which is not of an emergency life-threatening nature, without making an appointment and without the intention of developing an ongoing care relationship with the licensed practitioner. This term includes such facilities that are self-described as urgent care centers, retail health clinics, and convenient care clinics. A NEWCC can be a stand-alone entity, an entity located within a retail store or pharmacy or a mobile vehicle, which can be owned and operated by the retail store or pharmacy, or be owned and operated by a third party.

(bd) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(be) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bf) “Over-the-counter medications” means non-prescription medications.

(bg) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bh) “Patient” means any person registered to or in any way receiving care, services, or both from a NEWCC licensed in accordance with RSA 151 and He-P 806.

(bi) “Patient record” means documents maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 806 and all documentation compiled relative to the person receiving care and services as required by other applicable federal and state requirements.

(bj) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(bk) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(bl) “Personal representative” means “patient’s personal representative” as defined in RSA 151:19, V.

(bm) “Personnel” means an individual(s) who is employed by the facility, a volunteer of, or an independent contractor of a NEWCC who provides services to a patient.

(bn) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bo) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bp) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

(bq) “Point of care devices” means testing involving a system of devices, typically including, but not limited to:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip or reagents to apply the blood sample for testing; or

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

c. A Cholesterol meter.

(br) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bs) “Professional staff” means staff who are licensed, registered, or certified by the state to provide health care services.

(bt) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bu) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(bv) “Register” means the point in time when a patient has been accepted by a licensee for the provision of services.

(bw) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that do not result in a reconfiguration of the building spaces within.

(bx) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(by) “Reportable incident” means an occurrence of any of the following while the patient is either in the NEWCC or in the care of NEWCC personnel:

(1) The unanticipated death of the patient;

(2) An injury to a patient, that is of a suspicious nature or potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the patient;

(3) The unexplained absence of a patient from the NEWCC who is determined to be a danger to themselves or others;

(4) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;

(5) Medication errors; and

(6) Drug diversion.

(bz) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.

(ca) “Security provisions” means locked when not in use.

(cb) “ Service area” means “service area” as defined in RSA 151:4-a, I (c).

(cc) “Stabilize” means to provide medical care to allow the patient to be moved or transferred to another facility.

(cd) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(ce) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.

(cf) “State monitoring” means the placement of individuals by the department at an NEWCC to monitor the operation and conditions of the facility.

(cg) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (a), (i), (j) and (m) EXPIRED: 1-13-03
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24

N.H. Code Admin. R. Ann. He-P 806.04 Notice to Critical Access Hospitals

(a) Prior to submitting an application for licensure in accordance with He-P 806.05, a proposed health care facility shall comply with the requirements of RSA 151:4-a, II, and send written notification of its intent to submit an application for licensure as an ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in care center, dialysis center, or special health care service, via certified mail to the department and to the chief executive officer of all critical access hospitals with a primary physical location within a 15 mile radius of the proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in care center, dialysis center, or special health care service.

(b) The written notification required in (a) above shall contain the following:

(1) Name of the person or entity seeking to establish the proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in care center, dialysis center, or special health care service;

(2) Proposed physical location of the facility;

(3) Type of facility; and

(4) Scope of services for the facility.

(c) Upon receipt of the written notification in (a) above, the chief executive officer of the critical access hospital(s) shall have 30 days to file a written objection with the department.

(d) The written objection in (c) above shall contain the following:

(1) The critical access hospital’s detailed basis for the objection to the proposed health care facility to include:

a. If the proposed health care facility will have a material adverse impact on the critical access hospital’s operations; and

b. How the proposed heath care facility will impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

(2) Proof that the objection was sent via certified mail to the proposed individual or entity seeking to establish the proposed health care facility.

(e) Upon receipt of an objection meeting the requirements of (d) above from a critical access hospital located within a 15 mile radius of a proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in center, dialysis center, or special health care service, the department shall send a letter to the proposed health care facility informing them of the:

(1) Objection and the reason for the objection; and

(2) Opportunity to submit a written response to the objection, which shall include at a minimum;

a. Any information regarding the objection that might be relevant to the determination of material adverse impact; and

b. How the proposed health care facility will not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources.

(f) The department shall provide the names of 3 independent contractors, retained by the department through a competitive procurement process, to the critical access hospital and proposed health care facility for their consideration.

(g) The independent contractors proposed in (f) above shall be experts in the provision of health care services and skilled in determining how utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources could be impacted by the proposed health care facility.

(h) If, after proposing 3 independent contractors, the critical access hospital and proposed health care facility cannot agree on an independent contractor within 30 days of the proposal by the department, the department shall designate the independent contractor to perform the assessment and create the expert report.

(i) Within 30 days of the selection of the independent contractor in accordance with (f) and (h) above, the department shall send a letter to the selected independent contractor requesting their services. This letter shall include:

(1) A request to engage the independent contractor’s services to perform the assessment and create the expert report as required in RSA 151:4-a, II(b);

(2) A summary of the requirements for the content of the expert report, to include:

a. How the proposed project might or might not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

b. A summary of public comments, received in accordance with (p) below and taken into consideration in completing the assessment;

(3) The contact information for the proposed health care facility and chief executive officer of the critical access hospital(s) raising the objection(s);

(4) The objection and response along with any other documentation received by the department relative to this transaction; and

(5) A deadline for completion of the expert report, which shall be no later than 90 days from the date of retention of the expert, unless an extension is granted by the department in accordance with (s) below. Such an extension shall not exceed 30 days.

(j) Upon selection of the independent contractor, the department shall notify the proposed health care facility and critical access hospital of the selected independent contractor.

(k) The independent contractor will invoice the proposed health care facility and critical access hospital the cost of any fees associated with the retention and work to be completed which shall be shared equally between the proposed health care facility and the critical access hospital.

(l) Invoices in (k) above shall be paid for in advance of any services performed in accordance with RSA 151:4-a, II (b)(6).

(m) Payment of the proposed health care facility and critical access hospital’s portion of the advance retainer to the independent contractor shall be paid within 5 business days.

(n) If the proposed health care facility fails to make payment in accordance with (m) above, it shall forfeit its right to submit an application for licensure.

(o) If the critical access hospital fails to make payment in accordance with (m) above, it shall forfeit its right to object and the proposed health care facility shall be allowed to apply for licensure.

(p) I n accordance with RSA 151:4-a, II(b), the proposed health care facility and critical access hospital shall provide any information requested by the independent contractor to complete its report in accordance with the following:

(1) Information obtained at the request of the independent contractor shall not be considered confidential under RSA 151:13, unless the department determines that it should be exempt from disclosure under RSA 91-A:5;

(2) The proposed health care facility and critical access hospital shall provide the information within a reasonable time, as determined by the independent contractor based on the scope of work of the project and the expected time to review said documentation, so that the independent contractor can finish its report in the required 90 day time period;

(3) If the proposed health care facility fails to provide requested information in a reasonable time, it shall forfeit its right to submit an application for licensure; and

(4) If the critical access hospital fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to object and the proposed health care facility shall be allowed to apply for licensure.

(q) Within 30 days of retention of the independent contractor, the department shall publish a notice on the department’s website to notify the public of the proposed health care facility and solicit public comment for a period of at least 7 days.

(r) All public comments received in (q) above shall be provided to and considered by the independent contractor for use in the analysis.

(s) Within 90 days of retention of the independent contractor, the report as described in RSA 151:4-a, II(b) and (i)(2)-(4) above, shall be submitted to the department, unless an extension is granted by the department in accordance with the following:

(1) The department shall grant an extension for good cause;

(2) Good cause shall be determined by the department and a finding of good cause shall require the independent contractor to show why the report cannot be completed within the 90 days and show that the extension is not a result of the proposed health care facility or critical access hospitals failure to comply with the rules; and

(3) Such an extension shall not exceed 30 days.

(t) Within 10 days of receipt of the expert report, the department shall provide a copy of the report to the proposed health care facility and critical access hospital.

(u) If the report finds that the proposed health care facility will have a material adverse impact, then the proposed health care facility shall not be allowed to apply for licensure.

(v) If the report finds that the proposed health care facility will not have a material adverse impact, then the proposed health care facility may proceed with application for licensure.

(w) The person or entity seeking to establish the proposed health care facility and the critical access hospital(s) shall have the right to request a rehearing by the commissioner, pursuant to RSA 541:3.

(x) The result of the rehearing may be appealed by petition to the NH Supreme Court, pursuant to RSA 541:6.

(y) If the proposed health care facility chooses to move forward with the licensing process prior to all appeal rights being exhausted, the proposed health care facility shall do so at its own risk and shall not hold the critical access hospital or the department liable for any costs incurred.

(z) The appellant shall bear all costs of the state in connection with any rehearing or petition for appeal, including the state’s attorneys’ fees.

History

• #13987, eff 5-30-24

N.H. Code Admin. R. Ann. He-P 806.05 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a, and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services,” (May 2024) signed by the applicant or 2 of the corporate officers,

2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”; and

b. “I affirm that I have complied with RSA 151:4-a and a determination is on file with the department that finds the proposed health care facility shall be allowed to apply for licensure;

(2) A floor plan of the prospective NEWCC;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability company; or

c. “Certificate of Trade Name,” where applicable;

(4) List of affiliated or related parties;

(5) The applicable fee, in accordance with RSA 151:5, XIII payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the qualifications of and copies of applicable licenses or certificates for the NEWCC administrator and medical director;

(7) Written local approvals as follows:

a. The following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements;

2. The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code local fire ordinances and including but not limited to business or ambulatory health care; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

(8) If the NEWCC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02 or, if a public water supply is used, a copy of a water bill;

(9) The results of a criminal records check for the applicant(s), licensee if different than the applicant, the administrator and medical director which shall include a criminal history from the state of New Hampshire;

(10) A copy of the non-conviction attestation as described in He-P 806.19(k)(7) for the administrator and medical director;

(11) The results of the BEAS registry check from the bureau of elderly and adult services for the administrator and medical director; and

(12) Any waiver requests, if applicable.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (b) and (m) EXPIRED: 1-13-03
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.04)

N.H. Code Admin. R. Ann. He-P 806.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 806.05(a) or 806.27 have been received.

(b) If an application does not contain all of the items required by He-P 806.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 806.14(b) when, it determines that the applicant, or administrator:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse,

neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 806.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location including licenses issued for mobile NEWCC vehicles.

(h) A written notification of denial, pursuant to He-P 806.14(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 806.

(i) A written notification of denial, pursuant to He-P 806.14(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.05)

N.H. Code Admin. R. Ann. He-P 806.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant the He-P 806.05(a)(1) and (5) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 806.11(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 806.17(g)(2); and

(4) A copy of any temporary, new, or existing variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 806.10 a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) & (c) above, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 806, and all the federal requirements at the renewal inspections, or submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 806.05 and shall be subject to a fine in accordance with He-P 806.14.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.06)

N.H. Code Admin. R. Ann. He-P 806.08 NEWCC Construction, Modifications, or Renovations

(a) As required by RSA 151:6 any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicant’s own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building code, state laws, and rules and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(i) Exceptions to the FGI guidelines above shall be granted by the state fire marshal.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 806.10 prior to its use.

(l) He-P 806.08 shall not apply to mobile NEWCC vehicles.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly He-P 806.08); ss by #13987, eff 5-30-24 (formerly He-P 806.07)

N.H. Code Admin. R. Ann. He-P 806.09 NEWCC Requirements for Organizational or Service Changes

(a) The NEWCC shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) Services.

(b) The NEWCC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) A change in services.

(c) When there is a change in address without a change in location, the NEWCC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the NEWCC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) When there is to be a change in the services provided, prior to providing the additional services, the NEWCC shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, will be made to the physical environment.

(f) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection will be conducted as soon as practical by department;

(2) The physical location except for mobile NEWCC vehicle;

(3) A change in licensing classification; or

(4) A change that places the facility under a different life safety code occupancy chapter.

(g) A new license shall be issued for a change in ownership, classification, or physical location.

(h) A revised license shall be issued for any of the following:

(1) A change in name;

(2) A change of administrator or medical director;

(3) A change in address without a change in physical location; or

(4) When a waiver has been granted.

(i) The NEWCC shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) The results of a criminal records check for the new administrator or medical director which shall include criminal history from the state of New Hampshire;

(3) Copies of applicable licenses for the new administrator or medical director;

(4) A copy of the non-conviction attestation as described in He-P 806.17; and

(5) The results of the BEAS registry check from the bureau of elderly and adult services of the new administrator or medical director.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the positions as specified in He-P 806.16(c) or (e).

(k) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the NEWCC in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(l) The NEWCC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(m) A restructuring of an established NEWCC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) The department shall review the information submitted under He-P 806.09(e) and determine if the added services can be provided under the NEWCC current license including physical plant restrictions.

(o) If a licensee chooses to cease operation of an NEWCC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly He-P 806.07); ss by #13987, eff 5-30-24 (formerly He-P 806.08)

N.H. Code Admin. R. Ann. He-P 806.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 806, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the NEWCC; and

(3) Any records required by RSA 151 and He-P 806.

(b) The department shall conduct a clinical and life safety code inspection, as necessary to determine full compliance with RSA 151 and He-P 806 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 806.09(f)(1);

(3) A change in the physical location of the NEWCC except for mobile NEWCC vehicle;

(4) A change in the licensing classification;

(5) Occupation of space after construction, renovations, or structural alterations;

(6) The renewal of a non-certified NEWCC license; or

(7) The issuance of a mobile NEWCC vehicle license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the NEWCC is in violation of any of the provisions of He-P 806, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 806.13(c), within 21 days of the date on the letter that transmits the inspection report.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.09)

N.H. Code Admin. R. Ann. He-P 806.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 806 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required in (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.10)

N.H. Code Admin. R. Ann. He-P 806.12 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 806.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address, of the NEWCC, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 806.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed NEWCC, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate and statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 806.13(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

(2) In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required in (e)(1) above, to submit a written response to the findings prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 806;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 806.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any administrative or adjudicative proceedings relative to the licensee.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.11)

N.H. Code Admin. R. Ann. He-P 806.13 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 806, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice detailing:

a. How the licensee intends to correct each area on non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 806;

b. Addresses all areas of non-compliances as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 806 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 806.13(d) and a fine in accordance with He-P 806.14(c)(13);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 806.13(b); and

b. Issued a directed POC in accordance with He-P 806.13 (d) and a fine in accordance with He-P 806.14(c)(14).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department, or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license in accordance with He-P 806.14(b); or

(4) Revoke the license in accordance with He-P 806.14(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients;

(2) The presence of conditions in the NEWCC that negatively impact the health, safety, or well-being of patients; or

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.12)

N.H. Code Admin. R. Ann. He-P 806.14 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated a provision of RSA 151 or He-P 806, which poses a threat to a patient’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, or schedule an inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 806.05;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate, with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 806.13(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 806.13(c)(5) and has not submitted a revised POC as required by He-P 806.13(c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 806 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (k) below;

(10) Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 806;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a patient whose needs exceeds the services or programs provided by the NEWCC in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For accepting a patient whose needs, as determined by the medical evaluation, exceed the services or programs authorized by the NEWCC, in violation of He-P 806.15(b), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 806.12(e)(5), the fine for an unlicensed provider, unlicensed entity, or licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 806.07(e), the fine shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 806.09(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 806.09(a)(2), the fine shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 806.09(l), the fine shall be $100.00;

(11) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 806.09(d), the fine for a licensee shall be $100.00;

(12) For a refusal to allow access by the department to the NEWCC’s premises, programs, services, or records, in violation of He-P 806.10(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 806.13(c)(2) and (6), the fine for a licensee shall be $500.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 806.13(c)(8), the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement, or comply with licensee policies, as required by He-P 806.15 the fine for a licensee shall be $500.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 806.15(e), the fine for a licensee shall be $500.00;

(17) For providing false or misleading information or documentation, in violation of He-P 806.15(k), the fine shall be $1000.00 per offense;

(18) For failure to meet the needs of a patient as described in He-P 806.15(n)(2), the fine for a licensee shall be $1000.00 per client;

(19) For utilizing a room or space that has not been approved or licensed by the department, in violation of He-P 806.10(b)(5), the fine for a licensee shall be $500.00;

(20) For employing an administrator, medical director, or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 806.11, in violation of He-P 806.16(c) and (e) and He-P 806.17(k), the fine for a licensee shall be $500.00;

(21) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 806.08(a), the fine for a licensed facility shall be $500.00;

(22) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 806.10(b)(5), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(23) When an inspection determines that there is a violation of RSA 151 or He-P 806 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

(24) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 806 shall constitute a separate violation and shall be fined provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 806, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to appeal.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or well-being of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 806 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) RSA 541 shall govern further appeals of department decisions under this section.

(k) When an NEWCC’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator or medical director for at least 5 years, if the enforcement action pertained to their role in the NEWCC.

(l) The 5-year period referenced in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license became effective, if an appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an administrative hearing was made and a hearing was held.

(m) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 806.

(n) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 806.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.13)

N.H. Code Admin. R. Ann. He-P 806.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, as applicable.

(b) The licensee shall provide services to only those patients whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the NEWCC.

(c) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19–21.

(d) The licensee shall define, in writing, the scope and type of services to be provided by the NEWCC, including the mobile NEWCC vehicle, and shall post the same in the facility and on the facility’s website.

(e) The licensee shall have a written policies and procedures setting forth:

(1) The rights and responsibilities of registered patients in accordance with the patients’ bill of rights under RSA 151:19-21;

(2) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

(3) All other polices described in He-P 806.

(f) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the facility and for:

(1) Reviewing the policies and procedures every 3 years; and

(2) Revising them as needed.

(g) The licensee shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion.

(h) The policy in (g) above shall apply to all personnel, be the responsibility of a designated employee or interdisciplinary team, and include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion as required per He-P 805.14(j); and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

(i) All policies and procedures shall be reviewed and approved by the medical director.

(j) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(k) The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

(l) The licensee shall not advertise or provide services that it is not licensed to provide pursuant to RSA 151:2, III.

(m) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(n) Licensees shall:

(1) Have the responsibility and authority for managing, controlling, and operating the NEWCC;

(2) Meet the needs of the patients during those hours that the patients are in the care of the NEWCC;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the NEWCC;

(4) Appoint an administrator;

(5) Verify the qualifications of all personnel;

(6) Provide sufficient numbers of qualified personnel who are available to meet the needs of patients during all hours that the NEWCC has told the patients that they will provide services;

(7) Provide personnel with sufficient supplies, equipment, and lighting to meet the needs of the patients;

(8) Require all personnel to follow the orders of the licensed practitioner for every patient and encourage the patient to follow the licensed practitioner’s orders;

(9) Initiate action to maintain the NEWCC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(10) Implement any POC that has been accepted by the department; and

(11) Develop and implement a process for determining staffing levels. The plan shall include an assessment, to be conducted at least quarterly but more frequently if required, of the appropriateness of staffing levels.

(o) The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction;

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J;

(3) Has a surrogate designated in accordance with RSA 137-J; or

(4) Is an un-emancipated minor.

(p) In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

(1) Telephone at 603-271-4496;

(2) Telephone at 603-271-5300 after business hours; or

(3) Fax to 603-271-0545.

(q) If the licensee registers or treats a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patients, as specified by the Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(r) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license issued in accordance with RSA 151:2;

(2) All statement of findings reports issued for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits, except that mobile NEWCC vehicles shall be exempt from this requirement; and

(6) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the department of health and human services, health facilities administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345.

(s) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 806 as authorized by RSA 151:6 and RSA 151:6-a.

(t) A licensee shall, upon request, provide a patient or the patient’s guardian, agent, personal representative, or surrogate decision-maker if applicable, with a copy of their patient record pursuant to the provisions of RSA 151:21, X.

(u) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(v) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

(3) Systems to prevent tampering with information pertaining to patients and staff.

(w) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(x) The building or mobile vehicle that houses the NEWCC shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(y) Smoking shall be prohibited in the facility as required by RSA 155:66, I(b).

(z) For reportable incidents, licensees shall have responsibility for:

(1) Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Faxing to 603-271-4968 or, if a fax machine is not available, submit via regular mail, postmarked within 48 hours of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 48 hours of a reportable incident:

a. The NEWCC name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of patient(s) involved and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom, and the date and time;

h. When the patient’s guardian, agent, surrogate decision-maker, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident;

j. The date and time the patient’s licensed practitioner was notified, if applicable; and

k. The date the facility performed the investigation required by (1) above;

(3) As soon as practicable, notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a patient has an unexplained absence and the licensee has searched the building and the grounds of the NEWCC without finding the patient and it has been determined by the facility that the patient is a danger to themselves or others; and

(4) If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(aa) The licensee shall maintain a log in each mobile vehicle to document that all on-board water is from a verifiable potable source.

(ab) The licensee shall not exceed the maximum number of patients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(ac) The licensee shall respond to a notice of deficiencies by providing a POC in accordance with He-P 806.13(c).

(ad) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(ae) The licensee shall require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.

History

• #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5512, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; amd by #12928, eff 11-26-19; ss by #13987, eff 5-30-24 (formerly He-P 806.14)

N.H. Code Admin. R. Ann. He-P 806.16 Required Services

(a) Each facility shall have a governing body or owner whose responsibilities include:

(1) Management and control of the operation;

(2) Assurance of the quality of care and services;

(3) Appointment of the medical director and clinic administrator;

(4) Determination of the qualifications and appointment of physicians, administrator, and other professional staff;

(5) Management of overall operation and fiscal viability of the NEWCC; and

(6) Ensuring compliance with all relevant federal, state, and local laws, rules, codes, and ordinances.

(b) The licensee shall provide administrative services that include the appointment of an administrator who:

(1) Is responsible for the day-to-day operations of the NEWCC;

(2) Works no less than 35 hours per week at the NEWCC, which may include day, evening, night, and weekend hours;

(3) Meets the requirements of He-P 806.16(c);

(4) Designates, in writing, a qualified staff member who shall assume the responsibilities of the administrator in their absence; and

(5) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify they meet the requirements of He-P 806.16(c).

(c) Any administrator appointed shall:

(1) Possess at a minimum, a bachelor’s degree in business or a health-related field;

(2) Be a registered nurse; or

(3) Have at least 4 years equivalent experience in a health-related field.

(d) The administrator shall be responsible for maintaining the NEWCC in full compliance with all federal, state, and local laws, rules, codes, and ordinances at all times.

(e) Each facility shall have a medical director who shall be a physician or APRN licensed in the state of New Hampshire and who shall have training and experience commensurate with the services offered by the NEWCC as determined by the governing body described in He-P 806.16(a).

(f) The medical director shall be responsible for:

(1) The development and approval of NEWCC procedures and policies;

(2) The development of facility protocols for assisting patients whose medical needs are outside the NEWCC’s scope of practice;

(3) Monitoring and evaluation of the quality of patient care; and

(4) Providing medical direction, consultation, and supervision to the professional staff.

(g) The administrator and medical director may hold more than one position in the NEWCC and may serve in these capacities for multiple NEWCCs.

(h) All volunteers shall be oriented and educated relative to their prescribed function according to the NEWCC’s policies and procedures.

(i) The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

(1) Recruitment and retention;

(2) Health screening and 2-step TB testing;

(3) Orientation;

(4) Scope of function;

(5) Supervision;

(6) Ongoing training and support;

(7) Record of volunteer activities; and

(8) Criminal record checks.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.15)

N.H. Code Admin. R. Ann. He-P 806.17 Personnel

(a) Each NEWCC shall be staffed with at least one licensed practitioner on site during all hours of operation.

(b) The licensee shall ensure that sufficient numbers of qualified personnel are present in the NEWCC to meet the needs of the patients at all times.

(c) The licensee shall develop a job description for each position in the NEWCC containing:

(1) Position title;

(2) Duties of the position;

(3) Physical requirements of the position; and

(4) Qualifications and educational requirements of the position.

(d) For all applicants for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with He-P 806.17(e);

(3) Verify the qualifications and licenses, as applicable, of all applicants prior to employment; and

(4) Verify that the applicant is not on the BEAS registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49.

(e) Unless a waiver is granted in accordance with He-P 806.11 and He-P 806.17(f), the licensee shall not offer employment, contract with, or engage a person in He-P 806.17(d) if the person:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) If the information identified in (e) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (e) above.

(g) If a waiver of (e) above is requested, the department shall review the information and the underlying circumstances in (e) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (e) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(h) The licensee shall check the names of the persons in He-P 806.17(d) against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49, prior to employing, contracting with, or engaging them.

(i) The licensee shall:

(1) Not employ, contract with, or engage any person in (d) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

(j) In lieu of (d) and (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (d) and (h) above and do not meet the criteria in (e) above.

(k) Prior to having contact with patients or food, personnel shall:

(1) Receive a tour of the NEWCC;

(2) Receive a copy of the job description for their position at the NEWCC containing:

a. Position title;

b. Duties of the position;

c. Physical requirements of the position; and

d. Education and experience requirements of the position;

(3) Meet the educational qualifications of the position as listed on their job description;

(4) Be licensed, registered, or certified as required by state statute;

(5) Receive an orientation prior to the assumption of duties that includes:

a. The NEWCC’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The NEWCC’s policies, procedures, and guidelines;

d. The NEWCC’s infection control program policies and procedures;

e. The NEWCC’s fire, evacuation, and emergency plans which outline the responsibilities and educational requirements of personnel in an emergency;

f. The mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

g. The NEWCC complaint procedures; and

h. The medical emergency procedures;

(6) Complete mandatory annual in-service education, which includes a review of the NEWCC’s:

a. Policies and procedures on patient rights and responsibilities, and complaints pursuant to RSA 151;

b. Infection control program;

c. Education program on fire, evacuation, and emergency procedures; and

d. Mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

(7) Be at least 18 years of age unless they are:

a. A licensed nursing assistant working under the supervision of a registered nurse in accordance with RSA 326-B:13; or

b. Part of an established educational program working under the supervision of a registered nurse;

(8) Prior to contact with patients, submit to the NEWCC the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and submit to the licensee the results of a 2-step tuberculosis test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(9) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

(10) Comply with the requirements of the Centers for Disease control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(l) The licensee shall inform personnel of the line of authority at the NEWCC.

(m) Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner in one location, for example, hospital human resources department or on site of NEWCC.

(n) The licensee shall maintain a separate employee file for each employee, which shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A signed statement by each individual acknowledging the receipt of the licensee’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the licensee’s policy as required by RSA 151:20;

(4) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(5) A record of satisfactory completion of the orientation program required by (k)(5) above;

(6) A copy of each current New Hampshire license, registration, or certification in health care field and CPR certification, if applicable;

(7) Documentation that the required physical examination, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(8) Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

(9) Documentation of an annual performance review;

(10) Information as to the general content and length of all in-service or educational programs attended;

(11) A statement, which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient in this or any other state; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state;

(12) Documentation of the criminal records check; and

(13) The results of the registry checks in (h) above.

(o) The licensee shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in He-P 806.17(n)(1), (2), (3), (5), (6), (7), (8), (11), (12) and (13); and

(2) For independent contractors, the information in He-P 806.17(n)(2), (3), (5), (6), (7), (8), (11), (12), and (13), except that the letter in He-P 806.17(j) above may be substituted for (n) (12) and (13), if applicable.

(p) An individual need not re-disclose any of the matters in He-P 806.17(e) if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

(q) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.16)

N.H. Code Admin. R. Ann. He-P 806.18 Patient Records

(a) A patient record shall be maintained for each patient accepted for treatment by the facility.

(b) The licensee shall maintain a legible, current, and accurate record for each patient based on the services provided at the NEWCC.

(c) At a minimum patient records shall contain the following:

(1) Identification data, including the patient’s:

a. Name;

b. Home address;

c. Home telephone number;

d. Name, address, and telephone number for an emergency contact;

e. Date of birth; and

f. Guardian, agent, or surrogate decision-maker when applicable;

(2) A signed acknowledgment of receipt of the patient bill of rights and the facility’s complaint procedures, signed by the patient, guardian, agent, or surrogate decision-maker;

(3) Patient's health insurance information;

(4) A written or electronic record of a health assessment by a licensed practitioner or registered nurse;

(5) Dated and signed orders for medications, treatments, special diets, laboratory service, and referrals to other practitioners, as applicable;

(6) The consent for release of information signed by the patient, guardian, agent, or surrogate decision-maker, if any;

(7) The medication record as required;

(8) Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner;

(9) Documentation of all services provided including signed progress notes by:

a. Nursing personnel;

b. Physicians; and

c. Other health professionals authorized by facility policy;

(10) Documentation of a patient’s refusal of any care or services;

(11) Transfer or discharge documentation including planning, referrals, and notification to the patient and guardian, agent, or surrogate decision-maker, if any, of involuntary room change, if applicable;

(12) Orders and results of any laboratory tests, x-rays, or other diagnostic tests; and

(13) The name and telephone number of the patient’s licensed practitioner, if any.

(d) Patient records shall be available to the professional staff and health care workers and any other person authorized by law or rule to review such records.

(e) Patient records shall be retained in the facility and stored in an area inaccessible to those who do not have authorized access to such records.

(f) The licensee shall develop and implement a written policy and procedure that specifies the method by which release of information from a patient’s records shall occur.

(g) When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use by implementation of use, handling, and storage procedures.

(h) Patient records shall be retained 7 years after discharge of a patient. In the case of minors, patient records shall be retained until the patient reaches the age of 18, but in no case shall they be retained for less than 7 years after discharge.

(i) The licensee shall arrange for storage of and access to patient records for 7 years in the event the clinic ceases operation.

(j) The facility shall notify the department where the storage required in He-P 806.18(i) is located.

(k) Referrals to other health care providers shall occur if medically indicated and if the facility does not provide the services required.

(l) Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

(m) If the facility uses an electronic record storage system, it shall provide computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 806 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.17)

N.H. Code Admin. R. Ann. He-P 806.19 Quality Improvement

(a) The licensee shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing and correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The NEWCC shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the NEWCC;

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable;

(8) Ensure that quality control logs are maintained for any laboratory quality control testing; and

(9) Ensure that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer’s recommendations.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities including minutes of meetings, shall be confidential.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.18)

N.H. Code Admin. R. Ann. He-P 806.20 Infection Control

(a) The NEWCC shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items specified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The NEWCC shall appoint an individual who will oversee the development and implementation of the infection control program.

(d) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections;

(4) Prevention and containment of infections; and

(5) Use of universal precautions.

(e) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious as determined by a licensed practitioner.

(f) Personnel infected with scabies or lice or pediculosis shall not provide direct care to patients until such time as they are no longer infected as determined by a licensed practitioner.

(g) Pursuant to RSA 141-C, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the NEWCC until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(h) Personnel and staff with an open wound who prepare food or provide direct care in any capacity shall cover such wound at all times by an impermeable, tight-fitting, and durable bandage with secure edges.

(i) The licensee shall immunize all consenting personnel for influenza and report immunization data to the department’s immunization program.

(j) If the NEWCC has an incident of an infectious disease reported in He-P 806.20(b)(5), the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(k) The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

(l) The licensee shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

(m) The administrator shall appoint an infection control officer who shall:

(1) Receive reports of communicable and infectious diseases; and

(2) Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

(n) The licensee shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee, or patient has a communicable disease.

(o) The NEWCC shall develop and implement a point of care testing policy, if they provide POCT, that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(p) If equipment needs to be cleaned in order to prevent contamination, the NEWCC shall develop and maintain written procedures for safe and effective cleaning of the equipment.

(q) The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.19)

N.H. Code Admin. R. Ann. He-P 806.21 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment both inside and outside the facility.

(b) All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times, and precautions such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2022 edition), as available as noted in Appendix A., and summarized as follows:

(1) One hundred five degrees through 120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

(2) One hundred twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the ware washer, and may be by separate booster, unless a chemical rinse is provided; and

(3) One hundred sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

(f) All patient bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked closet or cabinet, separate from food, medications, and patient supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service area shall be covered at all times.

(m) Laundry and laundry rooms, if present, shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack, or covered container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled materials, linens, and clothing which are considered contaminated with infectious waste under Env-Wm 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Clean supplies shall be stored in dust-free and moisture-free storage areas or containers.

(p) Any NEWCC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

(q) Sterile supplies and equipment shall:

(1) Be stored in dust-free and moisture-free storage areas; and

(2) Not be mixed with un-sterile supplies.

(r) All soiled items at the NEWCC shall be disposed of according to the facility’s infection control policies.

(s) There shall be a designated, enclosed storage area for soiled, dirty, and bio-hazardous materials.

(t) If equipment or supplies need to be sterilized in order to prevent contamination, the NEWCC shall develop and maintain written procedures for cleaning, packaging, and sterilization that includes:

(1) Testing and documenting sterilization processes used;

(2) Testing and documenting the effectiveness of sterilization equipment for adequate sterilization in accordance with the manufacturer’s recommendations or using industry acceptable quality control standards;

(3) Documentation when supplies are outdated; and

(4) Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly provisions of He-P 806.19); ss by #13987, eff 5-30-24 (formerly He-P 806.20)

N.H. Code Admin. R. Ann. He-P 806.22 Physical Environment

(a) The licensed premises, including mobile NEWCC vehicles, shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(b) The licensee shall:

(1) Have all entrances and exits accessible at all times and be free from obstructions during hours of operation;

(2) Be maintained in good repair and kept free of hazards to personnel and patients,

including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not be limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Notwithstanding general access requirements from the FGI’s “Guidelines for the Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A, a NEWCC located on the premises of another entity shall not be required to provide separate exterior entrances or designated parking, or to provide a patient waiting area or reception area that is separated from the public area of the host entity.

(d) Equipment providing heat within an NEWCC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit if patient(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(e) Electric heating systems shall be exempt from He-P 806.22(d)(2).

(f) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employees areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(g) Unvented fuel-fired heaters shall not be used in any NEWCC.

(h) Plumbing shall be sized, installed, and maintained in accordance with the provisions of the International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

(i) Ventilation shall be provided throughout the entire building by means of a mechanical ventilation system or with one or more screened windows that can be opened.

(j) Screens shall be provided for doors, windows, or other openings to the outside.

(k) Doors that are self-closing and remain closed when not in use are exempt from the requirement in (j) above.

(l) In accordance with RSA 155:66, I(b), smoking shall be prohibited in the NEWCC.

(m) All NEWCCs shall have access within the NEWCC to a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels, or a hand-drying device providing heated air, and hot and cold running water.

(n) All bathroom doors shall have a side hinge door and not a folding or sliding door or a curtain.

(o) Notwithstanding (m) above, if the NEWCC is located within a retail store that has a public bathroom with a toilet and the bathroom complies with all applicable sanitation and construction regulations, the NEWCC shall not be required to have its own bathroom but shall:

(1) Have its own hand washing sink with hot and cold running water, soap dispenser, and paper towels or a hand-drying device providing heated air; and

(2) Not permit biological samples collected in the retail store’s public bathroom to be transported through the retail store except in properly enclosed biohazard containers and bags.

(p) There shall be sufficient space and equipment for the services provided at the NEWCC.

(q) All exam tables shall be changed with clean linens or common paper between use by different patients.

(r) The licensee shall provide patients with continuous access to a device or means that will signal NEWCC personnel when they are in need of assistance with care or in an emergency.

(s) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(t) If available, all showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(u) All mattresses and upholstered furniture or draperies shall comply with the state fire code.

(v) A privacy partition, curtain, or screen shall be required between beds in semiprivate rooms.

(w) The NEWCC shall be clean, sanitary, maintained in a safe manner and good repair, and kept free of hazards.

(x) The NEWCC shall provide the following:

(1) Reception and waiting areas that include a reception desk or counter, chairs, tables, and lighting adequate to read materials and complete forms as required;

(2) Public access to toilet facilities with non-porous floors;

(3) A number of examination and treatment rooms adequate to provide services to the average number of patients seen daily; and

(4) Hot water available at all times from taps available to patients and not less than 105 degrees Fahrenheit or more than 120 degrees Fahrenheit.

(y) Medical waste shall be disposed of in accordance with the requirements of Env-Sw 904.

(z) The NEWCC shall comply with all federal, state, and local health, building, fire and zoning laws, rules, and ordinances.

(aa) The water used in the NEWCC shall be suitable for human consumption, pursuant to drinking water quality standards as specified in Env-Dw 702 through Env-Dw 706.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly He-P 806.20); ss by #13987, eff 5-30-24 (formerly He-P 806.21)

N.H. Code Admin. R. Ann. He-P 806.23 Fire Safety

(a) All NEWCCs shall meet the appropriate chapters of NFPA 101, the appropriate chapters of the state fire code pursuant to RSA 153:5 and the appropriate chapters of the state building code.

(b) An emergency and fire safety program shall be developed and implemented and reviewed annually, and revised as needed, to provide for the safety of patients and personnel.

(c) The NEWCC shall have at least one UL listed ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 and shall:

(1) Be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

(2) Have records for manual inspection or electronic monitoring kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

(3) Have annual maintenance performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

(4) Have the components of the electronic monitoring device or system tested and maintained annually in accordance with the manufacturer’s listed maintenance manual.

(d) The NEWCC shall have an approved carbon monoxide monitor on every level.

(e) The NEWCC shall immediately notify the department by phone, fax, or electronic mail within 24 hours, and in writing within 72 hours, of any fire or emergency situation, excluding a false alarm, that requires either an emergency response to the NEWCC or the evacuation of the licensed premises.

(f) The written notification required by (e) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injuries to patients or personnel or damage sustained by the NEWCC;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or patient who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(g) For the use and storage of oxygen and other related gases, NEWCCs shall comply with NFPA 99, health care facilities code including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft or 6.1 m;

2. A minimum distance of 5 ft or 1.5 m if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the installation of sprinkler systems; or

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft or 1.5 m, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”;

(5) Precautionary signs, readable from a distance of 5 ft or 1.5 m, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means; and

(6) Must comply with NH department of transportation requirements with regard to oxygen transport, storage, and use.

(h) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(i) A written plan for fire safety, evacuation, and emergencies shall be adopted and posted in multiple locations throughout the facility.

(j) Evacuation drills shall include the transmission of a fire alarm signal, and simulation of emergency fire condition.

(k) Evacuation drills shall be quarterly.

(l) All staff shall participate in at least one drill annually.

(m) For NEWCCs located within a retail store or pharmacy, the fire drill shall consist of a required review of all fire safety procedures and evacuation protocols for the retail store or pharmacy. All personnel on duty shall participate fully in each drill held by the retail store or pharmacy in which the NEWCC may be located.

(n) At no time shall a staff member who has not participated in an evacuation drill be the only staff member on duty within the facility.

(o) The facility shall conduct an evacuation drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

(p) All emergency and evacuation drills shall be documented and include the following information:

(1) The names and titles of the personnel involved in the evacuation;

(2) The number of people, including patients, personnel, and visitors involved in the evacuation;

(3) The time, including AM or PM, date, month, and year the drill was conducted and if the actual fire system was used;

(4) The location of the exits utilized;

(5) The total time necessary to evacuate the NEWCC;

(6) The time needed to complete the drill; and

(7) Any problems encountered and corrective actions taken to rectify problems.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly provisions of He-P 806.21); ss by #13987, eff 5-30-24 (formerly He-P 806.22)

N.H. Code Admin. R. Ann. He-P 806.24 Emergency Preparedness

(a) Each facility shall have a group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in He-P 806.24(d);

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency that shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing patients and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the ICS in coordination with local emergency response agencies;

(6) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable;

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(7) Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

(8) Include the management of participants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

(9) Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(e) Annually, the facility shall participate in a community-based disaster drill which may be a tabletop discussion or an actual or functional drill with outside agencies.

(f) The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), or annual plan review. Any substantial changes to the plan as a result of drills and exercises, or real events, shall be submitted to the local emergency management director for review.

(g) Notwithstanding He-P 806.24(a)-(f), when an NEWCC is a part of a larger institution which has a comprehensive emergency preparedness plan, the NEWCC may use the institution’s plan, and if so, it shall:

(1) Identify the portions of the plan that pertain to the NEWCC in a separate document for use by NEWCC personnel;

(2) Provide annual training to prepare personnel in its application as required by He-P 806.24(e); and

(3) Review and update the plan as required by He-P 806.24(f) above.

History

• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly provisions of He-P 806.21); ss by #13987, eff 5-30-24 (formerly He-P 806.23)

N.H. Code Admin. R. Ann. He-P 806.25 Pharmacy and Medications

(a) Medications shall be administered only by a person licensed to do so by the state of NH.

(b) If an emergency drug cart is maintained, it shall be under the control of professional staff and shall be inventoried and maintained according to the written policy of the medical director.

(c) All medications shall be stored in a clean well-organized cabinet or closet which shall be locked when not in use.

(d) Appropriate security provisions shall be made for medications requiring refrigeration.

(e) Security provisions such as locked drawers shall be made for individual physician samples if no central storage location is established.

(f) Schedule I and II drugs scheduled in accordance with RSA 318-B:1-a shall be stored in a locked compartment within the locked medicine cabinet or closet accessible only to authorized personnel.

(g) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(h) Disposal of outdated medications and controlled drugs shall be in accordance with state and local ordinances and the provisions of RSA 318-B and Ph 707.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly He-P 806.22); ss by #13987, eff 5-30-24 (formerly He-P 806.24)

N.H. Code Admin. R. Ann. He-P 806.26 Laboratory

(a) Any NEWCC which obtains or performs tests on human samples for diagnostic or treatment purposes shall meet the requirements of this section.

(b) The licensee may only perform POCT that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(c) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(d) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(e) Licensees performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

(f) The licensee shall implement and maintain a laboratory service procedure manual that shall:

(1) Be readily accessible at all times to testing personnel; and

(2) Contain:

a. The written procedure for each test performed in the laboratory;

b. A copy of the package insert for each test performed;

c. The laboratory’s procedure for test requisition and specimen collection;

d. The specimen handling and follow-up procedure for all patient samples that are referred to another laboratory for testing;

e. The phlebotomy procedure;

f. Job descriptions for the testing personnel and specimen collection personnel; and

g. Documentation that the medical director has approved all procedures.

(g) Unless the facility holds a separate, He-P 808 license for the laboratory, the medical director required by He-P 806.16(e) shall be the director for all laboratory testing.

(h) All patient test requisitions, reports, and records shall be completed and maintained in accordance with 42 CFR 493.

(i) All patient test requisitions, reports, and records shall be safeguarded against loss, damage, tampering, and unauthorized access and maintained for a minimum of 4 years.

(j) Refrigerator and freezer temperatures shall be recorded each day specimens, reagents, or test kits are stored and must fall within the following ranges:

(1) Refrigerator temperatures shall be between 2 and 8 degrees centigrade; and

(2) Freezer temperatures shall be colder than minus 10 degrees centigrade.

(k) Centrifuge speed shall fall between 2800 and 3500 revolutions per minute or as specified by the manufacturer and be verified by tachometer on an annual basis.

(l) No expired specimen collection equipment and reagents, such as vacutainer tubes and glucola, shall be retained in the station or used for specimen collection.

(m) Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the NEWCC.

(n) The medical director shall assure that all testing and phlebotomy personnel have a documented annual competency review that shall include a visual inspection of the performance of a phlebotomy and each test method performed.

(o) If the NEWCC performs phlebotomies to collect blood specimens for testing, the facility shall have:

(1) A blood collection chair with a device to prevent patient falls or a reclining chair;

(2) A cot or an alternative method that allows a patient to lie down in the event of dizziness or illness;

(3) A specimen collection area that:

a. Is separate from the reception area;

b. Contains a work counter and hand washing facilities;

c. Measures, at a minimum, 36 square feet; and

d. Maintains patient confidentiality and privacy; and

(4) A processing area that, at a minimum, has 6 linear feet of counter space.

History

• #9655, eff 2-13-10, EXPIRED: 2-13-18
• #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19
• #12795, eff 5-30-19 (formerly provisions of He-P 806.21); ss by #13987, eff 5-30-24 (formerly He-P 806.25)

N.H. Code Admin. R. Ann. He-P 806.27 Mobile NEWCC Vehicles

(a) Mobile NEWCC vehicles shall be eligible for licensure only if they are:

(1) Operated by a NEWCC that is located in a building or other permanent structure and has a valid NH facility license issued by the department in accordance with He-P 806; or

(2) Operated by another NH licensed facility that is located in a building or other permanent structure.

(b) Each applicant shall comply with He-P 806, except that:

(1) He-P 806.07 shall not apply to mobile NEWCC vehicles;

(2) In lieu of He-P 806.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

a. A copy of the applicant’s current NEWCC license;

b. A valid New Hampshire motor vehicle registration for the mobile NEWCC vehicle;

c. The VIN of the mobile NEWCC vehicle; and

d. A space utilization diagram for the mobile NEWCC vehicle; and

(3) Client and facility records that are stored off site shall be available for inspection upon request of licensing staff within 30 minutes of being requested.

(c) The NEWCC portions of the mobile NEWCC vehicle shall have a non-porous floor.

(d) Detailed written documentation of travel dates, times and locations, including periods of non-use, shall be maintained for the mobile NEWCC vehicle.

(e) The NEWCC mobile vehicle shall have mounted smoke and carbon monoxide detection devices which are installed and maintained.

(f) The NEWCC mobile vehicle shall contain appropriately rated fire extinguishers mounted within;

(g) The NEWCC mobile vehicle shall have marked exits.

(h) The NEWCC mobile vehicle shall have at a minimum battery-operated emergency lighting for exiting.

History

• #12795, eff 5-30-19; ss by #13987, eff 5-30-24 (formerly He-P 806.26)

Part He-P 807 Rules for Residential Treatment and Rehabilitation Facilities

N.H. Code Admin. R. Ann. He-P 807.01 Purpose

Statutory Authority: RSA 151:9, I.

The purpose of this part is to set forth the licensing requirements for all residential treatment and rehabilitation facilities (RTRF) pursuant to RSA 151:2, I(d).

History

• #1779 eff 7-19-81; ss by #2347, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff,1-29-92, EXPIRED: 5-28-92
• #5751, eff 12-2-93, EXPIRED: 12-2-99
• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff, 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a RTRF, except:

(a) All facilities listed in RSA 151:2, II(a)-(i); and

(b) All facilities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.03 Definitions

In this part, the following words have the following meanings, unless context clearly indicates otherwise:

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of clients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving clients without his or her informed consent;

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management;

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure;

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B;

(e) “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise;

(f) “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility;

(g) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” shall include living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35;

(h) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies;

(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35;

(j) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a RTRF pursuant to RSA 151;

(k) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 807, or other federal or state requirements;

(l) “Assessment” means an evaluation of the client to determine the care and services that are needed;

(m) “Care plan” means a documented guide developed by the licensee, in consultation with the licensed practitioner, personnel, the client, and/or the client’s guardian, agent or personal representative, if any, as a result of the assessment process for the provision of care and services. This term also includes “treatment plan”;

(n) “Change of ownership” means a change in the controlling interest of an established RTRF to a successor business entity;

(o) “Chemical restraint” means any medication prescribed to control a client’s behavior or emotional state without a supporting diagnosis or for the convenience of program personnel;

(p) “Client” means any person admitted to or in any way receiving care, services or both from a RTRF licensed in accordance with RSA 151 and He-P 807;

(q) “Client record” means documents maintained for each client, which includes all documentation required by RSA 151 and He-P 807, and all documentation compiled relative to the client as required by other federal or state laws;

(r) “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee;

(s) “Comprehensive evaluation” means a multi-disciplinary assessment of level of function by healthcare professionals licensed or certified in the field of rehabilitation;

(t) “Contracted employee” means a temporary employee working under the direct supervision of the RTRF but employed by an outside agency;

(u) “Core services” means those minimal services to be provided to any client by the licensee that shall be included in the basic rate;

(v) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others;

(w) “Days” means calendar days unless otherwise specified in the rule;

(x) “Department” means the New Hampshire department of health and human services;

(y) “Direct care” means hands-on care and services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments;

(z) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance;

(aa) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the client will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”;

(ab) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency;

(ac) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 807;

(ad) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures;

(ae) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception or fraud;

(af) “Facility” means “facility” as defined in RSA 151:19, II;

(ag) “Guardian” means a person appointed in accordance RSA 464-A to make informed decisions relative to the client’s health care and other personal needs;

(ah) “Impaired” means when a physician or health care worker whose ability to function in his or her usual role has been reduced or otherwise compromised by any substances including but not limited to legally prescribed medications or alcohol;

(ai) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents;

(aj) “Infectious waste” means those items specified by Env-Sw 103.28;

(ak) “Informed consent” means the decision by a person or his or her guardian, agent, or surrogate decision maker to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently;

(al) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel;

(am) “Inspection” means the process followed by the department to determine an applicant or a licensee’s compliance with RSA 151 and He-P 807 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 807;

(an) “License” means the document issued by the department to an applicant at the start of operation as an RTRF, which authorizes operation of a RTRF in accordance with RSA 151 and He-P 807, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number;

(ao) “License certificate” means the document issued by the department to an applicant or licensee that, contains the information on a license and includes the name of the administrator, the type(s) of services authorized and the number of beds that the RTRF is licensed for;

(ap) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board;

(aq) “Licensed premises” means the building, or buildings, that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license;

(ar) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151;

(as) “Licensing classification” means the specific category of services authorized by a license;

(at) “Life safety code” means the national Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

(au) “Mechanical restraint” means locked or secured RTRFs or units within a RTRF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the RTRF or unit within;

(av) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance;

(aw) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes;

(ax) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional or physical health and safety of any client;

(ay) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes;

(az) “Nursing care” means the provision of care or oversight of a physical, mental, or emotional condition or diagnosis by a nurse;

(ba) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, or referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner;

(bb) “Owner” means a person or organization who has controlling interest in the RTRF;

(bc) “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21. This term includes “resident rights”;

(bd) “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions;

(be) “Personal representative” means a person, other than the licensee of an employee of or a person having a direct or indirect ownership interest in, a facility, who is designated in writing by a client or client’s legal guardian for a specific, limited purpose or for the general purpose of assisting the client in the exercise of any rights as defined in RSA 151:19, V;

(bf) “Personnel” means individual(s) employed by the facility, volunteer(s), or independent contractor(s), who provide direct care or services to a client;

(bg) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the client’s freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques;

(bh) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6;

(bi) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of client care;

(bj) “Procedure” means a licensee’s written, standardized method of performing duties and providing services;

(bk) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with a licensed practitioner’s orders;

(bl) “Protective care” means the provision of client monitoring services, including but not limited to:

(1) Knowledge of client whereabouts;

(2) Minimizing the likelihood of accident or injury; and

(3) Other means of ensuring client safety;

(bm) “Qualifications” means education, experience and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee;

(bn) “Qualified personnel” means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control or kitchen staff trained in food safety protocols;

(bo) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained;

(bp) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces;

(bq) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition;

(br) “Reportable incident” means an occurrence of any of the following while the client is either in the RTRF or in the care of the RTRF personnel:

(1) The unanticipated death of the client;

(2) An injury to a client, that is indicative of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or

(3) The unexplained absence of a client from the RTRF who is determined to be a danger to themselves or others;

(bs) “Residential treatment and rehabilitation facility”(RTRF) means a place, excluding hospitals as defined in RSA 151-C:2, which provides residential care, treatment and comprehensive specialized services relating to the individual’s medical, physical, psychosocial, vocational, or educational needs;

(bt) “Self administration of medication without assistance” means an act whereby the client takes his or her own medication(s) without the assistance of another person;

(bu) “Self administration with supervision” means an act whereby the client takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others;

(bv) “Self- directed medication administration” means an act whereby a client, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions, injections, or filling insulin syringes;

(bw) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client;

(bx) “Significant change” means a change in cognitive or physical capabilities that decreases a client’s ability to care for himself beyond an episodic event;

(by) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease or clinical conditions, or to increase or decrease specific nutrients in the food consumed by the client;

(bz) “Unexplained absence” means an incident involving a client leaving the premises of the RTRF without the knowledge of the RTRF personnel; and

(ca) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License, or Special Health Care Services” (March 2019) signed by the applicant or 2 of the corporate officers affirming the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

b. For any new RTRF to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a

description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any RTRF to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

(2) A floor plan of the prospective RTRF;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee in accordance with RSA 151:5, VI, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the name, qualifications, and copies of applicable licenses for the RTRF administrator;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000 under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, including the applicable chapter National Fire Protection Association (NFPA) 101 , and local fire ordinances applicable for an RTRF; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

(7) If the RTRF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if public water supply, a copy of a water bill; and

(8) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant and the administrator for which the application is submitted.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #9873-B, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 807.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 807.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted pursuant to He-P 807.10, the department shall deny a licensing request in accordance with He-P 807.13(b) if, it determines that the applicant, administrator, or a household member:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse,

neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 807.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 807.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 807.

(i) A written notification of denial, pursuant to He-P 807.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire one year from date of issuance, unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 807.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 807.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of current employees who have a permanent waiver granted in accordance with He-P 807.18(f); and

(4) A copy of any non-permanent or new variances applied for or granted by the state fire

marshall, in accordance with Saf-C 6005.03 - 6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

(d) Following an inspection as described in He-P 807.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151, He-P 807, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 807.04 and shall be subject to a fine in accordance with He-P 807.14.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.07 RTRF Construction, Modifications or Renovations

(a) For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 807 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) The RTRF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

(g) A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

(1) The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, as follows:

a. NFPA 101, Life Safety Code Residential Board and Care Occupancy Chapter; or

b. NFPA 101, Life Safety Code Health Care Occupancy Chapter; and

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) The FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities”, (2018 edition), available as noted in Appendix A; and

(h) All RTRFs newly constructed or rehabilitated after the 2019 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), as applicable, available as noted in Appendix A.

(i) Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” ( 2018 edition), available as noted in Appendix A.

(j) The department shall be the authority having jurisdiction for the requirements in He-P 807.07(i)-(k) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 807.10 as appropriate.

(k) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(l) Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(m) Exceptions or variances pertaining to the state fire code referenced in He-P 807.07(h)(1) shall be granted only by the state fire marshal.

(n) The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 807.09 prior to its use.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.08 RTRF Requirements for Organizational Changes

(a) The RTRF shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) Services.

(b) The RTRF shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) A change in service.

(c) When there is a change in address without a change in location the RTRF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the RTRF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

(2) The physical location;

(3) A change in licensing classification; or

(4) A change that places the facility under a different life safety code occupancy chapter.

(f) A new license and license certificate shall be issued for a change in ownership, classification, or a change in physical location.

(g) A revised license and license certificate shall be issued for changes in the RTRF’s name.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in address without a change in physical location; or

(3) When a waiver has been granted in accordance with He-P 807.10.

(i) The RTRF shall inform the department in writing when there is a change in administrator no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) The results of a NH criminal background check conducted pursuant to He-P 807(e);

(3) Copies of applicable licenses for the new administrator; and

(4) A copy of the criminal attestation as described in He-P 807.18(s).

(j) Upon review of the materials submitted in accordance with (e) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 807.16(a) and He-P 807.18(k).

(k) If the department determines that the new administrator does not meet the qualifications, it shall so notify the RTRF in writing so that a waiver can be sought or the program can search for a qualified candidate.

(l) The RTRF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(m) A restructuring of an established RTRF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) When there is to be a change in the services provided, the RTRF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

(o) The department shall review the information submitted under (n) above and determine if the added services can be provided under the RTRF’s current license including physical plan restrictions.

(p) If a licensee chooses to cease operation of an RTRF, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting that is consistent with the clinical needs of the resident based on assessment including but not limited to another RTRF, a higher level of care facility, a lower level of care facility, or a home.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 807, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the RTRF; and

(3) Any records required by RSA 151 and He-P 807.

(b) The department shall conduct a clinical and life safety code inspection, as necessary to determine full compliance with RSA 151 and He-P 807 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 807.08(e)(1);

(3) A change in the licensee’s physical location;

(4) A change in licensing classification;

(5) An increase in the number of clients beyond what was authorized under the initial license;

(6) Occupation of space after construction, renovations or structural alterations; or

(7) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the RTRF is in violation of any of the provisions of He-P 807, RSA 151, or other federal or state requirement.

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 807.12(c), within 21 days of the date on the letter that transmits the inspection report.

(f) A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 807.09(b) that the prospective premises are not in full compliance with RSA 151 and He-P 807.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 807 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety or well-being of the clients; and

(3) Does not negatively affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) of RSA 151 or He-P 807 occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegations(s), if proven true, would constitute a violation of any of the provisions of RSA 151 or He-P 807.

(b) When practicable the complaint shall be in writing and shall contain the following information:

(1) The name and address, if known, of the RTRF, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 807.

(c) Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, which include:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed RTRF, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

(3) If the department determines the complaint is unfounded, and does not violate their statutes, rules, or regulations the licensee will be notified in writing of such determination and the department will take no further action; and

(4) If areas of non-compliance are found, require the licensee to submit a POC in accordance with He-P 807.12(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV.

(2) In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by He-P 807.11 (e)(1) to submit a completed application for a license;

(3) If the owner of an unlicensed RTRF does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 807; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 807.13(c)(6).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.12 Administrative Remedies

(a) The department shall, after notice and opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 807, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee;

(4) Monitoring of a license;

(5) Immediate suspension of a license; or

(6) Revocation of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area of non-compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action.

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 807;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 807 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

2. The department determines that the health, safety or well-being of a client will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14-days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 807.13(c)(12);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with (f)(12) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14-days of the written notification from the department; and

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

(1) Impose a fine according to He-P 807.13(c)(6);

(2) Deny the application for a renewal of a license in accordance with He-P 807.13(b)(6); or

(3) Revoke or suspend the license in accordance with He-P 807.13(g).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings if the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department and shall include any evidence that has not yet been reviewed by the department.

(h) Upon receipt of the requested informal dispute resolution made by the applicant, licensee, or administrator, the department shall review the evidence presented and if requested, within the informal dispute resolution request, meet with, in person or via telephone, the applicant, licensee, or administrator.

(i) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect.

(j) The statement of findings or notice to correct shall not be changed, if based on the evidence presented, the statement of findings is determined to be correct.

(k) The department shall provide a written notice to the applicant or licensee notifying the applicant, licensee, or administrator of such determination.

(l) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(m) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(n) An informal dispute resolution shall not be available for any applicant or licensee against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(o) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of clients; or

(2) The presence of conditions in the RTRF that negatively impact the health, safety, or well-being of clients.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 807, which poses a risk of harm a client’s or employee’s health, safety or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 807.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 807.12(d) and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 806.12(c)(5) and has not submitted a revised POC as required by He-P 806.12(c)(5);

(8) The licensee is cited a third time under RSA 151 or He-P 807 for the same violations within the last 5 inspections;

(9) A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

(10) Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 807;

(11) Unless a waiver has been granted the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license and after receipt of an order to cease and desist, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed entity shall be $500.00;

(4) For a failure to transfer a client whose needs exceeds the services or programs provided by the RTRF, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For admission of a client whose needs at the time of registration exceed the services or programs authorized by the RTRF, in violation of RSA 151:5-a, II and He-P 807.15(a), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 807.11(e)(4), the fine for an unlicensed provider or licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 807.06(e), the fine shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 807.08(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 807.08(a)(2), the fine shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 807.08(l), the fine shall be $100.00;

(11) For a refusal to allow access by the department to the RTRF’s premises, programs, services or records, in violation of He-P 807.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(12) For a failure to submit a POC or revised POC, within 21 or 14-days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 807.12(c)(2) and (5), the fine for a licensee shall be $500.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 807.12(c)(8), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement or comply with licensee policies, as required by He-P 807.14(a), (d), and (e), the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified by He-P 807.14(c), the fine for a licensee shall be $500.00;

(16) For providing false or misleading information or documentation, in violation of He-P 807.14(i), the fine shall be $1000.00 per offense;

(17) For failure to meet the needs of a client or clients, as described in He-P 807.18(a) and He-P 807.24(j), the fine for a licensee shall be $1000 per client;

(18) For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 807.09(b)(5), the fine for a licensee shall be $500;

(19) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 807.10, in violation of He-P 807.16(a), the fine for a licensee shall be $500.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 807.07(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-p 807.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(22) When an inspection determines that there is a violation of RSA 151 or He-P 807 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

(23) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 807 shall constitute a separate violation and shall be fined in accordance with He-P 807.13(c), provided that if the applicant or licensee is making good faith efforts to comply with the violations of the provisions of RSA 151 or He-P 807, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of clients when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 807 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a RTRF’s license has been denied or revoked, the applicant, licensee or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years, if the enforcement action pertained to their role in the RTRF.

(k) The 5-year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if appeal is filed; or

(2) The date a final decision upholding the action of the department, if a request for a hearing was made and a hearing was held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 807.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 807.

(o) Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, regulations, codes, and ordinances as applicable.

(b) The licensee shall admit only those clients whose needs can be met by the RTRF.

(c) The licensee shall have a system to regularly identify the daily census, including times any client is absent from the RTRF.

(d) The licensee shall define, in writing, the scope and type of services to be provided by the RTRF.

(e) The licensee shall comply with the Patients’ Bill of Rights as set forth in RSA 151:19-30.

(f) The licensee shall have a written policies and procedures to include:

(1) The rights and responsibilities of all clients in accordance with the Patients’ Bill of Rights under RSA 151:21;

(2) The policies described in He-P 807.14, He-P 807.16, He-P 807.19, and He-P 807.26; and

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(g) The licensee shall develop and implement written policies and procedures governing the operation of the RTRF and all services provided by the facility and for:

(1) Reviewing the policies and procedures every 3 years; and

(2) Revising them as needed.

(h) The licensee shall assess and monitor the quality of care and service provided to clients on an ongoing basis.

(i) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(j) The licensee shall not:

(1) Advertise or otherwise represent itself as operating a RTRF, unless it is licensed; or

(2) Advertise that it provides services that it is not authorized to provide.

(k) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(l) Licensees shall:

(1) Meet the needs of the clients during those hours that the clients are in the care of the RTRF;

(2) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the RTRF;

(3) Appoint an administrator;

(4) Verify the qualifications of all personnel;

(5) Provide sufficient numbers of qualified personnel to meet the needs of clients during all hours of operation;

(6) Provide sufficient supplies, equipment, and lighting to meet the needs of the clients;

(7) Require all personnel to follow the orders of the licensed practitioner for every client that has such orders and encourage the client to follow the licensed practitioner’s orders;

(8) Initiate action to maintain the RTRF in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances; and

(9) Implement any POC that has been accepted by the department.

(m) The licensee shall consider all clients competent and capable of making health care decisions unless the client:

(1) Has a guardian appointed by a court;

(2) Has a durable power of attorney for health care or surrogate decision making that has been activated; or

(3) Is an un-emancipated minor.

(n) In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

(1) Telephone at 603-271-4496;

(2) Telephone at 603-271-5300 after business hours; or

(3) Fax to 603-271-0545.

(o) If the licensee registers and treats a client who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The license and current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with, He-P 807.09 (d)for the previous 12 months;

(3) A copy of the patients’ bill of rights;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) The licensee’s evacuation floor plan identifying the location of and access to all fire exits; and

(6) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345;

(q) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 807 as authorized by RSA 151:6 and RSA 151:6-a.

(r) A licensee shall, upon request, provide a client or the client’s guardian, agent, or surrogate decision-maker if any, with a copy of his or her client record pursuant to the provisions of RSA 151:21, X.

(s) All records required for licensing shall be legible, current, accurate and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(t) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

(3) Systems to prevent tampering with information pertaining to clients and staff.

(u) The licensee shall develop policies and procedures regarding the release of information contained in client records.

(v) The licensed premises shall comply with all state and local:

(1) Health requirements;

(2) Building ordinances;

(3) Fire ordinances; and

(4) Zoning ordinances.

(w) Smoking shall be prohibited in the RTRF per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

(x) For reportable incidents, allegations of abuse, neglect, mistreatment or misappropriation of property, the licensee shall have responsibility for:

(1) Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident; and

(2) Faxing to 603 271-4968, or if a fax machine is not available, submitting via regular mail, postmarked within 24 hours of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 24 hours of the reportable incident:

a. The RTRF name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of client(s) involved in or witnessing the incident;

e. The date and time of the incident;

f. The action taken in direct response to the incident, including any follow-up;

g. If medical intervention was required, who provided the medical intervention and the date and time that the medical intervention was provided;

h. When the client’s guardian, agent, surrogate decision-maker, or personal representative, if any, was notified;

i. The signature of the person reporting the incident; and

j. The date and time the client’s licensed practitioner was notified, if applicable; and

(3) Within 5 days, submit a completed investigation report to the department containing the following information:

a. All items referenced in (1) above;

b. The names and results of interview(s) with all personnel, resident(s) or other individuals involved in the reportable incident, including all applicable statement signatures; and

c. The action taken by the licensee in direct response to the incident(s), including any and all follow-up.

(4) Immediately notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client who has been assessed or is known as being a danger to self or others, has eloped after the licensee has searched the building and the grounds of the RTRF; and

(5) Submit additional information, if required to the department, to support the incident report referenced in (x)(3) above.

(y) The licensee shall provide the following core services:

(1) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided regarding:

a. The clients’ functioning, safety and whereabouts;

b. The clients’ health status, including the provision of intervention as necessary or required; and

c. Personnel safety.

(2) Emergency response and crisis intervention;

(3) Medication services in accordance with He-P 807.17;

(4) Food services in accordance with He-P 807.20;

(5) Housekeeping, laundry and maintenance services;

(6) On-site activities designed to sustain and promote physical, intellectual, social and spiritual well-being of all clients;

(7) Assistance in arranging medical and dental appointments, including arranging transportation to and from such appointments and reminding the clients of the appointments; and

(8) Personal supervision of clients when required to offset deficits that may pose a risk to self or others if the client is not supervised.

(z) The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(4):

(1) Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

(2) Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

(3) Behavioral health care services.

(aa) The licensee shall:

(1) Provide basic supplies necessary for clients to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper; and

(2) Not be responsible for the cost of purchasing a specific brand of product at a client’s request.

(ab) The licensee shall educate personnel about the needs and services required by the clients under their care.

(ac) Physical or chemical restraints shall only be used as allowed by RSA 151:21, IX.

(ad) Immediately after the use of a physical or chemical restraint, the client’s guardian or agent, if any, and the department shall be notified of the use of restraints.

(ae) The RTRF shall:

(1) Have policies and procedures on:

a. What type of emergency restraints may be used;

b. When restraints may be used; and

c. Who may authorize the use of restraints; and

(2) Provide personnel with education and training on the limitations and the correct use of restraints.

(af) The use of physical restraints shall be allowed only as defined under He-P 807.03(bf).

(ag) The RTRF shall document accidents, injuries, and reportable incidents and include:

(1) The date and time of the occurrence;

(2) A description of the occurrence, including identification of injuries, if applicable;

(3) The actions taken;

(4) The signature of the person documenting the unusual incident; and

(5) If medical intervention was required, the date and time that the emergency contact person and guardian or agent, if any, and the licensed practitioner were notified.

(ah) The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(ai) The licensee shall give a client a written notice as follows:

(1) For an increase in the cost or fees for any RTRF services 30 days advanced notice; or

(2) For an involuntary change in room or bed location, 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

(aj) The licensee shall determine the smoking status of the RTRF.

(ak) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P 807.24(f).

(al) The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other clients or other household members.

(am) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

(an) The licensee shall respond to a notice of areas of non-compliance by providing a POC in accordance with He-P 807.12(c).

(ao) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.15 Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria

(a) The licensee shall only admit an individual or retain a client whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the RTRF.

(b) A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

(c) The client shall be transferred or discharged, as defined in RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

(1) The client’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

(2) The client cannot be safely evacuated in accordance with Saf-C 6000;

(3) The client or the client’s guardian, if any, determines that the client shall leave the facility;

(4) The client is a danger to himself/herself or others;

(5) The client completed the program or was transferred based on changes in the client’s functioning; or

(6) The client was terminated from the program based on one of the following:

a. The client was administratively discharge;

b. The client was in non-compliance with the program;

c. The client left the program before completion against advise of treatment staff; or

d. The client is inaccessible.

(d) The licensee shall develop a discharge plan with the input of the client and the guardian or agent, if any.

(e) The following documents shall accompany the client upon transfer:

(1) The most recent client assessment tool, care plan, and quarterly progress notes;

(2) The most recent nursing assessment, if applicable;

(3) The most recent multi-disciplinary care plan, if applicable;

(4) Current medication records; and

(5) A licensed practitioner’s order for transfer, if applicable.

(f) If the transfer or discharge referenced in (c) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

(g) Notwithstanding (a) and (c) above, a client receiving hospice care from a licensed home health hospice caregiver, may remain in the RTRF upon written agreement with the client or his/her legal guardian and the RTRF.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the RTRF;

(2) Meets the requirements of He-P 807.18(k) and (l);

(3) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(4) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (2) above.

(b) At the time of application for admission, the licensee shall provide the client a written copy of the clientele service agreement pursuant to RSA 161-J:4.

(c) In addition to (b) above, at the time of admission, the licensee shall provide a written copy to the client and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions contract including the following information:

a. The basic daily, weekly, or monthly fee;

b. A list of the core services required by He-P 807.14 that are covered by the basic fee;

c. Information regarding the timing and frequency of cost of care increases;

d. The time period covered by the admissions contract;

e. The RTRF’s house rules;

f. The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

g. The RTRF’s responsibility for client discharge planning;

h. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The RTRF’s responsibility for arranging services; and

3. The fee and payment for services, if known;

i. The licensee’s policies and procedures regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the client and provided on the RTRF premises;

5. Handling of client funds pursuant to RSA 151:24 and He-P 807.14(t);

6. Storage and loss of the client’s personal property; and

7. Smoking;

j. The licensee’s medication management services; and

k. The list of grooming and personal hygiene supplies provided by the RTRF as part of the basic daily, weekly or monthly rate;

(2) A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the RTRF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) The RTRF’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29; and

(4) Information on advanced directives.

(d) The RTRF shall perform a preliminary assessment of each client’s needs and develop a preliminary care plan upon admission or within 24 hours following admission.

(e) A comprehensive evaluation shall be completed within 30 days for neuro-rehabilitation facilities.

(f) The evaluation required by (e) above shall:

(1) Be completed in consultation with the client’s licensed practitioner, as applicable, and guardian or agent, if any;

(2) Be reviewed every 6 months or after any significant change as defined in He-P 807.03(bl);

(3) Include a medication review;

(4) Include a review of the client’s clinical and treatment record; and

(5) Include an assessment for pain, vital signs, physical, cognitive, mental, and behavioral status, as well as an assessment as to how the client is psychologically adapting to his or her social environment.

(g) A care plan or treatment plan shall be written and shall include the date the problem or need was identified, the client goal or treatment to be taken, the date of re-evaluation, and responsible person(s), as applicable.

(h) The care plan or treatment plan shall:

(1) Be completed within 24 hours of the comprehensive evaluation;

(2) Be updated following the completion of each future assessment;

(3) Be made available to personnel who assist clients in the implementation of the plan; and

(4) Address the needs identified by the comprehensive evaluation in (e) above.

(i) The care plan or treatment plan as defined in He-P 807.03(k) and required by (g) above, shall include:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal or objective of the plan;

(4) The action or approach to be taken;

(5) The responsible person(s) or position; and

(6) The date of reevaluation, review, or resolution.

(j) Progress notes shall be written at least monthly and include at a minimum:

(1) Treatment care plan outcomes;

(2) Changes in the client’s physical, functional, and mental abilities;

(3) Changes in behavior, such as eating habits, sleeping pattern, and relationships; and

(4) Summary of protective care that has been provided.

(k) At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

(l) All personnel shall follow the orders of the licensed practitioner for each client and encourage clients to follow the practitioner’s orders.

(m) The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the RTRF.

(n) The health examination in (m) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies;

(7) Dietary needs; and

(8) Pain assessment for neuro-rehabilitation clients.

(o) Each client shall have at least one health examination every 12 months, unless the licensed practitioner determines that an annual physical examination is not necessary and specifies in writing an alternative time frame, or the client refuses in writing.

(p) A client may refuse all care and services.

(q) When a client refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the client and guardian of the potential results of their refusal;

(2) Notify the licensed practitioner of the client’s refusal of care; and

(3) Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

(r) The licensee shall maintain an information data sheet in the client’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

(s) The information data sheet in (r) above shall include:

(1) Full name and the name the client prefers, if different;

(2) Name, address, and telephone number of the client’s next of kin, guardian, or agent, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives; and

(10) Any other pertinent information not specified in (1)-(9) above.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.17 Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner, except as allowed in (b) below.

(b) Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24 hours or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the RTRF;

(2) Reorder medications for use at the RTRF; and

(3) Receive and record new medication orders.

(d) For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

(e) Each medication order shall legibly display the following information:

(1) The client’s name:

(2) The medication name, strength, and prescribed dose and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the licensed practitioner.

(f) For PRN medications the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

(g) All prescription medications brought by a client shall be in their original containers and comply with (e) above.

(h) Each prescription medication shall legibly display the following information:

(1) The client’s name;

(2) The medication name, strength, and the prescribed dose and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered;

(6) The name of the prescribing licensed practitioner; and

(7) The expiration date of the medication(s).

(i) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee with the client’s name and shall be exempt from (h)(2)-(6) above.

(j) The label of all medication containers maintained in the RTRF shall match the current written orders of the licensed practitioner unless authorized by (m) below.

(k) Only a pharmacist shall make changes to prescription medication container labels.

(l) Any change or discontinuation of medications taken at the RTRF shall be pursuant to a written order from a licensed practitioner.

(m) When the licensed practitioner changes the dose of a medication and personnel of the RTRF are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the RTRF’s written procedure, indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(n) Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

(o) All prescription medications, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be kept on the client’s person or stored in the client’s room, shall be stored as follows:

(1) Over-the-counter medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner;

(2) Medications shall be kept in a storage area that is:

a. Locked and accessible only to authorized personnel;

b. Organized to allow correct identification of each client's medication(s);

c. Illuminated in a manner sufficient to allow reading of all medication labels; and

d. Equipped to maintain medication at the proper temperature;

(3) Schedule II controlled substances, as defined by RSA 318-B:1-b, shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel; and

(4) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(p) Over-the-counter (OTC) medications shall be handled in the following manner:

(1) Only original, unopened containers of OTC medications shall be allowed to be brought into the program;

(2) OTC medication shall be stored in accordance with (p)(1) above; and

(3) OTC medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(q) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(r) Except as allowed by (x) below, any contaminated, expired or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first.

(s) Controlled drugs shall be destroyed only in accordance with state law and;

(1) Be accomplished in the presence of at least 2 people; and

(2) Be documented in the record of the client for whom the drug was prescribed.

(t) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(u) When a client is going to be absent from the RTRF at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering, as described in (ac) and (ad) below.

(v) If a client is going to be absent from the RTRF at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the RTRF.

(w) Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian or agent, if any.

(x) A written order from a licensed practitioner shall be required annually for any client who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(y) Clients shall receive their medications by one of the following methods:

(1) Self-administered medication as allowed by (z) below;

(2) Self-directed administration of medication as allowed by (aa) below;

(3) Self-administered with supervision as allowed by (ab) and (ac) below; or

(4) Administered by individuals authorized by law.

(z) For clients who self-administer medication as defined in He-P 807.03(br) the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the client to self-administer medications without supervision;

b. Authorizing the client to store the medications in their room; and

c. Identifying the medications that may be kept in the client’s room;

(2) Evaluate the client on a 6 month basis or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-administer;

(3) Have the client store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

(4) Have a copy of the key to access the locked medication storage area in the client’s room; and

(5) Allow the client to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

(aa) The licensee shall allow the client to self-direct administration of medications as defined in He-P 807.03(bt) if the client:

(1) Has a physical limitation due to a diagnosis that prevents them from self-administration;

(2) Receives evaluations every 6 months or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-direct administration of medications;

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the RTRF to file the verification in their client record; and

(4) Verbally directs personnel to:

a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing or cutting; and

b. Assist the client to apply, ingest or instill the ordered dose of medication.

(ab) If a client self-administers medication with supervision, as defined in He-P 807.03(bs), personnel shall:

(1) Remind the client to take the correct dose of his or her medication at the correct time;

(2) Place the medication container within reach of the client;

(3) Remain with the client to observe the client taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the client's daily medication record that they have supervised the client taking his or her medication; and

(5) Document in the client’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken.

(ac) If a client self-administers medication with supervision, personnel shall not physically handle the medication in any manner.

(ad) Medication administered by individuals authorized by law to administer medications shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

(ae) Personnel shall remain with the client until the client has taken the medication.

(af) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

(ag) A licensed nursing assistant (LNA) who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the RTRF:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

(3) Medicinal topical products to intact skin as ordered by the licensed practitioner.

(ah) Except for those clients who self-administer medication, the licensee shall maintain a written record for each medication taken by the client at the RTRF that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises or assists the client taking medication;

(5) For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(ai) Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a client with self-administration with supervision, self-directed administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

(aj) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner or pharmacist, whether in-person or through other means such as electronic media.

(ak) The medication supervision education program required by (ai) above shall include:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights which are as follows:

a. The right client;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. Administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as antihypertensives or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(al) The administrator may accept documentation of training required by (ai) above if it was previously obtained by the applicant for employment at another licensed facility.

(am) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

(an) The written documentation of the report in (am) above shall be maintained in the client’s record.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the RTRF to meet the needs of clients at all times.

(b) There shall be at least one awake personnel member on duty at all times while clients are in the facility.

(c) The licensee shall develop a job description for each position in the RTRF containing:

(1) Position title;

(2) Duties of the position;

(3) Physical requirements of the position; and

(4) Qualifications and educational requirements of the position.

(d) For all applicants for employment, volunteers, and independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d;

(2) Review the results of the criminal records check in accordance with (e) below;

(3) Verify the qualifications of all applicants prior to employment;

(4) Verify that the applicant is not listed on the BEAS state registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49; and

(5) Verify the applicant is licensed, registered, or certified if required by state statute.

(e) Unless a waiver is granted in accordance with (g) below, the licensee shall not offer employment, contract with, or otherwise engage a person in (d) above if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of the clients.

(f) If the information identified in (e) above regarding any person subject to (d) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(g) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, or the person shall not or no longer shall reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

(h) The licensee shall:

(1) Not employ, contract with, or engage any person in (d) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

(i) In lieu of (d) and (g), the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (d) and (g) and do not meet the criteria in (e) and (g).

(j) The waiver in (g)(2) above shall be permanent for as long as the individual remains in the same job unless additional convictions or findings under (e) above occur.

(k) Administrators shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and one year of relevant experience working in a health related field;

(2) A New Hampshire license as an RN, with at least one year relevant experience working in a health related field; or

(3) An associate’s degree from an accredited institution plus 3 years relevant experience in a health related field.

(l) All administrators shall obtain and document in accordance with (s)(7) and (s)(8) below, 12 hours of continuing education related to the operation and services of the RTRF each annual licensing period.

(m) All personnel shall be at least 18 years of age if working as direct care personnel unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(2) Involved in an established educational program working under the supervision of licensed staff.

(n) The licensee shall inform personnel of the line of authority at the RTRF.

(o) Prior to having contact with clients or food, personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(p) In lieu of (o)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (o)(1) and (3) above before working at the RTRF.

(q) Prior to having contact with clients or food, personnel shall receive a tour of the RTRF and an orientation that explains the following:

(1) The clients’ rights in accordance with RSA 151:20;

(2) The RTRF’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 807.21;

(7) The facility confidentiality requirements;

(8) Grievance procedures for both staff and clients;

(9) The procedures for food safety for personnel involved in preparation, serving and storing of food; and

(10) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(r) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s client’s rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The licensee’s policies and procedures; and

(5) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(s) The licensee shall provide an annual review of its policies and procedures for self-administration of medication, self-administration of medication with supervision, and self-directed medication administration to all direct care personnel, as applicable.

(t) The RTRF shall maintain a separate employee file for each employee, which shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (d) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (q) above;

(7) Information as to the general content and length of all in‑service or educational programs attended;

(8) Record of satisfactory completion of all required education programs required above;

(9) A copy of a current, valid driver’s license, including proof of insurance, if the employee transports clients;

(10) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(11) The statement required by (u) below; and

(12) The results of the registry checks in (h) above

(u) The RTRF shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (s)(1), (3), (4), (6), and (8)-(12) above; and

(2) For independent contractors, the information in (s)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (o) above may be substituted for (s)(4), (10), and (12) above, if applicable.

(v) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a client; or

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

(w) An individual shall not have to re-disclose any of the matters in (u) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

(x) An individual shall disclose any new convictions, as soon as practicable, to the facility administrator. Any such convictions shall be reported to the department for review.

(y) The licensee shall protect and store in a secure and confidential manner all records described in (s) and (t) above.

(z) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

(aa) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(ab) The RTRF shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(ac) The policy in (aa) above shall include provisions relating to the following:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Procedures for voluntary self-referral by employees who are misusing substances;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion of misuse or diversion by personnel exists;

(6) Employee assistance procedures;

(7) Confidentiality of investigations, reports, and resolutions of controlled drug misuse or diversion;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance misuse, and diversion prevention policy.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.19 Client Records

(a) The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the RTRF.

(b) Client records shall contain the following:

(1) A copy of the client’s service agreement and all documents required by He-P 807.16(c);

(2) Identification data, including:

a. Vital information including the client’s name;

b. Home address;

c. Home telephone number;

d. Name, address and telephone number for emergency contact;

e. Date of birth, and

f. Guardian, agent, or surrogate decision-maker where applicable.

(3) The name and telephone number of the client’s licensed practitioner(s);

(4) The client’s health insurance information;

(5) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(6) A record of the health examination(s) in accordance with He-P 807.16(m) and (o);

(7) Written, dated and signed orders for the following:

a. All medications, treatments, and special diets, as applicable; and

b. Laboratory services and consultations performed at the RTRF;

(8) Results of any laboratory tests, X-rays, or consultations performed at the RTRF;

(9) All evaluations, assessments, and treatment plans, including documentation that the client and the guardian or agent, if any, has participated in the development of the care and treatment plans;

(10) All admission and progress notes;

(11) If services are provided at the RTRF by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

(12) Documentation of any alteration in the client’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including practitioner notification;

(13) Documentation of any medical or specialized care;

(14) Documentation of reportable incidents;

(15) The consent for release of information signed by the client, guardian, or agent, if any;

(16) Discharge summary, planning, and referrals;

(17) Transfer or discharge documentation, including notification to the client, guardian, agent, or surrogate decision-maker, if any, of involuntary room change, transfer or discharge, if applicable;

(18) The information required by He-P 807.17(ai) as applicable;

(19) Information data sheet, which contains the information required by He-P 807.16(s);

(20) Documentation of nurse delegation of medications as required by the nurse practice act, as applicable; and

(21) Documentation of a client’s refusal of any care or services.

(c) Client records and client information shall be kept confidential and only provided in accordance with HIPAA, or any other applicable provision of law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur.

(e) When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

(f) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to residents and staff; and

(3) Systems to prevent tampering with information pertaining to residents and staff.

(g) Records shall be retained for at least 7 years after discharge, except that when the client is a minor, records shall be retained for at least 7 years after the minor reaches the age of majority.

(h) The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the RTRF ceases operation.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.20 Food Services

(a) The licensee shall provide food services that:

(1) Meet the US Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as listed in Appendix A;

(2) Meet the special dietary needs associated with health or medical conditions for each client as identified in their client record; and

(3) Offer at least 3 meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

(b) Snacks shall be available between meals and at bedtime if not contraindicated by the client’s care plan.

(c) If a client refuses the item(s) on the menu, a substitute shall be offered.

(d) Each day’s menu shall be posted in a place accessible to food service personnel and clients.

(e) A dated record of menus as served shall be maintained for at least the previous 4 weeks.

(f) The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

(g) If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

(h) All food and drink provided to the clients shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

(3) Served at the proper temperatures;

(4) Labeled, dated, and stored at proper temperatures; and

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling and all other sources of contamination.

(i) The use of outdated or unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

(j) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(k) All work surfaces shall be cleaned and sanitized after each use.

(l) All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(m) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(n) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(o) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(p) Garbage or trash in the kitchen area shall be placed in lined containers with covers.

(q) All RTRF persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.21 Infection Control

(a) The RTRF shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases to include:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

(3) The management of clients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

(5) The reporting of infectious and communicable diseases as required by He-P 301; and

(6) Maintenance of a sanitary physical environment.

(b) The infection control education program shall address:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(c) Personnel infected with a disease or illness transmissible through food, fomites, or droplets shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

(d) Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

(e) Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the RTRF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(f) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(g) Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A.

(h) The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting personnel and clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

(i) The RTRF shall develop and implement a POCT policy, if it provides POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.22 Sanitation

(a) The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institute “Guidelines for the Design and Construction of Residential Health, Care, and Support Facilities, Table 2.5-1” (2018 edition), available as noted in Appendix A, and summarized as follows:

(1) 70-120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures;

(2) 140 degrees Fahrenheit for dietary areas, except that provisions shall be made to provide 180 degrees Fahrenheit rinse water at the ware washer, which may be by separate booster, unless a chemical rinse is provided; and

(3) 160 degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven processes which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures specified by the manufacturer.

(f) All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and client supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(3) Soiled materials, linens and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

(p) Any RTRF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services ,shall notify the department.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.23 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

(b) Equipment providing heat within an RTRF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood or pellet stove, or wood or pellet furnace shall:

(1) Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the client(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(2) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Unvented fuel-fired heaters shall not be used in any RTRF.

(f) Plumbing shall be sized, installed, and maintained in accordance with the International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155:A:10,V.

(g) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(h) Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

(i) The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by clients.

(j) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(k) All hand-washing facilities shall be provided with hot and cold running water.

(l) In an RTRF licensed for 16 or fewer clients, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

(m) In an RTRF licensed for 17 or more clients, there shall be at least 100 square feet for each client in each private bedroom and at least 80 square feet for each client in a semi-private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities.

(n) Existing bedrooms in an RTRF licensed prior to the 2019 effective date of these rules shall be exempt from (l) and (m) above.

(o) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the client to reach his/her bedroom without passing through the room of another client;

(3) Have a side hinge or pocket door that meets applicable codes, and not a folding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors, and other rooms by floor to ceiling walls; and

(6) Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the assessment.

(p) The licensee shall provide the following for the clients’ use, as needed:

(1) A bed appropriate to the needs of the client;

(2) A firm mattress that complies with Saf-C 6000 under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

(3) Clean linens, blankets, and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) Adequate lighting;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades or curtains that provide privacy.

(q) The client may use his or her own personal possessions provided they do not pose a risk to the client or others.

(r) The resident or guardian may indicate and the home shall document that the resident does not wish or need to have one of more of the items in (p) above and the reason for the removal.

(s) The licensee shall provide the following rooms to meet the needs of clients:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all clients.

(t) Each licensee shall have a communication system in place so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

(u) Lighting shall be available to allow clients to participate in activities such as reading, needlework or handicrafts.

(v) All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(w) Screens shall be provided for:

(1) Doors;

(2) Windows; or

(3) Other openings to the outside.

(x) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (x) above.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.24 Fire Safety

(a) All RTRFs shall meet at a minimum the residential board and care chapter of NFPA 101 as adopted by the department of safety in Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(b) All RTRFs, including those with 3 or fewer clients, shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the RTRF’s electrical service, or wireless, as approved by the state fire marshal for the RTRF;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building with a maximum travel distance to each extinguisher not to exceed 50 feet and maintained as follows:

a. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

b. Records for manual inspection, or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed;

c. Annual maintenance shall be performed on each extinguisher by trained personnel, and a tag or label shall be securely attached that indicates that maintenance was performed; and

d. The components of the electronic monitoring device or system in a. above, if used, shall be tested and maintained annually in accordance with the manufacturers listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) An emergency and fire safety program shall be developed and implemented to provide for the safety of clients and personnel.

(d) Immediately following any fire or emergency, including but not limited to, gas leak or evacuation of the facility due to flooding or an explosion, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

(e) The written notification required by (e) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian or a person with durable power of attorney (DPOA) over the client, at the time of admission and a summary of the client’s responsibilities shall be provided to the client. Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(g) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available annually, and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, prior to the change.

(h) Fire drills shall be conducted as follows:

(1) For buildings constructed to the residential board and care or one and two family dwelling chapters of the life safety code (NFPA 101), the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All RTRF facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape, except as noted in c. above;

e. shall complete a written record of fire drills that include the following:

1. The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. At admission, the facility shall conduct a client Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the clients’ needs during a fire drill including mobility, assistance to evacuate, staff needed, risk of resistance, clients ability to evacuate on his or her own, and choosing an alternate exit; and

h. The fire drills for facilities built to the residential board and care chapter of the life safety code (NFPA 101), shall be permitted to be announced, in advance, to the clients just prior to the drill; and

(2) For RTRFs originally constructed to the health care occupancy chapter of the life safety code and to the codes, rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed engineer qualified in fire protection, the state fire marshal’s office, and the department pursuant to He-P 807.07, to meet the health care occupancy chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire, and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter-in-place plan, also known as defend-in-place plan, shall have this plan approved by the department per the state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. I f the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point, and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4 . The amount of time taken to completely evacuate the facility to an approved area of refuge or through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill, if any;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility.

(i) Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code including but not limited to:

(1) Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

a. Minimum distance of 6.1 m (20 ft);

b. Minimum distance of 1.5 m (5 ft) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

c. A gas cabinet constructed per NFPA 30, Flammable and Combustible Liquids Code, or NFPA 55, Compressed Gases and Cryogenics Fluids Code, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

(2) Cylinders shall be protected from damage by means of the following specific procedures:

a. Oxygen cylinders shall be protected from abnormal mechanical shock which is liable to damage the cylinder, valve, or safety device;

b. Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

c. Cylinders shall be protected from tampering by unauthorized individuals;

d. Cylinders or cylinder valves shall not be repaired, painted, or altered;

e. Safety relief devices in valves or cylinders shall not be tampered with;

f. Valve outlets clogged with ice shall be thawed with warm, not boiling, water;

g. A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

h. Sparks and flame shall be kept away from cylinders;

i. Even if they are considered to be empty, cylinders shall not be used as rollers or supports or for any purpose other than that for which the supplier intended them;

j. Cylinders exceeding size E and containers larger than 45 kg (100 lb) weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

k. Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

l. Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

(3) Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

a. Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

b. Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

c. Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

d. The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

e. Oxygen shall be referred to as “oxygen”, not air, and liquid oxygen shall be referred to as “liquid oxygen”, not liquid air;

f. Oxygen shall not be used as a substitute for compressed air;

g. The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

h. Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels/tags used for indicating cylinder status, for example, full, in use, and empty;

i. The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

j. Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, heat ducts;

k. Very cold cylinders or containers shall be handled with care to avoid injury; and

l. A precautionary sign, readable from a distance of 1.5 m (5 ft), shall be displayed on each door or gate of the storage room or enclosure, and shall include the following wording at a minimum:

CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING

(j) If the licensee has chosen to allow smoking under He-P 807.14(w), an outside location or a room used only for smoking shall be provided which:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non-combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act and He-P 1900.

(k) Each licensee shall develop a written emergency plan that covers:

(1) Loss of electricity;

(2) Loss of water;

(3) Loss of heat;

(4) Bomb threat;

(5) Severe weather;

(6) Fire;

(7) Gas leaks;

(8) Unexplained client absences; and

(9) Any situation that requires evacuation of the RTRF.

(l) Each licensee shall:

(1) Annually review and revise, as needed, its emergency plan;

(2) Submit its emergency plan to the local emergency management director for review and approval when initially written and whenever the plan is revised; and

(3) Maintain documentation on‑site which establishes that the emergency plan has been approved as required under (2) above.

(m) Each RTRF that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of the RTRF’s their local community provided that:

(1) It has a generator capable of supplying the entire facility;

(2) It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

(3) It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

N.H. Code Admin. R. Ann. He-P 807.25 Emergency Preparedness

(a) Each facility shall have an emergency management committee, of which the facility administrator must be a member.

(b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

(c) The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

(1) Elected state and local officials;

(2) Police, fire, civil defense, and public health professionals;

(3) Environment, transportation, and hospital officials;

(4) Facility representatives; and

(5) Representatives from community groups and the media.

(d) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan as described in (e) and (f) below;

(2) The roles and responsibilities of the committee members;

(3) A description of how the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(e) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(f) The plan in (e) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather or human-caused emergency such as missing residents and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as

appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the ICS in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment including the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention,protection, and mitigation strategies, and to determine the outcome of prior strategies at least annually;

(12) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. Heating, ventilation, and air conditioning (HVAC);

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure

that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that

creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

(14) Include the management of residents, particularly with respect to physical and clinical issues, to include:

a. Relocation of residents, with their medical record, including the medicine administration records, if time permits;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the NewHampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(g) The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not otherwise involved in the drill;

(2) Drills shall evaluate program plans, procedures, training, and capabilities toidentify opportunities for improvement;

(3) The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill. The debriefing shall include all key individuals, including observers,

administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

(h) For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

(1) Assumptions for calculations of food and water supplies, for maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, rotation of products, and contracts and memorandums of understanding with food and water suppliers such as;

(a) Enough refrigerated, perishable foods for a 3-day period;

(b) Enough non-perishable foods for a 7-day period; and

(c) Potable water for a 3-day period.

(2) Designated storage location(s); and

(3) Non-food and water, back-up supplies including but not limited to medical, office, and other supplies necessary to continue operation of the facility and provide necessary care and oversight of residents during the emergency.

History

• #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19
• #12962, eff 12-31-19

Part He-P 808 Laboratories and Laboratory Services Rules

N.H. Code Admin. R. Ann. He-P 808.01 Purpose

The purpose of this part is to set forth the licensing requirements for all laboratories, whether stationary or mobile, and laboratory services pursuant to RSA 151:2, I(c).

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a laboratory, except:

(a) The facilities listed in RSA 151:2, II (a)-(i);

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i);

(c) All laboratories which conduct testing solely for forensic purposes, pursuant to RSA 151:2, II(i);

(d) All entities that are licensed in accordance with RSA 153-A by the department of safety as providers of transporting or non-transporting emergency medical care;

(e) All entities that perform waived testing for the sole purpose of risk assessment and which test results are not used for the diagnosis or treatment of disease;

(f) Laboratories that are duly licensed by the state of New Hampshire under this rule shall not be required to be licensed as a collection station under He-P 817, to perform the functions of a collection station; and

(g) Laboratories that are owned, operated, and located on the licensed premises of a hospital licensed in accordance with RSA 151:2, I(a) and He-P 802.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY RULE, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; amd by #13214, EMERGENCY RULE, eff 6-17-21, EXPIRED: 12-14-21; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.03 Definitions

(a) “Administrator” means the licensee or an individual appointed by the licensee who has responsibility for all aspects of the daily operations of the laboratory.

(b) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license for a laboratory pursuant to RSA 151:2, I(c).

(c) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 808, or other federal or state requirements.

(d) “Change of ownership” means the transfer in the controlling interest of an established laboratory to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(e) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

(f) “Patient” means any person receiving services from a laboratory licensed in accordance with RSA 151 and He-P 808.

(g) “Patient record” means a separate file maintained for each patient, which includes all documentation required by RSA 151 and He-P 808, and as required by federal and state law.

(h) “Commissioner” means the commissioner of the department of health and human services or the commissioner’s designee.

(i) “Days” means calendar days unless otherwise specified in the rule.

(j) “Department” means the New Hampshire department of health and human services.

(k) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified deficiencies.

(l) “Emergency” means an unexpected occurrence or set of circumstances, which requires immediate, remedial attention.

(m) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(n) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 808.

(o) “Facility” means ”facility” as defined in RSA 151:19, II.

(p) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(q) “Independent contractor” means an individual or business entity working under the supervision of the licensee but not employed by the licensee.

(r) “Infectious waste” means those items specified by Env-Sw 904.

(s) “Inspection” means the process followed by the department to determine an applicant or a licensee's compliance with RSA 151 and He-P 808 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 808.

(t) “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease.

(u) “Laboratory director” means the person who shall provide overall management and direction for all laboratory testing procedures.

(v) “License” means the document issued to an applicant or licensee of a laboratory which authorizes operation, in accordance with RSA 151 and He-P 808, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

(w) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized that the laboratory is licensed for.

(x) “Licensed premises” means the building(s), other structure(s), or mobile laboratory vans, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. It does not include the private residence of a patient receiving services from an agency licensed under the authority of RSA 151.

(y) “Licensee” means any individual, agency, partnership, corporation, federal, state, county or local government entity, association, or other legal entity to which a license has been issued pursuant to RSA 151.

(z) “Licensing classification” means the specific category of services authorized by a license.

(aa) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(ab) “Mobile laboratory van” means a vehicle capable of traveling under its own power or being towed from site to site and fully equipped to meet all the requirements specified in section He-P 808.21.

(ac) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include “repair” or “replacement” of interior finishes.

(ad) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(ae) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(af) “Personnel” means an individual who is employed by the licensee, a volunteer, or an independent contractor.

(ag) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of the clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of complaint investigation conducted pursuant to RSA 151:6.

(ah) “Procedure” means a licensee's written, standardized method of performing duties and providing services.

(ai) “Qualification” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(aj) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(ak) “State fire code” means “state fire code” as defined in RSA 153:1.

(al) “State monitoring” means the placement of individuals by the department at a laboratory to monitor the operation and conditions of the facility.

(am) “Specimen” means a portion of tissue, body fluid, or material from a human body.

(an) “Technical consultant” means an individual qualified as a technical consultant by 42 CFR § 493.1411.

(ao) “Volunteer” means an unpaid person who assists with the provision of laboratory services, and who does not provide direct care or services to patients.

(ap) “Waived testing” means all laboratory tests categorized as waived by 42 CFR § 493.

(aq) “Waiver” means a request for an alternative means of satisfying a rule requirement in He-P 808.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.04 License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department, except that subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile laboratory vans:

(1) A completed application form entitled “Application for Residential and or Health Care License (Laboratories and Collecting Stations),” (July 2023 edition) signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government department if a government unit, affirming to the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

(2) A floor plan of the prospective laboratory;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability company; or

c. “Certificate of Trade Name,” if a sole proprietorship;

(4) The applicable fee in accordance with RSA 151:5, XXIII, payable in cash, or if paid by check or money order, in the exact amount of the fee and made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the qualifications, and copies of applicable licenses, for the administrator and laboratory director;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code and any local ordinances; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(7) If the laboratory uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02, or, if a public water supply is used, a copy of a water bill;

(8) The results of a criminal records check for the applicant, the licensee, if different than the applicant, the laboratory director, and the administrator, as applicable. The results must include criminal history from the state of New Hampshire; and

(9) List of all tests performed and a copy of the CLIA certificate.

(b) The applicant shall mail or hand deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 808.04(a), or He-P 808.21 for mobile laboratory vans, have been received.

(b) If an application does not contain all of the items required by He-P 808.04(a) or He-P 808.21, the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted under He-P 808.17(f), the department shall deny a license request if it determined that the applicant, licensee, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, theft, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) Following an inspection, a license shall be issued if the department determines that an applicant requesting such initial license is in full compliance with RSA 151 and He-P 808.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable, including licenses issued for mobile laboratory vans.

(h) A written notification of denial, pursuant to He-P 808.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 808.05(f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 808.

(i) A written notification of denial, pursuant to He-P 808.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.06 License Expirations and Procedures for Renewal

(a) A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an “Application for Residential and or Health Care License (Laboratories and Collection Stations)” (July 2023 edition) pursuant to He-P 808.04(a)(1) at least 120 days prior to the expiration of the current license and include with the application:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 808.10(f). If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 808.17(f);

(4) A copy of any temporary, new, or existing variances or waivers applied for or granted by the state fire marshal; and

(5) A list of all tests performed and a copy of the CLIA certificate.

(c) In addition to He-P 808.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all of the items required by He-P 808.06(b) and (c), as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 808, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if the area of non-compliance were cited.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.07 Laboratory Construction, Modifications, or Structural Alterations

(a) For new construction and for rehabilitation of an existing building including, but not limited to, renovations, modifications, reconstructions, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed including, but not limited to, window and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 808 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) The licensee or applicant shall comply with all applicable state laws, rules, and local ordinances when undertaking any construction or rehabilitation.

(g) A licensee or applicant undertaking construction, repairs, renovations, rehabilitation, or modifications of a building shall comply with the appropriate chapters and sections of the State Fire Code and State Building Code.

(h) Department approval shall not be required prior to initiating construction, repairs, renovations, rehabilitation, or modifications of a building, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

(i) All laboratories newly constructed or rehabilitated shall comply with the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2022 edition), available as noted in Appendix A.

(j) Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A.

(k) The department shall be the authority having jurisdiction for the requirements in He-P 808.07(i)-(j) above and shall negotiate compliance with the licensee or applicant or their representatives and grant waivers in accordance with He-P 808.10 as appropriate.

(l) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, or ceilings that allow for the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(m) Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(n) Variances pertaining to the State Fire Code referenced in He-P 808.07(g) above shall be granted only by the state fire marshal.

(o) Variances pertaining to the state building code shall be granted by the local building official or the state fire marshal if in a state owned building.

(p) The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 808.09 prior to its use.

(q) He-P 808.07 shall not apply to mobile laboratory vans.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.08 Laboratory Requirements for Organizational Changes

(a) The licensee shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of categories authorized under the current license or revisions to the current list of tests performed; or

(6) Services.

(b) The laboratory shall complete and submit a new application form, required by He-P 808.04(a)(1), and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of categories authorized under the current license; or

(4) A change in services.

(c) When there is to be a change of address without a change in location, the laboratory shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the laboratory shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practicable by department;

(2) The physical location;

(3) A change in the number of categories authorized under the current license;

(4) A change in licensing classification; or

(5) A change that places the facility under a different life safe code occupancy chapter.

(f) A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

(g) A revised license and license certificate shall be issued for changes in the laboratory name.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in categories authorized to test;

(3) A change in address without a change in physical location;

(4) A change in the scope of services provided; or

(5) When a waiver has been granted in accordance with He-P 808.10.

(i) The laboratory shall inform the department, in writing, when there is a change in administrator or laboratory director no later than 5 days prior to a change, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or laboratory director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or laboratory director;

(2) Copies of applicable licenses for the new administrator or laboratory director;

(3) The results of a criminal records check to include results for the state of New Hampshire for the new administrator or laboratory director; and

(4) A copy of the signed criminal attestation, as described in He-P 808.17(j), for the new administrator or laboratory director.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the administrator or laboratory director meets the qualifications for the position as specified in He-P 808.14(e)(6) and He-P 808.14(e)(6).

(k) If the department determines that the new administrator or laboratory director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(l) When there is to be a change in the testing provided, the licensee shall provide the department with:

(1) A description of the testing change(s);

(2) Identification of what additional personnel shall be hired and their qualifications, if applicable;

(3) How the new services shall be incorporated into the infection control and quality improvement programs; and

(4) A description of what changes, if any, shall be made to the physical environment.

(m) The department shall review the information submitted under (l) above and determine if the added services shall be provided under the licensee’s current license.

(n) The laboratory shall inform the department, in writing via email, fax, or mail, of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(o) A restructuring of an established laboratory that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) If a licensee chooses to cease operation of a laboratory, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 808, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the laboratory; and

(3) Any records required by RSA 151 and He-P 808.

(b) The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 808 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 808.08(e)(1);

(3) A change in the licensee’s physical location, except for mobile laboratory vans;

(4) Occupation of space after construction, renovations, or structural alterations;

(5) A change in the licensing classification;

(6) The renewal of a license; or

(7) The issuance of a mobile laboratory van license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety inspections shall be issued when, as a result of any inspection, the department determines that the licensee is in violation of any of the provisions of He-P 808, RSA 151, or any other federal or state requirement(s).

(e) If areas of non-compliance were cited, in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 808, within 21 days of the date on the letter.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 808 shall submit a written request for waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers granted shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the reasonable explanation or the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver when submitting a completed renewal application form pursuant to He-P 808.04(a)(1) or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92; ss by #13710, eff 8-2-23
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.11 Complaints

(a) The department shall accept and investigate written complaints that meet the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151, He-P 808, or any other applicable state or federal laws.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address, if known, of the laboratory or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 808.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the licensee;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For the licensed laboratory, the department shall:

(1) Provide written notification of the results of the investigation to the licensee, along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation as appropriate;

(3) Require the licensee to submit a POC in accordance with He-P 808.12(c), if applicable; and

(4) Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules.

(e) The following shall apply for the unlicensed laboratory:

(1) In accordance with RSA 151-7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reason(s) for, and the results of, the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(c);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice, required by (e)(1) above, to respond if the determination is that the services require licensing;

(3) If the owner of an unlicensed laboratory does not respond in accordance with (e)(2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 808; and

(4) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 808.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 808, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring a licensee.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of He-P 808; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a notice of the areas of non-compliance the licensee shall submit a POC detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action.

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 808;

b. Addresses all areas of non-compliance as cited in the statement of findings;

c. Prevents a new violation of RSA 151 or He-P 808 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance shall be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee, in writing, within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless within the 14 day period the licensee requests an extension, either via telephone or in writing, and the department grants the extension based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 808.12(d) and a fine in accordance with He-P 808.13(c)(9);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC has not been implemented by the completion, at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 808.12(b); and

b. Issued a directed POC in accordance with He-P 808.12(d).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health, safety, and well-being of patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application of a license in accordance with He-P 808.13(b); or

(4) Revoke the license in accordance with He-P 808.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC, in accordance with (c) above, shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the State Fire Code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed a fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients;

(2) The presence of conditions in the laboratory that negatively impact the health, safety, or well-being of patients;

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules; or

(4) Conditions exist for implementation of temporary management as described in (n) below but no temporary manager can be found.

(m) The department shall appoint a temporary manager to assume operation of a laboratory when, following an inspection, the department determines that:

(1) The licensee has repeatedly failed to manage and operate the laboratory in compliance with RSA 151 and He-P 808 and such laboratory practices have adversely impacted the health, safety, or well-being of patients;

(2) The licensee has failed to develop or implement policies and procedures for infection control, sanitation, or life safety codes, which results in imposing harm or the potential for harm to the patients; or

(3) The health, safety, and well-being of the patients are at risk and emergency action is required.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction by 25% if the fine is paid within 10 days of the date on the written notice from the department, and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, II as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 808, which violations have the potential to harm a patient’s or employee’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay a fine imposed under an enforcement action;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 808.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 808.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 808.12(c)(6) and has not submitted a revised POC in accordance with He-P 808.12(c)(6)b.;

(8) The licensee is cited a third time under RSA 151 or He-P 808 for the same violation(s) within the last 5 inspections;

(9) A licensee, including corporation or its corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premises is not in compliance with RSA 151 or He-P 808;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee, has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) Unless a waiver has been granted, the applicant or licensee fails to employ a qualified administrator or laboratory director; or

(13) The applicant has had a license revoked by the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000 for an applicant or unlicensed provider;

(2) For failure to cease operations after a denial of a license or after receipt of an order to cease and desist, in violation of RSA 151 and RSA 541-A:30 the fine for an unlicensed individual, applicant, unlicensed provider, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed individual or a licensee shall be $500.00;

(4) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 808.11(e), the fine for an unlicensed provider or a licensee shall be $500.00;

(5) For a failure to submit a renewal application prior to the expiration date, in violation of He-P 808.06(b), the fine for a licensee shall be $100.00;

(6) For failure to notify the department prior to a change of ownership, in violation of He-P 808.08(a)(1), the fine for a licensee shall be $500.00;

(7) For failure to notify the department, prior to a change of location, in violation of He-P 808.08(a)(2), the fine for a licensee shall be $500.00;

(8) For a failure to allow access by the department to the laboratory’s premises, programs, services, patients, or records, in violation of He-P 808.09(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

(9) For failure to submit a POC or revised POC within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 808.12(c)(2) and (6), the fine for a licensee shall be $100.00;

(10) For failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 808.12(c)(9), the fine for a licensee shall be $1000.00;

(11) For a failure to establish, implement, or comply with licensee policies, as required by He-P 808.14(e), the fine for a licensee shall be $500.00;

(12) For a failure to provide services or programs required by the licensing classification and specified by He-P 808.14(d), the fine for a licensee shall be $500.00;

(13) For false or misleading information or misleading information or documentation, in violation of He-P 808.13(b)(5), the fine for an applicant shall be $500.00 per offense;

(14) For employing an administrator or a laboratory director who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 808.10 in violation of He-P 818.18(h)-(j), the fine for a licensee shall be $500.00;

(15) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 808.07(a), the fine for a licensed facility shall be $500.00;

(16) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, as required by He-P 808.09(b)(5), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(17) When an inspection determines that a violation of RSA 151 or He-P 808 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same deficiency is cited within 2 years of the original deficiency, the fine for a licensee shall be double the original fine, but not to exceed $2000.00; or

b. If the same deficiency is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

(18) Each day that the licensee continues to be in violation of the provisions of RSA 151 or He-P 808 shall constitute a separate violation and shall be fined in accordance with He-P 808.12; and

(19) If the licensee is making good faith efforts, as verified by documentation or other means, to obtain a license in (1) above or comply with warnings in (4) above, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of cash, check, or money order for the exact amount due;

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds; and

(3) When payment is made in a form other than cash, it shall be made payable to the “Treasurer - State of New Hampshire.”

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 808 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a laboratory’s license has been denied or revoked, the applicant, licensee, administrator, or laboratory director shall not be eligible to reapply for a license or be employed as a laboratory director for 5 years, if the enforcement action pertained to their role in the laboratory.

(k) The 5-year period referenced in (i) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause, as verified by documentation or other means, to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 808.

(m) RSA 541 shall govern further appeals of department decisions under this section.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 808.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.14 Duties and Responsibilities of all Licensees

(a) The licensee shall comply with all applicable federal, state, and local laws, rules, codes, and ordinances.

(b) The licensee shall have a written policy and procedure setting forth the rights of patients in accordance with RSA 151:21.

(c) The licensee shall define, in writing, the scope and type of services to be provided at the laboratory, including mobile laboratory vans.

(d) The licensee shall not falsify or omit any information contained in:

(1) The application in He-P 808.04(a)(1) or any other documents required for the licensing of a laboratory; or

(2) The records maintained for the patients and personnel of the laboratory.

(e) The licensees shall have responsibility and authority for:

(1) Managing, controlling, and operating the laboratory;

(2) Developing and implementing written policies and procedures governing all of the operations and services provided, and for reviewing said policies and procedures annually and revising as needed;

(3) Initiating action to maintain the laboratory in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establishing, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the laboratory;

(5) Appointing a laboratory director who shall meet the qualification requirements as stated in:

a. 42 CFR § 493.1405 for laboratories performing moderate complexity testing;

b. 42 CFR § 493.1443 for laboratories performing high complexity testing; or

c. For labs performing only waived testing the director shall meet the following qualifications:

1. A bachelor's degree in health sciences with a minimum of 3 years’ experience in a laboratory; or

2. An associate’s degree in health sciences with a minimum of 5 years’ experience in a laboratory;

(6) Appointing an administrator who shall meet the following qualifications:

a. A bachelor's degree in health sciences with a minimum of 3 years’ experience in a laboratory; or

b. An associate’s degree in health sciences with a minimum of 5 years’ experience in a laboratory;

(7) Employing a clinical consultant in accordance with 42 CFR § 493.1417 or 42 CFR § 493.1455 as appropriate;

(8) Employing a technical consultant if the laboratory is performing moderately complex tests as defined in 42 CFR § 493.1411;

(9) Employing a general supervisor and a technical supervisor if the laboratory is performing highly complex tests as defined in 42 CFR § 493.1449, 1461, and 1469 if the laboratory is performing cytology;

(10) Providing sufficient numbers of personnel who are present in the laboratory and are qualified as testing personnel according to 42 CFR § 493 to perform the laboratory tests stated in the laboratory’s scope of services;

(11) Providing sufficient supplies, equipment, and lighting to ensure all services are provided in a safe and timely manner; and

(12) Implementing any POC that has been accepted or issued by the department.

(f) The licensee shall post the following documents in an area of the licensed premises that is conspicuous and open to patients and the general public:

(1) The current license issued in accordance with RSA 151:2;

(2) All inspection reports issued for the previous 12 months;

(3) Any notice of a pending hearing or order as required by RSA 151:29, II, pertaining to the licensee issued by the department or a court during the previous 24 months;

(4) A notice as required by RSA 151:29 stating complaints may be submitted to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

(5) A copy of the licensee’s complaint procedure as required by RSA 151:29, I; and

(6) A copy of the patients’ bill of rights, in accordance with RSA 151:21.

(g) The licensee shall admit and allow any department representative to inspect the licensed premises and laboratory services for the purpose of determining compliance with RSA 151 and He-P 808 as authorized by RSA 151:6 and RSA 151:6-a.

(h) All records required for licensing shall be:

(1) Available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

(2) Legible, current, and accurate.

(i) Any licensee maintaining electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent deletion;

(2) Safeguards to ensure the confidentiality of the information on patients and personnel; and

(3) Systems to prevent the tampering of information on patients and personnel.

(j) The licensee shall provide a patient or their legal representative with a copy of his or her patient record, pursuant to the provisions of RSA 151:21, X, upon request.

(k) The licensee shall develop a facility system with written policies and procedures that will ensure that only the patient and the ordering licensed practitioner are allowed to receive a copy of the laboratory tests results unless the laboratory has written consent from the patient to release the test results to others.

(l) The building or structure or mobile laboratory van that houses the laboratory shall comply with the following:

(1) All applicable local health requirements;

(2) All applicable state and local building ordinances;

(3) All applicable local zoning ordinances; and

(4) All applicable state and local fire ordinances.

(m) The licensee shall maintain a log in each mobile laboratory van to document that all on-board water is from a verifiable potable Source.

(n) Licensees that perform the functions of a collection station under this rule shall also be in compliance with He-P 817 rules for collection stations.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss 8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.15 Laboratory Standards

(a) All laboratories shall comply with all regulations contained in 42 CFR § 493.

(b) All laboratories shall require the individual functioning as technical consultant or general supervisor to have 2 years of laboratory experience in the specialties being supervised.

(c) All laboratory equipment shall be maintained as recommended by the manufacturer to include, but not limited to, annual tachometer checks of centrifuges, annual cleaning and maintenance of microscopes, and calibration of thermometers and pipettes.

(d) All laboratories shall disinfect point of care devices used for multiple patients after each use.

(e) All laboratories shall perform quality controls on waived meter devices each day they are used, unless the device performs internal electronic controls with each test performed.

(f) Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the collection station.

(g) All clinical equipment shall be:

(1) In good working order; and

(2) Serviced in accordance with manufacturers’ instructions and a written record of the service performed shall be kept at the collection station.

(h) Sharps containers shall be secured so as to prevent unauthorized access and tampering.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.16 Patient Records, Test Requisitions, and Test Reports

(a) All patient records, test requisitions, and test reports shall be completed and maintained in accordance with 42 CFR § 493.

(b) All records, requisitions, and reports shall be safeguarded against loss, damage, tampering, and unauthorized access and retained for a minimum of 4 years.

(c) Prior to ceasing operation, the licensee shall arrange for the storage of and access to records, requisitions, and reports for a minimum period of 4 years.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.17 Personnel

(a) All personnel shall:

(1) Meet the educational and physical qualifications of the position and in accordance with the requirements of 42 CFR § 493;

(2) Be licensed, registered, or certified if required by state statute;

(3) Receive an orientation within the first 7 days of work that includes:

a. The duties and responsibilities of the position;

b. The laboratory’s infection control program; and

c. The laboratory’s fire, evacuation, and emergency plans, which outline the responsibilities of personnel in an emergency; and

(4) Prior to testing patient samples, the employee shall have an orientation in the applicable policies, procedures, of the laboratory.

(b) All personnel shall complete annual in-service education in the laboratory:

(1) Policies and procedures on patients’ rights;

(2) Infection control program; and

(3) Fire and emergency procedures.

(c) All licensees using the service of independent clinical contractors shall:

(1) Provide the clinical contractors with an orientation as specified in (a)(3) above;

(2) Maintain a copy of the clinical contractors’ licenses as required by (a)(2) above, if applicable;

(3) Have a written agreement with each clinical contractor that describes the services that will be provided and agrees to comply with the requirements of (a)(1) through (3) above; and

(4) Have documentation of the criminal record check or employee waiver, as applicable.

(d) For all new hires, including volunteers and independent contractors whose scope of employment will involve direct contact with a patient, patient records, or patient tissue, body fluids, or other biological material, the licensee shall:

(1) Obtain and review a criminal records check, which shall include results of criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (e) below and verify the qualifications of all applicants prior to employment;

(3) Require the employee to submit the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(4) Allow the employee to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB;

(5) Comply with the requirements of the United States Centers for Disease Control and Prevention, “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

(6) Report all positive tuberculosis (TB) test results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02, and 301.03.

(e) Unless a waiver is granted in accordance with (f) below, the licensee shall not offer employment for any position if the individual:

(1) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

(2) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(3) Otherwise poses a threat to the health, safety, or well-being of the patients.

(f) The department shall grant a waiver of (e) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of patients.

(g) The waiver in (f) above shall be permanent for as long as the individual remains in the same job unless additional convictions or findings under (e) above occur.

(h) If the information identified in (e) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department.

(i) An employee shall not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department.

(j) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(k) For individuals with the waiver described in (f) above, the statement required by (j) above shall cover the period of time since the waiver was granted.

(l) An individual shall not be required to re-disclose any of the matters in (f) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

(m) Current and complete personnel files shall be maintained at the licensed premises, except as allowed by (p) below.

(n) Personnel files shall include:

(1) Identification data;

(2) Qualifications and work experience;

(3) Record of satisfactory completion of the orientation program required by (a)(3) above;

(4) A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

(5) Documentation of annual in-service education as required by (b) above; and

(6) The statement required by (j) above.

(o) Personnel files shall be:

(1) Maintained on an individual basis, separate and distinct from other employees, and contain only information relating to the specific personnel member;

(2) Stored in locked containers or cabinets or in a locked room on the premises; and

(3) Maintained for at least 5 years following termination of employment.

(p) Personnel files may be stored in a central location provided that:

(1) The personnel file is available to the department at the licensed premises within 30 minutes of being requested; and

(2) The files are in accordance with (n) and (o) above.

(q) All testing personnel shall have a competency review for each test procedure performed prior to testing patient samples, as well as twice in the first year and annually thereafter.

(r) The competency review shall include:

(1) Monitoring the pre-analytic, analytic, and post analytic phases of the testing procedure;

(2) Direct observation of the testing personnel in the performance of the test procedure; and

(3) Documentation of test results and awareness of test parameters and limitations as described in the package insert.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.18 Quality Assessment

Licensed laboratories, including mobile laboratory vans, shall develop and implement a quality assessment program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.19 Infection Control

(a) All laboratories shall develop and implement an infection control program.

(b) The laboratory’s infection control program shall:

(1) Comply with all regulations contained in 29 CFR § 1910.1030;

(2) Include education and instruction on:

a. Proper hand washing techniques; and

b. The utilization of universal precautions;

(3) Include written procedures for the handling, storage, transportation, or disposal of those items identified as infectious waste in Env-Sw 904;

(4) Include written procedures for the management of patients or staff with infectious or contagious diseases or illnesses; and

(5) Include the reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control program shall address at a minimum the:

(1) Causes of infections;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through contact, fomites, or droplets shall not have any contact with patients until they are no longer contagious.

(e) Only sterile equipment and containers such as needles, syringes, test tubes, and urine containers used for cultures shall be used when collecting specimens.

(f) The handling, storing, transporting, or disposing of items specified as infectious waste in Env-Sw 904.01 shall be done in accordance with Env-Sw 904.

(g) There shall be no use of tobacco products, smoking, eating, drinking, or applying of cosmetics in the areas where specimen collection takes place or where specimens are processed in accordance with 29 CFR § 1910.1030.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.20 Physical Environment.

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

(1) Buildings or mobile laboratory vans, as applicable;

(2) Health;

(3) Fire; and

(4) Waste disposal.

(b) The laboratory shall have all entrances and exits to the licensed premises accessible at all times.

(c) The laboratory shall be clean and maintained in a safe manner and good repair and kept free of hazards.

(d) All supplies shall be stored in enclosed storage spaces.

(e) All corridors shall be free from obstruction.

(f) The licensee shall ensure that the laboratory has:

(1) Working space for the analysis and reporting of tests performed by the laboratory;

(2) Refrigeration and freezers, as required, to preserve specimens and reagents at optimal temperatures as recommended by a given procedure or manufacturer;

(3) Cooling, heating, and ventilation systems that are maintained in accordance with manufacturers’ specification;

(4) Temperature and humidity control in the laboratory work area that is maintained and monitored in accordance with manufacturer’s instructions for the testing being performed to ensure quality results; and

(5) Access to bathrooms that contain at least one toilet and one hand-washing sink with:

a. A supply of hot and cold running water;

b. Soap dispensers;

c. Paper towels or a hand drying device providing heated air; and

d. Non-porous floors.

(g) If equipment or supplies need to be sterilized in order to prevent contamination, a system for sterilization shall be provided.

(h) The sterilization system required in (g) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented.

(i) Sterile supplies and equipment shall not be mixed with unsterile supplies and shall be stored in dust-proof, moisture-free storage areas.

(j) Cleaning solutions, compounds, and substances, which might be considered hazardous waste as defined in RSA 147-A:2, VII, also known as hazardous and toxic materials in these rules, shall be:

(1) Distinctly labeled and legibly marked so as to identify the contents;

(2) Stored in a place separate from food and supplies; and

(3) Kept in an enclosed section separated from other cleaning materials.

(k) Toxic materials shall not be used in a way that contaminates equipment or in any way that constitutes a hazard to personnel or other persons, or in any way other than in full compliance with the manufacturer's labeling.

(l) Equipment, work surfaces, and flooring within areas used for collection and processing patient specimens shall include only non-porous material suitable for disinfection and shall be free of tape and adhesives.

History

• #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
• #5758, eff 12-20-93, EXPIRED: 12-20-99
• #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.21 Mobile Laboratory Vans.

(a) Mobile laboratory vans shall be eligible for licensure only if they are:

(1) Operated by a laboratory that is located in a building or other permanent structure; and

(2) The laboratory in (1) above has a valid license issued by the department in accordance with He-P 808.

(b) Each applicant shall comply with He-P 808, except that:

(1) He-P 808.07 shall not apply to mobile laboratory vans;

(2) In lieu of He-P 808.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

a. A copy of the applicant’s current laboratory and laboratory services license;

b. A valid New Hampshire motor vehicle registration for the mobile laboratory van;

c. The VIN of the mobile laboratory van; and

d. A space utilization diagram for the mobile laboratory van; and

(3) Patient and facility records that are stored off site shall be available for inspection upon request of licensing personnel within 30 minutes of being requested.

(c) The laboratory portions of the mobile laboratory van used to collect, process, store, or transport specimens, reagents, or supplies shall have a non-porous floors and work surfaces.

(d) Only such tests that are identified as waived in 42 CFR § 493 shall be performed in a mobile laboratory van.

(e) Detailed written documentation of travel dates, times, and locations, including periods of non-use, shall be maintained for the mobile laboratory van.

(f) Mobile laboratory vans shall record temperatures each day of laboratory use and whenever testing reagents are stored in the van to ensure compliance with manufacturers’ instructions for the test system used by the laboratory.

History

• #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.22 Emergency and Fire Safety

(a) Laboratories shall meet the requirement in the applicable chapters and sections of the state fire code and state building code.

(b) An emergency and fire safety program shall be developed and implemented based upon the hazards present in the lab.

(c) Smoke detectors shall be hardwired, powered by the electrical service, and located on every level of the facility.

(d) At least one fire extinguisher shall be located on every level of the facility or every 75 feet of corridor, type based on the hazards present in the lab, and be:

(1) Manually inspected when initially placed in service; and

(2) Inspected either manually or by means of an electronic monitoring device or system at intervals not exceeding 31 days.

(e) A carbon monoxide monitor shall be located on every level.

(f) Immediately following any fire or emergency situation, excluding a false alarm, licensees shall notify the department by phone and follow up with written notification within 72 hours.

(g) The written notification under (f) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

(5) The name of the individual the licensee authorizes the department to contact if additional information is required.

(h) Storage of flammable gases or liquids shall be within an enclosed interior space constructed of noncombustible or limited-combustible construction. If stored outdoors, storage shall be in an enclosure with doors or gates, that can be secured against unauthorized entry.

(i) Oxidizing gases, such as oxygen and nitrous oxide, shall:

(1) Not be stored with any flammable gas, liquid, or vapor;

(2) Be separated from combustibles or incompatible materials by:

a. A minimum distance of 20 ft or 6.1 meters;

b. A minimum distance of 5 ft or 1.5 meters if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

c. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

(3) Be secured in an upright position, such as with racks or chains.

(j) All freestanding tanks of compressed gases shall be firmly secured to the adjacent wall, or secured in a stand or rack, except for in mobile laboratory vans, where they shall be secured during transport as required by the state fire code.

(k) Flammable gases and liquids shall be stored in metal fire retardant cabinets, except when located in a mobile laboratory van, where they shall be secured during transport as required by the state fire code.

(l) Quantities of flammable gases and liquids under 500 milliliters may be retained at the bench work area when directly in use.

(m) A precautionary sign, readable from a distance of 5 ft or 1.5 meters, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”.

(n) Precautionary signs, readable from a distance of 5 ft or 1.5 meters, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

(o) The laboratory shall develop a fire safety plan, which includes the following:

(1) Use of alarms;

(2) Transmission of alarms to fire department;

(3) Emergency phone call to fire department;

(4) Response to alarms;

(5) Isolation of fire;

(6) Evacuation of immediate area;

(7) Evacuation of smoke compartment;

(8) Preparation of floors and building(s) for evacuation;

(9) Extinguishment of fire; and

(10) List of written emergency telephone numbers for key personnel, fire and police departments, poison control center, 911, and ambulance service(s).

(p) Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative personnel, with the signals and emergency action required under varied conditions.

(q) Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions.

(r) Facilities shall complete written records of fire drills and include the following:

(1) The date and time, including AM or PM, the fire drill was conducted and if the actual fire alarm system was used;

(2) The location of exits used;

(3) The number of people participating at the time of the fire drill;

(4) The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

(5) The name and title of the person conducting the fire drill;

(6) A list of all problems and issues encountered during the fire drill;

(7) A list of improvements and resolutions to the issues encountered during the fire drill; and

(8) The names of all personnel participating in the fire drill.

(s) Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(t) At no time shall a personnel member who has not participated in a fire drill be the only personnel member on duty within the facility.

(u) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

(v) A written plan for fire safety, evacuation, and emergencies shall be adopted and posted in multiple locations throughout the laboratory.

History

• #13710, eff 8-2-23

N.H. Code Admin. R. Ann. He-P 808.23 Emergency Preparedness

(a) Each facility shall have an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The committee shall include:

(1) The facility administrator;

(2) Others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility; and

(3) An applicable external representation, if the licensee is a high complexity lab, including but not limited to:

a. Elected state and local officials;

b. Police, fire, civil defense, and public health professionals;

c. Environment, transportation, and hospital officials;

d. Facility representatives; and

e. Representatives from community groups and the media.

(c) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(d) The plan in (c) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of a fire, natural disaster, severe weather, chemical emergency, or human-caused emergency;

(2) Be reviewed and approved by the local emergency management director;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Federal Emergency Management Agency’s Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the facility’s plan shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Include the facility's response to both short-term and long-term interruptions in the availability of utility services in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems; and

g. Communications systems;

(8) Include a process for alerting and managing personnel in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(9) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

(10) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(11) Include an educational, competency-based program for the personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

(12) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this process in the plan in the event of a radiological disaster or emergency.

(e) The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both.

History

• #13710, eff 8-2-23

Part He-P 809 Home Health Care Providers

N.H. Code Admin. R. Ann. He-P 809.01 Purpose

The purpose of this part is to set forth the licensing requirements for all home health care providers (HHCPs) pursuant to RSA 151:2, I(b).

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; amd by #6240, HB 32, eff 5-3-96, EXPIRED 12-31-98; ss and amd by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.02 Scope

This part shall apply to any organization, business entity, partnership, corporation, government entity, association, or other legal entity operating a HHCP, except:

(a) All facilities listed in RSA 151:2, II(a)-(i);

(b) Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H;

(c) Agencies contracted with the department to provide family centered early supports and services (FCESS), whether area agencies or other entities, in accordance with He-M 510;

(d) Entities that are licensed under another home health care license and are providing only the services permitted under that license;

(e) A person furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment and educate the user on its proper use; and

(f) Emergency medical services units and emergency medical care providers operating under the jurisdiction and regulatory oversight of the New Hampshire department of safety, bureau of emergency medical services, in compliance with the “mobile integrated healthcare protocol” contained in the New Hampshire patient care protocols, incorporated by reference in Saf-C 7402.01.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #10939, eff 9-25-15; ss by #12640, eff 10-3-18; amd by #12893, eff 10-1-19; ss by #14073, eff 9-20-24; ss by #14353, eff 8-26-25, EXPIRES: 8-26-35

N.H. Code Admin. R. Ann. He-P 809.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a patient;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a patient; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a patient with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

(c) “Administer” means “administer” as defined by RSA 318:1, I, namely “an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.”

(d) “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HHCP.

(e) “Admission” means accepted by a licensee for the provision of services to a patient.

(f) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(g) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a HHCP pursuant to RSA 151.

(h) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 809, or other federal or state requirements.

(i) “Assessment” means an evaluation of the patient to determine the care and services that are needed.

(j) “Branch office” means a location physically separate from the primary location of the HHCP and that:

(1) Provides oversight for employees who provide direct care services to patients in their residential setting; and

(2) Is under the administration and supervision of the primary location of the HHCP.

(k) “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services as required by He-P 809.15(o)-(q).

(l) “Change of ownership” means a change in the controlling interest of an established HHCP to a successor business entity.

(m) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(n) "Community health services" means services that are provided in community settings, including but not limited to foot clinics, flu shot clinics, educational programs and nutrition services.

(o) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(p) “Days” means calendar days unless otherwise specified in the rule.

(q) “Department” means the New Hampshire department of health and human services.

(r) “Direct care” means hands-on care and services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(s) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

(t) “Do not resuscitate order (DNR order)” means an order that, in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes "do not attempt resuscitation order (DNAR order)”.

(u) “Drop site” means a location, which does not meet the definition of a branch office, where materials, equipment, and supplies used in the provision of services may be temporarily stored.

(v) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(w) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, or fraud.

(x) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and other personal needs.

(y) “Home health care provider (HHCP)” means any organization or business entity, whether public or private, whether operated for profit or not, which is engaged in arranging or providing, directly or through contract arrangement, one or more of the following services:

(1) Nursing services;

(2) Home health aide services; or

(3) Other therapeutic and related services, which can include, but are not limited to;

a. Physical and occupational therapy;

b. Speech pathology;

c. Nutritional services;

d. Medical social services;

e. Personal care services; and

f. Homemaker services which may be of a preventative, therapeutic, rehabilitative, health guidance, or supportive nature to persons in their places of residence.

(z) “Homemaker services” means services that are of a supportive nature that do not routinely require hands-on contact with a patient other than to maintain the patient’s safety. Such services may include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, companion services, and medication reminders.

(aa) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ab) “Infectious waste” means those items specified by Env-Sw 904.

(ac) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(ad) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 809 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 809.

(ag) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 809.

(ae) “License” means the document issued by the department to an applicant at the start of operation as an HHCP which authorizes operation in accordance with RSA 151 and He-P 809, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

(af) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which the HHCP is licensed.

(ag) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ah) “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices. This term does not include drop sites or the private residence of a patient receiving services from a HHCP.

(ai) “Licensing classification” means the specific category of services authorized by a license.

(aj) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ak) “Neglect” means an act or omission that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a patient.

(al) “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(am) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(an) “Patient” means any person admitted to or in any way receiving care, services, or both from a HHCP licensed in accordance with RSA 151 and He-P 809. Patient includes patient as used in RSA 151:20 and RSA 151:21.

(ao) “Patient record” means the documentation of all care and services, which includes all documentation required by RSA 151 and He-P 809 and any other applicable federal or state requirements.

(ap) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21-b.

(aq) “Personal care service provider” means a person who provides non-medical hands-on assistance to a patient, to help with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, assisting with topical medications, or reminding a patient to take medications.

(ar) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.

(as) “Personnel” means an individual who is employed by the facility, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to patients.

(at) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(au) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

(av) “Point of care devices” means testing involving a system of devices, typically including:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip to apply the blood sample; or

(3) A meter or monitor to calculate and show the results including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin time (PT) and iternational normalized ratio (INR) anticoagulation meters; or

c. Cholesterol meter.

(aw) “Primary location” means the principal site for the HHCP where the business office and administrative staff are located.

(ax) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(ay) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(az) “Professional staff” means:

(1) Physicians;

(2) Physician assistants;

(3) Advanced practice registered nurses;

(4) Registered nurses;

(5) Registered physical therapists;

(6) Speech therapists;

(7) Licensed practical nurses;

(8) Licensed respiratory therapists;

(9) Occupational therapists;

(10) Medical social workers; and

(11) Dietitians.

(ba) “Reportable incident” means an occurrence of any of the following while the patient is in the care of HHCP personnel:

(1) The unanticipated death of the patient; or

(2) An injury to a patient that is potentially due to abuse or neglect.

(bb) “Self-administration of medication with assistance” means an act whereby the patient takes his or her own medication after being prompted by personnel but without requiring physical assistance from others beyond placing the container within reach, opening the medication container, reading the medication label to the patient, and utilizing hand over hand technique pursuant to Nurs 404.03(b).

(bc) “Self-administration of medication without assistance” means the participant is able to take his or her own medication(s) without the assistance of personnel, including prompting.

(bd) “Self-directed medication administration” means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions, injections or filling insulin syringes.

(be) “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability of the patient.

(bf) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; amd by #6240, HB 32, eff 5-3-96, EXPIRED 12-31-98; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License,” (September 2018 edition) signed by the applicant or 2 of the corporate officers affirming and certifying the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

b. For any HHCP to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any HHCP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) If applicable, proof of authorization from the secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability company; or

c. “Certificate of Trade Name,” where applicable;

(3) The applicable $250 fee, in accordance with RSA 151:5, XI(b), payable in cash in the exact amount of the fee, or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(4) A resume identifying the qualifications of and copies of applicable licenses for the HHCP administrator;

(5) Written local approvals as follows:

a. For the proposed licensed premises the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements;

2. The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control and local fire ordinances applicable for a business; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project; and

(6) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant, licensee, and administrator.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #4073, eff 6-26-86, EXPIRED: 6-26
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 809.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 809.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted in accordance with He-P 809.10, the department shall deny a licensing request in accordance with He-P 809.13(b) if it determines that the applicant, licensee, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) An inspection shall be completed in accordance with He-P 809.09 prior to the issuance of a license.

(g) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

(h) Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 809.

(i) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(j) A written notification of denial, pursuant to He-P 809.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 809.

(k) A written notification of denial, pursuant to He-P 809.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall:

(1) Complete and submit to the department an application form pursuant to He-P 809.04(a)(1) at least 120 days prior to the expiration of the current license;

(2) The current license number;

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 809.10(f), as applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 809.17(d); and

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal.

(c) Following an inspection, as described in He-P 809.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) above, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 809 at the renewal inspection.

(d) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 809.04 and shall be subject to a fine in accordance with He-P 809.13(c)(5).

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.07 Branch Offices and Drop Sites

(a) The HHCP may establish branch offices and drop sites provided that no direct care is provided to a patient at a drop site.

(b) The HHCP shall notify the department in writing prior to establishing or operating branch offices with the following information:

(1) The branch office address;

(2) The branch office phone number; and

(3) The license number of the HHCP.

(c) The HHCP shall submit to the department the information required by He-P 809.04(a)(5) for branch offices.

(d) Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 809.

(e) All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.08 HHCP Requirements for Organizational or Service Changes

(a) The HHCP shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location of the licensed premises;

(3) Address; or

(4) Name.

(b) The HHCP shall complete and submit a new application and obtain a new license and license certificate prior to :

(1) A change in ownership; or

(2) A change in licensing classification.

(c) When there is a change in address without a change in location, the HHCP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in address due to a physical location change , the HHCP shall provide the department with:

(1) A letter which contains the license number, new address, and date of the move; and

(2) Local approval form as specified in He-P 809.04(a)(5).

(e) When there is a change in the name, the HHCP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(f) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance then an inspection shall be conducted as soon as practical by department; or

(2) A change in licensing classification.

(g) A new license shall be issued for a change in ownership.

(h) A revised license and license certificate shall be issued for a change in address.

(i) A revised license and license certificate shall be issued for a change in name.

(j) A license and license certificate shall be issued at the time of initial licensure.

(k) A revised license certificate shall be issued for any of the following:

(1) A change in administrator;

(2) When a waiver has been granted;

(3) When there is a change in services; or

(4) When a branch office has been added.

(l) The HHCP shall inform the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) Copies of applicable licenses for the new administrator;

(3) The results of a criminal records check from the NH department of safety for the new administrator; and

(4) Results of bureau and elderly adult registry check.

(m) Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 809.15(d).

(n) If the department determines that the new administrator does not meet the qualifications for his or her position as specified in (m) above, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(o) A restructuring of an established HHCP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) The HHCP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(q) If a licensee chooses to cease operation of an HHCP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 809, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the HHCP; and

(3) Any records required by RSA 151 and He-P 809.

(b) The department shall conduct an inspection to determine full compliance with RSA 151, He-P 809, and other federal or state requirements prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 809.08(f)(1);

(3) A change in licensing classification; or

(4) The renewal of a license.

(c) In addition to (b) above the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings shall be issued when, as a result of an inspection, the department determines that the HHCP is in violation of any of the provisions of He-P 809, RSA 151, or other federal or state requirements.

(e) If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 809.12(c), within 21 days of the date on the letter that transmits the inspection report.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #5630, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 809 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (c) through (f) above.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #6240, HB 32, eff 5-3-96, EXPIRED: 12-31-98
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 809.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address, if known, of the HHCP, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 809.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) Physical inspection of the licensed premises;

(3) Review of relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed HHCP, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 809.12(c) if the inspection results in areas of non-compliance being cited.

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 809; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine in accordance with He-P 809.13(c)(1).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any administrative or judicial proceedings relative to the licensee.

History

• #4073, eff 6-26-86, EXPIRED: 6-26-92
• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 809, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules ; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings, the licensee shall submit a written POC for each item, written in the appropriate place on the statement and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action.

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 809;

b. Addresses all areas of non-compliance as cited in the statement of findings;

c. Prevents a new violation of RSA 151 or He-P 809 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing within 14 days, of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

2. The department determines that the health, safety or wellbeing of a patient will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 809.13(c)(11);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an on-site follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 809.12(b); and

b. Issued a directed POC in accordance with (d) below and a fine in accordance with He-P 809.13(c)(11).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients or personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 809.13(b); or

(3) Revoke the license in accordance with He-P 809.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with He-P 809.12(c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to revoke, deny, or refuse to issue or renew a license.

(k) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

(2) The presence of conditions in the HHCP that negatively impact the health, safety, or well-being of patients.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 809 in a manner which posed a risk of harm to a patient’s health, safety, or well-being of a patient;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

(4) After being notified of and given an opportunity to supply missing information, or schedule an initial inspection an applicant or licensee fails to submit an application that meets the requirements of He-P 809.04;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 809.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 809.12(c)(5) and has not submitted a revised POC as required by He-P 809.12(c)(5);

(8) The licensee is cited a third time under RSA 151 or He-P 809 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 809;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 809.14(g), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 809.11(e)(4), the fine for an unlicensed entity or a licensee shall be $500.00;

(5) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 809.06(e), the fine for a licensee shall be $100.00;

(6) For a failure to notify the department prior to a change of ownership, in violation of He-P 809.08(a)(1), the fine for a licensee shall be $500.00;

(7) For a failure to notify the department prior to a change in the physical location, in violation of He-P 809.08(a)(2), the fine for a licensee shall be $1000.00;

(8) For a failure to notify the department of a change in e-mail address, in violation of He-P 809.08(n), the fine shall be $100.00;

(9) For a failure to allow access by the department to the HHCP’s premises, programs, services, patients, or records, in violation of He-P 809.09(a)(1)-(2), the fine for an applicant, unlicensed entity or licensee shall be $2000.00;

(10) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 809.12(c)(2) or (5), the fine for a licensee shall be $500.00;

(11) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 809.12(c)(8), the fine for a licensee shall be $1000.00;

(12) For a failure to establish, implement, or comply with licensee policies, as required by He-P 809.14(b), (d), and (s) the fine for a licensee shall be $500.00;

(13) For a failure to provide services or programs required by the licensing classification and specified by He-P 809.14(c), the fine for a licensee shall be $500.00;

(14) For a failure to transfer a patient whose needs exceeds the services or programs provided by the HHCP, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(15) For providing false or misleading information or documentation to the department, in violation of He-P 809.14(f), the fine shall be $1000.00 per offense;

(16) For a failure to meet the needs of the patient, as described in He-P 809.14(i)(2), the fine for a licensee shall be $1000.00 per patient;

(17) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 809.14, the fine for a licensee shall be $500.00;

(18) When an inspection determines that a violation of RSA 151 or He-P 809 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

(19) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 809 shall constitute a separate violation and shall be fined in accordance with He-P 809.13(c); and

(20) If the applicant or licensee is making good faith efforts to comply with above, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer”; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license, the cessation of services, patient when it finds that the health, safety, or well-being of patients is in jeopardy and requires emergency action in accordance with RSA 541:A-30.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 809 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a HHCP’s license has been denied or revoked, , the applicant, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for at least 5 years if the denial or revocation specifically pertained to their role in the program.

(k) The 5 year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an administrative hearing is made and a hearing is held.

(l) Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 809.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 809.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49, and rules promulgated thereunder, as applicable.

(b) The licensee shall have written policies and procedures to include:

(1) The rights and responsibilities of admitted patients in accordance with the “Home Care Clients’’ Bill of Rights” under RSA 151:21-b;

(2) The policies described in He-P 809; and

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the HHCP, which shall include at a minimum, the core services listed in He-P 809.15.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HHCP and for:

(1) Reviewing the policies and procedures every 2 years; and

(2) Revising them as needed.

(e) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(f) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(g) The licensee shall not advertise or otherwise represent the HHCP as providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) Licensees shall:

(1) Manage and operate the HHCP;

(2) Meet the needs, as determined by the care plan, of the patient during those hours that the HHCP personnel is in the patient’s home;

(3) Initiate action to maintain the HHCP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HHCP;

(5) Appoint an administrator;

(6) Verify the qualifications of all personnel;

(7) Accept new patients based upon the availability of personnel to meet the patients’ requested service needs;

(8) Require all personnel to follow the orders of the licensed practitioner for every patient that has such orders and encourage the patient to follow the licensed practitioner’s orders; and

(9) Implement any POC that has been accepted or issued by the department.

(j) The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(k) The licensee shall only accept a patient whose needs can be met through the program and services offered under the current license.

(l) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(m) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(n) The licensee shall post the following documents in a public area:

(1) The license and current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports for the last 12 months issued in accordance with He-P 809.09(d);

(3) A copy of the Home Care Patient'’ Bill of Rights specified by RSA 151:21-b;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

(o) For reportable incidents the licensees shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2 business days of a reportable incident:

a. The HHCP name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of the patient involved and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the patient’s guardian, agent, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the patient’s licensed practitioner was notified;

(3) If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(4) Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any patient who dies within 10 days of a reportable incident;

(5) Provide the information required by (3) above in writing within 3 business days of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

(6) Submit any further information requested by the department.

(p) The licensee shall admit and allow any department representative to inspect the HHCP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 809 as authorized by RSA 151:6 and RSA 151:6-a.

(q) The licensee shall, upon request, provide a patient or their guardian agent, or surrogate decision-maker if applicable, with a copy of his or her patient record, pursuant to the provisions of RSA 151:21, X.

(r) All records required for licensing shall be legible, current, accurate, and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(s) Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

(3) Systems to prevent tampering with information pertaining to patients and personnel.

(t) At the time of admission the licensee shall give a patient and their guardian, agent, or surrogate decision-maker if applicable, a listing of all applicable HHCP charges and identify what care and services are included in the charge.

(u) The licensee shall give a patient a written notice at least 30 days before any increase is imposed in the cost or fees, for any HHCP services, except for patients receiving Medicaid whose financial liability is determined by the state’s standard of need, or patients funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18; amd by #12893, eff 10-1-19

N.H. Code Admin. R. Ann. He-P 809.15 Required Services

(a) The licensee shall have a written contractual agreement for all services provided by arrangement.

(b) Any contractual agreement to provide care and services shall:

(1) Identify the care and services to be provided;

(2) Specify the qualifications of the personnel that will be providing the care and services;

(3) Require that the HHCP must authorize the services; and

(4) Stipulate the HHCP retains professional responsibility for all care and services provided.

(c) The licensee shall provide staff for the following positions:

(1) An administrator to oversee the HHCP, except as allowed by (e)(1) below; and

(2) A director of patient services.

(d) Any new administrator shall possess at least a bachelor’s degree in business or a health related field, or be a registered nurse (RN).

(e) The administrator shall:

(1) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(2) Be permitted to hold more than one position at the HHCP if:

a. The individual meets the qualifications of all positions; and

b. The duties and responsibilities of the positions can be accomplished by one individual.

(f) Any new director of patient services shall have at least 2 years’ experience supervising personnel or providing direct home health care services and:

(1) Be a New Hampshire–licensed or compact registered nurse; or

(2) Have a bachelor’s degree in a health related field.

(g) The director of patient services shall be responsible for the overall delivery of patient care and services.

(h) At the time of admission, personnel of the HHCP shall:

(1) Provide, both orally and in writing, to the patient, or the patient’s guardian or agent, if applicable, the HHCP’s:

a. Policy on patient rights and responsibilities, including a copy of the home care Clients’ Bill of Rights, pursuant to RSA 151:21-b;

b. Complaint procedure;

c. List of services that are to be provided by the HHCP; and

d. List of the care and services that are provided by an independent contractor;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, or the patient’s guardian or agent, if applicable;

(3) Collect and record the following information:

a. Patient’s name, home address, home telephone number, and date of birth;

b. Name and telephone number of an emergency contact and guardian or agent, if applicable;

c. Name of patient’s primary care provider and the provider’s address and telephone number, as applicable;

d. Written and signed consent for the provision of care and services; and

e. Copies of all legal directives such as durable power of attorney, guardianship, or living will, as applicable;

f. Copy of order activating durable power of attorney, if applicable; and

g. Copy of DNR order, if applicable; and

(4) Obtain documentation of informed consent and consent for release of information.

(i) Each patient shall have a health assessment conducted by professional personnel in the specific discipline providing care, as authorized by their provider, to determine the level of care and services required by the patient, except as allowed by (k) and (l) below:

(1) Prior to initiating care for the specified discipline;

(2) At least every 90 days thereafter; and

(3) Whenever there is a significant change in the patient’s condition.

(j) The assessment required by (i) above shall contain at a minimum the following:

(1) Pertinent diagnoses including mental status;

(2) Goals and objectives of the services that shall be provided by the HHCP;

(3) Estimated duration and frequency of care and services;

(4) Any equipment required;

(5) Prognosis;

(6) Functional limitations;

(7) Rehabilitation potential;

(8) Activities that are limited;

(9) Nutritional requirements;

(10) Medications and treatments administered or assisted by personnel of HHCP;

(11) Any safety precautions; and

(12) Discharge planning or referral information as applicable.

(k) Patients receiving only homemaker services shall not require an assessment or a care plan.

(l) For patients receiving only personal care services, the assessment in (i) above shall:

(1) Be performed initially and every 6 months thereafter by a registered nurse, licensed practical nurse (LPN), or the director of patient services to determine the services required; and

(2) At a minimum include (j)(1), (4), (6), (8), (9), (10), and (11) above.

(m) If the assessment required by (i) or (l)(1) and (2) above is completed by an LPN or the director of patient services who is not a registered nurse, the assessment shall be reviewed and co-signed by the registered nurse or physician prior to the development of the patient’s care plan.

(n) For those patients receiving direct care or personal care services, the licensee shall develop a care plan within 3 business days of admission or prior to the initiation of services, if later, that is based on the results of the assessment required by (i) and (l) above.

(o) The care plan required by (n) above shall include:

(1) The date of the assessment;

(2) A description of the problem or need;

(3) The goals for the patient, if applicable, and identifying which services require medical, nursing, or other therapeutic professional care and which of these services can be provided by personal care service providers as defined by He-P 809.03(aq);

(4) The action or approach to be taken by HHCP personnel;

(5) The responsible person(s) or position;

(6) The date of re-evaluation, reassessment, and resolution; and

(7) Documentation that the patient and their legal representative, if applicable, were involved in the development of the care plan and any revisions made to the plan.

(p) The care plan shall be prepared by an interdisciplinary team that includes:

(1) The personnel performing the assessment;

(2) Other personnel in disciplines as determined by the patient’s needs; and

(3) The patient or the patient’s legal representative.

(q) The care plan shall be reviewed and revised at least every 90 days by the interdisciplinary team, or every 6 months if only personal care services are provided, and shall be made available to all personnel that assist the patient in the implementation of the plan.

(r) The licensee shall have an order for any service for which such order is required by the licensing statute of the licensed practitioner. Such orders shall be renewed at least annually.

(s) All personnel of the HHCP shall follow the orders of the licensed practitioner and carry out the goals stated in the care plan, as applicable.

(t) The licensee shall develop a discharge plan with the input of the patient or the patient’s legal representative, if any, including:

(1) Date and reason for discharge;

(2) Discharge instructions and referrals, if applicable;

(3) Discharge or transfer summary; and

(4) Written and signed order for discharge, if applicable.

(u) Written notes shall be documented in the patient’s record at the time of each visit for:

(1) All care and services provided by the HHCP including the:

a. Date and time of the care or service;

b. Description of the care or service;

c. Progress notes, including, as applicable:

1. Changes in the patient’s physical, functional, and mental abilities;

2. Changes in the patient’s behaviors such as eating or sleeping patterns; and

3. The patient’s pain management, if applicable; and

d. Signature and title of the person providing the care or service; and

(2) Any reportable incident involving the patient when HHCP personnel are in the patient’s home.

(v) For each patient accepted for care and services by the HHCP, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by (h)(2) above;

(2) The identification data required by (h)(3) above;

(3) Consent and medical release forms, as applicable;

(4) Consent for release of information, as applicable;

(5) The record of the assessments required by (i) or (l) above;

(6) All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by (r) above;

(7) All care plans required by (n) above including documentation that the patient or their legal representative participated in the development of the care plan;

(8) All written notes required by (u) above;

(9) All daily medication records required by He-P 809.16(g)(7)d. and f.;

(10) A discharge plan or transfer summary as required by (t) above;

(11) Documentation of service authorization, if required, for a patient receiving third party payment including but not limited to Medicaid waiver services; and

(12) Documentation of any patient refusal to follow their licensed practitioner’s written and signed orders.

(w) Patient records shall be available to:

(1) The patient, the patient’s guardian, the patient’s agent, and the patient's surrogate decision-maker;

(2) HHCP personnel as required by their job responsibilities and subject to the licensee’s policy on confidentiality;

(3) Any individual given written authorization by the patient, the patient’s guardian, the patient’s agent, or the patient's surrogate decision-maker;

(4) Any individual authorized by a court of competent jurisdiction; and

(5) The department or any individual authorized by law.

(x) The licensee shall develop and implement a method for the written release of information in patient records that is consistent with federal and state law.

(y) The HHCP shall store all paper and electronic backup files of patient records in the primary or branch office except when they are being utilized by authorized personnel.

(z) Paper records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by authorized personnel.

(aa) Electronic records shall be maintained as required by He-P 809.14(s).

(ab) Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

(ac) The HHCP shall arrange for storage of, and access to, patient records as required by (ab) above in the event that the HHCP ceases operation.

(ad) If the HHCP is providing home hospice care, it shall be licensed in accordance with He-P 823.

(ae) Only personnel with documented phlebotomy training may collect human blood specimens from patients for laboratory testing.

(af) If CLIA-waived laboratory testing is performed by personnel of the HHCP, the licensee shall obtain a CLIA Certificate of Waiver and follow all CLIA requirements in the performance of the laboratory testing including the documentation of training and competency review of all testing personnel.

(ag) If the licensee collects human specimens for laboratory testing, it shall follow the manufacturer's instructions and/or the reference laboratory's instructions for collection and storage of human specimens.

(ah) If the licensee tests human specimens, it shall be licensed as a laboratory in accordance with He-P 808, except the licensee may perform CLIA-waived point of care tests without obtaining a laboratory license in accordance with He-P 809.15(af) and (aj).

(ai) The HHCP shall follow all manufacturer’s instructions to include:

(1) Storage requirements for POC meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, reporting results; and

(3) All recommended and required quality control procedures for POC meters and devices. If the manufacturer does not require or recommend procedures for external quality control performance, the licensee shall perform control testing using at least 2 levels of liquid quality control material for each test immediately before the first patient test each calendar day.

(aj) Licensee collecting human specimens for laboratory testing shall require a collecting station license in accordance with He-P 817 except when collected by a trained registered nurse or licensed nursing assistant.

(ak) Training consists of collection, storage, and transport of the specimens.

(al) Training will be done by a registered nurse trained in the collection, storage and transport of human specimens.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18; amd by #12893, eff 10-1-19

N.H. Code Admin. R. Ann. He-P 809.16 Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

(b) HHCP personnel who are not authorized by law to administer medications may remind and prompt patients to take their medications at the proper time, place medication container(s), including pill planners, within patient reach, opening the medication container when patient is present, reading the medication label to the patient, and utilizing hand over hand technique, as defined in 809.03 (bb), as per the care plan without requiring documentation of specific medications taken.

(c) If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

(d) A licensed nursing assistant (LNA) may perform hand over hand assistance by following the care plan, as delegated by a licensed nurse, to a competent and stable patient pursuant to RSA 326-B.

(e) The licensee shall allow the patient to self-direct medication administration, as defined in He-P 809.03(bb), if the patient:

(1) Has a physical limitation due to a diagnosis that prevents the patient from self-administration of medication with or without assistance;

(2) Obtains an annual written verification of the patient’s physical limitation and self-directing capabilities from the patient’s licensed practitioner or the assessment performed by an RN according to He-P 809.15(i) and such documentation is included in the patient record; and

(3) Verbally directs personnel to:

a. Assist the patient with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

b. Assist the patient to apply, ingest, or instill the ordered dose of medication.

(f) If personnel, who are authorized by law, administer medication(s), delegate medication administration, or prepare medication in advance for administration in accordance with RSA 318:42, XIII and XIV, the HHCP shall:

(1) Maintain a list of medications currently being taken by the patient;

(2) Administer all medications in accordance with the orders of the licensed practitioner;

(3) Maintain an order, or a copy thereof, in the patient’s record that includes:

a. The patient’s name;

b. The medication name, strength, prescribed dose, and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Only use medications that have been be kept in the original containers, as dispensed by the pharmacy, licensed practioner’s samples, or over the counter medications;

(5) Require that any change or discontinuation of medications shall be pursuant to an order from a licensed practitioner or other individual authorized by law;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner as soon as possible and with a documented reason if signed more than 30 days after the telephone order being taken;

(7) Require that the medication to be administered by HHCP personnel be:

a. Prepared immediately prior to administration; and

b. Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B;

(8) Require that when personnel are assisting or administering medication, they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

(9) Maintain documentation for all medications either assisted by or administered by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication was taken;

e. The signature and identifiable initials and job title of:

1. The person assisting or administering the medication; or

2. The person administering or assisting the patient taking his or her medication;

f. Documented reason for any medication refusal or omission; and

g. For PRN medications, the reason the patient required the medication and the effect of the PRN medication at the time of the next patient contact; and

(10) Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any.

a. Observed adverse reactions to or side effects of medication; and

b. Medication errors such as incorrect medications.

(g) If the HHCP provides “self-administration of medication with assistance” medication services to a patient as defined by He-P 809.03(bb), the HHCP shall:

(1) Maintain, in the home, a list of medications currently being taken by the patient;

(2) Assist with self-administration of medications in accordance with the orders of the licensed practitioner;

(3) Maintain either the original order, or a copy thereof, in the patient’s record that includes:

a. The patient’s name;

b. The medication name, strength, prescribed dose and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Not allow personnel to assist with self-administration of medications if anyone other than a pharmacist has changed prescription medication container labels except as allowed by (7)f. below;

(5) Require that any change or discontinuation of medications shall be pursuant to an order;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner within 30 days or with a documented reason if more than 30 days;

(7) Allow a patient to self-administer medication with assistance by personnel, as directed by the care plan, and which personnel shall be required to:

a. Remind the patient to take the correct dose of his or her medication at the correct time from the original medication bottle;

b. Place the medication container within reach of the patient;

c. Remain with the patient to observe them taking the appropriate number and type of medication as ordered by the licensed practitioner;

d. Record that they have supervised the patient taking their medication on the patient’s daily medication record;

e. Document in the patient’s record any observed or reported side effects, adverse reactions, refusal to take medications, and medications not taken; and

f. Require that if the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HHCP are unable to obtain a new prescription label:

1. The RN shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HHCP’s written procedure, indicating that there has been a change in the medication order;

2. The RN shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

3. The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first;

(8) Maintain documentation for all medications assisted by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication, including PRN medications, was taken;

e. The signature, identifiable initials, and job title of the person assisting the patient taking his or her medication; and

f. Documented reason for any medication refusal or omission;

(9) Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

a. Observed adverse reactions to or side effects of medication; or

b. Medication errors such as incorrect medications; and

(10) Require LNAs who assist patients with self-administration of medications to comply with the board of nursing requirements according to RSA 326-B

(h) A home health personal care service provider shall successfully complete a medication assistance education program taught by a licensed nurse, licensed practitioner, or pharmacist, whether in person or through other means such as electronic media, prior to assisting a patient with self-administration of medication with assistance, self-directed medication administration, or administration via nurse delegation.

(i) The medication assistance education program required by (h) above shall, at a minimum, include training on the following subjects:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights, including:

a. The right patient;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. Administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as antihypertensive medications or antibiotics;

(5) Desired effects and potential side effects versus adverse effects of medications; and

(6) Medication precautions and interactions.

(j) For patients who qualify for the use of therapeutic cannabis, the licensee shall keep a copy of the registry identification card in the patient’s record.

(k) The licensee shall develop, maintain, and implement a patient specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be handled and administered to the patient.

(l) If allowed by the policy in (k) above, cannabis shall be treated in a manner similar to controlled medications with respect to assisting qualifying patients with the therapeutic use of cannabis.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.17 Personnel

(a) The licensee shall develop a job description for each position in the HHCP containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Qualifications and educational requirements of the position.

(b) For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care or personal care services to patients the licensee shall:

(1) Obtain a criminal record check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

(2) Review the results of the criminal records check in (1) above in accordance with (c)(1)-(2) below; and

(3) Verify the qualifications of all applicants prior to employment.

(c) Unless a waiver is granted in accordance with He-P 809.10 and (e) below, the licensee shall not offer employment, contract with, or engage a person in (b) above,for any position if the individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(d) If the information identified in (c) above regarding any person identified in (b) above, is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (c) above.

(e) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a patient; or

(2) Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(f) The licensee shall:

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS;

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing.

(g) In lieu of (b) and (f) above, the licensee may accept from independent agencies contracted by the licensee to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) and (f) above and do not meet the criteria in (c) and (f) above.

(h) All personnel shall:

(1) Meet the educational and physical qualifications of the position as listed on their job description;

(2) Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(3) Be licensed, registered, or certified as required by state statute;

(4) Receive an orientation prior to contact with a patient that includes:

a. The HHCP’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The HHCP’s policies, procedures, and guidelines;

d. The HHCP’s infection control program;

e. The HHCP’s fire evacuation and emergency plans which outline the responsibilities of personnel in an emergency;

f. The mandatory reporting requirements such as RSA 161:F:46-48 and RSA 169-C:29-31; and

g. Body mechanics training;

(5) Complete mandatory annual in-service education, which includes a review of the HCCP’s:

a. Policies and procedures on patient rights and responsibilities;

b. Infection control program; and

c. Fire and emergency procedures;

(6) Be at least 18 years of age if working as direct care personnel unless they are:

a. An LNA working under the supervision of an RN in accordance with Nur 700; or

b. Part of an established educational program working under the supervision of an RN;

(7) Prior to contact with patients or food, submit to the HHCP the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2-step tuberculosis (TB) testing, mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(8) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

(9) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(i) In lieu of (h)(8) above, independent agencies contracted by the facility to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (h)(7) and (9) above before working at the HHCP.

(j) The scope of services provided by a personal care service provider shall be as follows:

(1) Basic personal care and grooming to include:

a. Sponge bathing;

b. Gathering and handing the patient materials related to bathing;

c. Regulating the bath or shower water temperature and running the water;

d. Hair care including shampooing;

e. Skin care to include application of preventive skin care products;

f. Filing of nails;

g. Assisting with oral hygiene;

h. Shaving of patient using an electric razor; and

i. Dressing to include putting on or removing clothing, shoes, and stockings;

(2) Transfer assistance as follows:

a. Weight bearing assistance such as steadying the patient and arranging items to assist the transfer of the patient; and

b. Non-weight bearing assistance on a case-by-case basis as specified by the HHCP;

(3) Mobility assistance as follows:

a. Accompanying the patient as he or she moves from one location to another, removing obstacles from his or her path, opening doors, and handing the patient his or her cane or walker;

b. Pushing a wheelchair which has been fitted to the patient; and

c. On a case-by-case basis steadying the patient as he or she ambulates;

(4) Assistance with toileting and toileting hygiene measures as follows:

a. Assistance with the use of the toilet, commode, bedpan, and urinal;

b. Assistance with the use of products related to hygiene care such as disposable incontinent briefs or pads;

c. Assistance with cleaning after elimination;

d. Assisting with cleaning the patient after instances of vomiting, diarrhea, and incontinence;

e. Assistance with ostomy care in a long term, well healed, trouble free ostomy, such as assisting in application of the stoma bag on a case-by-case basis as individually trained by the appropriate professional staff; and

f. Assistance with catheter care only by emptying the urinary drainage bag on a case-by-case basis as individually trained by the appropriate professional staff;

(5) Assistance with personal appliances as follows:

a. Insertion and cleaning dentures;

b. Insertion and cleaning hearing aids;

c. Cleaning and putting on eye glasses; and

d. Assisting with application of some types of braces, splints, slings, and prostheses on a case-by-case basis as determined by the HHCP and individually trained by the appropriate professional staff; and

(6) Assistance with nutrition, hydration, and meal preparation as follows:

a. Preparation of the meal;

b. Arranging food including cutting up or mashing the food;

c. Filling the patient’s fork or spoon;

d. Encouraging the patient to eat or drink; and

e. Feeding the patient by mouth on a case-by-case basis as determined by the agency.

(k) The HHCP shall determine the patient-related training required by the personal care service provider, in addition to the basic training described in (m) below, in order to provide the personal care services which are on a case-by-case basis as described in (j) above.

(l) Prior to assisting patients with transfers, bathing, feeding, or dressing, personal care service providers, whose duties include the aforementioned tasks, shall attend a minimum 8-hour training in the performance of these duties, the clinical portion of which shall be conducted by a licensed professional such as an LPN or RN.

(m) The training in (j) above shall include at a minimum:

(1) Orientation to home care including the role of the personal care service provider and the general orientation required by (h)(4) above;

(2) Communication with patients, and understanding patient needs;

(3) Personal and home safety including environmental safety and emergency response;

(4) Personal care skills including:

a. Supervision and verbal prompting;

b. Assisting in bathing, dressing, grooming, mouth care, hair care, and skin care;

c. Assisting in elimination including cleaning the patient after elimination and use of products related to hygiene care;

d. Moving and transferring patients;

e. Nutrition, the mechanics of eating, hydration, and how to prepare, serve, and encourage the patient to eat and drink;

f. Use of assistance devices;

g. Fall prevention; and

h. Medication reminder training; and

(5) Responsibility, accountability, and record keeping.

(n) LNAs who are working as personal care service providers shall be deemed as already having received the training required in (m) above but shall be required to receive the training required by (h)(4) above.

(o) The HHCP shall maintain a record for training of each personal care service provider.

(p) The HHCP shall provide supervision of the personal care service provider every 6 months.

(q) The director of patient services shall:

(1) Coordinate the individual training required for personal care services provided on a case-by-case basis; and

(2) Assure that the care plan is being carried out.

(r) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud,theft, abuse, neglect, or exploitation of any person.

(s) Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients or food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

(t) All personnel shall follow the orders of the licensed practitioner for each patient and encourage patients to follow the practitioner’s order.

(u) Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HHCP licensed premises.

(v) The employee records required by (u) above shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data, including date of birth; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the HHCP’s policy setting forth the patient rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (h)(4) above and any required continuing education program;

(5) A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

(6) Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Documentation of annual in-service education as required by (h)(5) above;

(8) Documentation of training as required by (m) above;

(9) The statement signed at the time of the initial offer of employment and renewed annually thereafter by all personnel as required by (r) above;

(10) Documentation of the criminal records check; and

(11) The results of the registry checks in (f) above.

(w) The HHCP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (v)(2) and (6)-(10) above; and

(2) For independent contractors, the information in (v)(2), and (4)-(12) above, except that the letter in (h) and (j) above may be substituted for (v)(6), (9), and (10) above, if applicable.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.18 Quality Improvement

(a) The HHCP shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of the HHCP quality improvement program, a quality improvement committee shall be established.

(c) The HHCP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the licensee; and

(7) Evaluate the effectiveness of the corrective actions.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.19 Infection Control and Sanitation

(a) The HHCP shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand-washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 904; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(e) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious unless they utilize appropriate infection control equipment as required by the facility’s policy and procedures on infection control.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(g) Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight-fitting bandage.

(h) Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

(i) If the HHCP has an incident of an infectious disease reported in (b)(5) above, the HHCP shall contact the public health nurse in the county in which the patient resides and follow the instructions and guidance of the nurse.

(j) Sterile supplies and equipment shall:

(1) Be stored in dust-proof, moisture-free storage areas; and

(2) Not be mixed with dirty supplies.

(k) If the HHCP has soiled items at itslicensed premises, they shall be disposed of according to the facility’s infection control policies.

(l) If equipment needs to be cleaned in order to prevent contamination, the HHCP shall develop and maintain written procedures for safe and effective cleaning of the equipment.

(m) The HHCP shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

(n) The HHCP shall not re-use any equipment or supplies that require sterilization.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.20 Physical Environment and Emergency Preparedness

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

(1) Building;

(2) Health, including waste disposal and water;

(3) Fire; and

(4) Zoning.

(b) The HHCP shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

(c) The HHCP shall be clean, maintained in a safe manner and in good repair, and kept free of hazards.

(d) Each licensee shall develop a written emergency plan that covers any situation that prevents the HHCP from providing patient services and which:

(1) Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

(2) Is approved by the local emergency management director or fire department, as appropriate;

(3) Is available to all personnel;

(4) Is based on realistic conceptual events;

(5) Is modeled on the incident command system (ICS) in coordination with local emergency response agencies;

(6) Provides that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Includes the HHCP's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources; and

f. Communications systems;

(8) Includes a plan for alerting and managing personnel in a disaster, and accessing critical incident stress management (CISM), if necessary;

(9) Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a patient;

(10) Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

(11) If the HHCP is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

(e) Each licensee shall annually review and revise, as needed, its emergency plan.

History

• #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12640, eff 10-3-18

N.H. Code Admin. R. Ann. He-P 809.21 Community Health Services

(a) The following rules shall not apply to the HHCP when providing community health services:

(1) He-P 809.14 (b), The Home Care Patients Bill of Rights; and

(2) He-P 809.15:

a. Paragraphs (a) and (b) on contractual agreement with patients;

b. Subparagraph (h)(1)a. on provision of the home care client Bill of Rights, procedures, and policies;

c. Subparagraph (h)(3)e. on obtaining copies of advance directives;

d. Paragraphs (i) and (j) on conducting health assessments;

e. Paragraphs (n), (o), (p), and (q) on plan of care;

f. Paragraph (t) on discharge plans; and

g. Paragraphs (u), (v), and (w) on record-keeping requirements.

History

• #12640, eff 10-3-18

Part He-P 810 Birthing Center Rules

N.H. Code Admin. R. Ann. He-P 810.01 Purpose

The purpose of this part is to set forth the licensing and operating requirements for birthing centers pursuant to RSA 151:2, I(d).

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a birthing center except:

(a) The facilities listed in RSA 151:2, II;

(b) All entities which are owned or operated in their entirety by the state of New Hampshire, pursuant to RSA 151:2, II(h); and

(c) All health promotion, disease prevention, or screening clinics operated by a New Hampshire licensed birthing center.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.

(b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(d) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151, He-P 810, or other licensing rules.

(e) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(f) “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services and is physically present in the licensed facility.

(g) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J or a “surrogate decision maker” in accordance with RSA 137-J:35.

(h) “Advanced practice registered nurse” means an individual licensed by the New Hampshire board of nursing in accordance with RSA 326-B:18 and be certified by a board-recognized national certifying body in the specialty for which the nurse was educated.

(i) “Advanced practice registered nurse-certified nurse midwife (APRN-CNM)” means an individual licensed by the New Hampshire board of nursing in accordance with RSA 326-B:11 and certified by the American Certified Nurse Midwife Certification Council.

(j) “Adverse medication reaction” means harm caused by a medication at normal doses.

(k) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, and captive or affiliated insurance companies.

(l) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA 137-J:35-37.

(m) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a birthing center pursuant to RSA 151.

(n) “Area of noncompliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 810, or other federal and state requirements.

(o) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.

(p) “Birthing center” means a facility that is not located in a licensed acute care hospital, and which provides prenatal care through postnatal care, and which instructs and assists women in natural childbirth.

(q) “Care plan” means a documented guide developed by a licensed or certified practitioner, in consultation with the patient, guardian, personal representative, or agent , as a result of the assessment process for the provision of care and services to a patient.

(r) “Certified midwife” means a “certified midwife” as defined in Mid 301.01(b).

(s) “Certified nurse-midwife” means a “certified nurse-midwife” as defined in Mid 301.01(c).

(t) “Change of ownership” means the transfers of a controlling interest in an established birthing center to any individual, agency, partnership, corporation, governmental entity, association, or other legal entity.

(u) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(v) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or their designee.

(w) “Contracted employee” means a temporary employee working under the direct supervision of the birthing center, but employed by an outside agency.

(x) “Controlling interest” means greater than 50% ownership interest.

(y) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR § 485.606.

(z) “Days” means calendar days unless otherwise specified in the rule.

(aa) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided.

(ab) “Department” means the New Hampshire department of health and human services.

(ac) “Direct care” means hands on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(ad) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, nursing, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(ae) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified areas of non-compliance.

(af) “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.

(ag) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes “do not attempt resuscitation order (DNAR order)”.

(ah) “Emergency” means an unexpected occurrence or set of circumstances that require immediate, remedial attention.

(ai) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(aj) “Employee” means anyone employed by the birthing center and for whom the birthing center has direct supervisory authority.

(ak) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 810.

(al) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures.”

(am) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(an) “Facility” means “facility” as defined in RSA 151:19, II.

(ao) “Good cause” means any circumstances beyond a person’s control, that the department considers to be circumstances that prevents that person from taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(ap) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and personal needs.

(aq) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).

(ar) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.

(as) “Infectious waste” means those items specified by Env-Sw 103.28.

(at) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(au) “Informed consent” means the decision by a person or their guardian, personal representative, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person, guardian, personal representative, agent, or surrogate decision maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(av) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 810, or to respond to allegations of non-compliance with RSA 151 or He-P 810.

(aw) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

(ax) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 810, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.

(ay) “Licensed or certified practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Licensed advanced practice registered nurse-certified nurse midwife (APRN-CNM);

(5) Doctor of osteopathy;

(6) Doctor of naturopathic medicine with certification in natural childbirth; or

(7) Certified midwife.

(az) “Licensed premises” means the physical location that the department has approved for the birthing center to conduct operations in accordance with its license. It can include the private home of the licensed or certified practitioner, but it does not include the private residence of a patient receiving services from the birthing center licensed under the authority of RSA 151.

(ba) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151and He-P 810.

(bb) “Licensing classification” means the specific category of services authorized by a license.

(bc) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bd) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b).

(be) “Medical director” means a New Hampshire licensed physician in accordance with RSA 329, doctor of naturopathic medicine with certification in natural childbirth, or an APRN-CNM who is responsible for overseeing the quality of medical care and services at the birthing center.

(bf) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(bg) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.

(bh) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bi) “Neglect” means an act or omission that results or could result in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.

(bj) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bk) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bl) “Over-the-counter medication” means non-prescription medication.

(bm) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a licensed birthing center.

(bn) “Patient” means any person admitted to or any way receiving care, services, or both from a birthing center licensed in accordance with RSA 151 and He-P 810.

(bo) “Patient record” means a separate file maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 810 and all documentation as required by other applicable federal and state requirements.

(bp) “Patient rights” means “patient rights” as defined in RSA 151:19, VI namely, “those rights established under RSA 151:21 or RSA 151:21-b, as applicable”.

(bq) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(br) “Personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having direct or indirect ownership interest in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”.

(bs) “Personnel” means an individual who is employed by, a volunteer of, or an independent contractor of the birthing center who provides direct care or services to a patient(s).

(bt) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bu) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bv) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

(bw) “Point of care devices” means testing involving a system of devices used to obtain medical, diagnostic results, including but not limited to:

(1) A lancing or finger stick device to obtain a blood specimen;

(2) A test strip or reagents to apply a specimen for testing; or

(3) A meter or monitor to calculate and show the results, including but not limited to:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

c. A cholesterol meter.

(bx) “Pro re nata (PRN) medication” means medication taken as circumstances might require in accordance with the licensed practitioner’s orders.

(by) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bz) “Professional staff” means staff who are licensed, registered, or certified by the state to provide health care services.

(ca) “Protective care” means the provision of patient monitoring services, including but not limited to:

(1) Knowledge of patient whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(cb) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(cc) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cd) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that do not result in a reconfiguration of the building spaces within.

(ce) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cf) “Reportable incident” means an occurrence of any of the following while the patient is either in the birthing center or in the care of birthing center personnel:

(1) The unanticipated death of a patient;

(2) The unexplained absence of a patient from the licensed premises who is determined to be a danger to themselves or others;

(3) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;

(4) Medication errors;

(5) Drug diversion; and

(6) An injury that requires examination or treatment by a licensed practitioner.

(cg) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.

(ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.

(ci) “Service area” means “service area” as defined in RSA 151:4-a, I (c).

(cj) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(ck) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.

(cl) “State monitoring” means the placement of individuals by the department at a birthing center to monitor the operation and conditions of the facility.

(cm) “Transfer” means “transfer” as defined in RSA 151:19, VII namely, “movement of a patient from one facility to another facility when the legal responsibility for the care of the patient changes from the transferring to the receiving facility. Transfer shall not include the temporary movement of a patient from a facility to a hospital or other location for emergency medical treatment, as long as the facility is in compliance with RSA 151:25. In the event a facility refuses to readmit a patient in accordance with RSA 151:25 following a therapeutic leave, a transfer shall be deemed to have occurred when the decision not to readmit is made. Transfer shall not include movement of a client from a home care to an institutional setting or the shifting of service provision from one home health care provider to another”.

(cn) “Underwriters Laboratories (UL) Listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(co) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.04 Notice to Critical Access Hospitals

(a) Prior to submitting an application for licensure in accordance with He-P 810.05, a proposed facility shall comply with the requirements of RSA 151:4-a, II, and send written notification of its intent to submit an application for licensure as a birthing center via certified mail to the department and to the chief executive officer of all critical access hospitals with a primary physical location within a 15 mile radius of the proposed birthing center.

(b) The written notification required in (a) above shall contain the following:

(1) Name of the person or entity seeking to establish the proposed birthing center;

(2) Proposed physical location of the facility; and

(3) Scope of services for the facility.

(c) Upon receipt of the written notification in (a) above, the chief executive officer of the critical access hospital(s) shall have 30 days to file a written objection with the department.

(d) The written objection in (c) above shall contain the following:

(1) The critical access hospital’s detailed basis for the objection to the proposed facility to include:

a. If the proposed facility will have a material adverse impact on the critical access hospital’s operations; and

b. How the proposed facility will impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

(2) Proof that the objection was sent via certified mail to the proposed individual or entity seeking to establish the proposed facility.

(e) Upon receipt of an objection meeting the requirements of (d) above from a critical access hospital located within a 15 mile radius of a proposed birthing center, the department shall send a letter to the proposed facility informing them of the:

(1) Objection and the reason for the objection; and

(2) Opportunity to submit a written response to the objection, which shall include at a minimum:

a. Any information regarding the objection that may be relevant to the determination of material adverse impact; and

b. How the proposed facility will not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources.

(f) The department shall provide the names of 3 independent contractors, retained by the department through a competitive procurement process, to the critical access hospital and proposed facility for their consideration.

(g) The independent contractors proposed in (f) above shall be experts in the provision of health care services and skilled in determining how utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources could be impacted by the proposed facility.

(h) If, after proposing 3 independent contractors, the critical access hospital and proposed facility cannot agree on an independent contractor within 30 days of the proposal by the department, the department shall designate the independent contractor to perform the assessment and create the expert report.

(i) Within 30 days of the selection of the independent contractor in accordance with (f) and (h) above, the department shall send a letter to the selected independent contractor requesting their services. This letter shall include:

(1) A request to engage the independent contractor’s services to perform the assessment and create the expert report as required in RSA 151:4-a, II (b);

(2) A summary of the requirements for the content of the expert report, to include:

a. How the proposed project might or might not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

b. A summary of public comments, received in accordance with (p) below shall be taken into consideration in completing the assessment;

(3) The contact information for the proposed facility and chief executive officer of the critical access hospital(s) raising the objection(s);

(4) The objection and response along with any other documentation received by the department relative to this transaction; and

(5) A deadline for completion of the expert report, which shall be no later than 90 days from the date of retention of the expert unless an extension is granted by the department in accordance with (s) below. Such an extension shall not exceed 30 days.

(j) Upon selection of the independent contractor, the department shall notify the proposed facility and critical access hospital of the selected independent contractor.

(k) The independent contractor shall invoice the proposed facility and critical access hospital the cost of any fees associated with the retention and work to be completed which shall be shared equally between the proposed facility and the critical access hospital.

(l) Invoices shall be paid for in advance of any services performed in accordance with RSA 151:4-a, II (b)(6).

(m) Payment of the proposed facility and critical access hospital’s portion of the advance retainer to the independent contractor shall be paid within 5 business days.

(n) If the proposed facility fails to make payment in accordance with (m) above, it shall forfeit its right to submit an application for licensure.

(o) If the critical access hospital fails to make payment in accordance with (m) above, it shall forfeit its right to object and the proposed health care facility shall be allowed to apply for licensure.

(p) In accordance with RSA 151:4-a, II (b), the proposed facility and critical access hospital shall provide any information requested by the independent contractor to complete its report in accordance with the following:

(1) Information obtained at the request of the independent contractor shall not be considered confidential under RSA 151:13, unless the department determines that it should be exempt from disclosure under RSA 91-A:5;

(2) The proposed facility and critical access hospital shall provide the information within a reasonable time, as determined by the independent contractor based on the scope of work of the project and the expected time to review said documentation, so that the independent contractor is able to finish its report in the required 90 day time period;

(3) If the proposed facility fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to submit an application for licensure; and

(4) If the critical access hospital fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to object and the proposed facility shall be allowed to apply for licensure.

(q) Within 30 days of retention of the independent contractor, the department shall publish a notice on the department’s website to notify the public of the proposed facility and solicit public comment for a period of at least 7 days.

(r) All public comments received in (q) above shall be provided to and considered by the independent contractor for use in the analysis.

(s) Within 90 days of retention of the independent contractor, the report as described in RSA 151:4-a, II(b) and (i)(2) through (4) above, shall be submitted to the department, unless an extension is granted by the department in accordance with the following:

(1) The department shall grant an extension for good cause;

(2) Good cause shall be determined by the department and a finding of good cause shall require the independent contractor to show why the report cannot be completed within the 90 days and that the extension is not a result of the proposed facility’s or critical access hospital’s failure to comply with the rules; and

(3) Such an extension shall not exceed 30 days.

(t) Within 10 days of receipt of the expert report, the department shall provide a copy of the report to the proposed facility and critical access hospital.

(u) If the report finds that the proposed facility will have a material adverse impact, then the proposed facility shall not be allowed to apply for licensure.

(v) If the report finds that the proposed facility will not have a material adverse impact, then the proposed facility may proceed with application for licensure.

(w) The person or entity seeking to establish the proposed facility and the critical access hospital(s) shall have the right to request a rehearing by the commissioner, pursuant to RSA 541:3.

(x) The result of the rehearing may be appealed by petition to the NH Supreme Court, pursuant to RSA 541:6.

(y) If the proposed facility chooses to move forward with the licensing process prior to all appeal rights being exhausted, the proposed facility shall do so at its own risk and shall not hold the critical access hospital or the department liable for any costs incurred.

(z) The appellant shall bear all costs of the state in connection with any rehearing or petition for appeal, including the state’s attorneys’ fees.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.05 License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I through III-a, and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (August 2025), signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

b. “I affirm that I have complied with RSA 151:4-a and a determination is on file with the department that finds the proposed health care facility shall be allowed to apply for licensure.”;

(2) A floor plan of the prospective birthing center including the location of all beds;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) List of affiliated or related parties;

(5) The applicable fee, in accordance with RSA 151:5, XXI, payable in cash or, if paid by check or money order, in the exact amount of the fee, made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the qualifications of and copies of applicable licenses or certificates for the birthing center administrator and medical director;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or, if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all local applicable zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances applicable for a birthing center; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(8) If the birthing center uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, and Env- Dw 704.02, or if a public water supply is used, a copy of a water bill;

(9) The results of a criminal records check for the applicant(s), licensee if different than the applicant, the administrator, and medical director, and if applicable, each household member 17 years of age or older who resides at the facility, for which the application is submitted which includes criminal history from the state of New Hampshire;

(10) A copy of the non-conviction attestation as described in He-P 810.20 for the administrator and medical director;

(11) The results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director;

(12) Any waiver requests, if applicable; and

(13) A list of all employees who have previously been granted waivers for criminal background check results from the department.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.04)

N.H. Code Admin. R. Ann. He-P 810.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 810.05(a) have been received.

(b) If an application does not contain all of the items required by He-P 810.05(a), the department shall notify the applicant in writing of the items required to be submitted and provide 30 days to supply the missing information before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 810.14(b) when it determines that the applicant, administrator, or a medical director:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 810.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 810.

(i) A written notification of denial shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.05)

N.H. Code Admin. R. Ann. He-P 810.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month in which it was issued, unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 810.05(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 810.11(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 810.20(f)(2); and

(4) A copy of any temporary, new, or existing variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

(d) Following an inspection, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 810, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 810.05 and shall be subject to a fine in accordance with He-P 810.14.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.06)

N.H. Code Admin. R. Ann. He-P 810.08 Birthing Center Construction, Modifications, or Structural Alterations

(a) As required by RSA 151:6 any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V; sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office, and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicant’s own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building code, state laws and rules, and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for the Design and Construction of Outpatient Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(i) Exceptions to the FGI guidelines above shall be granted by the state fire marshal.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 810.09 prior to its use.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.07)

N.H. Code Admin. R. Ann. He-P 810.09 Birthing Center Requirements for Organizational or Service Changes

(a) The birthing center shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds authorized under the current license; or

(6) Services.

(b) The birthing center shall complete and submit a new application and obtain a new or revised license, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in number of beds authorized under the current license; or

(4) A change in services.

(c) When there is a change in address without a change in location, the birthing center shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the birthing center shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) When there is to be a change in the services provided, prior to making any changes to the services provided or adding additional services, the birthing center shall provide the department with a description of the service change or additional services and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, will be made to the physical environment.

(f) The department shall review the information submitted under (e) above and determine if the change in services or added services can be provided under the birthing center’s current license.

(g) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection will be conducted as soon as practical by the department;

(2) The physical location;

(3) A change in the number of beds or patients authorized under the current license;

(4) A change in licensing classification; or

(5) A change that places the facility under a different life safety code occupancy chapter.

(h) A new license shall be issued for a change in ownership, classification, or physical location.

(i) A revised license shall be issued for any of the following:

(1) Change in name;

(2) A change in administrator or medical director;

(3) An increase or decrease in the number of beds;

(4) A change in the scope of services provided;

(5) A change in address without a change in physical location; or

(6) When a waiver has been granted in accordance with He-P 810.11.

(j) The birthing center shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) The results of a criminal records check for the new administrator or medical director conducted under He-P 810.20;

(3) Copies of applicable licenses for the new administrator or medical director;

(4) A copy of the non-conviction attestation as described in He-P 810.20; and

(5) The result of a BEAS registry check from the bureau of elderly and adult services for the new administrator or medical director.

(k) Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 810.20(b) or (d).

(l) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the birthing center in writing so that a waiver can be sought or the program can search for a qualified candidate.

(m) The birthing center shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(n) A restructuring of an established birthing center that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) If a licensee chooses to cease operation of a birthing center, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.07)

N.H. Code Admin. R. Ann. He-P 810.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 810, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services being provided by the birthing center; and

(3) Any records required by RSA 151 or He-P 810.

(b) The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 810 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as provided for in He-P 810.09(g)(1);

(3) A change in the physical location of the birthing center;

(4) A change in the licensing classification;

(5) An increase in the number of beds;

(6) Occupation of space after construction, renovations, modifications, or alterations; or

(7) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the birthing center is in violation of any of the provisions of He-P 810, RSA 151, or other federal or state requirement(s).

(e) If areas of noncompliance were cited in either a statement of findings or a notice to correct, the licensee shall submit a written POC, in accordance with He-P 810, within 21 days of the date on the letter that transmits the statement or notice.

History

• #5635, eff 6-7-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.09)

N.H. Code Admin. R. Ann. He-P 810.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 810 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule for which a waiver is sought or to provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.10)

N.H. Code Admin. R. Ann. He-P 810.12 Complaints and Investigations

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 810.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the birthing center, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 810.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For licensed birthing centers, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with a statement of findings or notice to correct if areas of noncompliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines the complaint is unfounded under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 810.13(c) if areas of noncompliance were found as a result of the investigation.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (e)(1) above to submit a written response to the findings or submit a completed application prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 810 if the owner of an unlicensed birthing center does not comply with (2) above, or if the department

does not agree with the owner’s response;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 810.13.

(f) Complaint investigations shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; and

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.11)

N.H. Code Admin. R. Ann. He-P 810.13 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 810, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a license;

(4) Imposing fines upon an unlicensed individual, applicant, or licensee in accordance with (f) below; or

(5) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 810;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 810 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(7). The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 810.13(d) and a fine in accordance with He-P 810.14(c)(12);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 810.13(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 810.13(e) and a fine in accordance with He-P 810.14(c)(12).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection or investigation, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If, at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine:

(3) Deny an application for a renewal of a license in accordance with He-P 810.14; or

(4) Revoke the license in accordance with He-P 810.14.

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients;

(2) The presence of conditions in the birthing center that negatively impact the health, safety, or well-being of patients; or

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.12)

N.H. Code Admin. R. Ann. He-P 810.14 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 810 which poses a threat to the health, safety, or well-being of a patient;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) An applicant or licensee fails to submit an application that meets the requirements of He-P 810.05 within 30 days of being notified to supply missing information;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) A licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department, in accordance with He-P 810.13(c), (d), and (e);

(7) A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 810.13(c)(5) and has not submitted a revised POC as required by He-P 810.13(c)(6);

(8) A licensee is cited a third time under RSA 151 or He-P 810 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (k) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 810;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine for an applicant or unlicensed provider shall be $2000.00;

(2) For failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for the applicant, unlicensed provider, or licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

(4) For failure to transfer a patient whose needs exceeds the services or programs provided by the birthing center, in violation of RSA 151:5-a and He-P 810.15(n), the fine for a licensee shall be $500.00;

(5) For acceptance or admission of a patient whose needs exceed the services or programs authorized by the birthing center’s licensing classification, in violation of RSA 151:5-a, II and He-P 810.15(m), the fine for a licensee shall be $1000.00;

(6) For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 810.12, the fine for an unlicensed provider or licensee shall be $500.00;

(7) For failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 810.07(b), the fine for the licensee shall be $100.00;

(8) For failure to notify the department prior to a change of ownership, in violation of He-P 810.09(a)(1), the fine for a licensee shall be $500.00;

(9) For failure to notify the department prior to a change in the physical location, in violation of He-P 810.09(a)(2), the fine for a licensee shall be $500.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 810.09(m), the fine shall be $100.00;

(11) For failure to allow access by the department to a birthing center’s premises, programs, services, patients, or records, in violation of He-P 810.15(q), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

(12) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 806.09(j), the fine for a licensee shall be $100.00;

(13) For failure to submit a POC or a revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the statement of findings or notice to correct, in violation of He-P 810.13(c)(2) or He-P 810.13(c)(6), the fine for a licensee shall be $100.00;

(14) For failure to implement the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 810.13(c)(11), the fine for a licensee shall be $1000.00;

(15) For failure to establish, implement, or comply with licensee policies the fine for a licensee shall be $500.00;

(16) For failure to provide services or programs required by the licensing classification and specified by He-P 810.16(h), the fine for a licensee shall be $500.00;

(17) For exceeding the licensed capacity of the birthing center, in violation of He-P 810.15(o), the fine for a licensee shall be $500.00 per day;

(18) For providing false or misleading information or documentation to the department in violation of He-P 810.15(h), the fine for an applicant or licensee shall be $1,000.00 per offense;

(19) For failure to meet the needs of the patient, in violation of He-P 810.15(k)(2), the fine for a licensee shall be $1,000.00 per patient;

(20) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 810.16(a) and He-P 810.16(h), respectively, or under circumstances where the department has not granted a waiver in accordance with He-P 810.11, the fine for a licensee shall be $500.00;

(21) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 810.08(a), the fine for a licensed facility shall be $500.00;

(22) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(23) When an inspection determines that a violation of RSA 151 or He-P 810 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance the fine for a licensee shall be double the original fine, but not exceed $1000.00; and

b. If the same area of non-compliance is cited for a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

(24) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 810 shall constitute a separate violation and shall be fined provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 810, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a patient is in jeopardy and emergency action is required, in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 810 is achieved.

(i) Hearings and appeals of department decisions under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) RSA 541 shall govern further appeals of department decisions under this section.

(k) When a birthing center’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years, if the enforcement action specifically pertained to their role in the birthing center.

(l) The 5-year period referenced in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing was held.

(m) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 810.

(n) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 810.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.13)

N.H. Code Admin. R. Ann. He-P 810.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(b) The licensee shall have a written policy and procedures setting forth the rights and responsibilities of patients admitted to the birthing center in accordance with RSA 151:20 and151:21.

(c) Pursuant to RSA 151:41, the licensee shall have a written policy establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion that apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(d) The written policy in (c) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion

prevention policy.

(e) The licensee shall define, in writing, the scope and type of services to be provided at the birthing center, which shall include at a minimum, the required services listed in He-P 810.16.

(f) The licensee shall develop and implement written policies and procedures governing all operation and services and shall assess and monitor the quality of care and services provided to patients on an ongoing basis.

(g) All policies and procedures shall be reviewed annually and revised as needed.

(h) The licensee shall not falsify any documentation or provide false or misleading information to the department.

(i) The licensee shall not advertise or provide services for which they are not licensed to provide, pursuant to RSA 151:2, III .

(j) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(k) Licensees shall have responsibility and authority for:

(1) Managing, controlling, and operating the birthing center;

(2) Meeting the needs of a patient when the patient is in the care of the birthing center;

(3) Initiating action to maintain the birthing center in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) The continuity of inpatient care;

(5) Establishing, in writing, a chain of command that sets forth the line of authority for the operation of the birthing center;

(6) Appointing an administrator;

(7) Appointing a medical director;

(8) Verifying the qualifications of all personnel;

(9) Providing sufficient numbers of personnel who are present in the birthing center and are qualified and available to meet the needs of patients during all hours of operation;

(10) Reporting all positive tuberculosis test (TB) results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03;

(11) Providing personnel with sufficient supplies, equipment, and lighting to ensure that the needs of patients are met; and

(12) Implementing any POC that has been accepted or issued by the department.

(l) The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction;

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J;

(3) Is a minor; or

(4) Has a surrogate decision maker designated in accordance with RSA 137-J.

(m) The licensee shall only admit an individual or retain a patient whose needs can be met through the programs and services offered under the current license.

(n) If the licensee has a patient whose needs cannot be met by the programs and services offered at the birthing center, the licensee shall transfer the patient to a licensed facility whose current license classification will allow it to meet the needs of the patient.

(o) The birthing center shall not exceed the maximum number of patients or licensed beds approved by its license, unless authorized by the department, such as during an emergency.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in an area of the birthing center that is conspicuous and open to patients and the general public:

(1) The current license issued in accordance with RSA 151:2;

(2) All statements of findings issued for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, N.H. 03301 or by calling 1-800-852-3345; and

(6) The licensee’s plan for fire safety, evacuation, emergencies, and floor plan identifying the location of and access to all fire exits.

(q) The licensee shall admit and allow any department representative to inspect the birthing center and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 810 as authorized by RSA 151:6 and RSA 151:6-a.

(r) For reportable incidents, the licensee shall:

(1) Fax to 603-271-4968 or convey by email to hfa-licensing@dhhs.nh.gov or regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 48 hours of a reportable incident as defined in He-P 810.03(ch):

a. The birthing center’s name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of patient(s) involved and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the patient’s guardian, personal representative, or agent, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the patient’s licensed practitioner was notified, if applicable;

(2) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report; and

(3) Submit any further information requested by the department.

(s) A licensee shall provide a patient, guardian, personal representative, or agent, or anyone else authorized in writing by the patient with a copy of the patient’s record pursuant to the provisions of RSA 151:21, X, upon request.

(t) All records required for licensing shall:

(1) Be available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a;

(2) Be legible, current and accurate; and

(3) Be maintained in a secure manner that safeguards confidentiality and prevents tampering with data.

(u) Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of patients and staff that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards to ensure the confidentiality of information pertaining to patients and staff; and

(3) Systems to prevent tampering with information pertaining to patients and staff.

(v) The licensee shall comply with the patient’s bill of rights as set forth in RSA 151:21.

(w) The licensee shall provide housekeeping and maintenance service, as needed to protect patients, personnel, and the public.

(x) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(y) Applicants, licensees, and staff shall cooperate with the department during all departmental visits authorized under RSA 151 and He-P 810, including allowing representatives of the department to:

(1) Enter and complete an inspection of the premises;

(2) Review and reproduce any forms or reports which are required to be maintained or made available to the department; and

(3) Interview staff and patients of the birthing center.

(z) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

(aa) The birthing center shall respond to a notice of deficiencies by providing a POC in accordance with He-P 810.13(c).

(ab) The birthing center shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(ac) The licensee shall require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.14)

N.H. Code Admin. R. Ann. He-P 810.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Has a bachelor’s degree in business administration or health and human services;

(2) Is a licensed physician in the state of New Hampshire;

(3) Is a certified midwife or certified nurse midwife (CNM) in the state of New Hampshire; or

(4) Is an APRN-CNM in the state of New Hampshire.

(b) The administrator shall designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their absence.

(c) The administrator shall be responsible for maintaining that the birthing center is in full compliance with federal, state, and local laws, rules, codes, and ordinances at all times.

(d) The licensee shall establish a process for verifying the credentials of personnel involved in the direct care of the patient which includes written documentation that:

(1) The individual is licensed or certified to practice health care in New Hampshire, if required; and

(2) The individual has the requisite education and experience to meet the requirements of the position, and required by this section.

(e) In addition to (d) above, the licensee shall:

(1) Document that each employee involved in the direct care of patients has been advised of the duties that they might perform and established competency in performing those duties;

(2) Establish in writing the process for updating the scope of practice of personnel as necessary; and

(3) Conduct an annual review of all credentialed personnel and document the review in their file.

(f) The licensee shall provide medical services that include the appointment of a medical director who:

(1) Is a physician licensed in the state of New Hampshire;

(2) Is an APRN-CNM licensed in the state of New Hampshire; or

(3) Is a doctor of naturopathic medicine with certification in natural childbirth.

(g) The medical director shall:

(1) Participate in the development of policies and procedures for the birthing center;

(2) Participate in the birthing center’s quality improvement program; and

(3) Provide consultation to the birthing center’s personnel.

(h) In addition to (f) above, the licensee shall:

(1) Provide qualified personnel sufficient to meet the needs of patients that, at a minimum, shall include:

a. A primary caregiver to attend each birth that is:

1. An obstetrician;

2. A family practice physician;

3. A licensed APRN;

4. A certified midwife; or

5. A naturopathic doctor with certification in natural childbirth; and

b. A second person to attend each birth that has been verified by the birthing center as being appropriately credentialed as specified in (d) above;

(2) Have at least 2 persons on call when births are anticipated, one of whom is a person listed under (h)(1)(a) above; and

(3) Provide the following services in the birthing center or at the home of the patient :

a. Orientation to the birthing center, the fees, and the services of the birthing center;

b. Education for pregnancy, labor, breastfeeding, infant care, early discharge, parenting, and sibling preparation;

c. Prenatal care;

d. Intrapartum care;

e. Postpartum care;

f. Follow up care for the mother and newborn; and

g. Medication services in accordance with He-P 810.19.

(i) The following services shall be prohibited in the birthing center or at the home of the patient :

(1) Regional or general anesthesia including awake sedation;

(2) Vacuum extraction; and

(3) Chemical induction and augmentation.

(j) The licensee shall provide dietary services that include light nourishment during labor and postpartum.

(k) The licensee may only perform point of care testing (POCT), that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(l) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(m) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, and reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(n) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.15)

N.H. Code Admin. R. Ann. He-P 810.17 Patient Services

(a) At the time of admission, personnel of the birthing center shall:

(1) Provide, both verbally and in writing, to the patient or the patient’s legal representative, the birthing center’s policy on patient rights and responsibilities, complaint procedure, list of care and services provided by the birthing center, and rules and obtain written confirmation acknowledging receipt of these items;

(2) Collect and record the following information:

a. Patient’s name, home address, and home telephone number;

b. Patient’s date of birth;

c. Name, address, and telephone number of an emergency contact, guardian, personal representative, or agent;

d. Name of patient’s primary care provider with the address and telephone number;

e Patient’s insurance information, if applicable; and

f. Written and signed consent for the provision of care and services;

(3) Provide an orientation to the scope of services provided at the birthing center;

(4) Provide instruction and education relevant to the following:

a. Conception;

b. Health and nutrition;

c. Pregnancy;

d. Lactation and lactation assistance;

e. Family planning

f. The postpartum period;

g. Holistic care;

h. Early recognition and prevention of potential health problems;

i. Detection of any abnormal conditions in the mother, fetus, and newborn;

j. Procurement of medical assistance, if necessary; and

k. Execution of emergency measures in the absence of medical help, if necessary;

(5) Complete a health examination and a social, family, medical, reproductive, nutritional, and behavioral history;

(6) Obtain from the patient, documentation of informed consent, as defined in He-P 810.03(aw); and

(7) Obtain from the patient a written consent for release of information, if the patient so authorizes.

(b) Only patients who meet the eligibility criteria and have registered at least 4 weeks prior to the anticipated date of birth shall be admitted to the birthing center.

(c) In order to be eligible:

(1) The patient’s licensed or certified practitioner shall determine that the patient was medically, psychologically, surgically, and obstetrically uncomplicated during her prenatal care;

(2) A patient shall not present any of the following contraindications:

a. Placenta previa;

b. Multiple fetuses;

c. Insulin dependent diabetes;

d. Previous cesarean section, unless authorized in accordance with Mid 503; or

e. Rh factor sensitivity with positive antibody titre; and

(3) A patient shall have written approval from a medical doctor (MD), doctor of osteopathic medicine (DO) with certification in natural childbirth, or APRN-CNM to deliver in the birthing center if she presents with any of the following potential medical risk factors:

a. Maintenance on anti-epileptic medications without convulsive activity within the last year;

b. Blood dyscrasias;

c. Current hepatitis;

d. A positive HIV test result or AIDS;

e. Current alcoholism;

f. Current drug addiction, including use of hallucinogens;

g. Chronic pulmonary disease that interferes with oxygen saturation;

h. Chronic hypertension;

i. Past history of significant heart disease; or

j. Maintenance on psychotropic medication which, as a result of a consultation with the patient’s physician, has been determined to have a sedating effect on the newborn.

(d) All patients who present with, or develop during prenatal care, any one or more of the following shall be evaluated by a physician or a certified nurse midwife to determine appropriateness for delivery in a birthing center:

(1) Younger than 16 or older than 45 years of age;

(2) High blood pressure, which is defined as 140/90 or elevation of 30 systolic or 15 diastolic on at least 2 occasions, at least 6 hours apart;

(3) Anemia, which is defined as hemoglobin of less than 10 grams, unresolved at term;

(4) History of genetic problems or previous intrauterine death at greater than 20 weeks or unexplained stillbirth;

(5) Possibility of multiple fetuses, malpresentation, or fetus too small or large for gestational age;

(6) Past history of significant hemorrhaging during delivery, which is defined as the loss of 500 cubic centimeters (cc) of blood or greater;

(7) Abnormal Pap smear;

(8) Active primary herpes at term;

(9) Positive cervical herpes cultures;

(10) Indications that the fetus has died in utero;

(11) Suspected postmaturity greater than 42 weeks;

(12) Heart murmur or arrhythmia other than functional;

(13) Prior obstetrical problems, including, but not limited to:

a. Past prematurity;

b. Uterine abnormalities;

c. Placental abruption; and

d. Incompetent cervix;

(14) Development of other conditions potentially detrimental to the pregnancy, such as recurrent urinary tract or kidney infection or active gonorrhea;

(15) Polyhydramnios or oligohydramnios;

(16) Suspected intrauterine growth retardation;

(17) Condyloma acuminata, significant or intravaginal;

(18) Suspected premature labor less than 37 weeks;

(19) Present with or develop a significant overweight or underweight state; or

(20) Non-insulin dependent gestational diabetes or abnormal glucose challenge test.

(e) If the patient’s risk factors, as outlined in (d) above, have been evaluated by an MD, DO with certification in natural childbirth, or APRN-CNM and deemed appropriate for delivery in the birthing center, the MD, DO with certification in natural childbirth, or APRN-CNM shall:

(1) Provide written documentation of their approval; and

(2) Include this documentation as part of the patient’s record.

(f) Any patient who develops the following conditions during prenatal care shall be prohibited from delivery at the birthing center and transferred to the care of a physician or a certified nurse midwife for a hospital delivery:

(1) Multiple fetuses;

(2) Malpresentation, including breech position, that is not resolved before the onset of labor;

(3) Confirmation that the fetus is small for gestational age;

(4) Placenta previa or abruptio placenta;

(5) Onset of labor prior to the 37th week of pregnancy; or

(6) Insulin dependent diabetes.

(g) A care plan shall be developed and revised based on needs identified by the patient’s licensed or certified practitioner.

(h) If a certified midwife is the primary practitioner, the midwife shall consult with a physician or licensed APRN who is certified as a midwife and develop a plan of care for all patients who present with the following conditions:

(1) Maternal distress as indicated by:

a. Hypertension, which is a systolic reading of 30 mm of mercury and a diastolic reading of 15 mm of mercury over baseline;

b. Blood loss greater than 500 cc; or

c. Temperature greater than 100 degrees Fahrenheit or less than 97 degrees Fahrenheit;

(2) Prolonged rupture of the membranes prior to the onset of labor for more than 18 hours;

(3) Fetal distress as indicated by:

a. Persistent bradycardia;

b. Persistent tachycardia; or

c. Particulate meconium;

(4) Failure to progress in spite of active labor that is defined as:

a. A lack of steady dilation and descent after 24 hours for primigravida or 18 hours for multigravida during the first stage of labor;

b. A lack of fetal descent after 2 hours during the second stage of labor; or

c. Failure to deliver the placenta after one hour during the third stage of labor; and

(5) Neonatal distress as indicated by:

a. Obvious congenital anomalies;

b. Apical pulse rate greater than 160 per minute;

c. Respiratory rate greater than 80 per minute;

d. Temperature outside the parameters of 97.7 to 99.4 degrees Fahrenheit or 36.5 to 37.5 degrees Celsius;

e. Persistent signs of respiratory difficulty without signs of improvement within one hour after birth;

f. Persistent central cyanosis or pallor;

g. Signs of hypoglycemia, such as jitteriness, lethargy, or hypothermia;

h. Jaundice appearing before 24 hours after birth;

i. Small for gestational age; or

j. A 5 minute Apgar score that is 6 or 7.

(i) All patients who present the following conditions during labor or delivery shall be immediately transferred to a hospital:

(1) Malpresentation;

(2) Multiple fetuses;

(3) Prolapsed cord;

(4) Neonatal distress as indicated by:

a. Apnea with persistent central cyanosis or pallor;

b. Persistent grunting and retractions;

c. A 5 minute Apgar score of 5 or less, or failure to achieve an Apgar score of 7 within 30 minutes; or

d. Jaundice before 24 hours; or

(5) Uncontrolled maternal bleeding.

(j) Prenatal care shall be provided at the home of the patient, at the office of the licensed practitioner, or at the birthing center.

(k) Prenatal care shall include, but is not limited to:

(1) A health examination including pelvic and speculum exam, as applicable;

(2) A social, family, medical, reproductive, nutritional, and behavioral history;

(3) Assessing vital signs including blood pressure;

(4) Arranging for the following blood tests if not previously completed during the present pregnancy:

a. Complete blood count (CBC);

b. Blood type and Rh antibody screen;

c. Rubella titre;

d. Syphilis serology;

e. Hepatitis B surface antigen; and

f. HIV testing, if requested by the patient;

(5) An initial nutritional assessment and counseling;

(6) Pap smear, if not done in the last 3 years;

(7) Chlamydia and gonorrhea screening tests, as applicable;

(8) Establishment of gestational age; and

(9) Advising of available prenatal testing.

(l) Following the initial visit, the licensed or certified practitioner shall see the patient:

(1) Once a month through the 28th week of pregnancy;

(2) Once every 2 weeks from the 28th week until the 36th week of pregnancy; and

(3) Once a week from the 36th week of pregnancy until the onset of labor.

(m) Each prenatal visit shall include, but is not limited to, the following care:

(1) Determining weight;

(2) Assessing blood pressure;

(3) Urine dip for protein and glucose, which may be performed by the patient, if clinically indicated;

(4) Assessment of general health;

(5) Monitoring of uterine measurements, fetal heart rate, and fetal activity; and

(6) Arranging for birthing center tests or procedures as indicated.

(n) Intrapartum care shall include, but is not limited to:

(1) Monitoring the condition of mother and fetus;

(2) Providing emotional and physical support;

(3) Assisting with the delivery;

(4) Repairing minor tears or episiotomies as necessary;

(5) Examination and assessment of the newborn;

(6) Inspection of the placenta, membranes, and cord vessels; and

(7) Management of any maternal or neonatal complications.

(o) Postpartum care shall include, but is not limited to:

(1) Remaining with the patient and newborn for a minimum of 2 hours after birth or until:

a. The infant:

1. Is alert;

2. Has good color;

3. Has a good sucking reflex;

4. Is breathing normally; and

5. Has a stable temperature within the range of 97 to 100 degrees Fahrenheit; and

b. The mother:

1. Has a firm fundus;

2. Does not have excessive vaginal bleeding;

3. Is afebrile;

4. Has voided; and

5. Has established successful breastfeeding, if applicable;

(2) Obtaining or arranging for a blood sample from the newborn for metabolic disorders, as required by RSA 132:10-a;

(3) Perform critical congenital heart defect screening on the newborn;

(4) Perform hearing screening on the newborn;

(5) Providing the patient with information on routine postpartum and newborn care, including follow up care with a pediatrician or family practitioner for the newborn;

(6) Providing the patient’s obstetrician, primary care physician, pediatrician, or certified nurse midwife with a written summary of labor and delivery and an assessment of the newborn;

(7) Contacting the patient by telephone within 24 hours of discharge to establish well-being and health of mother and newborn;

(8) Providing 2 postpartum visits within 6 weeks of delivery; and

(9) Managing any complications that might arise and, based on the complication:

a. Consulting with a physician under the arrangements required by Mid 502.06 or a certified nurse midwife; or

b. Transferring the patient with notification to the consulting physician or certified nurse midwife.

(p) The certified nurse midwife or certified midwife, or other person authorized by law, shall administer the following medications as clinically indicated:

(1) Rhogam, immune globulin, for Rh blood incompatibility;

(2) Eye prophylaxis for prevention of gonococcal infection in the newborn;

(3) Oxygen for maternal or fetal distress and infant resuscitation;

(4) Lidocaine hydrochloride by infiltration only for the purpose of postpartum repair of tears, lacerations, or episiotomies;

(5) Oxytocins, orally or intramuscular, for control of postpartum maternal hemorrhage;

(6) Intravenous fluids as an emergency measure for maternal complications such as:

a. Ringer's Lactate, with or without D5W;

b. Normosol-R, with or without D5W; and

c. Other medications as prescribed by a physician, consistent with the scope of midwifery practice;

(7) Antibiotics for prophylaxis for positive group B strep lab finding either as vaginal swab or in urine; and

(8) Oral, buccal, or rectal administration of the following medications:

a. Methergine, and misoprostol, only for postpartum control of maternal hemorrhage;

b. Vitamin K, for control and prevention of acute and late-onset hemorrhagic disease of the newborn; and

c. Other medications as prescribed by a physician, consistent with the scope of midwifery practice.

(q) Birthing center personnel shall follow the orders of the licensed or certified practitioner.

(r) The patient’s record shall contain written notes for:

(1) All care and services provided at the birthing center, including:

a. Date and time that the care or services were provided;

b. Description of the care or services provided;

c. Patient’s response to the care or services provided; and

d. Signature and title of the person providing the care or service; and

(2) Any reportable incidents involving the patient, which shall include, but not be limited to:

a. Date and time of the reportable incident;

b. Description of the reportable incident, including identification of injuries, if applicable;

c. Actions taken by personnel, including follow-up;

d. Date and time the guardian, personal representative, or agent and the licensed or certified practitioner were notified if medical intervention was required;

e. Signature and title of the person reporting the unusual incident; and

f. Signature and title of the person completing the report.

(s) The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX.

(t) In addition to (s) above, the use of mechanical restraints shall be prohibited.

(u) Patients shall be transferred or discharged from the birthing center:

(1) In accordance with:

a. RSA 151:21,V and RSA 151:26; and

b. The birthing center’s policies and procedures; and

(2) When there is:

a. A written order from a licensed practitioner;

b. A medical emergency and the patient is in need of care and services not available at the birthing center; or

c. The patient has developed one of the conditions listed in (f) above.

(v) A summary shall be written for any patient discharged or transferred from the birthing center which includes:

(1) The date and time the patient left the birthing center;

(2) The place to which the patient was transferred or discharged;

(3) The reason for the proposed transfer or discharge;

(4) The effective date of the proposed transfer or discharge;

(5) The condition of the patient at the time of discharge or transfer;

(6) The discharge plan and instructions for home and follow up care; and

(7) A statement telling the patient about their appellate rights pursuant to RSA 151:26, II(a)(5).

(w) After receiving permission from the patient or their legal representative, copies of the clinical progress notes and medication records shall accompany the transferred patient.

(x) The licensee shall provide an emergency data sheet to emergency medical personnel in the event of an emergency transfer to another medical facility.

(y) The data sheet referenced in (x) above shall include:

(1) The patient’s full name and the name the patient prefers, if different;

(2) Name, address, and telephone number of the patient’s next of kin, guardian, surrogate decision maker, or agent, if any;

(3) Diagnosis;

(4) Medications, including the last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives, if any; and

(10) Any other pertinent information not specified in (1)-(9) above.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.18 Patient Records

(a) The licensee shall maintain a legible, current, and accurate record for each patient based on services provided at the birthing center.

(b) At a minimum, patient records shall contain the following:

(1) Identification data, including:

a. Vital information including the patient’s name, home address, home phone number, date of birth, and marital status; and

b. Name, address, and telephone number of an emergency contact person;

(2) The name and telephone number of the patient’s licensed practitioner(s);

(3) Patient’s health insurance information;

(4) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA 137-J:35-37;

(5) A record of the health exam as required by He-P 810.17(a)(5);

(6) Written, dated, and signed orders for the following:

a. All medications and treatments; and

b. Laboratory services and consultations performed at the birthing center;

(7) Results of any assessments, laboratory tests, x-rays, ultra sounds, or consultations performed at the birthing center;

(8) All admission and progress notes;

(9) Documentation of medical or specialized care;

(10) Documentation of reportable incidents;

(11) The consent for release of information signed by the patient, guardian, or agent, if any;

(12) The medication record as required;

(13) Documentation of any accident or injuries occurring while in the care of the birthing center and requiring medical attention by a practitioner;

(14) Written and signed consent for the provision of care and services;

(15) Written confirmation of the requirements in He-P 810.17(a)(1);

(16) All written notes as required by He-P 810.17(r);

(17) A discharge or transfer summary as required by He-P 810.17(v);

(18) All progress notes including the signature of the person providing care; and

(19) The emergency data sheet required by He-P 810.17(y).

(c) Patient records and patient information shall be kept confidential and only provided in accordance with law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

(e) When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use or access.

(f) Records shall be retained for 4 years after discharge, except that when the patient is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

(g) The licensee shall arrange for storage of, and access to, patient records as required by (f) above in the event the birthing center ceases operation.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-P 810.19 Medications

(a) If the licensee maintains a pharmacy on the licensed premises it shall comply with RSA 318.

(b) All prescription medications listed under He-P 810.17(p) may be maintained as stock medications at the birthing center.

(c) The licensed practitioner shall approve all over-the-counter medications taken by patients at the birthing center.

(d) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

(e) Licensees shall maintain either the original, or a copy of the original written order in the patient’s record, signed by a licensed practitioner or other individual authorized by law, for each prescription medication being taken by a patient at the birthing center.

(f) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the birthing center;

(2) Reorder medications for use at the birthing center; and

(3) Receive and record new medication orders.

(g) Each medication order shall legibly display the following information:

(1) The patient’s name:

(2) The medication name, strength, prescribed dose, and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner.

(h) For PRN medications the ordering practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

(i) Each medication, including licensed practitioner’s samples, shall legibly display the following information:

(1) The patient’s name, unless it is a stock medication as allowed in (b) above;

(2) The medication name, strength, prescribed dose, and the route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered; and

(6) The name of the prescribing practitioner.

(j) Except for stock medications identified in He-P 810.17(p), the label of all medication containers maintained in the birthing center shall match the current written orders of the licensed practitioner.

(k) Only a pharmacist shall make changes to prescription medication container labels.

(l) Any change or discontinuation of medications taken at the birthing center shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

(m) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the birthing center are unable to obtain a new prescription label the following shall apply:

(1) Licensed nurse shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the birthing center’s written procedure, indicating that there has been a change in the medication order;

(2) Licensed nurse shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(n) All prescription medication not ordered, approved, or labeled for a specific patient, including but not limited to pharmaceutical samples, which is stored at the birthing center, shall be the responsibility of the medical director.

(o) All verbal orders from an authorized prescriber, including but not limited to telephone orders, shall be taken only by a licensed healthcare professional such as a nurse, if such action is within the scope of their practice act, and immediately transcribed and signed by the individual taking the order, and shall be counter-signed by the authorized prescriber within 48 hours.

(p) Over-the-counter medications shall be handled in the following manner:

(1) The licensee shall obtain written approval from the patient’s licensed practitioner annually; and

(2) Over-the-counter medication containers shall be marked with the name of the patient using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(q) The medication storage area shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean, organized in a fashion to ensure correct identification of each patient’s medication(s), and have lighting adequate to read all medication labels; and

(3) Equipped to maintain medication at the proper temperature.

(r) Medication kept at the birthing center shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(s) Topical liquids, ointments, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(t) Controlled drugs, as defined by RSA 318-B, stored in a central storage area of the birthing center shall be:

(1) Kept in a separately locked compartment within the locked medication storage area; and

(2) Accessible only to authorized personnel.

(u) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(v) Except as allowed by (x) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders, or if the medication becomes contaminated, whichever occurs first.

(w) The destruction of contaminated, expired, or discontinued controlled drugs medication shall:

(1) Be in accordance with acceptable standards of practice;

(2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

(3) Be documented in the record of the patient for whom the medication was prescribed.

(x) Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 703.06.

(y) If ordered by the department to do so, the birthing center shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient’s health and safety, as identified during an inspection or investigation.

(z) Only individuals authorized by law shall administer medications to patients.

(aa) Medication shall be prepared immediately prior to administration and shall be prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B.

(ab) When administering medication, personnel shall remain with the patient until the patient has taken all of the medication.

(ac) The licensee shall maintain a written record for each medication taken by the patient at the birthing center, containing the following information:

(1) Name of the patient;

(2) Any allergies or allergic reactions to medication;

(3) The name, strength, and frequency of the medication;

(4) The date and time the medication was taken;

(5) The dose taken by the patient;

(6) The route of administration, if other than by mouth;

(7) The signature and identifiable initials and job title of:

a. The person administering the medication; and

b. The person supervising or assisting the patient taking their medication;

(8) Documented reason for any medication refused or omitted; and

(9) For PRN medications, the reason the patient required the medication and the effect of the PRN medication.

(ad) The licensee shall develop and implement a system for reporting any observed adverse medication reaction and side effects or medication errors, such as incorrect medications, within 24 hours of the adverse medication reaction or medication error.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.17)

N.H. Code Admin. R. Ann. He-P 810.20 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the birthing center to meet the needs of patients at all times.

(b) The licensee shall develop a job description for each position in the birthing center containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Qualifications and educational requirements of the position.

(c) For all applicants for employment, volunteers, and independent contractors who will

provide direct care to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d which shall include criminal history from the state of New Hampshire ; and

(2) Review the results of the criminal records check in accordance with (d) below and verify the qualifications and licenses, as applicable, of all applicants prior to employment.

(d) Unless a waiver is granted in accordance with (f) below, the licensee shall not offer employment, contract with, or engage a person for any position if the individual:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patient(s).

(e) If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(f) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(g) If the information identified in (d) above regarding any employee is learned after the person begins employment, the licensee or administrator shall submit the information to the department immediately upon discovery.

(h) All personnel shall:

(1) Be at least 18 years of age if working as direct care personnel;

(2) Meet the educational and physical qualifications for their position, as listed in the job description in (b) above;

(3) Be licensed, registered, or certified if required by federal law or state law or rule; and

(4) Receive an orientation within the first 3 days of work, including:

a. The patient rights and responsibilities in accordance with RSA 151:21;

b. The duties and responsibilities of the position;

c. The birthing center’s policies, procedures, and guidelines;

d. The birthing center’s infection control program;

e. The birthing center’s fire, evacuation, and emergency plans outlining the responsibilities of personnel in an emergency;

f. Mandatory reporting requirements such as those found in RSA 161-F:46 or RSA 169-C: 29-30;

g. The medical emergency procedures; and

h. The procedures for food safety for those personnel involved in preparation, serving, and storing of food.

(i) Prior to having contact with patients or food, personnel, including volunteers, shall:

(1) Submit to the birthing center the results of a physical examination or health screening and results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control (CDC), conducted not more than 12 months prior to employment;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition, available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(j) All personnel shall complete annual in-service education, including a review of the birthing center’s:

(1) Policies and procedures relative to patient rights in accordance with RSA 151:21;

(2) Infection control program;

(3) Education program on fire, evacuation, and emergency procedures;

(4) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29-30;

(5) The medical emergency procedures;

(6) The procedures for food safety for those personnel involved in preparation, serving, and storing of food; and

(7) The birthing center’s policies, procedures and guidelines.

(k) All professional direct care personnel shall have current certificates in:

(1) Adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association; and

(2) Neonatal CPR equivalent to the American Heart Association and American Academy of Pediatrics’ “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines,” available as noted in Appendix A.

(l) All direct care personnel shall be familiar with the location, operation, and use of all equipment in the birthing center.

(m) All birthing centers using the service of independent clinical contractors who have direct contact with patients shall:

(1) Provide each clinical contractor with an orientation as specified in (h)(4) above;

(2) Maintain copies on file of a physical examination or health screening and 2-step tuberculosis testing, Mantoux method, that were conducted not more than 12 months prior to employment for each clinical contractor;

(3) Maintain a copy of the clinical contractors’ licenses as required by (h)(3) above, if applicable; and

(4) Have a written agreement with each clinical contractor that describes the services that will be provided.

(n) Current and complete personnel files shall be maintained at the birthing center for all personnel.

(o) The personnel file required by (n) above shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that they have received a copy of the birthing center’s policy setting forth the patient rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (c) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) A record of satisfactory completion of the orientation program required by (h)(4) above;

(7) Information as to the general content and length of all in-service or educational programs attended;

(8) Record of satisfactory completion of all required education programs required by (h), (j), and (k) above;

(9) A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

(10) Documentation that the required physical examination or health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(11) If applicable, copies of current certificates in:

a. Adult CPR equivalent to basic life support from either the American Red Cross or the American Heart Association; and

b. Neonatal CPR equivalent to the American Heart Association and American Academy of Pediatrics “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines,” available as noted in Appendix A; and

(12) The statement required by (p) below.

(p) All personnel shall sign a non-conviction attestation at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(q) The licensee shall maintain separate personnel records that:

(1) Contain the information required by (o) above; and

(2) Are protected and stored in a secure and confidential manner.

(r) The licensee shall document evidence of immunization against influenza for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V;

and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have

received or declined to receive immunizations.

(s) If the facility uses an electronic record storage system, it shall provide computer access to all

personnel records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 810 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

(t) All personnel electronic records shall have security provisions to ensure confidentiality.

(u) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, cannabis, or alcohol.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.18)

N.H. Code Admin. R. Ann. He-P 810.21 Quality Improvement

(a) The birthing center shall develop and implement a quality improvement program that reviews policies and all care and services provided to patients and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The birthing center shall determine the size and composition of the quality improvement committee based on the size of the birthing center and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the birthing center; and

(7) Evaluate the effectiveness of the corrective actions.

(e) If the birthing center utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review:

(1) The patient census;

(2) The number of unlicensed personnel administering medications via nurse delegation;

(3) Categories of medications administered;

(4) Route of administration; and

(5) Any incidents or medication errors and actions taken.

(f) The quality improvement committee shall meet at least quarterly.

(g) The quality improvement committee shall generate dated, written minutes after each meeting.

(h) Documentation of all quality improvement activities, including minutes of meetings, shall be confidential.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.19)

N.H. Code Admin. R. Ann. He-P 810.22 Infection Control

(a) The birthing center shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or communicable diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items specified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

(5) The reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections;

(4) Prevention and containment of infections; and

(5) Use of universal precautions.

(d) Personnel infected with a disease or illness transmissible through food, formites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious as determined by a licensed practitioner.

(e) Personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by an authorized medical professional.

(f) Personnel with an open wound who participate in food preparation or service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(g) Personnel infected with scabies or lice or peduculosis shall not provide direct care to patients or work in food services until such time as they are no longer infected.

(h) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an “infectious disease,” which means any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall provide the required procedures, equipment, staff and personnel training for the care of the patients, as specified by United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(i) If the birthing center has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the county, municipality, or state public health nurse as applicable, in the county in which the facility is located and follow the instructions and guidance of the nurse.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.20)

N.H. Code Admin. R. Ann. He-P 810.23 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside the facility.

(b) The birthing center shall have and maintain a source of potable water available for human consumption and food preparation.

(c) All furniture, floors, ceilings, walls, and fixtures shall be kept clean, sanitary, and in good repair at all times.

(d) All bathrooms shall have non-porous floors.

(e) All patient bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(f) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

(g) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for food preparations.

(h) Birthing center personnel shall clean and disinfect bedpans, commodes, basins, fixtures, toilets, and showers or tubs after each use.

(i) If equipment or supplies need to be sterilized in order to prevent contamination, the birthing center shall develop and maintain written procedures for cleaning, packaging, and sterilizing, including:

(1) Testing and documenting the sterilization processes used; and

(2) Documentation when supplies are outdated.

(j) The sterilization system required in (i) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented and available on site for review by the department.

(k) Sterile supplies and equipment shall:

(1) Be stored in dust-proof, moisture-free storage areas; and

(2) Not be mixed with non-sterile supplies.

(l) Cleaning solutions, compounds, and substances considered hazardous or toxic materials as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place such as a locked closet or cabinet, separate from food, medications, and patient supplies.

(m) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils, or in any way other than in full compliance with the manufacturer’s labeling.

(n) In-house trash and garbage receptacles shall be insect and rodent proof, water tight, lined or cleaned, and disinfected after emptying and kept covered except when in use.

(o) Trash receptacles in food service areas shall be covered.

(p) There shall be a designated work area for soiled materials and linens that contains a work counter of at least 6 linear feet, a sink, and a storage area.

(q) A supply of clean linens shall be stored in a clean area separated from soiled linens and available in sufficient amounts to meet the needs of the patients.

(r) Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack, or a covered container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations.

(s) Soiled linens and clothing, which would be considered contaminated with infectious waste shall be handled as infectious waste.

(t) Laundry rooms shall have non-porous floors and be kept separate from the kitchen and eating

areas.

(u) Clean linen shall be stored in a clean area and shall be separate from soiled linens at all times.

(v) Only individuals authorized by RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(w) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, and outdoor animals.

(x) In-house trash and garbage receptacles shall be emptied in a timely manner and lined or cleaned and disinfected after emptying or when visibly soiled.

(y) Any birthing center that has its own water supply and whose water has been tested and failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

(z) Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

History

• #8957, eff 7-27-07, EXPIRED: 7-27-15
• #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.21)

N.H. Code Admin. R. Ann. He-P 810.24 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of patients and personnel, which shall include accommodations for patients and personnel with disabilities.

(b) The birthing center shall:

(1) Have all entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and patients, including, but not limited to, hazards from falls, burns, or electrical shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take measures to prevent the presence of rodents, insects, and vermin, including but not limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self closing and remains closed unless in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within a birthing center, including but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature as follows, except where patients have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if there are patients present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any birthing center.

(g) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code pursuant to RSA 155-A.

(h) Delivery rooms shall have general lighting in addition to examination lighting at each birthing bed. Portable examination lights shall be permitted, but must be immediately accessible.

(i) Ventilation shall be provided throughout the entire building whenever necessary, including but not limited to, fans to remove excessive heat, moisture, smoke, objectionable odors, dust, and explosive or toxic gases.

(j) There shall be a reception and waiting area that includes chairs, tables, and lighting adequate to read materials and complete forms as required.

(k) Pursuant to RSA 155:66, I, smoking shall be prohibited in the birthing center.

(l) There shall be public access to a telephone and toilet facilities for the patient and the patient’s visitors.

(m) The licensee shall ensure the birthing center has properly maintained equipment including, but not limited to:

(1) A heat source for the newborn;

(2) Portable lighting;

(3) Sterilizer or demonstration of sterilizing capability;

(4) Blood pressure equipment, thermometers, fetoscope, or doptone;

(5) Oxygen;

(6) Neonatal resuscitation bag; and

(7) Intravenous equipment.

(n) The birthing center shall provide patients with continuous access to a device or means that will signal personnel when the patient(s) are in need of assistance.

(o) The number of sinks and toilets in the birthing center shall be as follows:

(1) Sinks and toilets in a ratio of one to every 6 patients; and

(2) Personnel and visitors shall either have:

a. Separate sinks and toilets; or

b. Be counted along with patients in the ratios in (1) above.

(p) All patients shall have access to a bathroom with a toilet, tub or shower, a hand washing sink, soap dispensers, and paper towels or a hand-drying device providing hot air.

(q) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(r) All bathroom and closet door locks or latches shall be designed so that the door can be easily unlocked and opened from the inside and outside in an emergency.

(s) Each patient bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(t) Each patient bedroom shall provide at least 100 square feet per room, exclusive of space required for closets, wardrobes, and bathrooms and contain the following:

(1) A bed with a mattress that complies with the state fire code;

(2) Clean pillow, linens, and blankets;

(3) A lamp for the bed; and

(4) Window blinds or curtains that provide privacy.

(u) Only one patient shall be admitted to each bedroom in the birthing center.

(v) Each bedroom shall have a door that shall be of the side hinge type and not a folding door or a curtain.

(w) Each bedroom shall have its own separate entry to permit the patient to reach their room without passing through the room of another person.

(x) All mattresses and new upholstered furniture or draperies shall comply with the state fire code.

(y) Each birthing center may be licensed for more than one licensing classification, but if the licensee has overnight beds for more than one licensing classification, physically separate and distinct units shall be required for each classification.

(z) All handwashing facilities shall be provided with hot and cold running water.

History

• #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.22)

N.H. Code Admin. R. Ann. He-P 810.25 Fire Safety

(a) All birthing center’s shall meet the appropriate chapter of NFPA 101, the appropriate chapters of the state fire code pursuant to RSA 153:5 and the appropriate chapters of the state building code.

(b) An emergency and fire safety program shall be developed and implemented to provide for the safety of patients and personnel in accordance with the following:

(1) The birthing center shall have a telephone and extensions accessible at all times in each patient bedroom in case of emergency;

(2) The birthing center shall have at least one UL listed ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 that shall:

a. Be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

b. Have records for manual inspection or electronic monitoring which shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

c. Have annual maintenance which shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

d. Have the components of the electronic monitoring device or system tested and maintained annually in accordance with the manufacturer’s listed maintenance manual;

(3) An approved carbon monoxide monitor on every level;

(4) The birthing center shall immediately notify the department by phone, fax, or electronic mail within 24 hours and in writing within 72 hours of any fire or emergency situation, excluding a false alarm or emergency medical services (EMS) transport for a non-emergent response, that requires either an emergency response to the birthing center or the evacuation of the licensed premises;

(5) The written notification required by (4) above shall include:

a. The date and time of the incident;

b. A description of the location and extent of the incident, including any damage;

c. A description of events preceding and following the incident;

d. The name of any personnel or patients who required medical treatment as a result of the incident, if applicable;

e. The name of any personnel or patients who were evacuated as a result of the incident if applicable; and

f. The name of the individual the birthing center wishes the department to contact if additional information is required; and

(6) The program in (b) shall be reviewed annually and revised as needed.

(c) For the use and storage of oxygen and other related gases, the birthing center shall comply with NFPA 99, health care facilities code including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft or 6.1 m;

2. A minimum distance of 5 ft or 1.5 m if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, standard for the installation of sprinkler systems; or

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft or 1.5 m, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”;

(5) Precautionary signs, readable from a distance of 5 ft or 1.5 m, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means; and

(6) Shall comply with NH department of transportation requirements with regard to oxygen transport, storage, and use.

(d) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(e) A written plan for fire safety, evacuation, and emergencies shall be adopted and posted in multiple locations throughout the facility.

(f) Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

(g) Evacuation drills shall be quarterly.

(h) All staff shall participate in at least 2 drills a year.

(i) At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility.

(j) The facility shall conduct an evacuation drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

(k) All emergency and evacuation drills shall be documented and include the following information:

(1) The names and titles of the personnel involved in the evacuation;

(2) The number of people, including patients, personnel, and visitors involved in the evacuation;

(3) The time, including AM or PM, date, month, and year the drill was conducted and if the actual fire system was used;

(4) The location of the exits utilized;

(5) The total time necessary to evacuate the birth center;

(6) The time needed to complete the drill; and

(7) Any problems encountered and corrective actions taken to rectify problems.

History

• #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.23)

N.H. Code Admin. R. Ann. He-P 810.26 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, of which the facility administrator shall be a member.

(b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating the emergency management program.

(c) The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(d) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (e) and (f) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(e) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(f) The plan in (e) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing patients and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(6) Include a plan for alerting and managing staff in a disaster;

(7) Include the management of patients, particularly with respect to physical and clinical issues to include relocation of patients with their medical record including the medication administration records, if time permits, as detailed in the emergency plan;

(8) Include an educational program for the staff, to provide an overview of the components of the emergency management program, and the staff’s specific duties and responsibilities; and

(9) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

(e) Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion, actual, or functional drill with outside agencies.

(f) The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), or annual plan review. Any substantial changes to the plan as a result of drills and exercises, real events, shall be submitted to the local emergency management director for review.

History

• #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.24)

Part He-P 811 End Stage Renal Disease Dialysis Centers

N.H. Code Admin. R. Ann. He-P 811.01 Purpose

The purpose of this part is to set forth the licensing requirements for all end stage renal disease dialysis centers (ESRDDC) pursuant to RSA 151:2, I(d).

History

• #5600, eff 3-24-93, EXPIRED: 3-24-99
• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25

N.H. Code Admin. R. Ann. He-P 811.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an end stage renal disease dialysis centers, except:

(a) All facilities listed in RSA 151:2, II(a)-(i); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #5600, eff 3-24-93, EXPIRED: 3-24-99
• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25

N.H. Code Admin. R. Ann. He-P 811.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.

(b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(d) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(e) “Admission” means acceptance by a licensee for the provision of care and services to a patient.

(f) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J or a “surrogate decision maker” in accordance with RSA 137-J:35.

(g) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

(h) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker identified under RSA 137-J:35-37.

(i) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ESRDDC pursuant to RSA 151.

(j) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause(s) a licensee to be out of compliance with RSA 151, He-P 811, or other federal and state requirements.

(k) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.

(l) “Care plan” means a documented guide developed by the licensee or their personnel, in consultation with the patient, or the patient’s guardian, personal representative, or agent, if any, as a result of the assessment process, for the provision of care and services to a patient. This term includes “treatment plan”.

(m) “Change of ownership” means the transfer of the controlling interest of an established ESRDDC to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(n) “Chemical restraint” means any drug or medication that is used as a restriction to manage a patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

(o) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

(p) “Commissioner” means the commissioner of the department of health and human services or their designee.

(q) “Contracted employee” means a temporary employee working under the direct supervision of the ESRDDC but employed by an outside agency.

(r) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

(s) “Critical incident stress management (CISM)” means an adaptive, short-term psychological

helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(t) “Days” means calendar days, unless otherwise specified in the rule.

(u) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post-test to the training provided.

(v) “Department” means the New Hampshire department of health and human services.

(w) “Dialysis” means the passage of a solute through a membrane.

(x) “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(y) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, psychological, or rehabilitative treatments.

(z) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee needs to take to correct identified areas of non-compliance.

(aa) “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.

(ab) “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ac) "Drug diversion" means the use of controlled substances for anything other than the intended purpose or the person to whom it was prescribed.

(ad) “Elopement” means when a patient leaves the licensed premises or a safe area unsupervised or unnoticed without knowledge of the licensee’s personnel, if knowledge and supervision is necessary.

(ae) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.

(af) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ag) “Employee” means anyone employed by the ESRDDC and for whom the ESRDDC has direct supervisory authority.

(ah) “End stage renal disease dialysis center (ESRDDC)” means a facility which provides hemodialysis or peritoneal dialysis on an outpatient basis and any other acute or chronic dialysis related procedures as approved by their governing body.

(ai) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 811.

(aj) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(ak) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(al) “Facility” means “facility” as defined in RSA 151:19, II.

(am) “Good cause” means a circumstance beyond a person’s control, that the department considers to be circumstances that prevents that person from complying with RSA 151 or He-P 811 or taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(an) “Governing body” means a group of designated person(s) functioning as a body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(ao) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

(ap) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).

(aq) “Hemodialysis” means a medical procedure that facilitates removal of toxic substances from the blood of persons for whom one or both kidneys are defective or absent by passing it through an artificial kidney, dialyzer, made of semi permeable membranes which are continually bathed by solution, dialysate, which selectively remove unwanted material.

(ar) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(as) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.

(at) “Infectious waste” means those items specified by Env-Sw 103.28

(au) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(av) “Informed consent” means the decision by a patient, or their guardian, personal representative, or agent to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(aw) “Inspection” means the process used by the department to determine an applicant’s or a licensee’s compliance with RSA 151, He-P 811, and all other federal and state requirements or to respond to allegations of non-compliance with RSA 151 or He-P 811.

(ax) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

(ay) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 811, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and the license number.

(az) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Other professional licensed by law to prescribe.

(ba) “Licensed premises” means the building(s) that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(bb) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(bc) “Licensing classification” means the specific category of services authorized by a license.

(bd) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(be) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I(b).

(bf) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the ESRDDC.

(bg) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(bh) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.

(bi) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bj) “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.

(bk) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bl) “Nursing care” means the provision of oversight of a patient’s physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.

(bm) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bn) “Over-the-counter medications” means non-prescription medications.

(bo) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bp) “Parenteral” means any non-oral means of administration, but is generally interpreted as relating to injecting directly into the body, bypassing the skin and mucous membranes. The common parenteral routes are intramuscular (IM), subcutaneous (SC) and intravenous (IV).

(bq) “Patient” means any person admitted to or in any way receiving care, services, or both from a ESRDDC licensed in accordance with RSA 151 and He-P 811.

(br) “Patient record” means documents maintained for each patient receiving care and services, which includes all documentation required by RSA 151 and He-P 811 and all documentation compiled relative to the patient as required by other federal and state requirements.

(bs) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(bt) “Patient’s personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having direct or indirect ownership interest in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”. This term includes “personal representative”.

(bu) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(bv) “Peritoneal dialysis” is a type of dialysis which uses the lining of the abdomen, peritoneum, as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure.

(bw) “Personnel” means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a patient(s).

(bx) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the patient’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.

(by) “Physician” means a medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bz) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(ca) “Point of care testing (POCT)” means laboratory testing to obtain medical, diagnostic results performed at or near the site of patient care involving a system of devices, typically including:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip or regents to apply to a specimen to for testing; or

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or

c. A Cholesterol meter.

(cb) “Pro re nata (PRN) medication” means medication administered as circumstances might require in accordance with licensed practitioner’s orders.

(cc) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(cd) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(ce) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cf) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(cg) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(ch) “Reportable incident” means an occurrence of any of the following while the patient is either in the ESRDDC or in the care of ESRDDC personnel:

(1) The unanticipated death of a patient which is not related to their diagnosis or underlying condition;

(2) A patient’s elopement from the ESRDDC;

(3) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;

(4) Medication errors; and

(5) Drug diversion.

(ci) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.

(cj) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.

(ck) “Service area” means “service area” as defined in RSA 151:4-a, I (c).

(cl) “Significant change” means a decline or improvement in a patient’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the patient’s health status; and

(3) Requires interdisciplinary review or revision of the care plan.

(cm) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(cn) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.

(co) “State monitoring” means the placement of individuals by the department at an ESRDDC to monitor the operation and conditions of the facility.

(cp) "Surrogate decision-maker" means an adult individual who has health care decision-making capacity, is available upon reasonable inquiry, is willing to make health care decisions on behalf of a patient who lacks health care decision-making capacity, and is identified by the attending practitioner as the person who is to make those decisions in accordance with RSA 137-J. This term includes “surrogate”.

(cq) “Transfer” means moving a patient from one licensed facility or entity to another licensed facility or entity.

(cr) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(cs) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25

N.H. Code Admin. R. Ann. He-P 811.04 Notice to Critical Access Hospitals

(a) Prior to submitting an application for licensure in accordance with He-P 812.05, a proposed facility shall comply with the requirements of RSA 151:4-a, II, and send written notification of its intent to submit an application for licensure as a dialysis center via certified mail to the department and to the chief executive officer of all critical access hospitals with a primary physical location within a 15 mile radius of the proposed dialysis center.

(b) The written notification required in (a) above shall contain the following:

(1) Name of the person or entity seeking to establish the proposed dialysis center;

(2) Proposed physical location of the facility; and

(4) Scope of services for the facility.

(c) Upon receipt of the written notification in (a) above, the chief executive officer of the critical access hospital(s) shall have 30 days to file a written objection with the department.

(d) The written objection in (c) above shall contain the following:

(1) The critical access hospital’s detailed basis for the objection to the proposed facility to include:

a. If the proposed facility will have a material adverse impact on the critical access hospital’s operations; and

b. How the proposed facility will impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

(2) Proof that the objection was sent via certified mail to the proposed individual or entity seeking to establish the proposed facility.

(e) Upon receipt of an objection meeting the requirements of (d) above from a critical access hospital located within a 15 mile radius of a proposed dialysis center, the department shall send a letter to the proposed facility informing them of the:

(1) Objection and the reason for the objection; and

(2) Opportunity to submit a written response to the objection, which shall include at a minimum:

a. Any information regarding the objection that might be relevant to the determination of material adverse impact; and

b. How the proposed health care facility will not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources.

(f) The department shall provide the names of 3 independent contractors, retained by the department through a competitive procurement process, to the critical access hospital and proposed facility for their consideration.

(g) The independent contractors proposed in (f) above shall be experts in the provision of health care services and skilled in determining how utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources might be impacted by the proposed facility.

(h) If, after proposing 3 independent contractors, the critical access hospital and proposed facility cannot agree on an independent contractor within 30 days of the proposal by the department, the department shall designate the independent contractor to perform the assessment and create the expert report.

(i) Within 30 days of the selection of the independent contractor in accordance with (f) and (h) above, the department shall send a letter to the selected independent contractor requesting their services. This letter shall include:

(1) A request to engage the independent contractor’s services to perform the assessment and create the expert report as required in RSA 151:4-a, II (b);

(2) A summary of the requirements for the content of the expert report, to include how the proposed project might or might not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources;

(3) The contact information for the proposed facility and chief executive officer of the critical access hospital(s) raising the objection(s);

(4) The objection and response along with any other documentation received by the department relative to this transaction; and

(5) A deadline for completion of the expert report, which shall be no later than 90 days from the date of retention of the expert, unless and extension is granted by the department in accordance with (s) below. Such an extension shall not exceed 30 days.

(j) Upon selection of the independent contractor, the department shall notify the proposed facility and critical access hospital of the selected independent contractor.

(k) The independent contractor shall invoice the proposed facility and critical access hospital the cost of any fees associated with the retention and work to be completed. The fees shall be shared equally between the proposed facility and the critical access hospital.

(l) Invoices shall be paid for in advance of any services performed in accordance with RSA 151:4-a, II(b)(6).

(m) Payment of the proposed facility’s and critical access hospital’s portion of the advance retainer to the independent contractor shall be paid within 5 business days of receipt of invoice.

(n) If the proposed facility fails to make payment in accordance with (m) above, it shall forfeit its right to submit an application for licensure.

(o) If the critical access hospital fails to make payment in accordance with (m) above, it shall forfeit its right to object and the proposed facility shall be allowed to apply for licensure.

(p) In accordance with RSA 151:4-a, II(b), the proposed health care facility and critical access hospital shall provide any information requested by the independent contractor to complete its report in accordance with the following:

(1) Information obtained at the request of the independent contractor shall not be considered confidential under RSA 151:13, unless the department determines that it should be exempt from disclosure under RSA 91-A:5;

(2) The proposed facility and critical access hospital shall provide the information within a reasonable time, as determined by the independent contractor based on the scope of work of the project and the expected time to review said documentation, so that the independent contractor can finish its report in the required 90 day time period;

(3) If the proposed facility fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to submit an application for licensure; and

(4) If the critical access hospital fails to provide requested information in a reasonable time as described in (2) above, it shall forfeit its right to object and the proposed facility shall be allowed to apply for licensure.

(q) Within 30 days of retention of the independent contractor, the department shall publish a notice on the department’s website to notify the public of the proposed facility and solicit public comment for a period of at least 7 days.

(r) All public comments received in (q) above shall be provided to and considered by the independent contractor for use in the analysis.

(s) Within 90 days of retention of the independent contractor, the report as described in RSA 151:4-a, II(b) and (i)(2) above, shall be submitted to the department, unless an extension is granted by the department in accordance with the following:

(1) The department shall grant an extension for good cause;

(2) Good cause shall be determined by the department and a finding of good cause shall require the independent contractor to show why the report cannot be completed within the 90 days and that the extension is not a result of the proposed facility’s or critical access hospital’s failure to comply with the rules; and

(3) Such an extension shall not exceed 30 days.

(t) Within 10 days of receipt of the expert report, the department shall provide a copy of the report to the proposed facility and critical access hospital.

(u) If the report finds that the proposed facility will have a material adverse impact, then the proposed facility shall not be allowed to apply for licensure.

(v) If the report finds that the proposed facility will not have a material adverse impact, then the proposed facility may proceed with application for licensure.

(w) The person or entity seeking to establish the proposed facility and the critical access hospital(s) shall have the right to request a rehearing by the commissioner, pursuant to RSA 541:3.

(x) The result of the rehearing may be appealed by petition to the NH supreme court, pursuant to RSA 541:6.

(y) If the proposed facility chooses to move forward with the licensing process prior to all appeal rights being exhausted, the proposed facility shall do so at its own risk and shall not hold the critical access hospital or the department liable for any costs incurred.

(z) The appellant shall bear all costs of the state in connection with any rehearing or petition for appeal, including the state’s attorneys’ fees.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25

N.H. Code Admin. R. Ann. He-P 811.05 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a and submit to the department:

(1) A completed application form entitled “Application for Residential, Health Care, or Special Health Care Services” (February 2025), signed by the applicant or 2 of the corporate officers, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”; and

b. “I affirm that I have complied with RSA 151:4-a and a determination is on file with the department that finds the proposed facility shall be allowed to apply for licensure;”

(2) A floor plan of the prospective ESRDDC;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) List of affiliated or related parties;

(5) The applicable fee in accordance with RSA 151:5, XIV, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the qualifications of and copies of applicable licenses for the ESRDDC administrator and medical director;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(8) If the ESRDDC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, and Env-Dw 704.02, or, if a public water supply is used, a copy of a water bill;

(9) The results of a criminal records check to include results for the state of New Hampshire for the applicant(s), licensee if different than the applicant, the administrator, medical director, and if applicable, each household member 17 years of age or older who resides at the facility, as applicable;

(10) A copy of the non-conviction attestation as described in He-P 811.19(q) for the administrator and medical director;

(11) Any waiver requests, if applicable;

(12) A list of all employees who have been previously granted waivers for criminal background check results from the department; and

(13) The results of a BAAS registry check from the bureau of adult and aging services for the administrator and medical director.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.04)

N.H. Code Admin. R. Ann. He-P 811.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 811.05(a) have been received.

(b) If an application does not contain all of the items required by He-P 811.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 811.

(f) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 811.14(b) above when it determines that the applicant, proposed licensee, administrator, or medical director:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 811.14(a) shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 811.06(e) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 811.

(i) A written notification of denial, pursuant to RSA 811.14(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.05)

N.H. Code Admin. R. Ann. He-P 811.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 811.05(a)(1) and (5) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 811.11(f), if applicable;

(3) A list of current employees who have a permanent waiver granted in accordance with He-P 811.17(f)(2); and

(4) A copy of any temporary, new, or existing non-permanent variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 811, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 811.05 and shall be subject to a fine in accordance with He-P 811.14.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25(formerly He-P 811.06)

N.H. Code Admin. R. Ann. He-P 811.08 ESRDDC Construction, Renovations, Modifications, or Structural Alterations

(a) As required by RSA 151:6, any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicant’s own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building codes, state laws and rules, and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(i) Applicants and licensees shall contact the state fire marshal for requests for exceptions to the FGI.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 811.10 prior to its use.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.07)

N.H. Code Admin. R. Ann. He-P 811.09 ESRDDC Requirements for Organizational Changes

(a) The ESRDDC shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of dialysis stations authorized under the current license; or

(6) Services.

(b) The ESRDDC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of dialysis stations beyond what is authorized under the current license; or

(4) A change in services.

(c) When there is a change in address without a change in location, the ESRDDC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is to be a change in the services provided, prior to implementing service changes, including adding additional services, the ESRDDC shall provide the department with a description of the service change or additional services and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, will be made to the physical environment.

(e) The department shall review the information submitted under (d) above and determine if the change in services or the additional added services can be provided under the ESRDDC’s current license.

(f) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection will be conducted as soon as practical by the department;

(2) The physical location;

(3) A change in licensing classification; or

(4) A change that places the facility under a different life safety code occupancy chapter.

(g) A new license shall be issued for a change in ownership, classification, or physical location.

(h) A revised license shall be issued for any of the following:

(1) A change in name;

(2) A change of administrator or medical director;

(3) A change in address without a change in physical location; or

(4) When a waiver has been granted.

(i) The ESRDDC shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal background check for the new administrator or medical director which shall include criminal history from the state of New Hampshire;

(4) A copy of the non-conviction attestation as described in He-P 811.19(q) for the new administrator or medical director; and

(5) The results of a BAAS registry check from the bureau of adult and aging services (BAAS) for the new administrator or medical director.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 811.16(a) or (f).

(k) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the ESRDDC in writing so that a waiver can be sought or the program can search for a qualified candidate.

(l) The ESRDDC shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(m) A restructuring of an established ESRDDC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) The department shall review the information submitted under He-P 811.09(d) and determine if the added services can be provided under the ESRDDC current license including physical plant restrictions.

(o) If a licensee chooses to cease operation of an ESRDDC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting including but not limited to another ESRDDC.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.08)

N.H. Code Admin. R. Ann. He-P 811.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 811, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the ESRDDC; and

(3) Any records required by RSA 151 and He-P 811.

(b) The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 811, to include a clinical and a life safety inspection, prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 811.09(f)(1);

(3) A change in the licensee’s physical location;

(4) A relocation within the facility or an increase in the number of beds beyond what is authorized under the current license;

(5) Occupation of space after construction, renovations, or structural alterations; or

(6) The renewal of a license for non-certified ESRDDCs.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determined that the ESRDDC is in violation of any of the provisions of He-P 811, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 811.13(c), within 21 days of the date on the letter that transmits the inspection report.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20l; ss by #14206, eff 2-28-25 (formerly He-P 811.09)

N.H. Code Admin. R. Ann. He-P 811.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 811, shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought if the waiver request is not for a permanent waiver.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not have the potential to negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew an existing non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) If the request in (f) above is not received with the renewal application or at least 60 days prior to the expiration of the existing waiver , the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license.

(h) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.10)

N.H. Code Admin. R. Ann. He-P 811.12 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 811.

(b) When practicable, the complaint shall be in writing and shall contain the following information:

(1) The name and address of the ESRDDC, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 811.

(c) Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the licensee;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For the licensed ESRDDC, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of alleged violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded; and

(4) Require the licensee to submit a POC in accordance with He-P 811.13(c) if areas of noncompliance were found as a result of the investigation.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

(2) In accordance with RSA 151:7-a II, the owner or person responsible shall have 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings or submit a completed application pursuant to He-P 811.05 prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 811 if the owner of an unlicensed ESRDDC does not comply with (2) above, or if the department does not agree with the owner’s written response to the findings;

(4) The department’s warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, II-III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 811.14.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.11)

N.H. Code Admin. R. Ann. He-P 811.13 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 811, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions on a license; or

(4) Monitoring a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed, reviewed, and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, including how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 811;

b. Addresses all area of non-compliance and deficient practices as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 811 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC meets the requirements in (3) above, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC does not meet the requirements in (3) above, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (1) above and be reviewed in accordance with (3) above;

(8) If the revised POC does not meet the requirements in (3) above or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 811.13(d) and a fine in accordance with He-P 811.14(c)(13);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 811.13(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 811.14(c).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted pursuant to (c)(3) above.

(e) If at the time of the next inspection the directed POC in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license; or

(4) Revoke or suspend the license in accordance with He-P 811.14.

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients;

(2) The presence of conditions in the ESRDDC that negatively impact the health, safety, or well-being of patients; or

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.12)

N.H. Code Admin. R. Ann. He-P 811.14 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, II-III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 811, which poses a threat to a patient’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 811.05;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 811.13(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 811.13(c)(5) and has not submitted a revised POC in accordance with He-P 811.13(c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 811 for the same violations within the last 5 inspections;

(9) A licensee, or its corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (k) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 811;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or medical director has been found guilty of or pled guilty to an assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

(4) For a failure to transfer a patient whose needs exceeds the services or programs provided by the ESRDDC, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For accepting a patient whose needs exceed the services or programs authorized by the ESRDDC licensing classification, in violation of RSA 151:5-a, II and He-P 811.17(d) and (e), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 811.13 the fine for an unlicensed provider or licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 811.08(b), the fine shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 811.09(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 811.09(a)(2), the fine shall be $500.00;

(10) For a refusal to allow access by the department to the ESRDDC’s premises, programs, services, or records, in violation of He-P 811.10(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

(11) For refusal to cooperate with the inspection or investigation conducted by the department, the fine shall be $ 2000.00;

(12) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 811.09(e), the fine for a licensee shall be $100.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 811.13(c)(2) or (b)(5), the fine for a licensee shall be $500.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 811.13(c)(11), the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement, or comply with licensee policies as specified in He-P 811.15(e)-(h), the fine for a licensee shall be $1000.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 811.15(d), the fine for a licensee shall be $500.00;

(17) For exceeding the maximum number of dialysis stations, in violation of He-P 811.15(n), the fine for a licensee shall be $500.00;

(18) For providing false or misleading information or documentation, in violation of He-P 811.15(k), the fine shall be $1000.00 per offense;

(19) For a failure to meet the needs of a patient, in violation of He-P 811.15(b) and (t), the fine for a licensee shall be $1000.00 per patient;

(20) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 811.16(a) and He-P 811.19(c), the fine for a licensee shall be $500.00;

(21) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 811.08(a), the fine for a licensed facility shall be $500.00;

(22) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(23) When an inspection determines that a violation of RSA 151 or He-P 811 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the initial fine, but not to exceed $1000.00; and

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the initial fine, but not to exceed $2000.00; and

(24) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 811 shall constitute a separate violation and shall be fined in accordance with He-P 811.14(c), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 811, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of patients when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 811 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) RSA 541 shall govern further appeals of department decisions under this section.

(k) When a ESRDDC’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license or be employed as an administrator or medical director for 5 years, if the enforcement action pertained to their role in the ESRDDC.

(l) The 5 year period in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(m) Notwithstanding (l) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 811.

(n) If the department has evidence that a licensee, applicant, administrator, or others are circumventing (m) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 811.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.13)

N.H. Code Admin. R. Ann. He-P 811.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

(b) The licensee shall provide services to only those patients whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the ESRDDC.

(c) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:21.

(d) The licensee shall define, in writing, the scope and type of services to be provided by the ESRDDC, which shall include, at a minimum, the core services listed in He-P 811.16.

(e) The licensee shall have written policies and procedures setting forth the following:

(1) The rights and responsibilities of registered patients in accordance with the patients’ bill of rights under RSA 151:19-21;

(2) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

(3) All other required polices described in He-P 811.

(f) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the facility and for:

(1) The review of the policies and procedures every 3 years; and

(2) The revision of the policies and procedures, as needed.

(g) Pursuant to RSA 151:41, the licensee shall have a written policy establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion, which shall apply to all personnel, contractors, and agents of the facility and which shall be the responsibility of a designated employee or interdisciplinary team.

(h) The written policy in (g) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

(i) The licensee shall educate personnel about the needs and services required by the patients under their care.

(j) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(k) The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

(l) The licensee shall not advertise, in any form or manner, as providing or being able to provide services other than those for which they are licensed pursuant to RSA 151:2, III.

(m) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(n) The licensee shall not exceed the maximum number of dialysis stations authorized by the department, unless authorized by the department, such as during an emergency.

(o) The licensee shall establish and maintain by-laws that:

(1) Define the operation and performance of the ESRDDC;

(2) Establish a credentialing process; and

(3) Maintain documentation of all medical staff privileges.

(p) The licensee shall respond to a notice of deficiencies by providing a POC in accordance with He-P 811.13.

(q) Licensees shall:

(1) Have the responsibility and authority for managing, controlling, and operating the ESRDDC;

(2) Ensure that the dialysis needs of the patients are met during those hours that the patients are in the care of the ESRDDC;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the ESRDDC;

(4) Appoint an administrator who shall meet the requirements of He-P 811.16(a);

(5) Appoint a medical director, who shall meet the requirements of He-P 811.16(f);

(6) Verify the qualifications of all personnel;

(7) Initiate action to maintain the ESRDDC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(8) Provide sufficient numbers of personnel who are present in the ESRDDC and are qualified to meet the needs of patients during all hours of operation;

(9) Provide the ESRDDC with sufficient supplies, equipment, and lighting to meet the needs of patients;

(10) Implement any POC that has been accepted or issued by the department;

(11) Initiate, implement, and continue action to correct any issue identified by the quality improvement committee; and

(12) Develop and implement a process for determining staffing levels. The plan shall include an assessment, to be conducted at least quarterly but more frequently if required, of the appropriateness of staffing levels.

(r) The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel, and the public.

(s) The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction;

(2) Has an agent or durable power of attorney for health care that has been activated in accordance with RSA 137-J; or

(3) Is an un-emancipated minor.

(t) The licensee shall have a written affiliation agreement with at least one acute care hospital for the provision of inpatient care and other acute care hospital services.

(u) In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

(1) Telephone at 603-271-4496;

(2) Telephone at 603-271-5300 after business hours; or

(3) Fax to 603-271-0545.

(v) If the licensee registers, treats, or accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(w) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license issued in accordance with RSA 151:2;

(2) All statement of findings reports issued for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patients’ rights and responsibilities as required by RSA 151:20;

(5) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits; and

(6) A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the ESRDDC website if available.

(x) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(y) The licensee shall ensure that all personnel required to be licensed in the state of New Hampshire are licensed in accordance with the appropriate practice act and the rules adopted there under.

(z) The licensee shall not exceed the number of occupants identified on the licensing certificate.

(aa) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(ab) The licensee shall admit and allow any department representative to inspect the ESRDDC and all programs, services, and any records for the purpose of determining compliance with RSA 151 and He-P 811 as authorized by RSA 151:6 and RSA 151:6-a.

(ac) The licensee shall ensure that all records required for licensing:

(1) Be available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

(2) Be legible, current, and accurate.

(ad) Smoking shall be prohibited in an ESRDDC per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a patient’s bedroom.

(ae) The water used in the ESRDDC shall be suitable for human consumption pursuant to Env-Dw 702.02 and Env-Dw 704.02.

(af) For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property, the licensee shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 603-271-4968 or email to hfa-licensing@dhhs.nh.gov the following information to the department within 48 hours of a reportable incident as defined in He-P 811.03(cg):

a. The ESRDDC name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the incident;

d. The name of patient(s) involved and the name of any witnesses to the reportable incident;

e. The date and time of the incident;

f. The action taken in direct response to the incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the patient’s guardian, agent, or personal representative was notified;

i. The signature of the person reporting the incident; and

j. The date and time the patient’s licensed practitioner was notified;

(3) As soon as practicable, notify the local police department, the department, and the guardian, agent, or personal representative, if any, when a patient has an unexplained absence, and the licensee has searched the building and the grounds of the ESRDDC without finding the patient, and it has been determined by the facility that the patient is a danger to themselves or others;

(4) If abuse or neglect is suspected, notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(5) Contact the department immediately by telephone, fax, or e-mail to report the information required by (2) above in the case of the death of any patient who dies within 10 days of a reportable incident;

(6) Provide the information required by (2) above, in writing, within 3 business days of the unexpected death of a patient or if a patient dies within 10 days of a reportable incident after contact was made pursuant to (5) above, or if additional information becomes available subsequent to the time the initial contact was made; and

(7) Submit additional information requested by the department.

(ag) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(ah) The licensee shall require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25-(formerly He-P 811.13)

N.H. Code Admin. R. Ann. He-P 811.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time administrator who:

(1) Meets one of the following requirements:

a. Has a bachelor’s degree in business administration or a health-related field; or

b. Is a registered nurse currently licensed in the state of New Hampshire with at least 12 months experience in clinical nursing with 6 months of the experience being in the care of patients with nephrology disorders;

(2) Is responsible for the day-to-day operations of the ESRDDC;

(3) Delegates, in writing, an alternate onsite, qualified designee who shall assume the responsibilities of the administrator in their absence; and

(4) May hold more than one position within the facility if qualified.

(b) The administrator shall be responsible for maintaining the ESRDDC in full compliance with all federal, state, and local laws, rules, codes, and ordinances at all times.

(c) The licensee shall credential licensed practitioners involved in the direct care of patients as follows:

(1) The licensee shall establish a credentialing committee composed of, at a minimum, the medical director, the administrator, and the director of nursing; and

(2) The credentialing committee shall be responsible for:

a. Establishing the education and experience requirements of each direct-care position;

b. Establishing a system for determining that the person being credentialed is:

1. Licensed or certified to practice health care in New Hampshire; and

2. Qualified by education and experience to meet the requirements of the position in a. above;

c. Approving, and documenting the approval of, the duties that may be performed by the person being credentialed;

d. Establishing a procedure for updating the approvals in b. above as necessary; and

e. The annual review of all credentialed personnel.

(d) The licensee shall provide medical services that meet the guidelines in the Association for the Advancement of Medical Instrumentation’s (AAMI) “American National Standard for Dialysate for Hemodialysis” (RD 52:2009 edition), available as noted in Appendix A for:

(1) Water quality requirements and testing; and

(2) The reuse of hemodialyzers and other dialysis supplies.

(e) The licensee shall provide instructions and education to patients, including but not limited to medical needs, nutrition, hygiene, medical emergencies, community support, and resources.

(f) The licensee shall appoint a medical director who:

(1) Is a physician licensed in the state of New Hampshire;

(2) Is board certified in internal medicine or pediatrics;

(3) Has completed a board-approved training program in nephrology;

(4) Has at least 12 months experience providing care to patients receiving dialysis; and

(5) Shall perform the following duties:

a. Participate in the ESRDDC’s quality assurance program;

b. Participate in the implementation of corrective action plans in affected problem areas;

c. Participate in the credentialing process for all licensed health care practitioners;

d. Act as a liaison between the licensed practitioners and the patient;

e. Be available to consult with the patient’s licensed practitioner, as needed;

f. Participate in the development of medical emergency procedures and all standing orders;

g. Be available to respond to the center by phone or in person in the case of an emergency or shall ensure that a physician meeting the qualifications of the medical director is available; and

h. Review and approve all patient care policies including infection control for the ESRDDC.

(g) The licensee shall provide nursing services that include:

(1) A department of nursing that is under the supervision of a director of nursing;

(2) The appointment of a full time director of nursing who:

a. Is a registered nurse currently licensed in the state of New Hampshire;

b. Has at least one year of experience as a registered nurse caring for patients with nephrology disorders; and

c. Shall perform the following duties:

1. Provide nursing direction, supervision, and staff evaluations to promote quality nursing care;

2. Be a member of the ESRDDC’s quality improvement committee; and

3. Participate in the development of nursing protocols and procedures; and

(3) Sufficient staff to meet the dialysis needs of patients at all times while in the care of the facility.

(h) The licensee shall provide dialysis technician services that include the employment of dialysis technicians who are qualified through education and technical training as required by the center’s policies and procedures.

(i) The licensee shall only perform point of care testing (POCT), that is waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(j) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate pursuant to 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(k) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, and reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(l) Licensees performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

(m) The licensee shall not be required to have a separate home health license, pursuant to He-P 809, to provide staff-assisted home dialysis in a patient’s place of residence.

(n) The licensee shall provide social work services, including the employment of a sufficient number of social workers to meet the needs of their patients and who:

(1) Have at least a master’s degree in social work; or

(2) Have a bachelor’s degree in a health or human services field, plus:

a. Two years experience as a social worker; and

b. Have proof of an established consultative relationship with a person holding a master’s degree in social work, that shall be retained in the personnel file.

(o) The licensee shall provide dietary services, including the employment of a sufficient number of dietitians to meet the needs of patients and who:

(1) Are registered by the American Dietetic Association and have one year of experience in clinical nutrition; or

(2) Have a bachelor’s or advanced degree with major studies in food and nutrition or dietitian and one year of experience in clinical nutrition.

(p) All volunteers shall be oriented and educated relative to their prescribed function according to the ESRDDC’s policies and procedures.

(q) The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

(1) Recruitment and retention;

(2) Health screening and 2-step tuberculosis (TB) testing;

(3) Orientation;

(4) Scope of function;

(5) Supervision;

(6) Ongoing training and support;

(7) Record of volunteer activities; and

(8) Criminal record checks.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 -(formerly He-P 811.15)

N.H. Code Admin. R. Ann. He-P 811.17 Patient Management

(a) At the time of admission, personnel of the ESRDDC shall:

(1) Have a written order from a licensed practitioner for the patient’s treatment at the ESRDDC;

(2) Provide, both orally and in writing, to the patient, or patient’s guardian, personal representative, or agent and obtain written confirmation acknowledging receipt and understanding of the following policies:

a. The facility’s policy on patient rights and responsibilities which, at a minimum, shall contain the patients’ bill of rights under RSA 151:21;

b. The facility’s policies and procedures on the reuse of dialysis supplies, including hemodialyzers, if applicable;

c. The facility’s complaint procedure; and

d. Information about advance directives such as:

1. Living wills, pursuant to RSA 137-J;

2. Durable powers of attorney for healthcare, pursuant to RSA 137-J; and

3. DNR order pursuant to RSA 137-J;

(3) Collect and record identification data that includes:

a. Patient’s name, home address, and home telephone number;

b. Patient’s date of birth;

c. Name, address, and telephone number of an emergency contact and guardian, personal representative, or agent, if applicable;

d. Name, address, and telephone number of the patient’s primary care provider;

e. Patient’s insurance information; and

f. Copies of all executed legal directives such as durable power of attorney, legal guardian, or living will;

(4) Obtain documentation of informed consent for:

a. All treatments prescribed by the licensed practitioner; and

b. The reuse of dialysis supplies, including hemodialyzers, if applicable;

(5) Obtain consent for release of information as applicable;

(6) Obtain a medical history and physical examination that has been completed by a licensed practitioner; and

(7) Conduct a nursing assessment completed by:

a. A registered nurse; or

b. An LPN, but a review and signature by a registered nurse shall be required in accordance with the nurse practice act RSA 326-B.

(b) The licensee shall ensure that medical care and services are provided as follows:

(1) Each patient shall be under the care of a licensed practitioner at all times;

(2) Each ESRDDC shall have a least one dialysis station in which a person with an infectious disease may be dialyzed;

(3) The reuse of dialysis supplies, including hemodialyzers, shall be permitted only when the patient, their guardian, personal representative, or agent has:

a. Been informed of the center’s policies and procedures regarding the reuse of dialysis supplies; and

b. Provided written consent for the staff use of reused dialysis supplies;

(4) An individualized care plan shall be developed by an interdisciplinary team, composed of the patient, the licensed practitioner, a registered nurse, a social worker, and a dietician, and based on the results of:

a. The patient’s medical history and physical examination; and

b. The interdisciplinary assessment as determined by the patient’s needs;

(5) The individualized care plan shall:

a. Identify the treatment, including modality and dialysis settings, for the patient;

b. Be reviewed and updated as indicated by the patient’s response to treatment; and

c. Contain documentation that the patient, their guardian, personal representative, or agent participated in the development of the care plan;

(6) The patient shall be provided education in the following areas:

a. Purpose and procedures for the different types of dialysis treatments;

b. Outcomes associated with end stage renal disease, or chronic kidney disease; and

c. The center’s emergency procedures, including both medical and non-medical procedures;

(7) Each patient shall receive a rehabilitative assessment, as applicable;

(8) The ESRDDC’s personnel shall notify the department within 48 hours of any reportable incidents or a significant change of status and document such notification;

(9) The ESRDDC’s personnel shall follow the orders of the licensed practitioner;

(10) Written notes shall be documented in the patient’s record for:

a. All care and services provided at the ESRDDC that shall include the:

1. Date and time of the care or service;

2. Description of the care or service;

3. Progress notes; and

4. Signature and title of the person providing the care or service;

b. Notification of the licensed practitioner of:

1. Any significant change in the status of the patient; or

2. Any side effects, adverse reactions, or ineffective results of any medications prescribed for the patient; and

c. Any significant changes or reportable incidents involving the patient, which shall include the:

1. Date and time of the incident or occurrence;

2. Description of the incident or occurrence, including identification of injuries, if applicable;

3. If medical intervention was required:

(i) Date and time the emergency contact person or the patient’s guardian, personal representative, or agent was notified; and

(ii) Date and time the licensed practitioner was notified;

4. Action taken including follow-up; and

5. Signature and title of the person reporting the incident or occurrence;

(11) The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX;

(12) If the ESRDDC offers a home dialysis program, it shall:

a. Have written policies and procedures for training patients and their caregivers;

b. Provide oversight and monitoring of the home dialysis procedure;

c. Provide consultations with a social worker, registered dietitian, or other professionals, as necessary;

d. Ensure either directly or indirectly that adequate supplies and equipment are available;

e. Provide annual testing of home water supplies for dialysis use as required by the AAMI’s “American National Standard for Dialysate for Hemodialysis” (RD 52:2009 edition), available as noted in Appendix A;

f. Maintain written documentation of all care and services provided by the staff of the ESRDDC; and

g. Not be required to have a separate home health care provider license, pursuant to He-P 809; and

(13) ESRDDC trained caregivers operating under the direction of the ESRDDC who assist with home dialysis shall not be required to hold a separate home health care provider license, pursuant to He-P 809.

(c) The licensee shall transfer a patient whose needs exceed those authorized by the current licensing classification or cannot be met by the programs and services offered at or arranged by the ESRDDC.

(d) If unforeseen complications arise that cannot be stabilized at the ESRDDC, the facility shall:

(1) Transfer the patient to an acute care hospital;

(2) Call 911 for transport; and

(3) Have copies of medical information regarding the treatment received at the center transferred with the patient.

(e) Documentation for any patient discharged or transferred from the facility shall include:

(1) The date and time of discharge or transfer;

(2) The physical, mental, and medical condition of the patient;

(3) Destination of patient;

(4) Name of responsible person accompanying the patient;

(5) Discharge planning and referrals;

(6) Discharge summary;

(7) Physician signed order for discharge or transfer; and

(8) In the event of death, the funeral director’s receipt.

(f) Transfers and discharges shall be done in accordance with RSA 151:21 and RSA 151:26.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 -(formerly He-P 811.16)

N.H. Code Admin. R. Ann. He-P 811.18 Medication

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

(b) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the ESRDDC;

(2) Reorder medications for use at the ESRDDC; and

(3) Receive and record new medication orders.

(c) For each prescription medication being taken by a patient at the ESRDDC, the licensee shall maintain in the patient’s record, the original or a copy of, the written or electronic order, signed by a licensed practitioner or other licensed professional licensed by law to prescribe.

(d) Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

(1) The patient’s name;

(2) The medication name, strength, prescribed dose, and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN;

(5) The dated signature of the licensed practitioner; and

(6) For PRN medications, the licensed practitioner shall indicate, in writing, the indications for use and any special precautions or limitations for use of the medication, including the maximum allowed dose in a 24-hour period.

(e) Medications shall be kept in locked storage.

(f) Except as allowed by (d)(6) above, each prescription medication shall legibly display the following information:

(1) The patient’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered;

(6) The name of the prescribing licensed practitioner; and

(7) The expiration date of the medication(s).

(g) Any change or discontinuation of medications taken at the ESRDDC shall be pursuant to a written order from a licensed practitioner.

(h) The label of all medication containers maintained at the ESRDDC shall match the current written orders of the licensed practitioner unless authorized by (i) below.

(i) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the ESRDDC are unable to obtain a new prescription label:

(1) The licensed nurse shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the ESRDDC’s written procedure, indicating that there has been a change in the medication order;

(2) The licensed nurse shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(j) The licensee shall require that all telephone orders for medications or treatments are:

(1) Taken only by a licensed health care professional if such action is within the scope of their practice act;

(2) Immediately transcribed and signed by the individual taking the order; and

(3) Be counter-signed by the authorized licensed practitioner authorized by law within 30 days.

(k) Over-the-counter medications shall be kept at the ESRDDC provided that these medications shall only be dispensed to a patient with a signed annual order from an authorized licensed practitioner specifying administration according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(l) There shall be a medication storage area for all medications kept at the ESRDDC, which shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean, organized in a fashion to ensure correct identification of each patient’s medication(s), and have lighting adequate to read all medication labels; and

(3) Equipped to maintain medication at the proper temperature.

(m) All medication at the ESRDDC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(n) If controlled drugs, as defined by RSA 318-B:1, are stored in a central storage area in the ESRDDC, they shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel.

(o) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(p) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(q) Except as allowed by (s) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders, or the medication becoming contaminated, whichever occurs first and shall:

(1) Be documented in the record of the patient for whom the drug was prescribed; and

(2) Be accomplished in the presence of at least 2 people if a controlled substance.

(r) Controlled drugs shall be destroyed only in accordance with RSA 318-B.

(s) If medication(s) are to be returned to pharmacies, the medication(s) shall be returned to pharmacies for credit only as allowed by the law.

(t) Medication administered by individuals authorized by law to administer medications shall be prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B and in accordance with manufacturer instructions.

(u) Personnel shall remain with the patient until the patient has taken the medication.

(v) If a nurse delegates the task of medication administration to a patient care technician, the nurse shall follow the requirements of the nurse practice act, RSA 326-B.

(w) The licensee shall maintain a written record for each medication taken by the patient at the ESRDDC which contains the following information:

(1) The name of the patient;

(2) Any allergies or allergic reactions to medications;

(3) The medication name, strength, dose, frequency, and route of administration;

(4) The date and the time the medication was taken;

(5) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;

(6) For PRN medications, the reason the patient required the medication and the effect of the PRN medication; and

(7) Documented reason for any medication refusal or omission.

(x) Each ESRDDC which permits patient care technicians to administer heparin or its derivatives shall:

(1) Require patient care technicians to be under the direction of a registered nurse as required by the nurse practice act for nurse delegation of medications;

(2) Require the delegating licensed nurse to document that patient care technicians have received the required initial competency verification and annual competency evaluations as required by the nurse practice act; and

(3) Have a copy of the patient assessment documented in the patient record, verifying the patient is stable and is an acceptable candidate to receive heparin via nurse delegation, as required by the nurse practice act.

(y) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, to the department within 24 hours of the adverse reaction or medication error.

(z) The written documentation of any reports in (y) above shall be maintained in the patient’s record.

(aa) If ordered by the department to do so, the ESRDCC shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient’s health and safety, as identified during an inspection or investigation.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.13)

N.H. Code Admin. R. Ann. He-P 811.19 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the ESRDDC to meet the needs of patients at all times.

(b) The licensee shall develop a job description for each position at the ESRDDC containing:

(1) Position title;

(2) Duties of the position;

(3) Physical requirements of the position; and

(4) Qualifications and education requirements of the position.

(c) For all applicants considered for employment, for all volunteers and for all independent contractors who will provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the ESRDDC, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (d) below;

(3) Verify that the person is not listed on the BAAS state registry maintained by the department’s bureau of adult and aging services in accordance with RSA 161-F:49;

(4) Verify that the applicant meets the educational and physical qualifications of the position; and

(5) Verify that the applicant is licensed, registered, or certified if required by state statute.

(d) Unless a waiver is granted in accordance with (f) below, the licensee shall not offer employment, contract with, or engage a person in (c) above if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation in this or any other state;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of the patients.

(e) If the information identified in (d) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(f) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(g) The licensee shall not employ, contract with, or engage, any person in (d) above who is listed on the BAAS state registry unless a waiver is granted by BAAS.

(h) All personnel shall be at least 18 years of age if working as direct care personnel unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse as required by the nurse practice act; or

(2) Involved in an established educational program working under the supervision of a licensed clinical supervisor.

(i) The licensee shall inform personnel of the line of authority at the ESRDDC.

(j) Prior to having contact with patients, all personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step TB test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contracting, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(k) In lieu of (j)(1) above, independent agencies contracted by the facility or by an individual patient to provide direct care or personal care services shall provide the licensee with a signed statement that its employees have complied with (j)(1) and (3) above before working at the ESRDDC.

(l) Prior to having contact with patients, all personnel shall receive a tour of the ESRDDC and have an orientation within the first 7 days of employment that explains the following:

(1) The patients’ rights in accordance with RSA 151:21;

(2) The ESRDDC’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 811.22;

(7) The licensee’s confidentiality requirements;

(8) The grievance procedures for staff and patients;

(9) The procedures for food safety for those personnel involved in preparation, serving, and storing of food; and

(10) The mandatory reporting requirements including RSA 161-F:46-48 and RSA 169-C:29-31.

(m) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s patient rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The licensee’s policies and procedures;

(5) The mandatory reporting requirements including RSA 161-F:46-48 and RSA 169-C:29-31;

(6) The ESRDDCs complaint procedures; and

(7) The medical emergency procedures.

(n) All licensees using the service of independent clinical contractors who have direct contact with patients shall ensure that these personnel have:

(1) Been oriented in accordance with (l) above;

(2) Submitted results of a physical examination or health screening and 2 step tuberculosis testing, mantoux method, conducted not more than 12 months prior to employment;

(3) Provided a copy of any license, registration, or certification as required by (b)(4) above; and

(4) Have a written agreement with the licensee that describes the services that will be provided and agrees to comply with (1) through (3) above.

(o) Current and complete personnel files shall be maintained and available to the department for inspection.

(p) The personnel file required by (o) above shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that they have received a copy and received training on the implementation of the licensee’s policy setting forth the patients’ rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check required by (c)(1) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) A record of satisfactory completion of the orientation program required by (l) above;

(7) A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

(8) Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(9) Documentation of annual in-service education as required by (m) above;

(10) For patient care technicians that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine the personnel member is competent to administer medications;

(11) Results of the registry checks required in (c) above;

(12) A signed statement from the employee required by (q) below; and

(13) Documentation to verify compliance with (t), (u), and (v) below, as applicable.

(q) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(r) For individuals with the waiver described in (e) above, the statement required by (o) above shall cover the period of time since the waiver was granted.

(s) An individual shall not be required to re-disclose any of the matters in (o) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

(t) The licensee shall ensure that all direct care personnel have current certification in:

(1) Basic life support (BLS);

(2) Cardio pulmonary resuscitation (CPR); and

(3) Automatic electronic defibrillator (AED).

(u) The licensee shall ensure that all personnel are familiar with the location of the equipment required by He-P 811.23(k).

(v) The licensee shall ensure that all personnel, in accordance with their practice act, are familiar with the operation and use of the equipment required by He-P 811.23(k).

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.18)

N.H. Code Admin. R. Ann. He-P 811.20 Patient Records

(a) The licensee shall maintain a legible, current, and accurate record for each patient based on services provided at the ESRDDC which includes, at a minimum:

(1) The written confirmation required by He-P 811.17(a)(2);

(2) The identification data required by He-P 811.17(a)(3);

(3) Consent forms as required by He-P 811.17(a)(4);

(4) Consent for release of information as applicable required by He-P 811.17(a)(5);

(5) The record of the medical history and health examination required by He-P 811.17(a)(6);

(6) All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

(7) Results of any laboratory tests;

(8) All consultation reports;

(9) All assessments for the last 12 months;

(10) All care plans for the last 12 months;

(11) All written notes required by He-P 811.17(b)(10);

(12) The medication record required by He-P 811.18(w) and (z);

(13) Discharge or transfer documentation as required by He-P 811.17(e);

(14) Documentation of nurse delegation of medications as required by the nurse practice act, as applicable;

(15) The name and telephone number of the patient’s licensed practitioner;

(16) The patient’s health insurance information;

(17) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare under RSA 137-J, or a living will;

(18) Documentation of reportable incidents; and

(19) Documentation of any accident or injuries to the patient occurring while in the care of the ESRDDC and requiring medical care by a practitioner.

(b) Patient records shall be:

(1) Safeguarded against loss, damage, or unauthorized use; and

(2) Retained for 7 years from the date of the patient’s last contact with the licensee, unless, before that date, the patient has requested that the file be transferred to another health care provider, except that when the patient is a minor, records shall be retained for 7 years or until the person reaches the age of 19, whichever is longer.

(c) Patient records and patient information shall be kept confidential and only provided in compliance with all applicable federal and state statutes and administrative rules.

(d) The licensee shall arrange for storage of and access to patient records as required by (b)(2) above in the event the ESRDDC ceases operation.

(e) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

(f) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

(3) Systems to prevent tampering with information pertaining to patients and staff.

(g) The ESRDDC shall, upon request, provide a patient, guardian, personal representative, or agent with a copy of the patient’s record pursuant to the provisions of RSA 151:21, X.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.19)

N.H. Code Admin. R. Ann. He-P 811.21 Quality Improvement

(a) The licensee shall develop and maintain a quality improvement program that reviews policies and all care and services provided to patients and whose objectives shall be to reveal patterns and initiate action to provide an optimum quality of care for all patients.

(b) The quality improvement program shall include a quality improvement committee, which shall consist of:

(1) The medical director;

(2) The director of nursing;

(3) A social worker;

(4) A dietitian; and

(5) At least one other direct care staff provider.

(c) The quality improvement committee shall:

(1) Review within 24 hours:

a. All patient cases where a medical emergency occurs; and

b. Patient cases which require unexpected transfer to an acute care facility;

(2) Determine the information to be monitored;

(3) Determine the frequency with which the information will be reviewed;

(4) Determine the indicators that will apply to the information being monitored;

(5) Evaluate the information that is gathered;

(6) Establish and implement a system for the monthly surveillance of dialysate water and reuse;

(7) Review all reports of unexpected occurrences involving patients, personnel, or visitors;

(8) Ensure that outside services such as laboratory services or water analysis are provided in accordance with federal and state laws and administrative rules;

(9) Ensure that individuals with appropriate qualifications maintain medical equipment;

(10) Determine the action that is necessary to correct identified problems;

(11) Recommend corrective actions to the licensee;

(12) Evaluate the effectiveness of the corrective actions;

(13) Establish an ongoing program to determine performance improvement projects, to carry out interventions to mitigate quality issues and to audit corrective actions; and

(14) Meet at least quarterly.

(d) Documentation of all quality improvement meetings shall be maintained on-site for at least 2 years.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.20)

N.H. Code Admin. R. Ann. He-P 811.22 Infection Control and Sanitation

(a) The ESRDDC shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as noted in Appendix A;

(3) The care and management of patients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

(5) The reporting of infectious and communicable diseases as required by He-P 301; and

(6) The prevention of cross contamination between patients, for the post treatment disinfection of machines and stations to provide a sanitary patient care environment.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies, lice, or any communicable disease shall not provide direct care to patients or prepare food until such time as they are no longer infected.

(f) Pursuant to RSA 141-C, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ESRDDC until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, and tight-fitting bandage.

(h) Each licensee caring for patients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as noted in Appendix A.

(i) The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

(j) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside the facility.

(k) All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(l) A supply of potable water shall be available for human consumption.

(m) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

(n) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(o) All patient bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(p) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and patient supplies.

(q) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(r) Only individuals authorized under RSA 430:33 shall apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(s) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and facility pets.

(t) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected, after emptying or when visibly soiled.

(u) Laundry and laundry rooms shall meet the following requirements:

(1) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(2) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations;

(4) Laundry and laundry rooms shall be kept separate from kitchen and dining areas; and

(5) Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack, or a covered container.

(v) Laundry rooms and bathrooms shall have non-porous floors.

(w) There shall be a designated work area for soiled materials and linens that contains a work counter of at least 6 linear feet, a sink, and a storage area.

(x) Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

(y) Sterile supplies and equipment shall not be mixed with unsterile supplies.

(z) Any ESRDDC with a non-municipal water supply and whose water has been tested and has failed to meet acceptable levels as required by the department of environmental services shall notify the department upon receipt of the results of testing.

(aa) Trash receptacles in food service area shall have covers and shall remain closed except when in use.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.21)

N.H. Code Admin. R. Ann. He-P 811.23 Physical Environment

(a) The licensed premises shall be maintained, inside and out, so as to provide for the health, safety, well-being, and comfort of patient(s) and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(b) Equipment providing heat within an ESRDDC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature that is a minimum of 70 degrees Fahrenheit when patient(s) are present;

(2) Be at least 65 degrees Fahrenheit at night; and

(3) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(3) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Unvented fuel-fired heaters shall not be used in any ESRDDC.

(f) The ESRDDC shall have:

(1) An emergency call system; and

(2) A generator, in working condition at all times.

(g) The generator in (f)(2) above shall be tested regularly in accordance with manufacturer’s recommendations.

(h) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 155-A.

(i) Ventilation shall be provided in all patient areas by means of a mechanical ventilation system or one or more screened windows that can be opened, per the state building code and the FGI “Guidelines for the Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A.

(j) The ESRDDC shall contain an UL listed nursing or monitoring station from which patients receiving dialysis services can be monitored and permits patients to contact personnel for assistance with care or in an emergency.

(k) Each ESRDDC shall provide the following supplies and equipment, which shall be maintained in an operable condition in accordance with the manufacturer’s recommendations:

(1) Oxygen delivery system;

(2) Emergency ventilating supplies including airways;

(3) Automatic External Defibrillator (AED);

(4) Intravenous fluids and administration devices;

(5) Suction machine capable of battery operation or a secondary power source;

(6) Emergency supplies, under the supervision of a registered nurse or physician, which shall be inventoried and maintained according to ESRDDC policy; and

(7) A stretcher, gurney, or transfer device capable of adjusting to the trendelenberg position.

(l) Restocking of the emergency supplies described in (k)(6) above shall occur immediately after each use.

(m) There shall be at least one toilet and one hand-washing sink for patient use, which shall have:

(1) Soap dispensers;

(2) Paper towels or a hand-drying device providing heated air;

(3) Hot and cold running water; and

(4) A door that either slides or swings and is not a folding door or curtain.

(n) If the ESRDDC has showers and tubs, they shall have:

(1) Slip resistant floors; and

(2) Surfaces which are intact, easily cleanable, and impervious to water.

(o) All bathroom and closet door latches shall be designed for easy opening from the inside of the bathroom or closet and from the outside in an emergency.

(p) The ESRDDC shall have a telephone to which the patients have access.

(q) The ESRDDC shall have sufficient space and equipment for the services authorized to be provided at the ESRDDC.

(r) Screens shall be provided for:

(1) Doors;

(2) Windows; and

(3) Other openings to the outside.

(s) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (r) above.

(t) Medical waste shall be disposed of in accordance with the requirements of Env-Sw 904.

(u) The ESRDDC shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(v) The water used in the ESRDDC shall be suitable for human consumption, pursuant to drinking water quality standards as specified in Env-Dw 702 through Env-Dw 706.

History

• #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.22)

N.H. Code Admin. R. Ann. He-P 811.24 Fire Safety

(a) All ESRDDCs shall meet the applicable chapters of NFPA 101, the applicable chapters of the state fire code pursuant to RSA 153:5, and the applicable chapters of the state building code.

(b) The licensee shall provide and maintain a complete fire alarm system installed and maintained in accordance with the state fire code, regardless of the size of the facility.

(c) The licensee shall comply with all state and local codes and ordinances for:

(1) State building code;

(2) Health;

(3) State fire code;

(4) Waste disposal; and

(5) Water, including the requirements of He-P 811.07(d).

(d) All ESRDDCs shall have:

(1) Smoke detectors on every level, powered by the ESRDDC’s electrical service, or wireless, as approved by the state fire marshal for the ESRDDC;

(2) At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 that shall:

a. Be manually inspected when initially placed in service;

b. Be inspected either manually or by means of an electronic monitoring device or system at intervals not exceeding 31 days; and

c. Be inspected at least once per calendar month and include:

1. Documentation of the manual fire extinguisher inspections which shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation; and

2. Documentation of electronically monitored fire extinguishers which shall be provided to the department within 2 business days of the completion of the inspection or investigation; and

(3) An approved carbon monoxide monitor on every level.

(e) The ESRDDC shall:

(1) Have all entrances and exits to the licensed premises accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electrical shocks;

(3) Be free from environmental nuisances, including noise and odors;

(4) Take measures to prevent the presence of rodents, insects, and vermin including, but not limited to:

a. Having tightly fitting screens to all doors, windows, or other openings to the outside unless the door is self-closing and remains closed unless in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430; and

(5) Keep all corridors free from obstructions.

(f) Each licensee shall develop a fire safety plan, which provides for the following:

(1) Use of alarms;

(2) Transmission of alarms to fire department;

(3) Emergency phone call to fire department;

(4) Response to alarms;

(5) Isolation of fire;

(6) Evacuation of immediate area;

(7) Evacuation of smoke compartment;

(8) Preparation of floors and building for evacuation;

(9) Extinguishment of fire; and

(10) Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s).

(g) The fire safety plan shall be reviewed and approved as follows:

(1) The ESRDDC shall obtain written approval initial from the local fire chief for all fire safety plans; and

(2) If changes are made to the fire safety plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(h) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) Emergency EMS transport related to pre-existing conditions.

(i) The written notification required by (h) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(j) All ESRDDCs shall conduct fire drills as follows:

(1) Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

(2) Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

(3) When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

(4) If the facility has an defend or shelter in place plan, then all personnel, patients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that patients shall be given the experience of evacuating to the appropriate location; and

(5) If the facility has an defend or shelter in place plan, the facility shall have this plan approved by the department and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code, as adopted within the state fire code.

(k) For personnel who are unable to participate in the scheduled drill described in (j) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility fire safety plan and emergency plans and document such instruction in their personnel file.

(l) Personnel who are unable to participate in a drill in accordance with (j) and (k) above shall participate in a drill within the next quarter.

(m) The timing of quarterly drills shall be at varying times to include all shifts and all patients and individuals in the ESRDDC at the time of the drill.

(n) At no time shall a staff member who has not participated in in a fire drill be the only staff member on duty within the facility.

(o) The facility shall conduct a fire drill in the presence of a representative of the department, the state fire marshal’s office, or the local fire department upon request.

(p) All emergency and evacuation drills shall:

(1) Be documented and the written records maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

(2) Include the following information:

a. The names of the participating personnel and patients;

b. The time, date, including AM or PM, month, and year the drill was conducted and if the actual fire alarm system was used;

c. The exits utilized if the ESRDDC does not comply with the health care chapter of the state fire code;

d. Location of exits used;

e. The total time necessary to;

1. Completely evacuate the ESRDDC:

2. Evacuate to an approved area of refuge; or

3. Evacuate through a horizontal exit;

f. The time needed to complete the drill;

g. The name and title of the person conducting the drill;

h. A list of problems and issues encountered during the drill;

i. A list of improvements and resolution to the issues encountered during the fire drill; and

j. The names of all staff members participating in the drill.

(q) For the use and storage of oxygen and other related gases, ESRDDCs shall comply with NFPA 99, health care facilities code including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft or 6.1 meters;

2. A minimum distance of 5 ft or 1.5 meters if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, standard for the installation of sprinkler systems; or

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 feet or 1.5 meters, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

(5) Precautionary signs, readable from a distance of 5 feet or 1.5 meters, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

(r) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(s) Cylinders shall be protected from damage by means of the following specific procedures:

(1) Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

(2) Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

(3) Cylinders shall be protected from tampering by unauthorized individuals;

(4) Cylinders or cylinder valves shall not be repaired, painted, or altered;

(5) Safety relief devices in valves or cylinders shall not be tampered with;

(6) Valve outlets clogged with ice shall be thawed with warm, not boiling water;

(7) A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

(8) Sparks and flame shall be kept away from cylinders;

(9) Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

(10) Large cylinders, exceeding size E, and containers larger than 45 kg or 100 lbs weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

(11) Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

(12) Cylinders shall not be supported by radiators, steam pipes, or heat ducts.

(t) Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

(1) Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

(2) Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

(3) Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

(4) The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

(5) Oxygen shall be referred to by its proper name, oxygen, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

(6) Oxygen shall not be used as a substitute for compressed air;

(7) The markings stamped on cylinders shall not be tampered with, in compliance with federal law;

(8) Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels or tags used for indicating cylinder status, for example, full, in use, or empty;

(9) The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

(10) Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, or heat ducts; and

(11) Very cold cylinders or containers shall be handled with care to avoid injury.

History

• #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.26)

N.H. Code Admin. R. Ann. He-P 811.25 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, of which the facility administrator shall be a member.

(b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency preparedness plan .

(c) The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

(1) Elected state and local officials;

(2) Police, fire, civil defense, and public health professionals;

(3) Environment, transportation, and hospital officials;

(4) Facility representatives; and

(5) Representatives from community groups and the media.

(d) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency preparedness plan, as described in (e) and (f) below;

(2) The roles and responsibilities of the committee members;

(3) A description of how the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(e) The emergency management committee shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency.

(f) The emergency preparedness plan in (e) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, or human-caused emergency such as missing patients and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the -licensee;

(11) Conduct a facility-wide walk-through and review, to include the property that the licensee is located on, to determine the status of hazards that might be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least annually;

(12) Include the licensee’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. Heating, ventilation, and air conditioning (HVAC);

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services, if applicable;

(13) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(14) Include the management of patients, particularly with respect to physical and clinical issues to include:

a. Relocation of patients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled and in a location where they will not interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the -licensee is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(g) The licensee shall conduct and document with a detailed log, including personnel signatures, 2 drills a year. A drill might include testing the facility’s communication systems and contact lists to include local authorities, the state authorities, and any other call trees the facility might utilize. One drill might be to rehearse mass casualty, if available, to the facility’s response with emergency services, disaster receiving stations, or both. If a mass casualty drill is utilized it shall comply with the following:

(1) Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the -licensee’s plan and who is not involved in the exercise;

(2) Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The –licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify areas of non-compliance and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the -licensee’s improvement plan.

(h) For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency treatment supplies such as potable water for treatment, water treatment equipment, dialyzers, blood lines, saline, medications, and any other necessary equipment.

History

• #14206, eff 2-28-25 (formerly He-P 811.27)

N.H. Code Admin. R. Ann. He-P 811.26 Home Dialysis in a Nursing Home Setting.

(a) An ESRDDC who provides home dialysis services to nursing home residents in a designated area of the nursing home shall do so under a written agreement with the nursing home.

(b) The ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home residents.

(c) The ESRDDC shall not provide dialysis services at the nursing home to persons other than current residents of the nursing home.

(d) A signed written agreement between the authorized representatives of the nursing home and the authorized representatives of the ESRDDC, shall be consistent with the written policies and procedures of the ESRDDC and the nursing home, and contain at a minimum:

(1) The lines of authority of each party;

(2) The responsibilities of each party, including that the ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home residents consistent with the federal End Stage Renal Disease (ESRD) Conditions for Coverage (CfC) requirements;

(3) A description of how coordination between the parties will occur;

(4) A description of the accountability for the dialysis services provided, including reporting any adverse events;

(5) Specification of the method by which the parties shall ensure adherence to the terms of the agreement, communicate as issues arise, and take remedial action when appropriate; and

(6) Specification that the agreement will be reviewed at least annually and updated as needed.

(e) An ESRDDC shall notify the department of their addition to provide home dialysis in a nursing home setting and submit a narrative that includes the following:

(1) In the area of space, the ESRDDC shall ensure a location that promotes dignity, individual privacy during treatments, access to a call system, hand washing sinks, a soiled utility area, and sufficient space for treatment. Sufficient space shall be 90 square feet per dialysis bed or 80 square feet per dialysis chair, minimum 4-foot clearance between dialysis beds, and a minimum 3-foot clearance between a dialysis bed or chair and any wall, and to accommodate the dialysis equipment both when in use and when not in use;

(2) In the areas of staffing and documentation of training, the ESRDDC shall ensure personnel meet the criteria for qualifications, training, and competency verification, including for hemodialysis by a trained registered nurse (RN) with dialysis experience. The dialysis facility shall ensure that staff are prepared to appropriately address and respond to dialysis related complications and provide emergency interventions, as needed. There shall be policy and procedures for the documentation of training and competency requirements for all individuals providing dialysis treatments;

(3) In the area of coordination of care and medical records, the ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home resident consistent with the federal ESRD CfC requirements pursuant to 42 CFR 494, as well as the terms of the written agreement with the nursing home, and how coordination between the parties shall occur. The ESRDDC shall have procedures for the initiation, administration, and discontinuation of dialysis treatments, the type of monitoring required before, during, and after the treatments, including documentation requirements, procedures for methods of communication between the nursing home and the ESRDDC including how it shall occur, with whom, and where the communication and responses shall be documented, and the development and implementation of a coordinated comprehensive care plans that identify nursing home and ESRDDC responsibilities and provides direction for nursing home and dialysis staff;

(4) In the areas of medication supply and security, the ESRDDC shall ensure the supply and security of how and where medications are stored in the nursing home including a refrigerator as necessary, and the procedures for discarding or disposal of medications used in the nursing home for dialysis services and care;

(5) In the areas of equipment and water, the ESRDDC shall be responsible for providing all equipment necessary for the nursing home resident’s dialysis treatment and for the maintenance of such equipment;

(6) In the areas of housekeeping and waste management, the ESRDDC shall ensure that housekeeping, cleaning, and waste, including medical or potentially hazardous waste, and the disposal of equipment and supplies shall follow professional standards and guidelines;

(7) In the area of emergencies, the ESRDDC shall develop and implement policies and procedures to ensure nursing home staff are prepared to appropriately address and respond to dialysis related complications and provide emergency interventions, as needed, and to ensure the availability of emergency equipment and supplies. The policy shall provide the plan for emergency back-up dialysis services when there is an interruption, or anticipated interruption, of routine home dialysis treatment in the nursing home, including but not limited to, non-functional equipment, power or water outages, or a resident’s anticipated travel away from the nursing home;

(8) In the area of infection control, the ESRDDC shall develop and implement policies and procedures to prevent the spread of disease and avoid the potential for cross-contamination. This includes ensuring that a resident who is hepatitis B+ is not dialyzed using the same machine or in the same location as resident who is not hepatitis B+. Consideration shall be given to implementing appropriate infection control practices related to care of a resident who is hepatitis B+, such as using dedicated staff, a dedicated machine, equipment, instruments, and supplies that shall not be used by other residents, including a resident who is not hepatitis B+. The ESRDDC shall be in compliance with the federal ESRD CfC for infection control pursuant to 42 CFR 494.30;

(9) In the area of resident choice, the nursing home shall accommodate and work with residents who may already be receiving, or prefer to receive, dialysis care from another provider; and

(10) In the area of quality assurance and performance improvement (QAPI) program, the ESRDDC shall collect data from the home dialysis program in the nursing home and incorporate the data into the ESRDDC QAPI program.

(f) Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities, Renal Dialysis Center Chapter” (2022 edition), available as noted in Appendix A.

History

• #14206, eff 2-28-25

Part He-P 812 Rules for Ambulatory Surgical Centers

N.H. Code Admin. R. Ann. He-P 812.01 Purpose

The purpose of this part is to set forth the licensing requirements for all ambulatory surgical centers (ASC) pursuant to RSA 151:2, I(d).

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24

N.H. Code Admin. R. Ann. He-P 812.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an ASC, except:

(a) All facilities listed in RSA 151:2, II(a)-(g); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24

N.H. Code Admin. R. Ann. He-P 812.03 Definitions

In this part, the following words have the following meanings, unless context clearly indicates otherwise:

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent;

(b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure;

(c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use, by an individual authorized by law, pursuant to RSA 318-B and RSA 326-B;

(d) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body;

(e) “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services;

(f) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J or a surrogate decision maker in accordance with RSA 137-J:35;

(g) “Adverse event” means a negative consequence of care, including any misadministration as defined in He-P 4047.03(t), which results in unintended injury which might have been preventable, and which is listed in RSA 151:38;

(h) “Affiliated parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders, and companies providing financial guarantees, captive or affiliated insurance companies. This term includes “related parties”;

(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision maker in accordance with RSA 137-J:35;

(j) “Ambulatory surgical center (ASC)” means any building, place, or a portion thereof, exclusive of physician’s or dentist’s offices that maintains and operates services for the performance of outpatient surgical procedures;

(k) “Anesthesiologist” means a physician who is licensed to practice medicine in the state of New Hampshire and who is accredited by the American Board of Anesthesiology, the American College of Anesthesiology, or the American Osteopathic Board of Anesthesiology;

(l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ASC pursuant to RSA 151:2, I(d);

(m) “Area of non-compliance” means any action or failure to act, that cause a licensee to be out of compliance with RSA 151, He-P 812, or other federal or state requirements;

(n) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning;

(o) “Care plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, or the patient’s guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services to the patient. This term includes “treatment plan”;

(p) “Certified ASC” means an ASC certified by the Centers for Medicare and Medicaid Services (CMS) to provide Medicare or Medicaid funded care or services;

(q) “Certified Registered Nurse Anesthetist (CRNA)” means an advanced practice nurse who administers anesthesia for surgery or other medical procedures;

(r) “Change of ownership” means a change in the controlling interest of an established ASC to an individual or successor business entity;

(s) “Chemical restraint” means any medication that is used for discipline or staff convenience, in order to alter a patient’s behavior such that the patient requires a lesser amount of effort or care, and is not in the patient’s best interest, and not required to treat medical symptoms;

(t) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which sets forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens;

(u) “Commissioner” means the commissioner of the New Hampshire department of health and human services or their designee;

(v) “Contracted employee” means a temporary employee working under the direct supervision of the ASC but employed by an outside agency;

(w) “Controlling interest” means greater than 50% ownership interest;

(x) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606;

(y) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others;

(z) “Days” means calendar days unless otherwise specified in the rule;

(aa) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided;

(ab) “Department” means the New Hampshire department of health and human services;

(ac) “Direct care” means hands-on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments;

(ad) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance;

(ae) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes “do not attempt resuscitation order (DNAR order)”;

(af) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention;

(ag) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency;

(ah) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license, or suspension of a license in response to non-compliance with RSA 151 or He-P 812;

(ai) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures;

(aj) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud;

(ak) “Facility” means “facility” as defined in RSA 151:19, II;

(al) “Good cause” means any circumstances beyond a person’s control, that prevents that person from taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification;

(am) “Governing body” means a person or group of designated persons that appoints the administrator and is legally responsible for establishing and implementing policies regarding the management and operation of the facility;

(an) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs;

(ao) “Health care occupancy” means occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupants’ control;

(ap) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a);

(aq) “Incident Command System (ICS)” means a standardized, on-scene, emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents;

(ar) “Independent contractor” means an individual or business entity providing service to the licensee or its clients but not employed by the licensee;

(as) “Infectious waste” means those items specified by Env-Sw 904;

(at) “Informed consent” means the decision by a person or their guardian, agent, or surrogate decision maker, to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently;

(au) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel;

(av) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 812 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 812;

(aw) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease;

(ax) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 812, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and the license number;

(ay) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate New Hampshire state licensing board;

(az) “Licensed premises” means the building(s) that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license;

(ba) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151;

(bb) “Licensing classification” means the specific category of services authorized by a license;

(bc) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5;

(bd) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b);

(be) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329 and certified by the American Board of Medical Specialties or certified by the American Osteopathic Association in the field of surgery or anesthesia, who is responsible for overseeing the quality of medical care and services at the ASC;

(bf) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal;

(bg) “Medical staff” means those physicians and other licensed practitioners permitted by law and ASC policies to provide patient care services independently within the scope of their practice act;

(bh) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance;

(bi) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes;

(bj) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any patient;

(bk) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes;

(bl) “Nursing care” means the provision or oversight by a nurse of a patient’s physical, mental, or emotional condition by diagnosis as confirmed by a licensed practitioner;

(bm) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for any or all medications, treatments, recommendations, or referrals and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner;

(bn) “Over-the-counter medications” means non-prescription medications;

(bo) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license;

(bp) “Patient” means any person admitted to or in any way receiving care, services, or both from an ASC or provider of any special health care service licensed in accordance with RSA 151 and He-P 812;

(bq) “Patient record” means documents maintained for each person receiving care, services, or both, which includes all documentation required by RSA 151 and He-P 812 and all documentation compiled relative to the patient as required by other federal and state requirements;

(br) “Patient rights” means “patient rights” as defined in RSA 151:19, VI namely, “those rights established under RSA 151:21or RSA 151:21-b, as applicable;

(bs) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria;

(bt) “Personal representative” means “personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose or for the general purpose of assisting a patient in the exercise of any rights”;

(bu) “Personnel” means individual who is employed by the facility, a volunteer, or an independent contractor, who provides direct or personal care or services to a patient;

(bv) “Physician” means a medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329;

(bw) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6;

(bx) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care;

(by) “Point of care devices” means testing involving a system of devices, typically including:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip or reagents to apply the blood sample for testing; or

(3) A meter or monitor to calculate and show the results; including but not limited to:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ration (INR) anticoagulation meters; or

c. Cholesterol meter;

(bz) “Procedure” means a licensee’s written standardized method of performing duties and providing services;

(ca) “Professional staff” means:

(1) Physicians;

(2) Physician assistants;

(3) Advanced practice registered nurses;

(4) Licensed nurses;

(5) Physical therapists;

(6) Speech therapists;

(7) Respiratory therapists;

(8) Occupational therapists;

(9) Social workers; and

(10) Dieticians;

(cb) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols;

(cc) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained;

(cd) “Rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

(1) Addition;

(2) Modification;

(3) Reconstruction;

(4) Renovation: and

(5) Repair;

(ce) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures, that does not result in reconfiguration of the building spaces within;

(cf) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purposes of maintaining such materials, elements, equipment, or fixtures in good or sound condition;

(cg) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services;

(ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient;

(ci) “Service area” means “service area” as defined in RSA 151:4-a, I (c);

(cj) “Stabilize” means to provide medical care to allow the patient to be moved or transferred to another ASC or general hospital without negative effects;

(ck) “State building code” means “state building code” as defined in RSA 155-A:1, IV;

(cl) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5;

(cm) “State monitoring” means the placement of individuals by the department at an ACS to monitor the operation and conditions of the facility;

(cn) “Surgery” means a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedures; and

(co) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or persons who provide religious services or entertainment.

History

• #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraphs (g), (p) and (q) EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24

N.H. Code Admin. R. Ann. He-P 812.04 Notice to Critical Access Hospitals

(a) Prior to submitting an application for licensure in accordance with He-P 812.05, a proposed health care facility shall comply with the requirements of RSA 151:4-a, II, and send written notification of its intent to submit an application for licensure as an ambulatory surgical center, hospital, emergency medical care center, birthing center, walk in care center, dialysis center, or special health care service, via certified mail to the department and to the chief executive officer of all critical access hospitals with a primary physical location within a 15 mile radius of the proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in care center, dialysis center, or special health care service.

(b) The written notification required in (a) above shall contain the following:

(1) Name of the person or entity seeking to establish the proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in care center, dialysis center, or special health care service;

(2) Proposed physical location of the facility;

(3) Type of facility; and

(4) Scope of services for the facility.

(c) Upon receipt of the written notification in (a) above, the chief executive officer of the critical access hospital(s) shall have 30 days to file a written objection with the department.

(d) The written objection in (c) above shall contain the following:

(1) The critical access hospital’s detailed basis for the objection to the proposed health care facility to include:

a. If the proposed health care facility will have a material adverse impact on the critical access hospital’s operations; and

b. How the proposed heath care facility will impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources; and

(2) Proof that the objection was sent via certified mail to the proposed individual or entity seeking to establish the proposed health care facility.

(e) Upon receipt of an objection meeting the requirements of (d) above from a critical access hospital located within a 15 mile radius of a proposed ambulatory surgical center, emergency medical care center, hospital, birthing center, walk in center, dialysis center, or special health care service, the department shall send a letter to the proposed health care facility informing them of the:

(1) Objection and the reason for the objection; and

(2) Opportunity to submit a written response to the objection, which shall include at a minimum:

a. Any information regarding the objection that might be relevant to the determination of material adverse impact; and

b. How the proposed health care facility will not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources.

(f) The department shall provide the names of 3 independent contractors, retained by the department through a competitive procurement process, to the critical access hospital and proposed health care facility for their consideration.

(g) The independent contractors proposed in (f) above shall be experts in the provision of health care services and skilled in determining how utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources could be impacted by the proposed health care facility.

(h) If, after proposing 3 independent contractors, the critical access hospital and proposed health care facility cannot agree on an independent contractor within 30 days of the proposal by the department, the department shall designate the independent contractor to perform the assessment and create the expert report.

(i) Within 30 days of the selection of the independent contractor in accordance with (f) and (h) above, the department shall send a letter to the selected independent contractor requesting their services. This letter shall include:

(1) A request to engage the independent contractor’s services to perform the assessment and create the expert report as required in RSA 151:4-a, II (b);

(2) A summary of the requirements for the content of the expert report, to include how the proposed project might or might not impact the health care services in the service area in terms of utilization, patient charges, market share, physician referral patterns, personnel resources, and referral sources;

(3) The contact information for the proposed health care facility and chief executive officer of the critical access hospital(s) raising the objection(s);

(4) The objection and response along with any other documentation received by the department relative to this transaction; and

(5) A deadline for completion of the expert report, which shall be no later than 90 days from the date of retention of the expert, unless and extension is granted by the department in accordance with (s) below. Such an extension shall not exceed 30 days.

(j) Upon selection of the independent contractor, the department shall notify the proposed health care facility and critical access hospital of the selected independent contractor.

(k) The independent contractor shall invoice the proposed health care facility and critical access hospital the cost of any fees associated with the retention and work to be completed. The fees shall be shared equally between the proposed health care facility and the critical access hospital.

(l) Invoices shall be paid for in advance of any services performed in accordance with RSA 151:4-a, II(b)(6).

(m) Payment of the proposed health care facility’s and critical access hospital’s portion of the advance retainer to the independent contractor shall be paid within 5 business days.

(n) If the proposed health care facility fails to make payment in accordance with (m) above, it shall forfeit its right to submit an application for licensure.

(o) If the critical access hospital fails to make payment in accordance with (m) above, it shall forfeit its right to object and the proposed health care facility shall be allowed to apply for licensure.

(p) In accordance with RSA 151:4-a, II(b), the proposed health care facility and critical access hospital shall provide any information requested by the independent contractor to complete its report in accordance with the following:

(1) Information obtained at the request of the independent contractor shall not be considered confidential under RSA 151:13, unless the department determines that it should be exempt from disclosure under RSA 91-A:5;

(2) The proposed health care facility and critical access hospital shall provide the information within a reasonable time, as determined by the independent contractor based on the scope of work of the project and the expected time to review said documentation, so that the independent contractor may finish its report in the required 90 day time period;

(3) If the proposed health care facility fails to provide requested information in a reasonable time, it shall forfeit its right to submit an application for licensure; and

(4) If the critical access hospital fails to provide requested information in a reasonable time, it shall forfeit its right to object and the proposed health care facility shall be allowed to apply for licensure.

(q) Within 30 days of retention of the independent contractor, the department shall publish a notice on the department’s website to notify the public of the proposed health care facility and solicit public comment for a period of at least 7 days.

(r) All public comments received in (q) above shall be provided to and considered by the independent contractor for use in the analysis.

(s) Within 90 days of retention of the independent contractor, the report as described in RSA 151:4-a, II(b) and (i)(2) above, shall be submitted to the department, unless an extension is granted by the department in accordance with the following:

(1) The department shall grant an extension for good cause;

(2) Good cause shall be determined by the Department and a finding of good cause shall require the independent contractor to show why the report cannot be completed within the 90 days and that the extension is not a result of the proposed health care facility or critical access hospitals failure to comply with the rules; and

(3) Such an extension shall not exceed 30 days.

(t) Within 10 days of receipt of the expert report, the department shall provide a copy of the report to the proposed health care facility and critical access hospital.

(u) If the report finds that the proposed health care facility will have a material adverse impact, then the proposed health care facility shall not be allowed to apply for licensure.

(v) If the report finds that the proposed health care facility will not have a material adverse impact, then the proposed health care facility may proceed with application for licensure.

(w) The person or entity seeking to establish the proposed health care facility and the critical access hospital(s) shall have the right to request a rehearing by the commissioner, pursuant to RSA 541:3.

(x) The result of the rehearing may be appealed by petition to the Supreme Court, pursuant to RSA 541:6.

(y) If the proposed health care facility chooses to move forward with the licensing process prior to all appeal rights being exhausted, the proposed health care facility shall do so at its own risk and shall not hold the critical access hospital or the department liable for any costs incurred.

(z) The appellant shall bear all costs of the state in connection with any rehearing or petition for appeal, including the state’s attorneys’ fees.

History

• #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (e) EXPIRED: 6-27-05
• #9727-B, eff 6-18-10; ss by #12557, INTERIM, ,eff 6-26-18, EXPIRES: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24

N.H. Code Admin. R. Ann. He-P 812.05 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III, and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (May 2024), signed by the applicant or 2 of the corporate officers, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”; and

b. “I affirm that I have complied with RSA 151:4-a and a determination is on file with the department that finds the proposed health care facility shall be allowed to apply for licensure;

(2) A floor plan of the prospective ASC;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority” if a corporation;

b. “Certificate of Formation” if a limited liability corporation; or

c. “Certificate of Trade Name” if a sole proprietorship or if otherwise applicable;

(4) List of affiliated or related parties;

(5) The applicable fee in accordance with RSA 151:5, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(6) A resume identifying the qualifications of and copies of applicable licenses or certificates for the ASC administrator and medical director;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances applicable for an ASC; and

b. For a building under construction, the written approvals required by He-P 812.04(a) shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(8) If the ASC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, or, if a public water supply is used, a copy of a water bill;

(9) The results of a criminal records check for the applicant(s), licensee if different than the applicant, the administrator and the medical director which shall include a criminal history from the state of New Hampshire;

(10) A copy of the non-conviction attestation as described in He-P 812.18(m)(9) for the administrator and medical director;

(11) The results of the BEAS registry check from the bureau of elderly and adult services for the administrator and medical director; and

(12) Any waiver requests, if applicable.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraphs (c) and (d) EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.04)

N.H. Code Admin. R. Ann. He-P 812.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 812.05(a) have been received.

(b) If an application does not contain all of the items required by He-P 812.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 812.14(b) when it determines that the applicant(s), administrator, or medical director:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of a patient.

(f) Following both a clinical and life safety inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 812.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 812.14(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 812.06(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 812.

(i) A written notification of denial, pursuant to He-P 812.14(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.05)

N.H. Code Admin. R. Ann. He-P 812.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued, unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 812.05(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 812.11(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 812.18(e)(2);

(4) A copy of any temporary, new, or existing variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:1; and

(5) A list of specialties that are performed at the center.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704 for nitrates.

(d) Following an inspection as described in He-P 812.10, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151, He-P 812, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 812.05 and shall be subject to a fine in accordance with He-P 812.15.

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.06)

N.H. Code Admin. R. Ann. He-P 812.08 ASC Construction, Modifications, or Renovations

(a) As required by RSA 151:6,II any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V; sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicants own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building code, state laws and rules, and local ordinances.

(g) Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(i) Exceptions to the FGI guidelines above shall be granted by the state fire marshal.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 812.10 prior to its use.

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.07)

N.H. Code Admin. R. Ann. He-P 812.09 ASC Requirements for Organizational Changes

(a) The ASC shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) Services.

(b) The ASC shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

(1) A change in ownership; or

(2) A change in the physical location.

(c) When there is a change in address without a change in location, the ASC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the ASC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) When there is to be a change in the services provided, including the type of sedation used, the ASC shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

(f) The department shall review the information submitted under (e) above and determine if the added services can be provided under the ASC current license.

(g) An inspection by the department shall be conducted prior to operation when there are changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department;

(2) The physical location;

(3) A change in licensing classification; or

(4) A change that places the facility under a different life safety code occupancy chapter.

(h) A new license shall be issued for a change in ownership, classification, or a change in physical location.

(i) A revised license shall be issued for any of the following:

(1) A change of name;

(2) A change of administrator or medical director;

(3) A change in address without a change in physical location; or

(4) When a waiver has been granted under He-P 812.11.

(j) The ASC shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of death or other extenuating circumstances requiring an administrator or medical director change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal records check for the new administrator or medical director which shall include criminal history from the state of New Hampshire;

(4) A copy of the non-conviction attestation as described in He-P 812.18(m)(9); and

(5) The results of the BEAS registry check from the bureau of elderly and adult services for the new administrator or medical director.

(k) Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the administrator or medical director meets the qualifications for the position as specified in He-P 812.17(c) and He-P 812.03(ay).

(l) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the ASC in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(m) The ASC shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days from the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(n) A restructuring of an established ASC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) If a licensee chooses to cease operation of an ASC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (b)(7) EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.08)

N.H. Code Admin. R. Ann. He-P 812.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 812, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the ASC; and

(3) Any records required by RSA 151:2-d, RSA 151:5-c, RSA151:21, He-P 812.15, He-P 812.16, He-P 812.17, He-P 812.18, He-P 812.19, He-P 812.20, He-P 812.21, He-P 812.22, He-P 812.26, and He-P 812.27.

(b) The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 812, prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 812.09(g)(1);

(3) A change in the physical location of the ASC;

(4) A change in the licensing classification;

(5) Occupation of space after construction, renovations or structural alterations; or

(6) The renewal of a non-certified ASC license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ASC is in violation of any of the provisions of He-P 812, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 812, within 21 days of the date on the letter that transmits the inspection report.

History

• #5514, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.09)

N.H. Code Admin. R. Ann. He-P 812.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 812 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #5514, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIREDS: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.10)

N.H. Code Admin. R. Ann. He-P 812.12 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainants’ first-hand knowledge regarding the allegations or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 812.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the ASC, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 812.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For the licensed ASC, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

(3) Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 812.13(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department may issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 812;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 812.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13 and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05
• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.11)

N.H. Code Admin. R. Ann. He-P 812.13 Administrative Remedies

(a) The department shall, impose administrative remedies for violations of RSA 151, He-P 812, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct the licensee shall submit its written POC for each item, written in the appropriate place on the state notice detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action.

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 812;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 812 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable the department shall notify the licensee in writing, within 14 days, of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the waiver;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P812.14(c)(12);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 812.13(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 812.14(c)(13).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall; as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license in accordance with He-P 812.14(b); or

(4) Revoke the license in accordance with He-P 812.14(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients;

(2) The presence of conditions in the ASC that negatively impact the health, safety, or well-being of patients; or

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 24 (formerly He-P 812.12)

N.H. Code Admin. R. Ann. He-P 812.14 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated a provision of RSA 151 or He-P 812, which poses a threat a patient’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee or fine in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, or schedule an initial inspection, an applicant, or licensee fails to submit an application that meets the requirements of He-P 812.05;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes with, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 812.13(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 812.13(c)(5) and has not submitted a revised POC in accordance with He-P 812.13(c)(5)(b);

(8) The licensee is cited a third time under RSA 151 or He-P 812 for the same violations within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 812;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

(4) For a failure to transfer a patient whose needs exceed the services or programs provided by the ASC, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For admission of a patient whose needs exceed the services or programs authorized by the ASC, in violation of RSA 151:5-a, II and He-P 812.16(a), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 812.12(e)(5), the fine for an unlicensed entity or licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 812.07(b), the fine shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 812.09(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 812.09(a)(2), the fine shall be $500.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 812.09(n), the fine shall be $100.00;

(11) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 812.09(d), the fine for a licensee shall be $100.00;

(12) For a refusal to allow access by the department to the ASC’s premises, programs, services or records, in violation of He-P 812.10(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 812.13(c)(2) or (5), the fine for a licensee shall be $500.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 812.13(c)(8), the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement or comply with licensee policies, as required by He-P 812.19, the fine for a licensee shall be $500.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 812.19, the fine for a licensee shall be $500.00;

(17) For providing false or misleading information or documentation, in violation of He-P 812.15(g), the fine shall be $1,000.00 per offense;

(18) For a failure to meet the needs of a patient or patients, as described in He-P 812.15(j), the fine for a licensee shall be $1,000.00 per patient;

(19) For utilizing a room or space that has not been approved or licensed by the department, in violation of He-P 812.10(b)(5), the fine for a licensee shall be $500.00;

(20) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 812.11, in violation of He-P 812.17(b), the fine for a licensee shall be $500.00;

(21) For failure to submit architectural plans or drawings; when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 812.08(a), the fine for a licensed facility shall be $500.00;

(22) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities; as required by He-P 812.10(b)(5), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(23) When an inspection determines that a violation of RSA 151 or He-P 812 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine shall be $1,000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in (a) above, the fine for a licensee shall be $2000.00; and

(24) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 812 shall constitute a separate violation and shall be fined in accordance with He-P 812.13(c), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 812, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire”, or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to appeal by submitting a written request for a hearing.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and provision of services when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 812 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When an ASC’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years, if the enforcement action pertained to their role in the ASC.

(k) RSA 541 shall govern further appeals of department decisions under this section.

(l) The 5-year period referenced in (j) above shall begin on:

(1) The date that the department’s decision to revoke or deny the license became effective, if an appeal is not filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an appeal is made and a hearing is held.

(m) Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has reasonable information or evidence that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 812.

(n) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 812.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 24 (formerly He-P 812.13)

N.H. Code Admin. R. Ann. He-P 812.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, regulations, codes, and ordinances, including RSA 161-F:40 and rules promulgated thereunder.

(b) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the ASC, which shall include at a minimum, the required services listed in He-P 812.19.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the ASC.

(e) Pursuant to RSA 151:41, the licensee shall have a written policy establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion that applies to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(f) The written policy in (e) above shall include:

(1) Education;

(2) Procedures for monitoring the storage, distribution, and procurement of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Provisions of confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion

prevention policy.

(g) All policies and procedures shall be reviewed annually.

(h) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(i) The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

(j) The licensee shall not advertise or provide services that it is not licensed to provide pursuant to RSA 151:2, III.

(k) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(l) Licensees shall:

(1) Meet the needs of the patients during those hours that the patients are in the care of the ASC;

(2) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ASC;

(3) Appoint an administrator and medical director;

(4) Verify the qualifications of all personnel;

(5) Provide sufficient numbers of qualified personnel to meet the needs of patients during all hours of operation;

(6) Provide sufficient supplies, equipment, and lighting to meet the needs of the patients; and

(7) Implement any POC that has been accepted by the department.

(m) The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

(1) Has a guardian appointed by a court;

(2) Has a durable power of attorney for health care or surrogate that has been activated; or

(3) Is an un-emancipated minor.

(n) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

(o) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 812.10(b), for the previous 12 months;

(3) A copy of the patients’ bill of rights;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) The licensee’s floor plan, identifying the location of, and access to all fire exits;

(6) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted by calling 1-800-852-3345 or in writing to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

(7) A list of physicians who have an ownership or financial interest in the ASC.

(q) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 812 as authorized by RSA 151:6 and RSA 151:6-a.

(r) Licensees shall, in accordance with He-P 812.16:

(1) Report all adverse events to the department as required by He-P 812.16(a)-(c);

(2) Submit additional information if required by the department; and

(3) Report the event to other agencies as required by law.

(s) A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of their patient record pursuant to the provisions of RSA 151:21, X.

(t) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(u) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

(3) Systems to prevent tampering with information pertaining to patients and personnel.

(v) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(w) The licensee shall provide cleaning and maintenance services, as needed, to protect patients, personnel, and the public.

(x) The licensed premises shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(y) Smoking shall be prohibited in the ASC pursuant to RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas pursuant to the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

(z) If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

(aa) Upon request, the licensee shall give a patient and the patient’s guardian, agent, or personal representative, or surrogate decision-maker as applicable, a listing of all known applicable charges and identify what care and services are included in the charge.

(ab) The licensee may only perform point of care testing (POCT), that are waived complexity as designated by the Federal Drug Administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(ac) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(ad) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(ae) Licensees performing CLIA-waived laboratory testing or specimen collection shall be incompliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

(af) The licensee shall require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 24 (formerly He-P 812.14)

N.H. Code Admin. R. Ann. He-P 812.16 Adverse Event Reporting

(a) Pursuant to RSA 151:37-38, the ASC administrator or designee shall report to the department the following adverse events:

(1) Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573, available as noted in Appendix A;

(2) The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker’s intentional unsafe act; and

(3) An act by a hospital or ambulatory surgery center staff with the potential to result or resulting in an infection or disease.

(b) If the licensee suspects an adverse event occurred, the ASC administrator or designee shall send a report to the department in electronic or paper format, within 15 business days after discovery of event including:

(1) ASC information;

(2) Patient information;

(3) Event information; and

(4) Type of occurrence as listed in (a) above.

(c) For events reported in (b) above the ASC shall, within 60 days, provide the department:

(1) An analysis that includes the type of harm and contributing factors; and

(2) A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the ASC determines that one is not required.

(d) If the ASC suspects that it received a patient from a sending ASC or hospital that was subject to an adverse event, then the receiving ASC administrator or designee shall notify the sending ASC or hospital’s administrator or designee and the department. The department shall inform the sending ASC or hospital that a report is required in accordance with (b) above.

(e) Upon receipt of a report of an adverse event, the department shall:

(1) Acknowledge receipt of event and review information for completeness;

(2) Review corrective action plan for system changes that reduce the risk repeat of similar adverse events;

(3) Communicate specific concerns to the ASC if the department does not find the corrective action plan credible;

(4) Track and analyze adverse events for trends, underlying system problems; and

(5) Provide information and make referrals to other state agencies as appropriate.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 24 (formerly He-P 812.15)

N.H. Code Admin. R. Ann. He-P 812.17 Organization and Administration

(a) Each ASC shall have a governing body whose duties include:

(1) Management and control of the operation of the ASC;

(2) Assessment and improvement of the quality of care and services;

(3) Appointment of the ASC administrator;

(4) Adoption of policies and procedures defining responsibilities for the operation of the ASC and the establishment of a medical staff;

(5) Approval of medical staff policies and procedures establishing the medical staff responsibilities;

(6) Responsibility for management of the overall operation and fiscal viability of the ASC;

(7) Responsibility for determination of the qualifications for appointment for all managers, medical staff, and personnel; and

(8) Ensuring compliance with all relevant health and safety requirements of federal, state, and local laws rules and regulations.

(b) If the ASC is a sole proprietorship, the duties in (a)(1) above shall pertain to the individual in ownership status.

(c) Each ASC shall have a full-time administrator who:

(1) Meets one of the following qualifications:

a. The administrator shall have a master’s degree from an accredited institution in business administration or a health-related field;

b. The administrator shall have a bachelor’s degree from an accredited institution and at least 2 years of experience working in a health-related field; or

c. The administrator shall be a registered nurse and have at least 3 years of experience working in a health-related field;

(2) Shall be responsible to the governing body for the daily management and operation of the ASC including:

a. Management and fiscal matters;

b. Implementing the policies and procedures adopted by the governing body;

c. The employment and termination of personnel necessary for the efficient operation of the ASC;

d. The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the ASC in the absence of the administrator;

e. Attendance at meetings of the governing body, medical staff, and personnel, to serve as a liaison to the governing body;

f. The planning, organizing, and directing of such other activities as may be delegated by the governing body;

g. The delegation of responsibility to subordinates as appropriate;

h. Ensuring development and implementation of ASC policies and procedures on:

1. Patient’s rights as required by RSA 151:20-21;

2. Advanced directives as required by RSA 137-J;

3. Discharge planning as required by RSA 151:26;

4. Organ and tissue donor identification and procurement, as applicable;

5. Withholding of resuscitative services from patients pursuant to RSA 137-J; and

6. Adverse event reporting; and

i. Notifying the department, directly or through delegation, as specified in He-P 812.15, of any adverse event involving a patient; and

(3) May hold more than one position within the ASC provided the individual meets the qualifications of each position.

(d) Each ASC shall have a medical staff in accordance with the policies and procedures established under (a)(4) above.

(e) There shall be a full-time director of nursing services who:

(1) Is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact;

(2) Has a minimum of 4 years’ relevant experience;

(3) Is responsible for:

a. Establishment of standards of nursing practice used in the ASC;

b. Ensuring that the admission process and patient assessment process coordinates patient requirements for nursing care with available nursing resources;

c. Participating with the governing body, administrator, and medical staff to improve the quality of nursing care at the ASC; and

d. Nursing care as authorized by their nurse practice act and according to RSA 326-B; and

(4) May hold more than one position within the ASC provided the director of nursing meets the qualifications of each position.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.16)

N.H. Code Admin. R. Ann. He-P 812.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the ASC to meet the needs of the patients at all times.

(b) For all applicants for employment, volunteers, or independent contractors who provide direct personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal services within the facility, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (d) below;

(3) Verify the qualifications of all applicants prior to employment;

(4) Verify that the applicant is not on the List of Excluded Individuals or Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

(5) Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

(c) Unless a waiver is granted in accordance with (e)(2) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, if the person:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(d) If the information identified in (c) above regarding any person subject to (b) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging with the person; or

(2) Request a waiver of (c) above.

(e) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

(1) Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a patient(s); or

(2) Grant a waiver of (c) above, if after the investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(f) The licensee shall:

(1) Not employ, contract with, or engage with any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage with board of nursing licensees who are listed on the licensing site with the NH board of nursing registry or compact site.

(g) In lieu of (b) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) above and do not meet the criteria in (c) and (f) above.

(h) All personnel shall:

(1) Meet the educational and physical qualifications of the position as listed in their job description;

(2) Be licensed, registered, or certified as required by state statute and as applicable;

(3) Receive an orientation prior to the assumption of duties that includes:

a. The ASC’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities, policies, procedures, and guidelines, of the position they were hired for;

c. The ASC’s infection prevention program;

d. The ASC’s fire, evacuation, and emergency plans which outline the responsibilities and educational requirements of personnel in an emergency; and

e. Mandatory reporting requirements for abuse or neglect such as those found in RSA 161–F and RSA 169-C:29; and

(4) Complete a mandatory annual in-service education, which includes a review of the ASC’s:

a. Policies and procedures on patient rights and responsibilities and abuse or neglect;

b. Infection prevention; and

c. Education program on fire and emergency procedures.

(i) Prior to having contact with patients, personnel shall:

(1) Submit to the licensee proof of a physical examination or a health screening conducted not more than 12 months prior to employment which shall include at a minimum the following:

a. The name of the examinee;

b. The date of the examination;

c. Whether or not the examinee has a contagious illness or any other illness that would affect the examinee’s ability to perform their job duties;

d. Results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control (CDC); and

e. The dated signature of the licensed health practitioner;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(j) Personnel who have direct contact with patients who have a history of TB or a positive laboratory and antigen testing shall have a symptomology screen of a TB test.

(k) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s patient’s rights and complaint procedures required under RSA 151;

(2) The licensee’s written emergency plan; and

(3) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(l) Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner.

(m) The licensee shall maintain a separate employee file for each employee, which includes the following:

(1) A completed application for employment or a resume;

(2) A signed statement acknowledging the receipt of the ASC’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (h)(3) above;

(5) A copy of each current New Hampshire license, registration, or certification in health care field and basic life support certification, if applicable;

(6) Documentation that the required physical examination or health screening and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by employee;

(8) Documentation of annual performance review;

(9) A statement which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation or pose a threat to the health, safety, or well-being of a patient(s) in this or any other state; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state;

(10) Documentation of the criminal records check;

(11) Documentation that the individual is not on the List of Excluded Individuals or Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

(12) The results of the registry check in (11) above.

(n) The licensee shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (m)(1), (3), (4), (6) and (8) through (12) above; and

(2) For independent contractors, the information in (m) (3), (4), (6) and (8) through (12) above.

(o) An individual need not re-disclose any of the matters in (9) and (10) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.17)

N.H. Code Admin. R. Ann. He-P 812.19 Required Services

(a) The licensee shall determine the scope of surgical services that shall be performed in the surgical suite.

(b) The licensee shall determine the types of anesthesia to be utilized and shall meet NFPA 99, Health Care Facilities Code for supply and storage. Once determined, the ASC shall assure its availability in the surgical suite. Flammable anesthetics shall not be used in an ASC.

(c) Each licensee shall ensure the availability of sufficient personnel, with the required skills and experience, to provide the services in (a) above.

(d) The licensee shall have a policy governing basic life support training and use.

(e) The licensee shall have a surgical suite, which shall be a separate unit, physically set apart from all other departments.

(f) The surgical suite shall contain the following:

(1) At least one operating room equipped for general operating use within the scope of surgical services determined by the ASC in accordance with (a) above;

(2) Facilities for sterilization, scrubbing, and clean-up, separate from the operating room;

(3) Clean, sterile, soiled, or decontamination rooms which shall be separate and distinct from each other;

(4) Appropriate storage space for sterile supplies, instruments, anesthesia, and medications;

(5) Emergency lighting;

(6) Heating ventilation and air conditioning (HVAC) systems which shall comply with the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2022 Edition), available as noted in Appendix A, including the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE/ANSI/ASHE) Standard 170-2017 and the state of NH the International Mechanical Code; and

(7) Space routinely used for administering inhalation anesthesia and inhalation analgesia, which shall be served by a scavenging system to vent waste gases.

(g) The ASC shall have appropriately certified or licensed supervisory personnel present during the procedures being performed.

(h) No operation shall be performed until:

(1) The patient has had a physical examination and medical history completed, within the past 30 days;

(2) Any indicated laboratory and x-ray examinations have been completed;

(3) The preoperative diagnosis has been recorded in the patient’s record; and

(4) The patient has signed a consent for anesthesia.

(i) The ASC shall complete discharge planning on all patients admitted to the ASC including the provision of verbal and written instructions to the patient, or personal representative, agent, surrogate decision-maker, or guardian as applicable.

(j) Discharge planning shall include, as applicable:

(1) The patient’s medication needs upon discharge;

(2) The need for medical equipment, special diets, or potential food-drug interactions; and

(3) The need for home health services upon discharge.

(k) The ASC shall have a procedure for the immediate transfer to a hospital, of patients requiring emergency medical care beyond the capabilities of the ASC.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.18)

N.H. Code Admin. R. Ann. He-P 812.20 Patient Records

(a) A patient record shall be maintained for each patient accepted for treatment by the facility.

(b) The license shall maintain a legible, current, and accurate record for each patient based on the services provided at the ASC.

(c) At a minimum, patient records shall contain the following:

(1) Identification data including the patient’s:

a. Name;

b. Home address;

c. Telephone number;

d. Name, address, and telephone number for an emergency contact;

e. Date of birth; and

f. Guardian, agent, or surrogate decision-maker, as applicable;

(2) A signed acknowledgment of receipt of the patients’ bill of rights by the patient, guardian, agent, or surrogate decision-maker;

(3) Patient’s health insurance information;

(4) Written or electronic record of a health examination by a licensed practitioner;

(5) Written, dated, and signed orders for medications, treatments, special diets, laboratory services, and referrals to other practitioners, as applicable;

(6) The consent for release of information signed by the patient, guardian, agent, or surrogate decision-maker, if any;

(7) The medication record;

(8) Documentation of any accident or injuries occurring while in the care of the facility;

(9) Documentation of all services provided including signed notes by:

a. Nursing personnel;

b. Physicians; and

c. Other health professionals authorized by ASC policy;

(10) Documentation of a patient’s refusal of any care or services;

(11) Transfer or discharge documentation including planning, referrals, and notifications to the patient and guardian, agent, or surrogate decision-maker, if any, of involuntary room change, if applicable;

(12) Laboratory, x-rays, or results of other diagnostic tests; and

(13) The consent for treatment signed by the patient, guardian, agent, or surrogate decision-maker, if any.

(d) Patient records shall be available to the professional staff and health care workers and any other person authorized by law or rule to review such records.

(e) Patient records shall be retained in the facility and stored in an area inaccessible to those who do not have authorized access to such records.

(f) The licensee’s policy shall determine the method by which release of information from patient records shall occur.

(g) When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use by implementation of appropriate use, handling, and storage procedures.

(h) Patient records shall be retained 7 years after the discharge of a patient. In the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

(i) The ASC shall arrange for the storage of and access to patient records for 7 years in the event the ASC ceases operation.

(j) The licensee shall arrange for storage of and access to patient records for 7 years in the event the clinic ceases operation.

(k) The facility shall notify the department where the storage required in (i) above is located.

(l) Referrals to other health care providers shall occur if medically indicated and the facility does not provide the services required.

(m) Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

(n) If the facility uses an electronic record storage system, it shall provide the department computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 812 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

(o) Radiologic services shall only be provided when integral to procedures offered by the ASC.

(p) The ASC shall adopt and implement policy and procedures that provide safety for patient and personnel and are based on nationally recognized standards.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.19)

N.H. Code Admin. R. Ann. He-P 812.21 Infection Control

(a) The licensee shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

(5) Reporting of infectious and communicable diseases as required by He-P 301;

(6) Evaluating and revising the infection control program in accordance with current CDC recommended actions;

(7) Maintenance of a sanitary physical environment; and

(8) Infection control policies specific to each department.

(c) The infection control education program shall:

(1) Be completed by all personnel on an annual basis; and

(2) Address the:

a. Cause of infections;

b. Effect of infections;

c. Transmission of infections; and

d. Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, saliva, or droplets, shall not provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to patients until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel and staff with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, secure-fitting bandage.

(h) If the ASC has an incident of an infectious disease reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(i) The ASC shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

(j) The ASC shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

(k) The ASC administrator shall appoint an infection control officer who shall:

(1) Receive reports of communicable and infectious diseases; and

(2) Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

(l) The ASC shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee, or patient has a communicable disease.

(m) The ASC shall identify, track, and report infections, as required by RSA 151:33 and He-P 309.

(n) The infection control program shall report to quality assurance and performance improvement (QAPI) on at least a quarterly basis.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.20)

N.H. Code Admin. R. Ann. He-P 812.22 Quality Assessment and Performance Improvement

(a) The licensee shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing and correcting identified problems.

(b) As part of its quality improvement program, an interdisciplinary quality assurance and performance improvement committee shall be created and required to:

(1) Meet at least quarterly to evaluate quality assurance and performance improvement activities;

(2) Generate dated, written minutes for each meeting;

(3) Maintain all quality improvement activities, including minutes of meetings, for at least 2 years from the date the record was created; and

(4) Make recommendations to the governing body to improve the quality of care.

(c) Quality assurance and performance improvement activities shall include:

(1) Review of patterns and trends of activities which affect the quality of care;

(2) Ensuring that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer’s recommendations or code requirements;

(3) Monitoring and evaluation of the quality of patient care and patient care services in the ASC which shall include:

a. Monitoring of medication use and review of pharmacy activity in the ASC;

b. Review of patient record quality;

c. Review of blood use in the ASC, as applicable; and

d. Review of other functions such as risk management, infection control, disaster planning, ASC safety, and utilization review; and

(4) Reviewing and making recommendations for improvement in areas such as:

a. Infection surveillance;

b. Morbidity;

c. Mortality;

d. Monitoring of personnel quality control practices in each service; and

e. Adverse events in accordance with He-P 812.16.

(d) For each quality assurance and performance improvement activity, the committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the ASC; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.21)

N.H. Code Admin. R. Ann. He-P 812.23 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment both inside and outside the facility.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption.

(d) A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the patients.

(e) Hot water shall be of a high enough temperature to ensure sanitation when used for laundry, as required in the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2022 edition), available as noted in Appendix A, and summarized as follows:

(1) One hundred and five to 120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures; and

(2) One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures specified by the manufacturer.

(f) All patient bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and program supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, and outdoor animals.

(j) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

(k) Laundry and laundry rooms, if present, shall meet the following requirements:

(1) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(2) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(3) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(l) Laundry rooms and bathrooms shall have non-porous floors.

(m) Clean supplies shall be stored in dust-free and moisture-free storage areas.

(n) Any ASC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.22)

N.H. Code Admin. R. Ann. He-P 812.24 Pharmacy and Medications

(a) Medications shall be administered only by a person licensed to do so by the state of NH.

(b) An emergency drug cart shall be maintained, and it shall be under the control of a licensed nurse or physician, and shall be inventoried, in accordance with the written policy of the ASC.

(c) All medications shall be stored in a clean, well-organized cabinet or closet which shall be locked when not in use.

(d) Appropriate security provisions shall be made for medications requiring refrigeration.

(e) Security provisions such as locked drawers shall be made for individual physician samples if no central storage location is established.

(f) Schedule I and II drugs scheduled in accordance with RSA 318-B:1-a shall be stored in a locked compartment within the locked medicine cabinet or closet.

(g) Disposal of outdated medications and controlled drugs shall be in accordance with state and local ordinances and the provisions of RSA 318-B .

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.23)

N.H. Code Admin. R. Ann. He-P 812.25 Physical Environment

(a) The licensed premises shall be maintained so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(b) The licensed premises shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not be limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within an ASC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

(1) Maintain a temperature of at least 55 degrees Fahrenheit during the day if patient(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Any heating device other than a central plan shall be designed and installed so that:

(1) Combustible material cannot be ignited by the device or its appurtenances;

(2) If fuel-fired, such heating devices comply with the following:

a. They shall be chimney or vent connected;

b. They shall take air for combustion directly from outside; and

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(3) Any heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(g) Unvented fuel-fired heaters shall not be used in any ASC.

(h) Plumbing shall be sized, installed, and maintained in accordance with the state building code under RSA 155-A.

(i) Screens shall be provided for doors and windows that are left open to the outside.

(j) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (i) above.

(k) The ASC shall have a telephone to which the patients have access.

(l) Toilet and bathing facilities shall be provided to meet patient needs in relation to the number, acuity, and gender of the patients, but no less than one toilet per 8 patient care stations.

(m) Separate toilet facilities with hand washing sinks shall be provided for personnel and visitors.

(n) All toilets shall be vented out-of-doors.

(o) Each bathroom shall be equipped with:

(1) Soap dispensers;

(2) Paper towels or a hand-drying device providing heated air; and

(3) Hot and cold running water.

(p) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(q) All hand-washing facilities shall be provided with hot and cold running water.

(r) All bathroom and closet doors must either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

(s) The licensee shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(t) The facility shall be accessible at all times of the year.

(u) The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel, and the public.

(v) Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

(w) Doors shall be of such width as to permit removal of a patient in a bed and meet the state fire and building codes.

(x) Ventilation shall be provided throughout the entire ASC and, whenever necessary, mechanical means such as fans shall be provided to remove excessive heat, moisture, objectionable odors, dust, or explosive or toxic gases.

(y) There shall be an emergency generator system to provide emergency power pursuant to the following, as adopted by the state fire code:

(1) The Electrical Systems chapter of NFPA 99, Health Care Facilities Code; and

(2) The Standard for Emergency and Standby Power Systems, NFPA 110.

(z) Waste water shall be disposed of through a system which meets the requirements of RSA 485:1-A and Env-Wq 1000. Sink drains which have no connection to sanitary sewers or septic systems and similar methods of disposal above ground shall be strictly prohibited.

(aa) Facilities shall provide for prompt cleaning of bedpans, urinals, and other utensils.

(ab) Any locking mechanism utilized by the facility on egress doors shall comply with the ambulatory health care occupancy chapter of NFPA 101 as adopted by the state fire code .

(ac) The ASC shall maintain a system for sterilization of equipment and supplies as follows:

(1) The sterilization system shall be checked for effective sterilization in accordance with the manufacturer’s recommendation; and

(2) The results of these quality control tests shall be documented.

(ad) The ASC shall have a storage room for clean and sterile supplies, including packs, which meets the following requirements:

(1) There shall be provisions for ventilation, humidity, and temperature control;

(2) Sterile supplies and equipment shall not be mixed with unsterile supplies; and

(3) Sterile supplies shall be stored in dustproof and moisture free, labeled containers or cupboards.

(ae) Signs shall be provided at all entrances to restricted areas and shall clearly indicate that surgical attire is required.

(af) The ASC shall be divided into 3 designated areas, unrestricted, semi-restricted, and restricted, which are defined by the physical activities performed in each area and by the FGI’s “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.7 Specific Requirements for Outpatient Surgery Facilities” (2022 edition), available as noted in Appendix A.

(ag) Operating room sizes shall be based on procedures to be performed, including the number of staff required and the amount and size of equipment that will be used. At a minimum operating room sizes shall meet the requirements of the FGI’s “Guidelines for the Design and Construction of Outpatient Facilities, Chapter 2.1 Common Elements for Outpatient Facilities and Chapter 2.7 Specific Requirements for Outpatient Surgery Facilities” (2022 edition), available as noted in Appendix A. In addition, at a minimum, the square footage requirements, shall take into account circulation pathways, sterile fields, movable equipment, and anesthesia work area.

(ah) Operating rooms shall be located within the restricted corridors of the surgical suite.

(ai) Semi-restricted areas shall have ceilings that are smooth and without crevices, scrubbable, non-absorptive, Non-perforated and capable of withstanding cleaning with chemicals.

(aj) Restricted areas shall have ceilings that are monolithic. Cracks or perforations in these ceilings shall not be permitted and the central diffusers shall not be considered part of a monolithic ceiling. All access openings in these ceilings shall be gasketed.

(ak) If utilizing lay-in ceilings, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot.

(al) A nurse call system shall be required pursuant to the FGI’s “Guidelines for the Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A.

History

• #9727-A, eff 6-18-10, EXPIRED: 6-18-18
• #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.24)

N.H. Code Admin. R. Ann. He-P 812.26 Life Safety and Fire Safety Procedures

(a) All ASC’s shall meet the appropriate chapter of NFPA 101, the appropriate chapters of the state fire code pursuant to RSA 153:5, and the appropriate chapters of the state building code.

(b) The administrator or designee shall appoint a safety committee to include representatives from administration, clinical services, and support services.

(c) The safety committee shall:

(1) Appoint a safety officer who shall:

a. Inspect the ASC at least semi-annually to assure that all safety precautions are met; and

b. Report to the safety committee any findings noted during the inspections;

(2) Develop or approve written policies and procedures covering all matters of safety and fire protection and an emergency response plan, including:

a. The emergency procedures required by the emergency response plan shall include, but are not limited to, evacuation routes, emergency notification numbers, and emergency instructions and shall be posted in locations accessible to personnel and visitors;

b. The ASC fire safety plan shall provide for the following:

1. Use of alarms;

2. Transmission of alarm to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation; and

9. Extinguishment of the fire;

c. Ensuring that the fire safety and evacuation plans are available to all supervisory personnel;

d. Ensuring that all employees receive in-service annual training to clarify their responsibilities in carrying out the emergency plan; and

e. Ensuring that the required plan shall be readily available at all times in the telephone operator’s location or at the security center; and

(3) Conduct fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

a. Recovery and operating room patients shall not be required to be moved during drills to safety areas or to the exterior of the building; and

b. Drills shall be conducted quarterly on each shift to familiarize ASC personnel with the signals and emergency action required under varied conditions.

(d) The emergency plan required by (b)(2) above shall be approved and signed by the local fire chief.

(e) The ASC shall notify the department and local fire department when a required sprinkler or fire alarm system is out of service for more than 4 hours in a 24-hour period. The ASC shall be evacuated or an approved dedicated fire watch shall be provided for all parties left unprotected by the shutdown until the sprinkler or alarm system has been returned to service.

(f) The ASC shall notify the department when the emergency power has been utilized for 6 or more hours due to power outage.

(g) Provisions shall be made for the medical gas(es) used in the facility. Adequate space for supply and storage, including space for serve cylinders, shall be provided. Protection of this area shall meet NFPA 101 and NFPA 99 health care facilities code, as adopted by the state fire code.

(h) If piped medical gas is used, the installation, testing, and certification of nonflammable medical gas and air systems shall comply with the requirements of NFPA 99, as adopted by the state fire code.

(i) Where the functional program requires, central clinical vacuum system installations shall be in accordance with NFPA 99, as adopted by the state fire code.

(j) If there is an incident including, but not limited to, fire, toxic fumes including smoke, flooding, and power outage, which requires the evacuation of the ASC all or in part, the ASC shall immediately notify the department by phone, once the incident has been stabilized. Within 72 hours of the incident, the ASC shall submit a written report which gives further details of the incident and the action taken.

History

• #12926, eff 11-26-19; ss by #14042, eff 8-6-24 (formerly He-P 812.25)

N.H. Code Admin. R. Ann. He-P 812.27 Emergency Preparedness

(a) Each facility shall have an emergency management committee, of which the facility administrator shall be a member.

(b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

(c) The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(d) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (e) and (f) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(e) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(f) The plan in (e) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the incident command system (ICS) in coordination with local emergency response agencies;

(6) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(7) Include a plan for alerting and managing staff in a disaster, and for accessing critical incident stress management (CISM), if necessary;

(8) Include the management of participants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

(9) Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(g) Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies or actual, and functional drills.

(h) The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

(i) Notwithstanding (a)-(g) above, when an ASC is a part of a larger institution which has a comprehensive emergency preparedness plan, the ASC may use the institution’s plan, and if so, it shall:

(1) Identify the portions of the plan that pertain to the ASC in a separate document for use by ASC personnel;

(2) Provide annual training to prepare personnel in its application as required by (g) above; and

(3) Review and update the plan as required by (h) above.

History

• # 14042, eff 8-6-24 (formerly He-P 812.26)

Part He-P 813 Adult Family Care Residence

N.H. Code Admin. R. Ann. He-P 813.01 Purpose

Statutory Authority: RSA 151:2, IV; and RSA 151:9:VIII

The purpose of these rules is to establish the minimum standards and procedures for the certification of an adult family care residence.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.02 Scope

These rules shall apply to any individual, agency, partnership, association, or other legal entity offering adult family care services to one or 2 residents in a home-like environment and receiving reimbursement from the New Hampshire Medicaid choices for independence (CFI) waiver program for those services.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.03 Definitions

(a) “Abuse” means “abuse” as defined in RSA 161-F:43, II.

(b) “Activities of daily living (ADL)” means basic daily routine tasks common to the average individual, such as personal hygiene, transfers and walking.

(c) “Admission” means the act of a resident’s initial physical move into an AFCR.

(d) “Adult family care (AFC)” means a housing option for eligible participants under the CFI waiver program, which includes a combination of personal care, homemaking, and other services that are provided to a participant who is a resident in a certified residence of an unrelated individual or the CFI waiver participant’s relative in accordance with a person-centered plan.

(e) “Adult family care provider” means an individual 21 years or older who has been certified by the department in conjunction with the oversight agency to provide care and assistance in his or her home residence to 1 or 2 individuals.

(f) “Adult family care residence (AFCR)” means the dwelling in which AFC is provided for one or 2 residents.

(g) “Applicant” means an individual, agency, partnership, corporation, federal, state, county or local government entity, association, or other legal entity seeking a certificate to operate an AFCR pursuant to RSA 151:2, IV.

(h) “Assessment” means an evaluation of the resident to determine what care and services are needed.

(i) “Case manager” means a person providing services in accordance with He-E 805, who has the primary responsibility for assessing the participant’s needs, developing a comprehensive care plan, and coordinating and monitoring the services described in the comprehensive care plan.

(j) “Certification” means the written approval by the manager of the office of program support for the operation of an AFCR in accordance with He-P 813.

(k) “Certificate holder” means the person or agency whose name is on the AFCR certification issued.

(l) “Choices for Independence (CFI) waiver program” means a system of long-term services and supports (LTSS) provided under Section 1915(c) of the Social Security Act to participants who meet the eligibility requirements in He-E 801.03 and He-E 801.04. This term is also known as home and community-based care for the elderly and chronically ill (HCBC-ECI) and as home and community-based services- choices for independence (HCBS-CFI).

(m) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(n) “Deficiency” means any action, failure to act or other set of circumstances that cause a certificate holder or oversight agency to be out of compliance with RSA 151 or He‑P 813.

(o) “Department” means the New Hampshire department of health and human services.

(p) “Emergency plan” means a document outlining the responsibilities of certificate holders and the oversight agency in an emergency.

(q) “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV.

(r) “Fire safety assessment” means a documented evaluation completed by a certificate holder based on a drill, completed in accordance with He-P 813.20.

(s) “Household member” means the adult family care provider and all adult household members age 17 or older that reside at the AFCR.

(t) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of caregivers.

(u) “Investigation" means the process used by the department to respond to allegations of non‑compliance with RSA 151 and He-P 813.

(v) “Licensed practitioner” means any of the following disciplines acting within their relevant scope of practice:

(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced registered nurse practitioner (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(w) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(x) “Neglect” means “neglect” as defined in RSA 161-F:43, III.

(y) “Orders” means prescriptions, instructions for treatments, special diets or therapies, signed by a licensed practitioner, or other individual authorized by law.

(z) “Oversight agency” means an agency, entity or organization enrolled as a New Hampshire Medicaid provider that is designated by the department to provide oversight functions of AFCRs.

(aa) “Over-the‑counter medications” means non‑prescription medications for use by a resident at the certified premises.

(ab) “Person-centered” means that the CFI waiver participant receiving services or his or her authorized representative are the center of the system of care, and participant’s needs and preferences drive the care and services provided.

(ac) “Plan of correction (POC)” means a plan developed and written by the adult family care provider or oversight agency, which specifies the actions that will be taken to correct deficiencies identified by the department.

(ad) “Procedure” means a written, standardized method of performing duties and providing services.

(ae) “Representative” means an individual granted authority by law to represent another individual, including a legal representative as defined in RSA 161-F:11, VII, and a resident’s personal representative as defined in RSA 151:19, V.

(af) “Resident” means any person who has been determined eligible for nursing home level of care under the CFI waiver program in accordance with He-E 801, and who is admitted to an AFCR certified in accordance with RSA 151 and He-P 813.

(ag) “Resident record” means a secure file, located in the AFCR, that contains the resident’s person-centered plan, service agreement, emergency data sheet, medication record and progress notes.

(ah) “Self administered with supervision” means an act whereby the resident is prompted by an adult family care provider to take his or her own medication(s) without requiring physical assistance from others.

(ai) “Self administration of medication” means an act whereby the resident is able to take his or her own medication(s) without the verbal or physical assistance of another person.

(aj) “Self directed” means an act whereby a resident, who has a physical limitation that prohibits him or her from self-administering, directs the adult family care provider to physically assist in the medication process.

(ak) “Service” means a specific activity performed by the adult family care provider or oversight agency, either directly or indirectly, to benefit or assist a resident.

History

• #8595, eff 4-1-06; #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.04 Adult Family Care Provider Qualifications, Duties and Responsibilities

(a) An adult family care provider shall:

(1) Be at least 21 years of age;

(2) Possess a high school or general equivalency diploma;

(3) Possess and maintain a NH driver’s license;

(4) Possess the results of a physical examination or health screening completed no more than 12 months prior to filing the initial application;

(5) Possess the results of a 2-step tuberculosis (TB) test, Mantoux method, completed no more than 12 months prior to filing the initial application;

(6) Be equipped to provide care to an elderly and/or disabled adult in accordance with a respective resident’s person-centered plan;

(7) Have a written agreement with an oversight agency; and

(8) Prior to accepting a resident within an AFCR, participate in 6 hours of orientation, offered by or through the oversight agency, which includes, at a minimum, the following:

a. The aging process and associated changes;

b. The philosophy and provision of person-centered services and supports;

c. The role of the oversight agency and case management services;

d. The resident’s rights in accordance with RSA 151:21;

e. AFCR complaint procedures;

f. The services provided by the AFCR in accordance with these rules;

g. Based on the adult family care provider’s resident(s), information on the specific diseases and conditions, including:

1. All medical conditions, medical history, routine and emergency protocols, and any special nutrition, dietary, hydration, elimination, and ambulation needs;

2. Any communication needs;

3. Any behavioral supports required of residents served;

4. Any assistance that residents need to evacuate the AFCR in case of an emergency;

5. The procedures for food safety regarding preparation, serving, and storing of food; and

6. The mandatory reporting requirements in accordance with RSA 161-F:46-50.

(b) Annually, the adult family care provider shall participate in a minimum of 6 hours of continuing education or training, as conducted by or coordinated by the oversight agency, which presents the information contained in (a)(8) above.

(c) Adult family care providers shall follow the orders of the licensed practitioner or other licensed professional with prescriptive authority for each resident and encourage residents to follow the practitioner’s orders.

(d) The adult family care provider shall provide care in accordance with the resident’s person-centered plan, fire safety plan and personal safety plan.

(e) The adult family care provider shall provide services in accordance with He-P 813.16.

(f) During a planned absence or in the event of an emergency, the adult family care provider in collaboration with the oversight agency and case manager shall arrange for a substitute adult family care provider to provide care for the residents in accordance with the resident’s person-centered plan and these rules.

(g) The adult family care provider shall provide access to the home for licensed professionals for the delivery of other services to the resident if the resident requires additional specific services not provided by the adult family care provider as outlined in the resident’s person-centered plan.

(h) The adult family care provider shall provide or arrange for the resident with access to community activities, including:

(1) Religious services;

(2) Social and cultural events;

(3) Educational activities;

(4) Recreational activities; and

(5) Opportunities for the resident to visit with his or her family and friends.

(i) The adult family care provider shall provide or arrange for sufficient supplies, including but not limited to toiletries, clean linens, and towels, to ensure that the needs of the resident are met.

(j) An adult family care provider file shall be available at the AFCR for review by the department and contain the following:

(1) A completed application by the adult family care provider to provide adult family care services;

(2) Proof that the applicant meets the minimum age requirements;

(3) A statement signed by the adult family care provider that he or she has received a copy of and received training by or through the oversight agency, in the implementation of the policy and procedures setting forth the resident’s rights and responsibilities as required by RSA 151:20;

(4) A copy of the results of the criminal records, motor vehicle, and bureau of adult and aging services (BAAS) Adult Registry checks for all adults living or working in the AFCR;

(5) Documentation of satisfactory completion of the required orientation program;

(6) Documentation regarding the content, length, and dates of all subsequent annual training or educational programs attended;

(7) A copy of a current driver’s license; and

(8) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x‑rays, if required, have been completed by the appropriate health professionals.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.05 Oversight Agency Responsibility

Oversight agencies through a signed written agreement between the oversight agency’s executive director and the adult family care provider shall:

(a) Comply with these rules, which include:

(1) Providing the services described in these rules;

(2) Requesting a waiver for an adult family care provider or AFCR in accordance with He-P 813.25; and

(3) Reporting based on the department’s quality assurance measures developed in accordance with RSA 126-A:4, IV;

(b) Monitor the AFCRs compliance with these rules which includes:

(1) Identifying possible deficiencies pursuant to these rules to assist adult family care providers with necessary corrective action and to maintain compliance;

(2) Conducting periodic announced or unannounced quality assurance visits, at least annually;

(3) Complete criminal, motor vehicle, and BAAS registry checks for all adult household members prior to submission of the initial application; and

(4) Notify the department within 7 days of a resident moving into an AFCR; and

(c) Provide the following supports:

(1) Coordinate with adult family care providers to provide coverage for absences, both planned and in the event of an emergency;

(2) Provide education and training as described in He-P 813.18(aa)-(ac), and as follows:

a. Initial orientation training;

b. Continuing education and training; and

c. Medication supervision training in accordance with He-P 813.18;

(3) Facilitate the transfer of residents due to revocations of certification, voluntary closure of AFCR, or immediate suspension of operation;

(4) Develop a person-centered plan with the adult family care provider;

(5) Approve personal safety plans prior to a resident being left unsupervised;

(6) Conduct quarterly evaluations of physical and cognitive functioning of residents;

(7) Quarterly discuss the progress notes of each resident with the adult family care provider; and

(8) Assist with orders for medications from a licensed practitioner as needed.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.06 Resident Eligibility

The AFCR shall only admit residents who:

(a) Meet financial and clinical eligibility requirements for the CFI waiver program;

(b) Have needs for supports and services that are able to be met directly by the AFCR or through arrangement with other providers;

(c) Are able to evacuate the residence in compliance with Saf-C 6008.04 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control; and

(d) Do not place the health or safety of any other resident or household member in jeopardy.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.07 Administrative Requirements

(a) An AFCR shall:

(1) Be located in areas where other family housing is located;

(2) Not display any sign that labels the individuals or functions of the residence; and

(3) Have no more than 2 persons receiving paid services in the residence without regard to payment.

(b) The adult family care provider shall hold the certificate to operate the residence in conjunction with an enrolled medicaid adult family care provider agency that is authorized by the department as an oversight agency to administer adult family care.

(c) The adult family care provider shall provide a list of the names of all persons living in the residence to the oversight agency, changes to the list shall be reported to the oversight agency within 30 days of the change.

(d) The adult family care provider shall have personal injury liability insurance for the residence. Certificates of insurance shall be on file at the premises.

(e) All AFCR household members and staff that transport a resident, shall have a valid driver’s license and current automobile liability insurance, which shall be in at least the following amounts and coverage:

(1) $100,000 coverage for any single person injured; and

(2) $300,000 coverage for personal injuries per accident.

(f) No adult family care provider or other person living or working in an adult family care residence shall serve as the legal guardian or legally liable representative of an individual living in the residence.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.08 Certification Process

(a) The certification process shall only apply to those homes where the resident is living with an adult family care provider who is not a family member.

(b) An applicant shall apply to be certified via an application form obtained from the department’s health facilities administration entitled “Request for Certification of Adult Family Care Residence” (November 2019).

(c) An applicant shall request certification for any of the following reasons:

(1) Certification of a new AFCR; or

(2) For an existing AFCR:

a. A change in the oversight agency;

b. A change in physical location; or

c. A request for an increase from one to 2 certified beds or a decrease from 2 to one certified bed.

(d) The applicant shall provide the following with the application:

(1) Directions to the home;

(2) Copies of all approved waivers, pending waiver requests, or both;

(3) Verification from the department or local fire official that the applicant complies with all applicable state and local fire ordinances for a single or 2 family dwelling, including verification that the AFCR:

a. Has smoke detectors that are:

1. Placed on every level of the AFCR;

2. Placed in every bedroom;

3. Interconnected and hardwired or a wireless system approved by the New Hampshire state fire marshal’s office; and

4. Powered by the AFCR’s electrical service;

b. Has at least one ABC type fire extinguisher on every level of the AFCR;

c. Is free from fire hazards; and

d. Has at least one functioning carbon monoxide detector on every inhabited level of the home and in the basement;

(4) An approval from the local fire official signed and dated with the following information:

a. Date indicates that approval was obtained more than 90 days prior to the submission of the application;

b. Verifies the street address of the proposed or existing AFCR;

c. Verifies that the home complies with all state and local fire codes;

d. Includes the date of the life safety inspection; and

e. States the specific the number of beds for safe occupancy by AFC residents living in the proposed of existing AFCR; and

(5) For AFCRs not served by a public water system, an analysis report completed within the previous 12 months by a certified laboratory that verifies the water supplied to or used in the prospective home is suitable for human consumption and in compliance with Env-Dw702.02 and Env-Dw 704.02.

(e) The applicant shall provide to the department a written agreement, signed by the oversight agency’s executive director, or his or her designee, that indicates that the oversight agency agrees to monitor the residence.

(f) The applicant and all household members living within the home shall authorize the oversight agency, pursuant to He-P 813.05, to complete a registry check in the BAAS adult registry to verify that the applicant and other adult household members do not have a non-criminal finding of abuse, neglect, or exploitation of an incapacitated adult.

(g) Information disclosed regarding adjudication of juvenile delinquency, as required by (c)(10)b. above, shall be confidential and shall not be released except in a proceeding involving the question of certification or revocation of a license, or pursuant to court order.

(h) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

(i) The department shall process applications in accordance with RSA 541-A:29.

(j) An application for an initial certification shall be deemed to be complete when the department determines that all items required in (b ), and (d)-(g) above have been received.

(k) If an application does not contain all of the items required by (b), and (d)-(g) above the department shall notify the applicant in writing of the items required before the application can be processed.

(l) All certifications issued in accordance with RSA 151 shall be non-transferable by person or location.

(m) A temporary certification shall be granted for 90 days, or until the certification has been approved or denied, from the date that the department receives all information required on the application form incorporated by reference in He-P 813.08(b).

(n) Within 90 days of the receipt of the application, the department’s health facilities administration shall complete an inspection for the purposes of determining whether the AFCR is in compliance with these rules.

(o) At the time of inspection, the department shall be provided with the results of criminal record checks, motor vehicle records, and BAAS adult registry checks for the applicant, adult family care provider, and all household members age 17 years or older as completed by the oversight agency, pursuant to He-P 813.05.

(p) If the applicant, adult family care provider, or any household member age 17 years or older has been convicted on a felony or misdemeanor, or has a substantiated complaint by a state agency, he or she shall provide to the department a written disclosure containing a list of any:

(1) Misdemeanor or felony convictions, in this or any other state;

(2) Adjudications of juvenile delinquency;

(3) Permanent restraining or protective orders;

(4) Evidence of any conduct that could endanger the well-being of the individual receiving care;

(5) Findings by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation;

(6) Current investigations by any law enforcement agency;

(7) Current investigations by the department for abuse, neglect or exploitation; or

(8) An explanation of the circumstances surrounding disclosure of matters described in a. through g. above.

(q) After the inspection, if the department deems the AFCR not in compliance with these rules, the AFCR shall submit a plan of correction in accordance with He-P 813.09.

(r) After the inspection, if the department deems the AFCR in compliance with these rules, the department shall issue a certification to the AFCR.

History

• #8595, eff 4-1-06; amd by #9899-A, eff 3-29-11, (paras (b)-(p)); amd by #9899-B, eff 3-29-11 (para (a)); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.09 Inspections and Plans of Correction

(a) The department shall conduct inspections to determine compliance with all applicable rules prior to:

(1) Issuing an initial certification; and

(2) Renewal of a certificate except as allowed by He-P 813.10.

(b) Following an inspection and determination pursuant to (a) above, the department shall issue a written inspection report that includes:

(1) The name and address of the physical location of the AFCR;

(2) The name of the responsible oversight agency;

(3) The date of the inspection;

(4) The name of the person(s) conducting the inspection; and

(5) A listing of all rules with which the AFCR failed to comply.

(c) If deficiencies were cited in the inspection report, within 21 days of the date of issuance of the report, the AFCR shall submit a written plan of correction or submit information as to why the deficiency(ies) did not exist.

(d) The department shall evaluate any submitted information on its merits and render a written decision on whether a written plan of correction is necessary.

(e) The plan of correction submitted in accordance with (c) above shall describe:

(1) How the AFCR corrected or intends to correct the deficiency(ies);

(2) How the AFCR intends to prevent reoccurrence of each deficiency; and

(3) The date by which each deficiency shall be corrected.

(f) The department shall issue a certificate if it determines that the plan of correction:

(1) Addresses the deficiency in a manner which achieves full compliance with rules cited in the inspection report;

(2) Addresses all deficiencies cited in the inspection report;

(3) Does not create a new violation of statute or rule as a result of its implementation; and

(4) States a completion date.

(g) The department shall reject a plan of correction that fails to comply with (e) and (f) above.

(h) If the proposed plan of correction is rejected, the department shall notify the AFCR in writing of the reason(s) for rejection.

(i) Within 21 days of the date of the written notice under (h) above, the AFCR shall submit a revised plan of correction that:

(1) Includes proposed alternatives that address the reason(s) for rejection; and

(2) Is reviewed in accordance with (e) and (f) above.

(j) If the revised plan of correction is rejected, the department shall deny the certification request.

(k) The department shall verify that a plan of correction, as submitted and accepted, has been implemented by:

(1) Reviewing materials submitted by the AFCR;

(2) Conducting a follow-up inspection; or

(3) Reviewing compliance during the next certification inspection required by He-P 813.

(l) AFCR’s shall receive announced or unannounced quality assurance visits.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.10 Renewal of Certifications

(a) Each adult family care provider shall complete and submit an application form entitled “Request For Certification of Adult Family Care Residence” (November 2019).

(b) Applications for renewal of certification shall be received by the department at least 60 days prior to the expiration of the current certification.

(c) The adult family care provider shall submit with the renewal application:

(1) The information required by He-P 813.08(d)-(g);

(2) A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 813.25, if applicable; and

(3) A statement identifying any variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03 - Saf-C 6005.04 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

(4) If renovations were completed since the last certification was granted, a new signed approval from the local fire official, which includes a statement that:

a. Required building permits pursuant to local building codes were obtained; or

b. Indicates whether or not the adult family care provider altered any means of egress.

(d) An application for certification renewal shall be approved if:

(1) The application contains all the information required by (a) and (c) above;

(2) The application is received prior to the expiration of the current certificate; and

(3) The AFCR is found to be in compliance with He-P 813 as a result of an inspection performed pursuant to He-P 813.09.

(e) An AFCR shall be granted certification for a period of one year, from the date of expiration, if:

(1) At its previous annual inspection, an AFCR had no deficiencies cited; and

(2) The adult family care provider submitted 60 days prior to the expiration of the current certificate the following in lieu of an onsite inspection:

a. A completed and signed application for certification;

b. Documentation, signed by the oversight agency’s executive director, or his or her designee, that the adult family care provider agency has monitored and will continue to monitor the residence and that the residence remains in full compliance with all applicable rules; and

c. Copies of quality assurance reviews in accordance with He-E 801.

(f) If at the time of the annual inspection is due, the AFCR does not have any residents, the adult family care provider may:

(1) Submit a letter notifying health facilities administration of its intent to close; or

(2) Submit a written request to the health facilities administration for certification renewal without an annual inspection which contains the following information:

a. The name and location of the residence;

b. The certificate number; and

c. The expiration date of the certificate.

(g) A certification issued pursuant to (e) and (f) above shall be granted only once in any 2-year period.

(h) If a certification has been approved in accordance with (f) above, the certificate shall indicate “renewed without inspection.”

(i) An oversight agency shall notify health facilities administration, in writing within 7 days of an individual moving into a residence certified in (e) and (f) above.

(j) An on-site inspection shall be conducted within 90 days of receipt any notification in (i) above.

(k) Any adult family care provider who does not submit a complete application for renewal prior to the expiration of an existing certification shall be required to apply for a new certification in accordance with He-P 813.08.

(l) If the adult family care provider chooses to cease operation of the AFCR, the adult family care provider shall submit written notification to the oversight agency and the department at least 45 days in advance of closure.

History

• #8595, eff 4-1-06; amd by #9899-A, eff 3-29-11, (paras (b)-(l)); amd by #9899-B, eff 3-29-11, (para (a)); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.11 Denial of Certification

(a) The department shall deny an application for certification if:

(1) The applicant, certificate holder, or any person living in the AFCR has:

a. Been found guilty of abuse, neglect, or exploitation of any person, or assault, fraud or a felony against a person in this or any other state by a court of law; or

b. Had a complaint investigation for abuse, neglect, or exploitation substantiated by the department or an administrative agency of any other state and has not received a waiver in accordance with He-P 813;

(2) Any adult family care provider or person living in the AFCR has a felony conviction;

(3) Any individual living in the AFCR has a misdemeanor conviction;

(4) An applicant or family member has an illness or behavior that, as evidenced by the documentation obtained and the observations made by the department, would endanger the well-being of the individuals or impair the ability of the AFCR to comply with department rules;

(5) The applicant or any representative of the applicant:

a. Knowingly provides false or misleading information to the department;

b. Prevents or interferes with any inspection or investigation by the department; and

c. Fails to provide required documents to the department;

(6) An inspection of an applicant for a new certificate finds the applicant to be out of compliance with RSA 151 or He-P 813 or other applicable certification rules;

(7) At an inspection the applicant or certificate holder is not in compliance with RSA 151 or He-P 813 or other applicable certification rules;

(8) The applicant has demonstrated a history or pattern of multiple, or repeat violations of RSA 151 or its implementing administrative rules that pose or have posed a health or safety risk to individuals receiving care in the AFCR;

(9) The applicant has submitted a plan of correction that has been rejected by the department in accordance with He-P 813; or

(10) The applicant failed to fully implement and continue to comply with a plan of correction that has been accepted by the department in accordance with He-P 813.

(b) If the department determines that the AFCR meets any of the criteria for denial listed in He-P 813 the department shall deny the certification of the residence.

(c) Certification shall be denied upon the written notice by the department to the AFCR stating the specific rule(s) with which the residence does not comply.

(d) Any applicant aggrieved by the denial of an application may request an adjudicative proceeding in accordance with He-P 813.

(e) An AFCR shall not admit additional residents if a notice of denial of certificate has been issued.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.12 Certification

(a) Certification shall be valid on the date of issuance and expire the following year on the last day of the same month it was issued.

(b) To be eligible for reimbursement by the department, a non-relative adult family care residence shall be certified in accordance with He-P 813.

(c) All certificates shall be non-transferable from one adult family care provider or oversight agency to another or from one physical location to another.

(d) A certificate issued to an applicant shall indicate:

(1) The effective date of the certificate;

(2) The expiration date of the certificate;

(3) The certificate number;

(4) The type of certificate, which shall be listed as:

a. Temporary; or

b. Annual, which shall encompass both initial and renewal certifications;

(5) The maximum number of certified beds allowed;

(6) The name of the oversight agency; and

(7) Information regarding any waivers issued in accordance with He-P 813.

(e) Temporary certificates shall be valid for 90 days from the date of issuance.

(f) Renewal certificates shall be issued for one year from the expiration date of the previous certificate.

(g) Upon written request, the department shall issue a revised certificate when the local, state or federal government modifies the street address of an AFCR without any change in the physical location of the AFCR.

(h) The request submitted in accordance with (g) above shall contain the following:

(1) The name and address of the adult family care residence as it appears on the current certificate;

(2) The name and address of the adult family care residence as it will appear on the new certificate; and

(3) A copy of the notification of the required change in street address.

(i) When a certificate is revised in accordance with (g) above, the certificate number and expiration date shall not change.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.13 Revocation of Certification

(a) The department shall issue a notice of intent to revoke an AFCR’s certification if the certificate holder or any household member:

(1) Fails to comply with the provisions of He-P 813 above; and

(2) Meets the criteria for denial in He-P 813.11, or for the following:

a. An inspection finds the certificate holder to be out of compliance with RSA 151 or any of the applicable certification rules;

b. The certificate holder has demonstrated a history of multiple, or repeat violations of RSA 151, He-P 813, or other applicable rules that pose or have posed a health or safety risk to residents;

c. The certificate holder has submitted a plan of correction that has been rejected by the department in accordance with He-P 813;

d. The certificate holder has failed to fully implement or continue to comply with a plan of correction that has been accepted by the department in accordance with He-P 813; or

e. Prior denial or revocation of certification or denial of application for certification has taken place.

(b) The notice of intent to revoke the certification of the AFCR shall state the specific rule(s) with which the residence does not comply.

(c) Any certificate holder aggrieved by the revocation of the AFCR’s certificate may request an adjudicative proceeding in accordance with He-P 813.24 and the revocation shall not become final until the period for requesting an adjudicative proceeding has expired or, if the certificate holder requests an adjudicative proceeding, until such time as the administrative appeals unit issues a decision upholding the department’s action.

(d) An AFCR shall not accept additional individuals if a notice of intent to revoke the certification of the AFCR has been issued.

(e) If certificate has been revoked, the certificate holder, in conjunction with the oversight agency, shall transfer all individuals to another appropriately certified AFCR within 10 days of certificate revocation becoming final in accordance with He-P 813.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.14 Immediate Suspension of Certification

Notwithstanding the provision of He-P 813, if the department orders suspension of a certificate in accordance with RSA 541-A:30, III, and the AFCR shall immediately cease operating.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.15 Resident Admission and Person-Centered Plan Development

(a) Prior to admission, adult family care provider shall provide the resident and, if applicable, his or her authorized representative with a written copy of the resident admissions contract pursuant to RSA 161- J:4, which includes the following information:

(1) The basic daily, weekly, and monthly rate paid to the adult family care provider;

(2) A list of the services required by He-P 813 that are covered by the basic rate;

(3) The time period covered by the admissions contract;

(4) The AFCR’s house rules;

(5) The grounds for immediate termination of the agreement, pursuant to RSA 151:26, II(b);

(6) The AFCR’s responsibility for resident discharge planning;

(7) Information regarding services not provided by the AFCR, to include:

a. Contact and other information regarding nursing and other health care services;

b. The AFCR’s responsibility for arranging services;

c. The rate and payment for services;

(8) The AFCR’s policies and procedures regarding:

a. Providing transportation;

b. Arranging for the provision of third party services, such as cable television;

c. Third party services contracted directly by the resident and provided on the AFCR premises;

d. Storage and loss of the resident’s personal property;

e. Filing complaints; and

f. When a residents temporarily leaves the AFCR, the policy for holding a bed open, in compliance with RSA 151:25;

(9) The AFCR’s medication management services;

(10) A copy of the current version of the patients’ bill of rights under RSA 151: 21 and the AFCR’s policies and procedures for implementation of the patient’s bill of rights pursuant to RSA 151:20, II;

(11) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5), and the AFCR ’s policy and procedure for assisting with the appeals process; and

(12) The AFCR’s policy and procedure for handling reports of abuse, neglect, or exploitation.

(b) The adult family care provider and the oversight agency shall develop a person-centered plan, reviewed every 6 months, and revised based on the resident’s needs.

(c) The person-centered plan shall include the following:

(1) A description of the resident’s needs;

(2) The date the need was identified;

(3) The goals or objectives of the plan;

(4) The actions or approaches to be taken;

(5) A statement about whether or not the resident may safely be left alone in the home or community and, if so, the time frame and duration that he or she may be left alone;

(6) The name of the individual responsible for carrying out the plan; and

(7) The date(s) of re-evaluation, review, or resolution for any identified issues.

(d) The person-centered plan shall be a written guide:

(1) Developed by the case manager, the resident and/or his or her representative, the adult family care provider and the oversight agency that outlines the resident’s needs and process for the provision of services which shall address the resident’s:

a. Ability to manage his or her ADL’s;

b. Physical health, including impairments of mobility, sight, hearing and speech;

c. Intellectual functioning and mental health;

d. Need for supervision;

e. Need for medication assistance;

f. Need for family and community involvement; and

g. Need for community and social health services; and

(2) Reviewed and updated whenever there is a change in the resident’s condition and at the time of annual eligibility redetermination.

(e) Monthly progress notes for every resident shall be recorded by the adult family care provider including, at a minimum:

(1) A brief description of the care, including assistance with ADLs, that has been provided;

(2) Observations regarding changes in the resident’s physical, functional and cognitive abilities;

(3) Observations regarding changes in behavior, such as eating habits, sleeping patterns, and relationships; and

(4) The current status of the individual’s goals noted in the current person-centered plan.

(f) The adult family care provider, case manager and oversight agency shall meet or confer quarterly to review the progress notes required in (e) above.

(g) At the time of admission the adult family care provider, with the assistance of the oversight agency, if necessary, shall obtain orders from a licensed practitioner for medications if applicable.

(h) Each resident shall have a health examination not more than 6 months prior to admission and at least one health examination every 12 months.

(i) If a resident refuses care or services, the adult family care provider shall notify the case manager and oversight agency.

(j) The adult family care provider shall maintain an emergency data sheet in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility, which includes:

(1) The resident’s full name and the name the resident prefers to be called by, if different;

(2) The name, address and telephone number of the resident’s next of kin or representative;

(3) The resident’s diagnoses;

(4) The resident’s allergies, if any;

(5) The resident’s functional limitations, if any;

(6) The resident’s date of birth;

(7) The resident’s advanced directives; and

(8) Any other pertinent information not specified in (1)-(7) above.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.16 AFCR Services and Supports

(a) The adult family care provider shall maintain the health and safety of all household members to minimize the possibility of accident or injury when providing the following services and supports:

(1) Food services, as described in He-P 813.17;

(2) Medication services, as described in He-P 813.18;

(3) Housekeeping, laundry, and maintenance services, as described in He-P 813.19;

(4) Sanitation services; pursuant to He-P 813.04(i);

(5) Activities designed to engage the resident to sustain and provider physical, intellectual, and social and spiritual well- being including those described in He-P 813.04(h);

(6) Assistance in arranging appointments, including:

a. Reminding the resident of appointments; and

b. Providing transportation to and from appointments; and

(7) Supervision of residents with cognitive deficits that might pose a risk to themselves or others if the resident is not supervised.

(b) For adult family care providers that provide transportation, the adult family care provider shall maintain current registration and inspection on all vehicles used for the transportation of a resident.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.17 Food Services

(a) The adult family care provider shall:

(1) Meet the nutritional needs of each resident, including special dietary needs associated with any health or medical conditions or religious requirements as specified in the person-centered plan or medical orders;

(2) Offer at least 3 meals in each 24-hour period, with no more than 14 hours between the evening meal and breakfast, excepting snacks that are offered at bedtime, unless contraindicated by the resident’s person-centered plan or medical orders;

(3) Make snacks available between meals and at bedtime if not contraindicated by the resident’s person-centered plan; and

(4) If a resident has a pattern of refusing to follow a prescribed diet:

a. Document the reason for the refusal in the resident’s record; and

b. Notify the resident’s licensed practitioner, case manager and oversight agency.

(b) For the purposes of emergency preparedness, each AFCR shall have a supply of food and water sufficient for all household members and residents, including:

(1) Refrigerated, perishable foods for a 3-day period;

(2) Non-perishable foods for a 7-day period; and

(3) Drinking water for a 3-day period.

(c) The adult family care provider shall maintain:

(1) All food and drinks safe for human consumption and free of spoilage, filth or other contamination including the immediate disposal of outdated food, or canned goods that have damage to their hermetic seals; and

(2) All food preparation and food service areas safe, clean and in sanitary condition including:

a. Ensuring all work surfaces, dishes, utensils and glassware shall be in good repair and cleaned after each use; and

b. When preparing and serving food, adult family care providers shall wash their hands and exposed portions of their arms with liquid soap and running water before preparing or serving food.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.18); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.18 Medication Services

(a) All medications shall be administered in accordance with the orders of the resident’s prescribing licensed practitioner or other licensed professional with prescriptive authority.

(b) Medications and treatments ordered by the licensed practitioner or other licensed professional with prescriptive authority shall be available to give to the resident within 24 hours of being ordered.

(c) The adult family care provider shall have a system in place to:

(1) Obtain any medication ordered for immediate use by the resident;

(2) Re-order medications for use by the resident; and

(3) Receive new medication orders.

(d) For each prescription medication being taken by a resident, the adult family care provider shall have a copy of the signed order in the resident’s record.

(e) All medication orders shall not be older than one year.

(f) Adult family care providers shall not make changes to the label of any residents’ prescription container.

(g) Any licensed practitioner’s order for a change or discontinuation of medications taken by the resident in the AFCR shall be noted by the home adult family care provider, who shall:

(1) Notify the oversight agency and case manager of the change or discontinuation; and

(2) Follow up with the licensed practitioner or other individual authorized by law to ensure the receipt of written documentation of same.

(h) The change in dosage, without a pharmacist changing the prescription label as described in (h) above, shall be allowed for a maximum of 30 days from the date of the new medication order, or 90 days for mail order medications.

(i) At the time of admission and on an annual basis, the adult family care provider shall obtain from a licensed practitioner written approval for the specific over-the counter medications requested by, or on behalf of, the resident.

(j) Adult family care providers shall store all over-the-counter medications in a secure area to restrict access by other residents, household members and children residing in the home.

(k) All over-the-counter medication containers shall be:

(1) Marked by the adult family care provider with the name of the resident using the medication; and

(2) Taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(l) The medication storage area for medications not stored in the resident’s room shall be:

(1) Locked and accessible only to the adult family care provider;

(2) Clean, organized and lit in a fashion to ensure correct identification of each resident's medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(m) Except as allowed by RSA 318:42, all medication at the AFCR shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(n) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic and parenteral products shall not occur.

(o) When a resident is going to be absent from the AFCR at the time medication is scheduled to be taken, the medication container shall be given to the resident or to the person responsible for the resident’s care during the absence.

(p) Upon discharge or transfer, a resident shall be provided with his or her current medication(s).

(q) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry and self-administer without supervision emergency medications such as nitroglycerine, inhalers or EpiPens.

(r) Residents shall receive their medications in the following manner:

(1) Self-administer medication as allowed by (w) below;

(2) Self-administer with supervision as allowed by (x) below; or

(3) Administered by an individual that a nurse has delegated the task of medication administration to.

(s) For residents who self-administer medication, the adult family care provider shall:

(1) Obtain on a bi-annual basis a written order from a licensed practitioner authorizing him or her to self-administer medications without supervision;

(2) Ensure that the resident receives quarterly evaluations by the oversight agency to ensure that he or she maintains the physical and cognitive ability to self-administer;

(3) Assist the resident in storing the medications in their room by locking them up to safeguard against unauthorized access and to maintain them at proper temperatures; and

(4) Maintain a key to access the locked medication storage area in the resident’s room with a copy of the key being given to the home adult family care provider.

(t) If a resident self-administers medication with supervision, adult family care providers shall be permitted to:

(1) Remind the resident to take the correct dose of his or her medication at the correct time;

(2) Place the medication container within reach of the resident;

(3) Remain with the resident to observe him or her taking the appropriate dose and type of medication as ordered by the licensed practitioner;

(4) Record on a resident’s daily medication record that he or she has supervised the resident taking his or her medication; and

(5) Document in the resident’s record any observed or reported side effects, adverse reactions, and refusal to take medications or medications not taken.

(u) If a resident self-administers medication with supervision, home adult family care providers shall not physically handle the medication in any manner.

(v) The licensed practitioner shall allow the resident to self-direct medications if the resident has a physical limitation and wishes to self-direct.

(w) If a resident self-directs the administration of medication, the adult family care provider may, upon the request of the resident, physically assist the resident with his or her medication, including opening the medication container, handing the resident the medication, and closing the container.

(x) If individuals authorized by law administer medications, the medication shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person pursuant to RSA 318 and RSA 326-B.

(y) When administering medication, the adult family care provider or other individual authorized by law shall remain with the resident until the resident has taken all of the medication.

(z) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall comply with RSA 326-B concerning nurse delegation.

(aa) Except for those residents who self-administer prescription and over the counter medications, adult family care providers shall maintain a written record for each medication taken by the resident at the AFCR, containing the following:

(1) The name and strength of the medication;

(2) The dose taken by the resident;

(3) The date and the time the medication was taken;

(4) The signatures, identifiable initials and job titles of the home adult family care providers or adult family care providers who supervise, assist with, or administer the medications;

(5) The reason for any medication refused or omitted;

(6) For medication taken as needed, the reason the resident required the medication and the effect of the medication; and

(7) Any allergies or allergic reactions to medications.

(ab) Adult family care providers shall administer as needed medications in accordance with a PRN protocol that shall contain specific written parameters for medication administration and shall be written and approved by a licensed nurse or prescribing practitioner.

(ac) When a controlled drug is prescribed for a resident, the adult family care provider shall maintain an inventory that includes documentation of a daily count.

(ad) The licensed nurse from the oversight agency shall provide, at a minimum, an initial 4-hour medication supervision education program to adult family care providers who assist residents with self-administration with supervision, self-directed administration, or who administer medication, via nurse delegation which shall cover the administration of both prescription and non-prescription medication.

(ae) On an annual basis, adult family care providers who administer medication via nurse delegation shall complete a minimum of 2 hours of training to review the medication supervision education program referenced in (ad) above.

(af) The medication supervision education program and annual in-service training required by (ad) and (ae) above shall include:

(1) A review of the medications that the resident is currently taking;

(2) Infection control and proper hand washing techniques;

(3) The 6 rights which are:

a. The right resident;

b. The right medication;

c. The right dose;

d. Administered at the right time;

e. Administered via the right route; and

f. The right documentation.

(4) Documentation requirements;

(5) General categories of medications, such as anti-hypertensives and antibiotics;

(6) Desired effects and potential side effects of medications; and

(7) Medication precautions and interactions.

(ag) The adult family care provider shall develop and implement a system for immediately notifying the resident’s prescribing, licensed practitioner and the oversight agency RN within 24 hours of the occurrence of any:

(1) Observed adverse reactions to medication; or

(2) Medication errors such as incorrect medications or omissions.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 803.17); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.19 Physical Environment

(a) Living space and outdoor space shall be arranged and maintained as to provide for the health and safety of all household members.

(b) The adult family care provider shall protect the resident’s right to privacy.

(c) An AFCR shall:

(1) Be maintained in good repair and free of hazard to all household members;

(2) Be free from environmental nuisances, including loud noise and foul odors;

(3) Replace all smoke detector batteries twice per year;

(4) Ensure that all doors, hallways, and stairs are clear and unobstructed;

(5) Ensure that all flammable or combustible materials are stored at least 3 feet from electric heaters, wood, coal, kerosene or pellet stoves, furnaces, boilers, or water heaters;

(6) Ensure that oil furnaces are serviced annually, and that all of furnaces are serviced annually or as recommended or required by the service provider or manufacturer; and

(7) Ensure that, if oxygen is stored in the residence, that all doors entering the home are labeled accordingly. Any oxygen in the AFCR shall be firmly secured to the wall or secured in a stand or rack.

(d) Each resident bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the resident to reach his or her bedroom without passing through the room of another resident;

(3) Not be used as an access way to a common area or another bedroom or for any other purposes;

(4) Be separated from halls, corridors and other rooms by floor to ceiling walls; and

(5) Have at least one operable window with a tightly fitting screen to the outside.

(e) A resident having impaired mobility as determined by his or her licensed practitioner or person-centered plan shall:

(1) Have a bedroom located on the same level as the bathroom facilities; and

(2) Not be assigned a bedroom above or below the ground level of the AFCR;

(f) The certified home adult family care provider shall provide the following for the resident’s use:

(1) A bed appropriate to the needs of the resident, including a mattress, pillow, linens, and blankets;

(2) Clean linens for personal care;

(3) Furniture including, a bureau, mirror, and lamp;

(4) Easily accessible closet or storage space for clothing and personal belongings;

(5) Window blinds or curtains that provide privacy; and

(6) A lockable container for the storage of medications.

(g) The adult family care provider shall permit the use of a resident’s personal possessions, provided they do not pose a risk to the resident or others.

(h) The adult family care provider shall provide at least one living room or a multi-purpose room and a designated dining area.

(i) The resident shall be able to access adult family care providers whenever they assistance is needed.

(j) Ample and adequate lighting shall be available throughout the AFCR to enable residents to navigate safely throughout the AFCR and to participate in activities such as reading, writing, crafts, or using a computer.

(k) At least one operating telephone shall be accessible to the residents at all times for incoming and outgoing calls.

(l) An AFCR shall have:

(1) At least one indoor bathroom, which includes a sink, toilet, and a bathtub or shower for every 6 persons in the household including the resident and all adults living in the AFCR;

(2) A functioning septic or other sewage disposal system; and

(3) A supply of hot and cold running potable water shall be available for human consumption and food preparation at all times, as follows:

a. If drinking water is supplied by a non-public water system, the water shall be tested and found to be in accordance with Env-Dw 702.02 and Env-Dw 704.02 initially and every 6 years thereafter; and

b. If the water is not approved for drinking, an alternative method for providing safe drinking water shall be implemented.

(m) The provider shall maintain the furniture, floors, ceilings, walls, and fixtures shall be clean and in good repair.

(n) The adult family care provider shall maintain:

(1) Linens, clothing and other laundry shall be clean and sanitary;

(2) A supply of clean linens shall be provided as needed to each resident; and

(3) Bathing and toileting facilities for all residents, clean and disinfected as often as necessary to prevent illness or contamination.

(o) The adult family care provider shall distinctly label and legibly mark poisonous compounds, such as cleaning products and solutions and insecticides, to identify the contents and store in a place separate from food, medications and resident supplies.

(p) The adult family care provider shall not use toxic materials in a way that contaminates food, equipment or utensils, or in any way other than in full compliance with the manufacturer’s labeling.

(q) Except where residents have control of the thermostat in their own rooms, equipment providing heat to each the AFCR shall:

(1) Be capable of maintaining temperatures of:

a. At least 65 degrees Fahrenheit at night; and

b. At least 70 degrees Fahrenheit during the day if the resident(s) are present; and

(2) Be maintained in good repair.

(r) When new plumbing is installed, it shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15.

(s) The AFCR shall provide ventilation in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(t) All bathroom, bedroom and closet door latches shall be designed for easy opening from the inside and easy opening of the locked door from the outside in the event of an emergency.

(u) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(v) Any firearms or ammunition kept at the AFCR shall be stored in a locked cabinet when not in use.

(w) Prior to beginning construction or renovations, or modifications to an AFCR, the certificate holder shall notify the health facilities administration of the plans.

(x) A adult family care provider or applicant undergoing construction, renovations, or modifications to an AFCR shall comply with:

(1) The state fire code Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

(2) The state building code as adopted under RSA 155-A:2; and

(3) Local building, zoning and ordinance codes.

(y) At all times, including during any construction at the AFCR, the adult family care provider shall maintain the environment free of hazardous conditions, including but not limited to:

(1) Electrical hazards;

(2) Plumbing hazards;

(3) Exposed insulation;

(4) Tripping hazards, such as throw rugs, cords and construction debris;

(5) Chemical fumes; and

(6) Sawdust or sheetrock dust.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.20); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.20 Safety and Emergency Protocol

(a) If the resident is provided unsupervised time, the adult family care provider shall complete a personal safety assessment to identify a resident's knowledge of and ability to respond to each of the following:

(1) Fire;

(2) Medical emergency;

(3) Unsafe conditions in the home and community;

(4) Abuse and exploitation;

(5) Being lost in one’s community;

(6) Severe weather and other natural disasters; and

(7) Building maintenance problems, such as power outages.

(b) If the personal safety assessment determines that the resident needs assistance to respond appropriately to situations outlined in (a) above, a personal safety plan shall be developed and implemented by the resident, the adult family care provider or caregiver.

(c) A personal safety plan shall:

(1) Identify the supports necessary for a resident to respond to each of the contingencies listed in (a) above;

(2) Indicate who will provide the needed supports;

(3) Describe how the supports will be activated in an emergency;

(4) Indicate approval of the resident, guardian, or representative, the adult family care provider and the oversight agency prior to the resident being left alone; and

(5) Be reviewed every 6 months and revised whenever there is a change in the resident’s ability to respond to the contingencies listed in the plan or the resident moves to a new AFCR.

(d) An emergency and fire safety plan shall be developed and implemented to provide for the safety of residents, adult family care providers and household members.

(e) The plan in (d) above shall:

(1) Address any situation that requires evacuation of the AFCR;

(2) Identify the location of all evacuation routes and exits; and

(3) Provide for and assures the safe evacuation of all persons from the premises.

(f) Each adult family care provider shall comply with all laws and rules designed to protect life and safety in the event of a fire or other emergency.

(g) Prior to providing services, the adult family care provider and oversight agency shall develop a written emergency and fire safety plan that contains the following information:

(1) The name and address of the AFCR;

(2) The responsible oversight agency;

(3) The name of the resident(s) living in the AFCR;

(4) Whether 24-hour supervision is provided;

(5) In the event of an emergency, the name and phone number of agency back-up;

(6) The AFCR’s evacuation plan;

(7) The signature of the adult family care provider; and

(8) A fire safety assessment for each resident in accordance with (k) below.

(h) Each adult family care provider shall annually review and revise, as needed, its emergency and fire safety plan.

(i) Evacuation drills shall be held at varied times of day, and include all residents and all individuals in the home at the time of the drill.

(j) Fire drills shall be conducted at least once per month for the first 4 months after the admission of a new resident, and then every other month thereafter.

(k) At least 2 of the fire drills conducted annually shall be conducted during the night, the first of which shall occur within the first 4 months after the admission of a new resident. Night time fire drills shall be conducted between the hours of 10 p.m. and 6 a.m. EST.

(l) When a new resident moves into the AFCR, the AFCR shall:

(1) Conduct monthly drills until all residents have evacuated the premises in 3 minutes or less for 4 consecutive monthly drills; and

(2) Thereafter conduct drills every other month.

(m) The adult family care provider shall maintain a report of each fire drill conducted, which includes:

(1) The names of the residents, household members, and other individuals involved;

(2) The time, day, month, and year the drill was conducted;

(3) The exits utilized;

(4) The total time required to evacuate the AFCR; and

(5) Any problems encountered and corrective actions taken to rectify problems.

(n) A fire safety assessment to review a resident’s ability to evacuate the building with or without assistance within 3 minutes shall be completed by the adult family care provider within 5 days of the resident’s move into an AFCR.

(o) The fire safety assessment shall:

(1) Be based on an actual evacuation drill conducted at the residence; and

(2) Include the following individual risk factors:

a. Response to alarm;

b. Response to instruction;

c. Vision and hearing;

d. Impaired consciousness;

e. Mobility;

f. Resistance to evacuation;

g. The resident’s ability to independently exit and complete the evacuation from the house;

h. Whether the resident is capable of choosing a backup strategy; and

i. Whether the resident would be able to stay at a designated meeting point.

(p) The fire safety assessment shall indicate the date completed and signature of the person documenting the resident’s risk factors.

(q) For each resident unable to evacuate within 3 minutes, a fire safety plan shall be developed and approved by the resident or representative, case manager, adult family care provider and the oversight agency that identifies:

(1) The cause(s) for such inability;

(2) The specific assistance needed by the resident from the adult family care provider; and

(3) Specific actions that the resident shall take to reduce the evacuation time to 3 minutes or less.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.21); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.21 Resident Records

(a) The adult family care provider shall maintain on site a legible, current, and accurate record for each resident based on services provided at the AFCR.

(b) At a minimum, resident records shall contain the following:

(1) A copy of the admissions contract and all documents required by He-P 813.15;

(2) Identification data, which shall include:

a. Vital information including the resident’s name, date of birth, and marital status;

b. If a resident is present only for respite care as described in He-P 813.24, the resident’s home address and phone number;

c. The resident’s religious preference, if known;

d. The name, address, and telephone number of an emergency contact person;

(3) The names and telephone numbers of the resident’s licensed practitioners;

(4) The names, employers, business addresses, and telephone numbers of individuals contracted by the resident to provide services at the AFCR;

(5) Copies of all executed legal directives, such as durable power of attorney and living will;

(6) A record of the health examination(s) conducted by a licensed practitioner, which includes the information required by He-P 813.18(p) unless the licensed practitioner or resident documents refusal;

(7) Written, dated and signed orders for the following:

a. All medications;

b. Treatments; and

c. Special diets;

(8) All assessments and plans;

(9) Documentation that the resident or representative has participated in the development of the person-centered plan;

(10) All admission and progress notes;

(11) If services are provided at the AFCR by individuals not employed by the AFCR, documentation, which shall include:

a. The name of the agency providing the services;

b. The date services were provided; and

c. The name of the person providing the services;

(12) Documentation of any alteration in the resident’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken, including practitioner notification;

(13) Documentation of specialized care;

(14) Documentation of unusual incidents;

(15) The resident’s or representative’s consent for release of information;

(16) Transfer or discharge planning and referrals;

(17) Notification to the resident or representative of involuntary room change, transfer or discharge;

(18) The medication record, including:

a. The medication name, strength, dose, frequency and route of administration;

b. The date and time the medication was taken;

c. Effects of over the counter medications;

d. Documentation of medication errors or resident refusal to take the medication; and

e. Notice to the resident’s licensed practitioner of any undesirable effects;

(19) Emergency data sheet, which contains the information required by He-P 813;

(20) Documentation of any resident refusal of care or services; and

(21) Documentation of nurse delegation as required by He-P 813.18(y), if applicable.

(c) Resident records shall be available to:

(1) The resident;

(2) The AFCR and oversight agency staff as required by their job responsibilities;

(3) Any individual(s) given written authorization by the resident or representative; and

(4) The department and its agents.

(d) The adult family care provider shall arrange for retention of and access to resident records for 6 years from the date the resident leaves the AFCR or for 4 years from the date the AFCR ceases operation.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.22); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.22 Voluntary Closure of AFCR

When an AFCR no longer intends to operate, an oversight agency shall notify the department in writing of the following:

(a) The name of the AFCR;

(b) The certificate number of the AFCR;

(c) The address of the AFCR;

(d) The date the AFCR closed or will close; and

(e) The location that the resident(s) have moved to, including the name of the home and certificate number of the home, if available.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.23 Complaints and Investigations

(a) The department shall accept and investigate complaints that allege:

(1) A violation of RSA 151 or He-P 813;

(2) That an individual or entity is operating as an AFCR without being certified; or

(3) That an individual or entity is advertising or otherwise representing the AFCR as having or performing services for which it is not certified to provide, pursuant to RSA 151.

(b) When practicable, the complaint shall be in writing containing the following information:

(1) The name and address of the alleged uncertified AFCR;

(2) The name, address and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 813.

(c) The department shall not investigate a complaint unless the commissioner determines that, if the allegations are proven to be true, would constitute a violation of the provisions of RSA 151 or He-P 813.

(d) For a certified AFCR, the department shall:

(1) Provide written notification of the results of the investigation to the adult family care provider along with an inspection report if deficiencies were found as a result of the investigation; and

(2) Notify any other state or local agencies of suspected violations of their statutes or rules based on the results of the investigation.

(e) If the department determines that the complaint is unfounded or does not violate any statutes or rules, the department shall take no further action.

(f) If the investigation results in deficiencies being cited, the adult family care provider shall be required to submit a plan of correction in accordance with He-P 813.09.

(g) The department shall provide written notification to the adult family care provider or the oversight agency that includes:

(1) The date of investigation;

(2) The reasons for the investigation; and

(3) Whether or not the investigation revealed that the services being provided require certification under RSA 151.

(h) In accordance with RSA 151 the adult family care provider or the oversight agency shall be allowed 7 days from the date of the notice required by (g) above to respond to any findings cited by the department.

(i) The department shall accept the response in (f) and (h) above if it includes:

(1) For certified programs, a POC to achieve compliance with RSA 151 and He-P 813 within 30 days; or

(2) For uncertified programs, a complete application for certification.

(j) If the owner of an uncertified home does not provide a response as described in (h) above, the department shall:

(1) Issue a written warning to immediately comply with RSA 151 and He-P 813; and

(2) Provide information stating that the resident has the right to appeal the warning in accordance with RSA 151:7-a, III.

(k) Any person or entity who fails to comply after receiving a warning as described in (j) above shall be subject to an action by the department for injunctive relief under RSA 151:17.

(l) Except for any deficiency reports issued or POC’s received, the name of the complainant and the information contained in the investigation file shall be kept confidential as required by RSA 151:13, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To a law enforcement agency(ies) when relevant to a specific criminal investigation;

(3) To appropriate professional licensing boards, as authorized by RSA 151:13, if the information contained in the complaint file appears contrary to professional practices;

(4) During any adjudicative proceeding that concerns:

a. The issuance of a warning in accordance with RSA 151:7-a;

b. The imposition of an administrative fine in accordance with RSA 151:16-a; or

c. The suspension, denial or revocation of a license under RSA 151:8 and RSA 151:9, I(f);

(5) After the department suspends, denies or revokes a license under RSA 151:7, II; or

(6) When a court of competent jurisdiction orders the department to release such information.

History

• #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.11); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.24 Appeals

(a) An applicant for certification, adult family care provider, AFCR, or oversight agency may request a hearing regarding a denial or revocation of certification;

(b) Within 10 days of the date of the notification of denial or revocation of certification, a request for appeal shall be submitted in writing to the department's administrative appeals unit at:

Administrative Appeals Unit

Department of Health and Human Services

109 Pleasant Street- Main Building

Concord NH 03301

(c) Appeals shall be conducted in accordance with He-C 200.

History

• #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

N.H. Code Admin. R. Ann. He-P 813.25 Waivers

(a) An oversight agency may request a waiver of specific procedures outlined in this rule, in writing, from the department.

(b) A request for waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternative provisions or procedures being proposed;

(4) If the residence is certified, the date of certification;

(5) If it applies to a specific resident, the signature of the resident(s) or legal guardian(s) indicating knowledge of the request; and

(6) Signature of the oversight agency’s executive director or designee approving that a waiver be requested.

(c) A request for waiver shall be submitted to:

Health Facilities Administration

Department of Health and Human Services

129 Pleasant Street- Brown Building

Concord NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(e) A request for waiver shall be granted after the commissioner or his or her designee within 30 days if the alternative proposed by the AFCR meets the objective or intent of the rule and:

(1) Does not negatively impact the health or safety of the resident(s); or

(2) Is administrative in nature, and does not affect the quality of resident care.

(f) The determination on the request for waiver shall be made within 30 days of the receipt of the request.

(g) Upon receipt of approval of a waiver request, the oversight agency’s or AFCR’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

(h) With the exception of waivers granted pursuant to (i) below, and unless otherwise specified, waivers granted by the department shall have no expiration date.

(i) Those waivers which relate to the following shall be effective for the current certification period only:

(1) Fire safety; or

(2) Other issues relative to resident health, safety, or welfare that require periodic reassessment.

(j) All waivers shall end with the closure of an AFCR.

(k) An AFCR applicant, adult family care provider or oversight agency may request a renewal of a waiver from the department. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

• #9899-A, eff 3-29-11 (from He-P 813.10); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
• #12934, eff 12-6-19

Part He-P 814 Community Residences at the Residential Care and Supported Residential Care Level

N.H. Code Admin. R. Ann. He-P 814.01 Purpose

The purpose of these rules is to set forth the licensing requirements for all community residences (CR) at the residential care and supported residential care level licensed pursuant to RSA 151:2, I(e), and thereby ensure, through basic standards, the health and safety of individuals in a community residence receiving shelter, food, training, and protective oversight services.

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.02 Scope

This part shall apply to any person, agency, partnership, corporation, government entity, association, or other legal entity operating a community residence except:

(a) All facilities listed in RSA 151:2, II(a)-(g); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of an individual;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to an individual; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving an individual without his or her informed consent.

(b) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition, which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

1. A motor vehicle incident;

2. A fall;

3. An assault; or

4. Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

1. Cardiopulmonary arrest;

2. Carbon monoxide poisoning;

3. Airway obstruction;

4. Hemorrhage; or

5. Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; and

h. Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by:

a. Significant decline in cognitive functioning and ability;

b. Deterioration in:

1. Personality;

2. Impulse control;

3. Judgment;

4. Modulation of mood; or

5. Awareness of deficits; or

c. Both a. and b. above.

(c) “Activities of daily living (ADL)” means basic daily routine tasks such as:

(1) Walking;

(2) Bathing;

(3) Shaving;

(4) Brushing teeth;

(5) Combing hair;

(6) Dressing;

(7) Food preparation and eating;

(8) Getting into or out of bed;

(9) Laundry;

(10) Cleaning room;

(11) Managing money;

(12) Shopping;

(13) Using public transportation;

(14) Writing letters;

(15) Making telephone calls;

(16) Obtaining and keeping appointments;

(17) Monitoring and supervision of medication;

(18) Recreational and leisure activities; and

(19) Management of incontinence.

(d) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(e) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to an individual for immediate consumption or use by a person authorized by law, including RSA 318-B and RSA 326-B.

(f) “Administrator” means the licensee or person appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

(g) “Admission” means accepted by a licensee for the provision of services to an individual.

(h) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for heath care executed in accordance with RSA 137-J.

(i) “Applicant” means an person, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a CR pursuant to RSA 151:2, I(e).

(j) “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 814, or other federal and state requirements.

(k) “Building rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

(1) Addition;

(2) Modification;

(3) Reconstruction;

(4) Renovation; and

(5) Repair.

(l) “Change of ownership” means a change in the controlling interest of an established CR to a successor business entity.

(m) “Chemical restraint” means any medication prescribed to control an individual’s behavior or emotional state without a supporting diagnosis or for the convenience of personnel.

(n) “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

(o) “Community residence (CR)” means a facility of 4 or more individuals that is both certified by the department under RSA 126-A and licensed by the department under RSA 151, and that is operating in accordance with He-M 1001 or He-M 1002. The term includes “home”.

(p) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(q) “Days” means calendar days unless otherwise specified in the rule.

(r) “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

(s) “Designated Receiving Facility (DRF)” means a facility which receives persons for involuntary admissions under RSA 171-B, designated by the commissioner for one or more purposes, including, but not limited to:

(1) Receiving persons for involuntary admission directly pursuant to a court order; and

(2) Receiving involuntarily admitted persons by transfer with the approval of the commissioner or designee.

(t) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

(1) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(2) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.

(u) “Direct care” means hands-on care or services provided to an individual, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(v) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(w) “Elopement” means when an individual who is cognitively, physically, mentally, emotionally, or chemically impaired, or any combination thereof, wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or contrary to the hours of supervision specified in his or her service agreement, as described in He-M 401 or He-M 503.

(x) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(y) “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

(z) “Exploitation” means the illegal use of an individual’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from an individual through the use of undue influence, harassment, duress, deception, or fraud.

(aa) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the individual’s health care and other personal needs.

(ab) “Household member” means the caregiver, all family members, and any other persons age 17 or older, who is not an individual, as defined in (ad) below, who resides at the licensed premises for more than 30 days.

(ac) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ad) “Individual” means the person who is admitted to the CR for care, services, and training regardless of the length of stay and who is eligible for services due to acquired brain disorder, developmental disability, or mental illness.

(ae) “Individual record” means a separate file maintained for each individual receiving care and services, which includes all documentation required by RSA 151 and He-P 814, and all documentation received relative to the individual as required by other federal and state requirements.

(af) “Infectious waste” means those items specified by Env-Wm 2604.

(ag) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 814 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 814.

(ah) “License” means the document issued to an applicant or licensee which authorizes operation of a CR in accordance with RSA 151 and He-P 814, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number.

(ai) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the CR is licensed.

(aj) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ak) “Licensed premises” means the building(s), or portion thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

(al) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(am) “Licensing classification” means the specific category of services authorized by a license.

(an) “Load-bearing element” means any column, girder, beam, joist, truss, rafter, wall, floor, or roof sheathing that supports any vertical load in addition to its own weight, or any lateral load.

(ao) “Mechanical restraint” means locked, secured, or alarmed CRs or units within an CR, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing an individual from freely exiting the CR or unit within.

(ap) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(aq) “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “a substantial impairment of emotional processes, or of the ability to exercise conscious control of one’s actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by:

(1) Epilepsy;

(2) Mental retardation;

(3) Continuous or noncontinuous periods of intoxication caused by substances such as alcohol or drugs; or

(4) Dependence upon or addiction to any substance such as alcohol or drugs.”

(ar) “Modification” means:

(1) The reconfiguration of any space;

(2) The addition, relocation, or elimination of any door or window;

(3) The addition or elimination of load-bearing elements;

(4) The reconfiguration or extension of any system;

(5) The installation of any additional equipment; and

(6) The term does not include repair or replacement of interior finishes.

(as) “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of an individual.

(at) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(au) “Patient rights” means the privileges and responsibilities possessed by each individual provided by RSA 151:21.

(av) “Personal assistance” means providing or assisting an individual in obtaining one or more of the following services:

(1) Assistance with ADL, such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, or monitoring, supervision, or administration of medication;

(2) Assistance with instrumental activities of daily living such as doing laundry, food preparation, obtaining appointments, or engaging in recreational or leisure activities;

(3) Supportive services such as recreational and leisure activities, transportation, social services, medical, dental, and other health care services, habilitation or rehabilitative services, day care, or other services required to meet an individual’s needs; or

(4) Monitoring an individual’s activities to provide for the individual’s and others’ safety and well-being including, general supervision or oversight of the physical and mental well-being of an individual who needs assistance to maintain his or her participation in the facility or who needs assistance to manage his or her personal or financial affairs, regardless of whether a guardian has been appointed for the individual.

(aw) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the individual for a specific, limited purpose or for the general purpose of assisting an individual in the exercise of any rights.

(ax) “Personnel” means a person who is employed by the facility, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to individuals.

(ay) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the individual’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

(az) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(ba) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(bb) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bc) “Protective care” means the provision of individual monitoring services, including but not limited to:

(1) Knowledge of individual whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(bd) “Reconstruction” means the reconfiguration of a space:

(1) That affects an exit or a corridor shared by more than one occupant space; or

(2) Such that the building rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(be) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

(bf) “Repair” means the patching, restoration, or painting of materials, elements, equipment or fixtures for the purpose of maintaining such materials, elements, equipment or fixtures in good or sound condition.

(bg) “Reportable incident” means an occurrence of any of the following while the individual is either in the CR or in the care of CR personnel:

(1) The unanticipated death of the individual;

(2) An injury to an individual that is potentially due to abuse or neglect; or

(3) The elopement or unexplained absence of an individual from the CR.

(bh) “Residential board and care occupancy”, as defined in National Fire Protection Association (NFPA) 101 of the fire code, means an occupancy used for lodging and boarding of 4 or more individuals not related by blood or marriage to the owners or operators for the purpose of providing personal care services.

(bi) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist an individual.

(bj) “Supervision” means the process by which the individual is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

(bk) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

(bl) “Written and signed orders” means a document, produced electronically or via paper, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.04 Certification Required

In order to be licensed under He-P 814, a community residence shall also be certified under He-M 1001 or He-M 1002.

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.05 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers affirming and certifying the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”

b. For any CR to be newly licensed on or after July 1, 2016:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any CR to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) A floor plan of the prospective CR;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” if a sole proprietorship or if otherwise applicable;

(4) A resume identifying the name and qualifications of the CR administrator;

(5) Copies of applicable licenses, certificates, or both for the CR administrator;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with Saf-C 6000, the state fire code, including, at a minimum, the residential board and care chapter of National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(7) If the CR uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

(8) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and all household members.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.06 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 814.05(a) have been received.

(b) If an application does not contain all of the items required by He-P 814.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 814.14(b) if it determines that the applicant, licensee, administrator, or household member:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of individuals.

(d) Following a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 814.

(e) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(f) If the applicant does not provide the items required by the written notice in (b) above within 90 days, the application will be closed and a new application will be required.

History

• #5515, eff 11-25-92, EXPIRED: 11-25-98
• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.07 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 814.05(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The materials required by He-P 814.05(a)(1);

(2) The current license number;

(3) A request for renewal of any existing non-permanent waiver(s) previously granted by the department, in accordance with He-P 814.11(f), if applicable;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 814.18(e), He-M 506, He-M 1001, or He-M 1002; and

(5) A statement identifying any variances applied for or granted by the state fire marshal.

(d) In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(e) Following an inspection as described in He-P 814.10, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) and (d) above as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 814 at the renewal inspection.

(f) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 814.05 and shall be subject to a fine in accordance with He-P 814.14(c)(6).

(g) Prior to issuing a renewal license the department shall review any of the information submitted in accordance with He-P 814.05(b) above and shall deny a license renewal in accordance with He-P 814.06(c).

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.08 CR New Construction and Existing Building Rehabilitation

(a) For new construction and for building rehabilitation of an existing building, including, but not limited to, certain repairs, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 814 shall and notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

(g) The CR shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or building rehabilitation.

(h) A licensee or applicant undertaking construction or building rehabilitation of a building shall comply with the following:

(1) The state fire code, Saf-C-6000, including, but not limited to, at a minimum, for 4 residents or more, the residential board and care occupancy chapter of NFPA 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control; and

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

(i) All CRs newly constructed or rehabilitated after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as applicable, as available as noted in Appendix A.

(j) Where building rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as available as noted in Appendix A.

(k) Per the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as available as noted in Appendix A, and notwithstanding (j) above, where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

(l) The department’s bureau of health facilities administration shall be the authority having jurisdiction for the requirements in (i)-(k) above and shall negotiate compliance and grant waivers in accordance with He-P 814.11 as appropriate.

(m) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

(n) Waivers granted by the department for construction or building rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(o) Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

(p) The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 814.10 prior to its use.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.09 CR Requirements for Organizational Changes

(a) The CR shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) Capacity.

(b) The CR shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in the number of individuals beyond what is authorized under the current license.

(c) When there is a change in address without a change in location, the CR shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the CR shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

(2) The physical location;

(3) An increase in the number of beds;

(4) A change in licensing classification; or

(5) A change in the life safety code occupancy chapter.

(f) A new license shall be issued for a change in ownership or a change in physical location.

(g) A revised license and license certificate shall be issued for changes in the CR name.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in the number of individuals from what is authorized under the current license;

(3) A change in address without a change in physical location; or

(4) When a waiver has been granted.

(i) The CR shall notify the department in writing no later than 5 days prior to a change in administrator as soon as practicable in the event of a death or other extenuating circumstances and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) Copies of applicable licenses, certificates, or both, for the new administrator; and

(3) The results of a criminal records check from the NH department of safety for the new administrator.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 814.18(l) and either He-M 1001 or He-M 1002.

(k) If the department determines that the new administrator does not meet the qualifications as specified in (j) above, it shall so notify the CR in writing so that a waiver can be sought or the CR can search for a qualified candidate.

(l) The CR shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(m) A restructuring of an established CR that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) Licenses issuedfor a change in ownership shall expire on the date the license issued to the previous owner would have expired.

(o) If a licensee chooses to cease the operation of the CR, the licensee shall submit written notification to the department at least 30 days in advance, which shall include a written closure plan that ensures adequate care of individuals until they are transferred or discharged to an appropriate alternate setting.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.10 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 814, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the CR; and

(3) Any records required by RSA 151 and He-P 814.

(b) The department shall conduct a life safety inspection, and a clinical inspection, as appropriate, to determine full compliance with RSA 151 and He-P 814 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed under He-P 814.09(e)(1);

(3) A change in the physical location of the CR;

(4) An increase in the number of beds beyond what is currently authorized;

(5) Occupation of space after construction, modifications, or structural alterations; or

(6) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings for clinical inspections or notice to correct for life safety inspections shall be issued when, as a result of an inspection, the department determines that the CR is in violation of any of the provisions of He-P 814, RSA 151, or any applicable state law, administrative rule, or code.

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a written POC, in accordance with He-P 814.13(c), within 21 days of the date on the letter that transmits the inspection report.

(f) A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 814.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.11 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 814 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary and how a waiver is justified; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and individuals as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

(1) Meet the objective or intent of the rule;

(2) Do not negatively impact public health or the health or safety of the individuals; and

(3) Do not affect the quality of individual services.

(d) The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.12 Complaints

(a) The department shall investigate complaints that allege:

(1) A violation of RSA 151, He-P 814, or rules adopted under RSA 126-A:20;

(2) That a person or entity is operating as a CR without being licensed; or

(3) That an person or entity is advertising or otherwise representing the CR as having or performing services for which it is not licensed to provide, pursuant to RSA 151:2, III.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the CR, or the alleged unlicensed person or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151, He-P 814, or rules adopted under RSA 126-A:20.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant and have probative value; and

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

(d) For the licensed CR, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 814.13(c) if the inspection results in areas of non-compliance being cited.

(e) For the unlicensed person or entity, the department shall:

(1) Provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

(2) Require the owner or person responsible to submit a completed application for a license in accordance with RSA 151:7-a, II, within 7 days from the date of the notice required by (1) above; and

(3) Issue a written warning to immediately comply with RSA 151 and He-P 814 if the owner of an unlicensed facility does not comply with (2) above.

(f) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine as described in He-P 814.14(c)(1).

(g) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any administrative or judicial proceedings relative to the licensee.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.13 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 814, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a license; or

(4) Monitoring of a licensee in accordance with (l) below.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate place on the notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position/job title of the personnel responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of an individual will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 814;

b. Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 814 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

2. The department determines that the health, safety or well being of an individual will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 814.14(c)(12) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the individuals and employees;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such later date as is applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has been found not to have been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 814.14(b); or

(3) Revoke the license in accordance with He-P 814.14(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) Any violations cited for fire code may be appealed to the New Hampshire state fire marshal, pursuant to RSA 151:6-a, II.

(i) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(j) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (i) above has been provided to the applicant or licensee.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, initiated action to suspend or revoke a license, or denied an application for a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of individuals; or

(2) The presence of conditions in the facility that negatively impact the health, safety, or well-being of individuals.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.14 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated RSA 151 or He-P 814 in a manner which poses a risk of harm to an individual’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 814.05;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents. interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 814.13(c), (d), and (e);

(7) The licensee is cited a third time under RSA 151 or He-P 814 for the same violations within the last 5 inspections;

(8) A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

(9) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 814;

(10) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been convicted of or adjudicated for a sexual assault or other violent crime, theft or fraud, or a finding of abuse, neglect or exploitation in this or any other state, or poses a threat to the health, safety, or well-being of an individual;

(11) The applicant or licensee fails to employ a qualified administrator; or

(12) The applicant has had a license revoked by another division or unit of the department within a 5 year period of the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed person or entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed person or entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 814.15(g), the fine for an applicant, licensee, or unlicensed person or entity shall be $500.00;

(4) For a failure to transfer an individual whose needs exceed the services or programs provided by the CR after being directed by the department to transfer the individual, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 814.12(f), the fine shall be $500.00;

(6) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 814.07(b), the fine shall be $100.00;

(7) For a failure to notify the department prior to a change of ownership, in violation of He-P 814.09(a)(1), the fine shall be $500.00;

(8) For a failure to notify the department prior to a change in the physical location, in violation of He-P 814.09(a)(2), the fine shall be $1000.00;

(9) For a failure to notify the department of a change in e-mail address, in violation of He-P 814.09(m), the fine shall be $100.00;

(10) For a refusal to allow access by the department to the CR’s premises, programs, services, or records, in violation of He-P 814.10(a), the fine for an applicant, person, or licensee shall be $2000.00;

(11) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 814.13(c)(2) and (5), the fine for a licensee shall be $500.00;

(12) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 814.13(c)(8), the fine for a licensee shall be $1000.00;

(13) For a failure to establish, implement, or comply with licensee policies, as required by He-P 814.15(d), the fine for a licensee shall be $500.00;

(14) For a failure to provide services or programs required by the licensing classification and specified by He-P 814.15(c), the fine for a licensee shall be $500.00;

(15) For exceeding the maximum number of occupants, in violation of He-P 814.15(k), the fine for a licensee shall be $500.00;

(16) For providing false or misleading information or documentation, in violation of He-P 814.15(f), the fine shall be $1000.00 per offense;

(17) For a failure to meet the needs of an individual, in violation of He-P 814.15(i)(1), the fine for a licensee shall be $1000.00 per individual;

(18) For placing an individual in a room that, based on the floor plan required by He-P 814.05(a)(2), has not been approved or licensed by the department, the fine for a licensee shall be $500.00;

(19) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 814.11, in violation of He-P 814.15(i)(4) and (5), the fine for a licensee shall be $500.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 814.08(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, the fine shall be $500.00, which shall be assessed daily;

(22) When an inspection determines that a violation of RSA 151 or He-P 814 has the potential to jeopardize the health, safety, or well-being of an individual, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

(23) Each day that the person or licensee continues to be in violation of the provisions of RSA 151 or He-P 814 shall constitute a separate violation and shall be fined in accordance with He-P 814.14(c); and

(24) If the applicant or licensee is making good faith efforts to comply with (4), (5) or (19) above, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of individuals is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 814 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a CR’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the CR, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years.

(k) The 5 year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 814.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

(n) RSA 541-A shall govern further appeals of department decisions under this section.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 814.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRES: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.15 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and rules promulgated thereunder.

(b) In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of individuals receiving services at the CR, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21, “Patients’ Bill of Rights” are upheld.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the CR, which shall include at a minimum, the required services listed in He-P 814.16.

(d) The licensee shall develop and implement written polices and procedures governing the operation and all services provided by the CR and for:

(1) Reviewing the policies and procedures annually;

(2) Revising them as needed; and

(3) Implementing a written policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(e) The licensee shall assess and monitor the quality of care and service provided to individuals on an ongoing basis.

(f) The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

(g) The licensee shall not:

(1) Advertise or otherwise represent the program as operating a CR, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) Licensees shall:

(1) Meet the needs of the individuals during those hours that the individuals are in the care of the CR;

(2) Initiate action to maintain the CR in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the CR;

(4) Appoint a qualified administrator;

(5) Verify the qualifications of all personnel, in accordance with He-M 1001 or 1002;

(6) Provide sufficient numbers of personnel who are present in the CR and are qualified to meet the needs of individuals during all hours of operation;

(7) Provide the CR with sufficient supplies, equipment, and lighting to meet the needs of the individuals; and

(8) Implement any POC that has been accepted or issued by the department.

(j) The licensee shall consider all individuals to be competent and capable of making health care decisions unless the individual:

(1) Has a guardian appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated.

(k) The licensee shall not exceed the number of occupants as authorized by NFPA 101 as adopted by the commissioner of the department of safety under RSA 153 as Saf-C 6000, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the license certificate issued by the department.

(l) The licensee shall not admit an individual whose needs exceed the program and services offered by the CR.

(m) If the licensee accepts an individual who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the individuals, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(n) The licensee shall report all positive tuberculosis test results for employees to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(o) Any licensee who admits or who has an individual with a diagnosis of dementia, Alzheimer’s disease, or a primary or secondary diagnosis of mental illness shall:

(1) Require all direct care personnel caring for the individual to be trained in the special care needs of individuals with dementia, Alzheimer's disease, or mental illness; and

(2) Provide a physical environment that has a safety and security system that prevents an individual from leaving the premises without the knowledge of personnel, if the individual:

a. Has eloped from the CR in the last 60 days; or

b. Is a danger to self or to others.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 814.12(d), for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to “Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301” or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

(q) For reportable incidents, the licensee shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 271-4968 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

a. The CR name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or employees involved in, witnessing, or responding to the reportable incident;

d. The name of individual(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. When the individual’s guardian or agent, if any, or personal representative was notified;

i. The signature of the person reporting the reportable incident;

j. The date and time the individual’s licensed practitioner was notified, if applicable; and

k. The date the facility performed the investigation required by (1) above;

(3) As soon as practicable, notify the guardian, agent, or personal representative, if any;

(4) As soon as practicable, notify the local police department, the department, and the guardian, agent, or personal representative, if any, when an individual has an elopement or unexplained absence and the licensee has searched the building and the grounds of the CR without finding the individual; and

(5) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(r) The licensee shall admit and allow any department representative to inspect the CR and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 814 as authorized by RSA 151:6 and RSA 151:6-a.

(s) Applicants, licensees, and employees shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 814, including allowing representatives of the department to:

(1) Enter and complete an inspection of the premises;

(2) Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

(3) Interview employees and individuals of the CR.

(t) A licensee shall, upon request, provide an individual or the individual’s guardian or agent, if any, with a copy of his or her individual record pursuant to the provisions of RSA 151:21, X.

(u) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(v) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of individuals and employees that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to individuals and employees; and

(3) Systems to prevent tampering with information pertaining to individuals and employees.

(w) The licensee shall develop policies and procedures regarding the release of information contained in individual records.

(x) The licensee shall provide cleaning and maintenance services, as needed, to protect individuals, employees, and the public.

(y) The CR shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(z) If the CR is not on a municipal water system, the water used in the CR shall be potable and suitable for human consumption.

(aa) The licensee shall determine whether smoking will be allowed at the CR.

(ab) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking-permitted areas in accordance with RSA 155:68 and RSA 155:69 and He-P 1900, as applicable.

(ac) If the licensee holds or manages an individual’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other individuals, or other household members.

(ad) At the time of admission the licensee shall give an individual and the individual’s guardian, agent, or personal representative, if applicable, a listing of all CR charges and identify what care and services are included in the charge.

(ae) The licensee shall give an individual a 30-day written notice before any increase is imposed in the cost or fees for any CR services.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.16 Required Facility and Individual Services

Each CR shall provide, at a minimum, services and programs for the individuals they provide services to in accordance with He-M 1001 or He-M 1002.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.17 Medication Services

(a) Each CR shall provide medication services in accordance with He-M 1201 or He-M 1202.

(b) The therapeutic use of cannabis by individuals who are qualifying patients possessing a registry identification card shall be permitted at a CR provided:

(1) The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or

(2) The facility permits an individual to possess and use cannabis at the licensed premises, the individual is able to self-administer medication without assistance, and the cannabis remains in the possession of the individual.

(c) A CR that permits the therapeutic use of cannabis in accordance with (b) above shall develop, maintain, and implement a general policy relative to individual use of cannabis at the licensed premises, including storage, security, and administration.

(d) A CR that designates itself as a facility caregiver according to (b)(1) above shall:

(1) Have an individual-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the individual; and

(2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying patients with the therapeutic use of cannabis.

(e) A CR shall not permit the smoking of cannabis if smoking is not allowed on the CR premises.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.18 Personnel

(a) CRs operating under He-M 1001 shall provide personnel in accordance with He-M 506 staff qualifications and staff development requirements for developmental services agencies.

(b) Prior to delivering services to an individual, personnel in all CRs shall have received training in the following areas:

(1) Rights as set forth in He-M 309 or He-M 310;

(2) The specific health-related requirements of each individual, including:

a. All current medical conditions, medical history, and routine and emergency protocols; and

b. Any special nutrition, dietary, hydration, elimination, or ambulation needs;

(3) Any specific communication needs of individuals served;

(4) Any behavioral supports required of individuals served; and

(5) Any assistance individuals need to evacuate the residence in the case of emergency.

(c) Documentation of the training in (b) above shall be maintained in personnel records.

(d) Unless a waiver is granted in accordance with (e) below, the licensee shall not offer employment, allow to be a volunteer, contract with an independent contractor who will provide direct care or personal care services to individuals or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, or allow a household member to continue to reside in the residence if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of individuals.

(e) The department shall grant a waiver of (d) above if, after reviewing the underlying circumstances, it determines that the person does not pose a current threat to the health, safety, or well-being of individuals.

(f) If the information identified in (d) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

(2) Request a waiver of (d) above.

(g) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the residence if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of an individual; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of an individual.

(h) The licensee shall check the names of the persons in (d) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, and, if appropriate, the NH board of nursing registry maintained pursuant RSA 326-B:26 and 42 CFR 483.156, prior to employing, contracting with, or engaging them, or prior to allowing or continuting to allow a household member to reside at the residence.

(i) The licensee shall not employ, contract with, engage, or allow to reside in the residence any person in (d) above who is listed on the BEAS state registry or the NH board of nursing, nursing assistant registry, unless a waiver is granted by BEAS or the NH board of nursing, respectively.

(j) In lieu of (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual to provide direct care or personal care services a signed statement that the agency’s employees have complied with (h) above and do not meet the criteria in (d) and (i) above.

(k) All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made, and then annually thereafter, stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a resident; and

(3) Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(l) All administrators appointed after the 2017 effective date of these rules shall be at least 21 years of age and have one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and one year of experience working in a health care facility;

(2) A New Hampshire license as an RN and at least 6 months of experience working in a health care facility;

(3) An associate’s degree from an accredited institution and at least 2 years of experience working in a health care facility; or

(4) A New Hampshire license as an LPN and at least one year of experience working in a health care facility.

(m) All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the CR each annual licensing period.

(n) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V and as required by He-P 309.02 and He-P 309.08; and

(2) The facility shall have a plan that identifies and documents, with dates, all individuals and employees that have received or declined to receive immunizations.

(o) Employees shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(p) The CR shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(q) The policy in (p) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.19 Quality Improvement

Each CR shall provide quality improvement in accordance with He-M 1001 or He-M 1002.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRES: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.20 Infection Control

(a) The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of individuals with infectious or contagious diseases or illnesses who can safely participate in the program;

(4) The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 904; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control program shall address at a minimum the:

(1) Cause of infection;

(2) Effect of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) If the CR has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(e) Personnel infected with a disease or illness transmissible through food, saliva, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

(f) Personnel infected with scabies or lice shall not provide direct care to individuals or work in food services until such time as they are no longer infected.

(g) Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(h) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight-fitting bandage.

(i) In accordance with RSA 151:9-b, the licensee shall:

(1) Arrange for or provide all consenting individuals an immunization for influenza and pneumococcal disease;

(2) Arrange for or provide all consenting employees an immunization for influenza; and

(3) Report immunization data to the department’s immunization program as required by He-P 309.02 and He-P 309.08.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.21 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment throughout the CR licensed premises.

(b) All furniture, floor, ceiling, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the individuals.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All individuals’ bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, program supplies, and other cleaning materials.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only professionals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make in inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

(l) Trash receptacles in food service area shall be covered at all time.

(m) If the CR provides laundry services, the following requirements shall be met:

(1) The laundry room shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas and shall not be mixed with soiled supplies.

(p) Any CR that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services, shall notify the NH department of health and human services upon receipt of notice of a failed water test.

(q) Waste water shall be disposed of through a system that meets the requirements of the NH department of environmental services. Sink drains not connected to the sanitary sewer or septic system and similar methods of disposal above ground shall be strictly prohibited.

(r) Tightly fitting screens shall be provided for all doors, windows, or other outside openings, which are kept open during the season when flies, mosquitoes, and other insects are prevalent. Reasonable precautions such as repair of holes and caulking of pipe channels shall be taken to prevent the entrance of rodents and vermin.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.22 Physical Environment

(a) The licensed premises shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of individuals and employees, including reasonable accommodations for individuals and employees with mobility limitations.

(b) The CR shall comply with all state and local codes and ordinances for:

(1) Zoning;

(2) Building;

(3) Health;

(4) Fire;

(5) Waste disposal; and

(6) Water.

(c) The CR shall be accessible at all times of the year.

(d) The CR shall have a telephone accessible at all times in case of emergency.

(e) Doors and windows opening to the outside air shall be tight fitting.

(f) The CR shall be free from environmental nuisances such as noise and odors.

(g) Equipment providing heat within a CR including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit during the day if individual(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(h) Electric heating systems shall be exempt from (g)(2) above.

(i) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in personnel areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(j) Unvented fuel-fired heaters shall not be used in any CR.

(k) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

(l) Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

(m) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in He-P 814.21(r).

(n) Lighting shall be available to allow individuals to partake in activities such as reading, needlework, or handicrafts.

(o) The CR shall have dining facilities to accommodate each individual.

(p) All CRs shall have at least one toilet and one hand sink and as many additional toilets and sinks as are necessary to meet the needs of the individuals in the home, as follows:

(1) At a minimum there shall be one sink, toilet, and tub or shower for every 6 individuals, and there shall be as many additional showers or bathing facilities as are necessary to meet the needs of the individuals in the home; and

(2) Separate bathroom facilities for family members and employees shall not be counted in the 1:6 ratio as set forth in (1) above.

(q) Each bathroom shall be equipped with:

(1) Soap dispensers;

(2) Paper towels or a hand-drying device providing heated air; and

(3) Hot and cold running water.

(r) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(s) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(t) There shall be sufficient space and equipment for the services provided at the CR, as follows:

(1) Furniture to allow for each individual to sit comfortably as necessary throughout the day;

(2) Tables and chairs to assure that each individual has a seat at a table for each meal or snack and for doing activities such as crafts or puzzles; and

(3) Supplies such as plates, cups, glasses, silverware, liquid soap for hand washing, toilet tissue, and paper towels in a supply to accommodate the number of individuals authorized by the license.

(u) There shall be at least 80 square feet per one bedroom and 140 square feet per room with 2 beds exclusive of space required for closets, wardrobe, dressers, and toilet room.

(v) No individual’s room shall accommodate more than 2 individuals.

(w) Each individual shall have:

(1) A bed appropriate to the needs of the individual;

(2) A firm mattress with cover;

(3) A pillow, linens, and blankets;

(4) Personal hygiene and grooming equipment such as a comb, toothbrush, and razor;

(5) A bureau with mirror;

(6) A bedside table;

(7) A lamp; and

(8) An upholstered chair.

(x) The individual or guardian may indicate and the home shall document that the individual does not wish or need to have one or more of the items in (w) above and the reason for the removal.

(w) The individual may provide items listed in (w) from his or her own personal possessions provided that they are clean and in good repair.

(z) Each individual room door shall be of the side hinge type. Folding doors or curtains shall be prohibited.

(aa) Each individual room shall contain a closet or storage space for the individual’s personal belongings.

(ab) Each individual room shall have its own separate entry to permit the individual to reach his or her room without passing through the room of another person.

(ac) Individuals shall have a living or multi-purpose room for their use which has a capacity of meeting the needs of the individuals. Such rooms shall be provided with reading lamps, chairs, tables, and couches, which shall be comfortable and in good repair.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.23 Fire Safety

(a) All CRs shall meet the requirements of the appropriate chapter of NFPA 101 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and any pertinent chapter and related codes regarding the installation, testing, and maintenance of the fire alarm system.

(b) All CRs shall have, at a minimum:

(1) One of the following:

a. Approved smoke alarms installed inside every sleeping room, outside every sleeping area in the immediate vicinity of the bedrooms, and on all levels, including basements, that are interconnected and powered by the CR’s electrical service; or

b. A wireless fire alarm system approved by the NH fire marshal;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building with a maximum travel distance to each extinguisher not to exceed 50 feet and maintained as follows:

a. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

b. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

c. Annual maintenance shall be performed on each extinguisher by trained personnel, and a tag or label shall be securely attached that indicates that maintenance was performed; and

d. The components of the electronic monitoring device or system in a. above, if used, shall be tested and maintained annually in accordance with the manufacturers listed maintenance manual; and

(3) A carbon monoxide monitor on every level.

(c) An emergency and fire safety program shall be developed and implemented to provide for the safety of individuals and personnel.

(d) Immediately following any fire or emergency situation, licensees shall notify the department by phone and in writing within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) EMS transport related to known pre-existing conditions.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injuries to individuals or employees or damage sustained by the CR;

(3) A description of events preceding and following the incident;

(4) The name of any employees or individuals who were evacuated as a result of the incident, if applicable;

(5) The name of any employees or individuals who required medical treatment as a result of the incident, if applicable; and

(6) The name of the person the licensee wishes the department to contact if additional information is required.

(f) For the use and storage of oxygen and other related gases, CRs shall comply with NFPA 99 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft (6.1 m);

2. A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

c. Be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

(5) Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

(g) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(h) Pursuant to RSA 155:68 and 69, if the licensee has chosen to allow smoking, a designated smoking-permitted area shall be provided which has, at a minimum:

(1) A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Walls and furnishings constructed of non-combustible materials; and

(3) Metal waste receptacles and safe ashtrays.

(i) Each licensee shall develop a written fire safety plan.

(j) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the individual, or the individual’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the individual’s responsibilities shall be provided to the individual. Each individual shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(k) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(l) For buildings constructed to the Residential Board and Care Chapter of the NFPA 101, the following shall be required:

(1) The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

(2) Individuals shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

(3) All CR facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when individuals are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

(4) The drills shall involve the actual evacuation of all individuals to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide individuals with experience in egressing through all exits and means of escape;

(5) Facilities shall complete a written record of fire drills that includes the following:

a. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

b. The location of exits used;

c. The number of people, including individuals, personnel, and visitors, participating at the time of the drill;

d. The amount of time taken to completely evacuate the facility;

e. The name and title of the person conducting the drill;

f. A list of problems and issues encountered during the drill;

g. A list of improvements and resolution to the issues encountered during the fire drill; and

h. The names of all staff members participating in the drill;

(6) At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

(7) At least annually, the facility shall conduct a resident Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the individuals needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, individuals ability to evacuate on their own and choose an alternate exit; and

(8) The fire drills for facilities built to the Residential Board and Care chapter of the NFPA 101, shall be permitted to be announced, in advance, to the individuals just prior to the drill.

(m) Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

(n) All personnel shall participate in at least one drill quarterly.

(o) For personnel who are unable to participate in the scheduled drill described in (n) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

(p) Personnel who are unable to participate in a drill in accordance with (n) and (o) above shall participate in a drill within the next quarter.

(q) Per-diem or temporary personnel shall not be the only person on duty unless they have:

(1) Participated in at least 2 actual fire drills in the facility in the past year; and

(2) Participated in the facility’s orientation program pursuant to He-M 1001 or He-M 1002.

History

• #9288, eff 10-3-08, EXPIRED: 10-3-16
• #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17
• #12374, eff 9-1-17

N.H. Code Admin. R. Ann. He-P 814.24 Emergency Preparedness

(a) Each facility shall have group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(b) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(c) The plan in (b) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, missing individuals and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

(12) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(14) Include the management of individuals, particularly with respect to physical and clinical issues to include:

a. Relocation of individuals with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(d) The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not involved in the exercise;

(2) Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

(e) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of individuals and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Potable water for a 3-day period.

(f) Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (e) above. The plan shall include the following:

(1) Assumptions for calculations of food and water supplies including maximum number of staff and individuals, water source of supply (tap or commercial) and expiration (months), tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

(2) Storage location(s); and

(3) Back-up supplies.

History

• #12374, eff 9-1-17

Part He-P 815 Intermediate Care Facilities for Individuals with Intellectual Disabilities (icf/Iid)

N.H. Code Admin. R. Ann. He-P 815.01 Purpose

The purpose of this part is to set forth the licensing requirements for all intermediate care facilities for individuals with intellectual disabilities(ICF/IID) licensed pursuant to RSA 151:2, I(e), and thereby ensure, through basic standards, the health and safety of residents in an ICF/IID that provides comprehensive and individualized health care and rehabilitation services to residents to promote their functional status and independence including shelter, food, training, and protective oversight services.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.02 Scope

This part shall apply to any person, agency, partnership, corporation, government entity, association, or other legal entity operating an ICF/IID except:

(a) All facilities listed in RSA 151:2, II (a)-(h); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a resident;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to an resident; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a resident without his or her consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a resident for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(f) “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(g) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

(h) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies.

(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA-J:35-37.

(j) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ICF/IID pursuant to RSA 151:2, I(e).

(k) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 815, or other federal or state requirements.

(l) “Assessment” means an evaluation of the resident to determine the care and services that are needed.

(m) “Care plan” means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if applicable, as a result of the assessment process for the provision of care and services to a resident.

(n) “Certified intermediate care facility” means an intermediate care facility that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 815.

(o) “Change of ownership” means the transfer of the controlling interest of an established ICF/IID to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(p) “Chemical restraint” means a drug or medication that is used as a restriction to manage the residents behavior or restrict the resident’s freedom of movement and is not a standard treatment or dosage for the resident’s condition.

(q) “Clinical Laboratory Improvement Amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(r) “Commissioner” means the commissioner of the New Hampshire department of health and human services or the commissioner’s designee.

(s) “Contracted employee” means a temporary employee working under the direct supervision of the ICF/IID but employed by an outside agency.

(t) “Core services” means those minimal services to be provided to any resident that must be included in the basic rate.

(u) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(v) “Days” means calendar days unless otherwise specified in the rule.

(w) “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

(x) “Direct care” means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(y) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(z) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(aa) “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

(ab) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).

(ac) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

(ad) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(ae) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(af) “Employee” means anyone employed by the ICF/IID and for whom the ICF/IID has direct supervisory authority.

(ag) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to the non-compliance of RSA 151 or He-P 815.

(ah) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(ai) “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from an resident through the use of undue influence, harassment, duress, deception, or fraud.

(aj) “Facility” means “facility” as defined in RSA 151:19, II.

(ak) “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(al) “Guardian” means a parent of a minor or a person appointed in accordance with RSA 464-A or RSA 463 to make informed decisions relative to the resident’s health care and other personal needs.

(am) “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical, or mental disability, or because of security measures not under the occupant’s control.

(an) “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days.

(ao) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ap) “Infectious waste” means those items specified by Env-Sw 103.28.

(aq) “Informed consent” means the decision by a parent, a resident, guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the parent, resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(ar) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(as) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 815 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 815.

(at) “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease.

(au) “License” means the document issued by the department to an applicant or licensee of an ICF/IID which authorizes operations in accordance with RSA 151 and He-P 815, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

(av) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds that the ICF/IID is licensed for.

(aw) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse;

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ax) “Licensed premises” means the building(s), or portion thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

(ay) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(az) “Licensing classification” means the specific category of services authorized by a license.

(ba) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bb) “Mechanical restraint” means locked, secured, or alarmed ICF/IIDs or units within an ICF/IID, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ICF/IID or unit within. These do not include postural supports for residents with inadequate tone or motor control to balance independently.

(bc) “Medical director” means a medical doctor, advanced practice registered nurse, doctor of osteopathy or doctor of naturopathic medicine licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in an ICF/IID.

(bd) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(be) “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “a substantial impairment of emotional processes, or of the ability to exercise conscious control of one’s actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by:

(1) Epilepsy;

(2) Intellectual disability;

(3) Continuous or non-continuous periods of intoxication caused by substances such as alcohol or drugs; or

(4) Dependence upon or addiction to any substance such as alcohol or drugs.”

(bf) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bg) “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.

(bh) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bi) “Nursing care” means the provision or oversight of a resident’s physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.

(bj) “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

(bk) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bl) “Over-the-counter medications” means non-prescription medications.

(bm) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bn) “Personal assistance” means providing or assisting a resident in carrying out activities of daily living.

(bo) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting a resident in the exercise of any rights.

(bp) “Personnel” means an individual who is employed by the facility, a volunteer, or an independent contractor, and provides direct care or personal care services to residents.

(bq) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques. Physical restraints does not include postural supports for residents with inadequate tone or motor control to balance independently.

(br) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bs) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bt) “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of resident care.

(bu) “Point of care devices” means a system of devices used to obtain medical, diagnostic results. Examples include, but are not limited to:

(1) A lancing or finger stick device to obtain blood specimen;

(2) A test strip or reagents to apply a specimen to for testing; or;

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time and International Normalized Ratio anticoagulation meters; or

c. A Cholesterol meter.

(bv) “Pro re nata (PRN) medication” means medication taken as circumstances might require in accordance with licensed practitioner’s orders.

(bw) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bx) “Protective care” means the provision of resident monitoring services, including but not limited to:

(1) Knowledge of resident whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(by) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bz) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(ca) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

(cb) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cc) “Reportable incident” means an occurrence of any of the following while the resident is either in the ICF/IID or in the care of ICF/IID personnel:

(1) The unanticipated death of the resident;

(2) An injury to a resident, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the resident; or

(3) The elopement or unexplained absence of a resident from the ICF/IID.

(cd) “Resident” means any person admitted to or in any way receiving care, services, or both who resides in an ICF/IID.

(ce) “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 815 and as required by other federal and state law.

(cf) “Resident rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

(cg) “Seclusion” means an intervention defined as solitary containment in a fully protective environment with close surveillance by qualified personnel for purposes of safety or behavior management.

(ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(ci) “Significant change” means a decline or improvement in a resident’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident’s health status; and

(3) Requires interdisciplinary review or revision of the care plan.

(cj) “State monitoring” means the placement of individuals by the department at an ICF/IID to monitor the operation and conditions of the facility.

(ck) “Supervision” means the process by which the resident is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

(cl) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

(cm) “Underwriters Laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(cn) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (February 2023), signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit affirming and certifying the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

(2) A floor plan of the prospective ICF/IID;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” if a sole proprietorship or if otherwise applicable;

(4) The applicable fee in accordance with RSA 151:5, VI, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the name and qualifications of the ICF/IID administrator;

(6) Copies of applicable licenses, certificates, or both for the ICF/IID administrator;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the appropriate occupancy chapter of the life safety code 101 and the uniform fire code, NFPA 1, as published by the National Fire Protection Association (NFPA) and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5, and local fire ordinances applicable for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(8) If the ICF/IID uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill;

(9) The results of a criminal records check for the applicant(s), licensee if different than the applicant, medical director, and the administrator, as applicable;

(10) A copy of the criminal attestation as described in He-P 815.17(m)(8) for the administrator and medical director;

(11) If residents are adults, the results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director; and

(12) If residents are minors, the results of the DCYF central registry check of founded report of abuse and neglect for the administrator and medical director.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 815.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 815.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 815.13(b) if it determines that the applicant, licensee, administrator, or medical director:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 815.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 815.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 815.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 815.

(i) A written notification of denial, pursuant to He-P 815.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 815.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 815.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 815.10; and

(4) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03-6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

(c) In addition to He-P 815.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 815.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by He-P 815.06(b) and (d) as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 815, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation, shall be required to submit an application for an initial license pursuant to He-P 815.04.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.07 ICF/IID New Construction and Existing Building Rehabilitation

(a) For new construction and for building rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 815 and notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

(g) The ICF/IID shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or building rehabilitation.

(h) A licensee or applicant undertaking construction or building rehabilitation of a building shall comply with the following:

(1) The state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300, including but not limited to the health care chapter of NFPA 101, and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5 including the;

a. NFPA 101, “Life Safety Code Residential Board and Care Occupancy Chapter”; or

b. NFPA 101, “Life Safety Code Health Care Occupancy Chapter”;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) The Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities”, (2022 edition), available as noted in Appendix A.

(i) All ICF/IID’s newly constructed or rehabilitated after the 2023 effective date of these rules shall comply with the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(j) Where building rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,”(2022 edition), as available as noted in Appendix A.

(k) The department shall be the authority having jurisdiction for the requirements in He-P 815.07(h)-(i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 815.10 as appropriate.

(l) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using an UL listed or approved sealant that provides an equivalent rating as provided by the original surface.

(m) Waivers granted by the department for construction or building rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(n) Exceptions or variances pertaining to the state fire code referenced in He-P 815.07(h)(1) shall be granted only by the state fire marshal.

(o) The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 815.09 prior to its use.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.08 ICF/IID Requirements for Organizational Changes

(a) The ICF/IID shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds authorized under the current license; or

(6) Services.

(b) The ICF/IID shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of beds authorized under the current license; or

(4) A change in services.

(c) When there is a change in address without a change in location, the ICF/IID shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the ICF/IID shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department:

(2) The physical location;

(3) An increase in the number of beds or residents authorized under the current license;

(4) A change in licensing classification; or

(5) A change that places the facility under a different life safety code occupancy chapter.

(f) A new license and license certificate shall be issued for a change in ownership or a change in physical location.

(g) A new license and license certificate shall be issued for change of ownership, classification, or physical location.

(h) A revised license and license certificate shall be issued for changes in the ICF/IID name or a change in address without a change in physical location.

(i) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) An increase or decrease in the number of beds;

(3) A change in the scope of services provided; or

(4) When a waiver has been granted in accordance with He-P 815.10.

(j) The ICF/IID shall notify the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses, certificates, or both, for the new administrator or medical director;

(3) The results of a criminal records check to include results for the state of New Hampshire for the new administrator or medical director; and

(4) The results of the criminal attestation as described in He-P 815.17(m)(8).

(k) Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position.

(l) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the ICF/IID in writing so that a waiver can be sought or the ICF/IID can search for a qualified candidate.

(m) The ICF/IID shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change.

(n) The department shall use email as the primary method of contacting the facility in the event of an emergency.

(o) A restructuring of an established ICF/IID that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) If a licensee chooses to cease the operation of the ICF/IID, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 815, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the ICF/IID; and

(3) Any records required by RSA 151 and He-P 815.

(b) The department shall conduct a clinical and life safety inspection as necessary, to determine full compliance with RSA 151 and He-P 815 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed under He-P 815.08(e)(1);

(3) A change in the physical location of the ICF/IID;

(4) A relocation within the facility;

(5) A change in the life safety code occupancy chapter the facility is licensed under;

(6) An increase in the number of beds;

(7) Occupation of space after construction, modifications, or structural alterations; or

(8) The renewal of a non-certified license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of an inspection, the department determines that the ICF/IID is in violation of any of the provisions of He-P 815, RSA 151, or other federal or state requirement.

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a written POC, in accordance with He-P 815.12, within 21 days of the date on the letter that transmits the inspection report.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 815 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary and how a waiver is justified;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought if less than permanent.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

(1) Meet the objective or intent of the rule;

(2) Do not negatively impact public health or the health, safety, or well-being of the residents; and

(3) Do not affect the quality of resident services.

(d) The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s);

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 815; or

(4) The complaint is received from any source and alleges a violation that occurred at any time if the complaint alleges:

a. Physical injury or abuse;

b. Verbal or emotional abuse; or

c. The danger of physical injury to one or more residents.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the ICF/IID, or the alleged unlicensed person or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 and He-P 815.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with residents who might have information that is relevant to the investigation.

(d) For the licensed ICF/IID, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Require the licensee to submit a POC in accordance with He-P 815.12, unless the department determined the complaint is unfounded or does not violate any statutes or rule; and

(4) If it is determined the complaint is unfounded or does not violate any statutes or rules, notify the licensee in writing and take no further action.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

(3) If the response described in (e)(2) is not received within 7 days from the date of receipt of the notice described in (e)(1) and in accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 815;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 815.13(c)(5).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any administrative or judicial proceedings relative to the licensee.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 815, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a license; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate space on the state notice detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 815;

b. Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 815 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 815.12(d) and a fine in accordance with He-P 815.13(c)(11);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 815.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 815.13(c)(12) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and employees;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such later date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has been found not to have been implemented by the completion date stated in the directed POC, the department shall:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 815.13(b)(6); or

(3) Revoke the license in accordance with He-P 815.13(b)(6).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, initiated action to suspend or revoke a license, or denied an application for a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of residents; or

(2) The presence of conditions in the facility that negatively impact the health, safety, or well-being of residents.

(m) The department shall appoint a temporary manager to assume operation of an ICF/IID when, following an inspection, the department determines that:

(1) The licensee has repeatedly failed to manage and operate the ICF/IID in compliance with RSA 151 and He-P 815 and such ICF/IID practices have failed to meet the needs of the residents;

(2) The licensee has failed to develop or implement policies and procedures for infection control, sanitation, or life safety codes, imposing harm or the potential for harm to the residents; or

(3) The health, safety, and well-being of the residents are at risk and emergency action is required.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated RSA 151 or He-P 815 in a manner which poses a risk of harm to a resident’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 815.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 815.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 815.12 (c)(5) and has not submitted a revised POC as required by He-P 815.12 (c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 815 for the same violations within the last 5 inspections;

(9) A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 815;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been convicted of or adjudicated for a sexual assault or other violent crime, theft or fraud, or a finding of abuse, neglect or exploitation in this or any other state, or poses a threat to the health, safety, or well-being of a resident;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by another division or unit of the department within a 5 year period of the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed person or entity;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed person or entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 815.14(g), the fine for an applicant, licensee, or unlicensed person or entity shall be $500.00;

(4) For a failure to transfer an resident whose needs exceed the services or programs provided by the ICF/IID after being directed by the department to transfer the resident, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 815.11(e), the fine shall be $500.00;

(6) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 815.06(b), the fine shall be $100.00;

(7) For a failure to notify the department prior to a change of ownership, in violation of He-P 815.08(a)(1), the fine shall be $500.00;

(8) For a failure to notify the department prior to a change in the physical location, in violation of He-P 815.08(a)(2), the fine shall be $500.00;

(9) For a failure to notify the department of a change in e-mail address, in violation of He-P 815.08(m), the fine shall be $100.00;

(10) For a refusal to allow access by the department to the ICF/IID’s premises, programs, services, or records, in violation of He-P 815.09(a), the fine for an applicant, person, or licensee shall be $2000.00;

(11) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 815.12(c)(2) and (6), the fine for a licensee shall be $500.00;

(12) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 815.12(c)(11), the fine for a licensee shall be $1000.00;

(13) For a failure to establish, implement, or comply with licensee policies, as required by He-P 815.14(b) and (d), the fine for a licensee shall be $500.00;

(14) For a failure to provide services or programs required by the licensing classification and specified by He-P 815.14(c), the fine for a licensee shall be $500.00;

(15) For exceeding the licensed capacity in violation of He-P 815.14(k), the fine for a licensee shall be $500.00 per day;

(16) For providing false or misleading information or documentation, in violation of He-P 815.14(f), the fine shall be $1000.00 per offense;

(17) For a failure to meet the needs of an resident, in violation of He-P 815.14(i)(1), the fine for a licensee shall be $1000.00 per resident;

(18) For placing a resident in a room that, based on the floor plan required by He-P 815.04(a)(2), has not been approved or licensed by the department, the fine for a licensee shall be $500.00;

(19) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 815.10, in violation of He-P 815.14(i)(4) and (5), the fine for a licensee shall be $500.00;

(20) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 815.09(a), the fine shall be $2000.00;

(21) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 815.07(a), the fine for a licensed facility shall be $500.00;

(22) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, in violation of He-P 815.09(b)(7), the fine shall be $500.00, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(23) When an inspection determines that a violation of RSA 151 or He-P 815 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

(24) Each day that the person or licensee continues to be in violation of the provisions of RSA 151 or He-P 815 shall constitute a separate violation and shall be subject to fines in accordance with He-P 815.13(c); and

(25) If the applicant or licensee is making good faith efforts to comply with (4), (5), or (19) above, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of residents is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 815 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When an ICF/IID’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the ICF/IID, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years.

(k) The 5 year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has reasonable information or evidence that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 815.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

(n) RSA 541-A and He-C 200 shall govern further appeals of department decisions under this section.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 815.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and rules promulgated thereunder.

(b) In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of residents receiving services at the ICF/IID, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21, “Patients’ Bill of Rights” are upheld.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the ICF/IID, which shall include at a minimum, the required services listed in He-P 815.15.

(d) The licensee shall develop and implement written policies and procedures governing the operation of all services provided by the ICF/IID and for:

(1) Reviewing the policies and procedures annually;

(2) Revising them as needed;

(3) Implementing a written policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

(4) Managing the behavior of residents under the age of 18, including how and under what circumstances seclusion or restraint is used, pursuant to RSA 126-U:2.

(e) The licensee shall assess and monitor the quality of care and service provided to residents on an ongoing basis.

(f) The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

(g) The licensee shall not:

(1) Advertise or otherwise represent the program as operating an ICF/IID, without a valid license; and

(2) Advertise that it provides services that it is not authorized to provide.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) Licensees shall:

(1) Meet the needs of the resident;

(2) Initiate action to maintain the ICF/IID in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ICF/IID;

(4) Appoint a qualified administrator and medical director;

(5) Verify the qualifications of all personnel;

(6) Provide sufficient numbers of personnel who are present in the ICF/IID and are qualified to meet the needs of residents during all hours of operation;

(7) Provide the ICF/IID with sufficient supplies, equipment, and lighting to meet the needs of the residents;

(8) Implement any POC that has been accepted or issued by the department; and

(9) Require that all personnel follow the orders of the licensed practitioner for each resident and encourage the residents to follow the licensed practitioner’s orders.

(j) The licensee shall consider all residents to be competent and capable of making health care decisions unless the resident:

(1) Has a guardian appointed by a court of competent jurisdiction;

(2) Has a durable power of attorney for health care that has been activated; or

(3) Is an un-emancipated minor.

(k) The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

(l) The licensee shall not admit a resident whose needs exceed the program and services offered by the ICF/IID.

(m) If the licensee accepts a resident who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the residents, as specified by the United States Centers for Disease Control and Prevention (CDC) “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(n) The licensee shall report all positive tuberculosis test results for employees to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(o) The licensee shall implement measures to ensure the safety of residents who are assessed as an elopement risk or danger to self or others.

(p) If serving an adult population, the licensee shall ensure compliance with all dementia training requirements pursuant to RSA 151:47-49 including continuing education to include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

(2) A minimum of 4 hours of ongoing training each calendar year.

(q) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 815.09, for the previous 12 months;

(3) A copy of the residents’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of resident rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to “Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301” or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

(r) For reportable incidents, the licensee shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 603-271-4968 or, if a fax machine is not available, convey by electronic mail to hfa-licensing@dhhs.nh.gov or regular mail to 129 Pleasant Street, Concord, NH 03301, the following information to the department within 48 hours of a reportable incident:

a. The ICF/IID name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or employees involved in, witnessing, or responding to the reportable incident;

d. The name of resident(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. When the resident’s guardian or agent, if any, or personal representative was notified;

i. The signature of the person reporting the reportable incident;

j. The date and time the resident’s licensed practitioner was notified, if applicable; and

k. The date the facility performed the investigation required by (1) above;

(3) As soon as practicable, notify the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a resident has an elopement or unexplained absence and the licensee has searched the building and the grounds of the ICF/IID without finding the resident; and

(4) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(s) For uses of restraint with a resident under the age of 18, the license shall notify the resident’s parents or guardians in accordance with RSA 126-U:7 including verbal and written documentation.

(t) The licensee shall admit and allow any department representative to inspect the ICF/IID and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 815 as authorized by RSA 151:6 and RSA 151:6-a.

(u) Applicants, licensees, and employees shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 815, including allowing representatives of the department to:

(1) Enter and complete an inspection of the premises;

(2) Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

(3) Interview employees and residents of the ICF/IID.

(v) A licensee shall, upon request, provide a resident or the resident’s guardian or agent, if any, with a copy of his or her resident record pursuant to the provisions of RSA 151:21, X.

(w) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(x) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and employees that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to residents and employees; and

(3) Systems to prevent tampering with information pertaining to residents and employees.

(y) The licensee shall develop policies and procedures regarding the release of information contained in resident records.

(z) The licensee shall provide cleaning and maintenance services, as needed, to protect residents, employees, and the public.

(aa) The ICF/IID shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(ab) If the ICF/IID is not on a municipal water system, the water used in the ICF/IID shall be potable and suitable for human consumption.

(ac) If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.

(ad) The licensee shall develop and follow policies and procedures regarding resident room or bed location changes.

(ae) Following the death of a roommate, the licensee shall facilitate the provision of social services for the resident as needed.

(af) If the residents are minors, any licensee, employee, personnel, or other person associated with the facility who suspects that a child is being abused or neglected is a mandated reporter in accordance with RSA 169-C:29 and shall report the suspected abuse to the division for children, youth, and families at 1-800-894-5533.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.15 Required Services

(a) The licensee shall provide administrative services which include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the ICF/IID;

(2) Works no less than 35 hours per week at the ICF/IID, which may include day, evening, night, and weekend hours;

(3) Delegates, in writing, an alternate onsite, qualified designee who shall assume the responsibilities of the administrator in his or her absence;

(4) Ensures development and implementation of ICF/IID policies and procedures on:

a. Patient’s rights as required by RSA 151:20;

b. Advance directives and DNR orders as required by RSA 137-J;

c. Discharge planning as required by RSA 151:26;

d. The use restraints in residents under the age of 18 in accordance with RSA 126-U;

e. The use of seclusion in accordance with RSA 126-U; and

f. Reportable incident reporting;

(5) Monitoring and evaluating the quality of resident care and resident care services in the ICF/IID pursuant to He-P 815.24;

(6) Identifying and making available education programs designed to maintain the personnel’s expertise in areas related to the services provided in the ICF/IID; and

(7) Any new administrator shall be appointed by the board of directors of the ICF/IID and possess:

a. A master’s degree in the field of human services, business administration, or public administration, awarded by a regionally accredited college or university, plus 2 years of experiences as a professional in human services, which included administrative responsibilities; or

b. A bachelor’s degree with a minimum of 12 credits in the field of human services, business administration, or public administration, awarded by a regionally accredited college or university, plus 3 years of experience as a professional in human services, which included administrative responsibilities.

(b) There shall be a full time director of nursing services who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN with at least 2 years relevant experience in resident care.

(c) The director of nursing services shall be responsible for:

(1) Establishment of standards of nursing practice used in the ICF/IID;

(2) Ensuring that the admission process and resident assessment process coordinates resident requirements for nursing care with available nursing resources;

(3) Participating with the administrator and personnel to improve the quality of nursing care at the ICF/IID;

(4) Nursing care as authorized by the nurse practice act and according to RSA 326-B;

(5) The overall health and safety of residents; and

(6) Maintaining written personnel schedules, which shall be retained on-site for a period of at least 90 days and which include:

a. At least one licensed nurse in the facility 24 hours a day;

b. At least one registered nurse, for 8 consecutive hours a day 7 days a week; and

c. Nursing assistants who have been verified in accordance with the New Hampshire board of nursing.

(d) Each ICF/IID shall have a medical director who is a licensed physician in the state of New Hampshire.

(e) Prior to or upon the time of admission, the licensee shall provide the resident a written copy of the admission agreement, except in the case of an emergency admission where the written agreement shall be given as soon as practicable.

(f) In addition to (e) above, at the time of admission, the licensee shall provide a written copy to the resident and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions packet including the following information:

a. A list of the core services required by He-P 815.15(g);

b. The ICF/IID’s facility rules;

c. The grounds for transfer or discharge and termination of the agreement, pursuant to RSA 151:21, V;

d. The ICF/IID’s policy for resident discharge planning;

e. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The ICF/IID’s responsibility for arranging services; and

3. The fee and payment for services, if known; and

f. Information regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the resident and provided on the ICF/IID premises;

5. Handling of resident funds pursuant to RSA 151:24 and He-P 815.14(ac);

6. Bed hold, in compliance with RSA 151:25;

7. Storage and loss of the resident’s personal property;

8. Smoking;

9. Roommates; and

10. The licensee’s policy regarding the use of restraints;

(2) A copy of the residents’ bill of rights under RSA 151:21 and the ICF/IID’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5);

(4) The ICF/IID’s policy and procedure for handling reports of abuse, neglect, or exploitation, which shall be in accordance with RSA 161-F:46 and RSA 169-C:29;

(5) Information on accessing the office of the long term care ombudsman; and

(6) Information on advance directives and DNR status.

(g) The licensee shall provide the following core services:

(1) Services of a licensed nurse provided 24 hours a day;

(2) Services of an RN provided at least 8 hours within a 24-hour period;

(3) Emergency response and crisis intervention;

(4) Medication services in accordance with He-P 815.16;

(5) Food services in accordance with He-P 815.25;

(6) Housekeeping, laundry, and maintenance services;

(7) On-site activities or access to community activities designed to meet the resident interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents, and access to educational services if ages 3 to 21; and

(8) Assistance in arranging medical and dental appointments, including arranging transportation to and from such appointments and reminding the residents of the appointments.

(h) The licensee shall:

(1) Make available basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper;

(2) Identify in the admission packet the cost, if any, of basic supplies for which there will be a charge; and

(3) Not be required to pay for a specific brand of the supplies referenced in (1) above.

(i) Consistent with Medicaid Utilization Control regulations at 42 CFR §456.380 at the time of admission, clients shall be evaluated by a licensed practitioner to identify all diagnoses and complaints, provide orders for all medications and treatments and provide recommendations for restorative and rehabilitative services.

(j) The licensee shall have each resident seen by a licensed practitioner at least annually and a health examination completed and documented.

(k) The health examination referenced in (j) above shall include in the medical record:

(1) Diagnoses, if any;

(2) Medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies;

(7) Dietary needs;

(8) Evaluation of vision and hearing; and

(9) Routine screening laboratory examinations as determined necessary by the physician.

(l) An initial nursing care plan shall be initiated upon admission and completed within 48 hours of the resident’s admission.

(m) The nursing care plan shall:

(1) Be updated following the completion of each future assessment in (i) above;

(2) Be made available to personnel who assist residents in the implementation of the plan; and

(3) Address the needs identified by (i) and (k) above.

(n) Nursing notes shall be written as per the licensee’s policy, and appropriate to resident condition, resident change in condition, and in accordance with professional standards.

(o) Pursuant to RSA 151:21, IX, residents shall be free from chemical and physical restraints except when they are authorized in writing by a licensed practitioner for a specific and limited time necessary to protect the resident or others from injury, or as permitted by the CMS conditions of participation, or as allowed by (p) below.

(p) Pursuant to RSA 151:21, IX, in an emergency, physical restraints may be authorized by the personnel designated in (r)(3) below in order to protect the resident or others from injury, and such action shall be promptly reported to the resident’s physician and documented in the resident’s clinical record.

(q) All restraints involving residents under the age of 18, shall be in accordance with RSA 126-U and reported to the department in accordance with He-C 901.

(r) The ICF/IID shall have written policies and procedures for implementing physical, chemical, and mechanical restraints, including:

(1) What type of emergency restraints may be used;

(2) When restraints may be used;

(3) What professional personnel may authorize the use of restraints;

(4) The documentation of their use in the resident record including the physician order as applicable;

(5) How the licensee plans for reduction of restraint use for any resident requiring restraints;

(6) Initial personnel training and subsequent education and training required to demonstrate competence related to the use of physical, chemical, and mechanical restraints;

(7) The least restrictive to the most restrictive method to be utilized to control a resident’s behavior; and

(8) That the training shall be conducted by individuals who are qualified by education, training, and experience.

(s) The written policies and procedures required in (r) above shall include policies and procedures for restraints involving residents under the age of 18, which shall be in accordance with RSA 126-U and include reporting to the department in accordance with He-C 901.

(t) A resident or parent or guardian, if the resident is a minor, may refuse all care and services.

(u) When a resident or parent or guardian, if the resident is a minor, refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the resident or parent or guardian of the potential results of their refusal;

(2) Notify the licensed practitioner of the resident’s or parent or guardian’s refusal of care;

(3) Notify the agent, as applicable, unless the resident or parent or guardian objects; and

(4) Document in the resident’s or parent or guardian record a pattern of refusal of care and the reason for the refusal, if known, including education to the resident or parent or guardian, of the risk of refusal.

(v) The licensee shall provide the following information to emergency medical personnel in the event of an emergency transfer to another medical facility:

(1) Full name and the name the resident prefers, if different;

(2) Name, address, and telephone number of the resident’s next of kin, guardian, or agent, if any;

(3) Diagnosis, as applicable;

(4) Medications, as applicable, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directives and DNR status; and

(10) Any other pertinent information not specified in (1)-(9) above.

(w) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.

(x) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(y) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, and reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(z) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be incompliance with He-P 808, He-P 817, and 42 CFR 493.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.16 Medication Services

(a) All medications shall be administered in accordance with the orders of the licensed practitioner.

(b) Medications, treatments and diets ordered by the licensed practitioner shall be made available to the resident within 24 hours of the order, or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the ICF/IID;

(2) Reorder medications for use at the ICF/IID; and

(3) Receive and record new medication orders.

(d) For each prescription medication being taken by a resident, the licensee shall maintain one of the following:

(1) The original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

(2) A copy of the original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers.

(e) Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

(1) The resident’s name:

(2) The medication name, strength, and prescribed dose and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated original or electronic signature of the ordering practitioner.

(f) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s order and labeled with the resident’s name.

(g) The label of all medication containers maintained in the ICF/IID shall match the current orders of the licensed practitioner and include the expiration date of the medication unless authorized by (aa) below.

(h) Except as allowed by (f) above and (i) below, only a pharmacist shall make changes to prescription medication container labels.

(i) When the licensed practitioner changes the dose of a medication and personnel of the ICF/IID are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the ICF/IID’s written procedure, indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(j) Any change or discontinuation of medications taken at the ICF/IID shall be pursuant to an order from a licensed practitioner or other professional with prescriptive powers.

(k) The licensee shall require that all telephone orders for medications, treatments, and diets are immediately transcribed and signed by the resident receiving the order.

(l) The transcribed order in (k) above shall be counter-signed by the authorized provider within 30 days of receipt or next visit but not to exceed 60 days.

(m) The licensee shall obtain an order from a licensed practitioner for all over-the-counter medications.

(n) The medication storage area shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

(3) Equipped to maintain medication at the proper temperature per manufacturer’s requirements.

(o) All medications at the ICF/IID shall be kept in the original containers or packaging and properly closed after each use.

(p) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(q) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the ICF/IID, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(r) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(s) All contaminated, expired, or discontinued medication shall be destroyed within 90 days of the expiration date, the end date of a licensed practitioner’s orders, or the date the medication becomes contaminated, whichever occurs first.

(t) Controlled drugs shall be destroyed only in accordance with state law.

(u) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(v) If a resident is going to be absent from the ICF/IID at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication shall be given to the person responsible for the resident while the resident is away from the ICF/IID.

(w) Upon discharge or transfer, the licensee may make the resident’s current medications available to the resident and the guardian or agent, if any.

(x) An order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(y) The licensee shall maintain a written record for each resident for each medication taken by the resident at the ICF/IID that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials and job title of the person who administers, supervises, or assists the resident taking medication;

(5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(z) Stock medications shall only be accessed and administered by the licensed nurse or any other professional authorized by state or federal regulation pursuant to a licensed practitioner’s order.

(aa) An ICF/IID shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.02 under circumstances where the ICF/IID:

(1) Has a director of nursing who is a registered nurse (RN) licensed in accordance with RSA 326-B; and

(2) Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

(ab) The licensee shall develop and implement a system for reporting to the director of nursing or designee within 24 hours after any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications.

(ac) The written documentation of the report in (ab) above shall be maintained in the resident’s record.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.17 Personnel

(a) The licensee shall develop a job description for each position at the ICF/IID containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Education and experience requirements of the position.

(b) All direct care personnel shall be at least 18 years of age unless they are:

(1) A student in a New Hampshire board of nursing approved nursing or nursing assistant program;

(2) A nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(3) Part of an established educational program working under the supervision of a nurse.

(c) For all applicants for employment, for all volunteers, or for all independent contractors who will provide direct care or personal care services to residents, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d;

(2) Verify the qualifications and licenses, as applicable, of all applicants prior to employment;

(3) If residents are adults the licensee shall check the names of the persons in (c) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49; and

(4) If residents are minors, the licensee shall check the names of the persons in (c) above against the DCYF central registry check of founded reports of abuse and neglect.

(d) Unless a waiver is granted in accordance with He-P 815.10 and (f) below, the licensee shall not make a final offer of employment for any position if the individual:

(1) Has been convicted of any felony in this or any other known state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other known state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(e) If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(f) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

(g) If residents are adults, the licensee shall not employ, contract with, or engage, any person who is listed on the BEAS state registry unless a waiver is granted by BEAS.

(h) If residents are minors, the licensee shall not employ, contract with, or engage, any person who is listed on the DCYF central registry of founded reports of abuse and neglect.

(i) In lieu of (c), (g), and (h), if applicable, above, the licensee may accept from independent agencies contracted by the licensee or by a resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c), (g), and (h), if applicable, above and do not meet the criteria in (d) above.

(j) All employees shall:

(1) Meet the educational and physical qualifications of the position as listed in their job description;

(2) Not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department;

(3) Be licensed, registered, or certified as required by state statute and as applicable;

(4) Receive an orientation within the first 3 days of work prior to the assumption of duties that includes:

a. The ICF/IID’s policies on resident rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities, policies, procedures, and guidelines of the position they were hired for;

c. The ICF/IID’s infection control program;

d. The ICF/IID’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

e. Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

(5) Complete a mandatory annual in-service education, which includes a review of the ICF/IID’s:

a. Policies and procedures on resident rights and responsibilities and abuse or neglect;

b. Infection control;

c. Education program on fire and emergency procedures; and

d. Mandatory reporting requirements.

(k) Prior to having contact with residents, employees shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the CDC, conducted not more than 12 months prior to employment;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

(3) Comply with the requirements of the CDC “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

(4) Comply with all public health guidelines with regard to the requirements for communicable infectious disease reporting pursuant to He-P 301.

(l) All licensees using the services of independent contractors as direct care personnel shall ensure and document that the independent clinical contractors have:

(1) Been oriented in accordance with (i)(4) above;

(2) Documented results of all infectious disease testing shall comply as required by (k) (1)-(4) above;

(3) Licenses that are current and valid; and

(4) A written agreement that describes the services that will be provided.

(m) Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the ICF/IID.

(n) The employee file shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the ICF/IID’s policy setting forth the resident’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the employee that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) A record of satisfactory completion of the orientation program required by (i)(4) above and any required annual continuing education, if any;

(5) Verification of current New Hampshire license, registration or certification in health care field, and CPR certification, if applicable;

(6) Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Documentation of annual in-service education as required by (i)(5) above;

(8) A statement, which shall be signed at the time the initial offer of employment is made and then annually thereafter, stating that he or she:

a. Does not have a felony conviction in this or any other state;

b. Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety, or well-being of a resident; and

c. Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person;

(9) Documentation of the criminal records check;

(10) Documentation that the employee is not on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49 if serving residents who are adult; and

(11) Documentation that the employee is not on the DCYF central registry of founded reports of abuse and neglect if serving residents who are minors.

(o) An employee shall not be required to re-disclose any of the matters in (n)(8) and (n)(9) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.18 Quality Improvement

(a) The ICF/IID shall establish an interdisciplinary quality improvement committee which:

(1) Shall have a minimum of 3 members, including the medical director, an individual representing nursing, and an individual representing administration;

(2) Shall meet at least quarterly to evaluate quality improvement activities; and

(3) Shall make recommendations to the administrator to improve the quality of care.

(b) The quality improvement committee shall be responsible for:

(1) Determining the information to be monitored;

(2) Determining the frequency with which information will be reviewed;

(3) Determining the indicators that will apply to the information being monitored;

(4) Evaluating the information that is gathered;

(5) Determining the action that is necessary to correct identified problems;

(6) Recommending corrective actions to the licensee; and

(7) Evaluating the effectiveness of the corrective actions and determine additional corrective actions as applicable.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.19 Infection Control

(a) The ICF/IID shall appoint a person to be in charge of developing and implementing an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include documented procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the CDC “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

(3) The management of residents with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected.

(f) Personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ICF/IID until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable bandage with secure edges.

(h) If the ICF/IID has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(i) The licensee shall immunize all consenting residents for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.20 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment both inside and outside.

(b) The furniture, floor, ceiling, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation, pursuant to Env-Dw 700.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the residents.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and resident supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only professionals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make in inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

(l) Trash receptacles in food service area shall be covered at all time.

(m) The following requirements shall be met for laundry services:

(1) Dirty laundry shall not be permitted to contaminate kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing that are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

(p) Any ICF/IID that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify department.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.21 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of residents and personnel, including reasonable accommodations for residents and personnel with disabilities.

(b) Equipment providing heat within an ICF/IID including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(2) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in personnel areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Unvented fuel-fired heaters shall not be used in any ICF/IID.

(f) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 155-A.

(g) Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

(h) Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(i) The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

(j) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(k) All hand-washing facilities shall be provided with hot and cold running water.

(l) There shall be at least 100 square feet in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom.

(m) The space requirements in above shall be exclusive of space required for closets, wardrobes, and bathroom.

(n) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the resident to reach his/her bedroom without passing through the room of another resident;

(3) Have a side hinge door and not a folding or sliding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors and other rooms by floor to ceiling walls;

(6) Be located on the same level as the bathroom facilities, if the resident has impaired mobility; and

(7) If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom without requiring additional construction or renovation.

(o) The licensee shall provide the following for the residents’ use, as needed, except as requested by the resident or guardian and documented in their resident record:

(1) A bed appropriate to the needs of the resident;

(2) A firm mattress that complies with the state fire code and codes adopted by referenced as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

(3) Clean linens, blankets, and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) A lamp;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades, or curtains that provide privacy.

(p) The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others.

(q) The licensee shall provide the following rooms to meet the needs of residents:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all residents.

(r) Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

(s) Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

(t) All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(u) During seasons when insects are active, screens shall be provided for:

(1) Doors;

(2) Windows; and

(3) Other openings to the outside.

(v) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (u) above.

(w) If the ICF/IID admits residents under the age of 18, each age group shall have separate and distinct units.

(x) If the ICF/IID admits residents between the age of 10 and 17 years, residents shall be provided privacy for bathing, toileting, and sleeping.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.22 Fire Safety

(a) All ICF/IID s shall meet the requirements of the appropriate chapter of NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5 and any pertinent chapter and related codes regarding the installation, testing, and maintenance of the fire alarm system.

(b) All ICF/IID’s shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the ICF/IID’s electrical service, or wireless, as approved by the state fire marshal for the ICF/IID;

(2) At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10; and

(3) An approved carbon monoxide monitor on every level.

(c) Immediately following any fire or emergency situation, licensees shall notify the department by phone and in writing within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) EMS transport related to known pre-existing conditions.

(d) The written notification required by (c) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injuries to residents or employees;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(e) Storage and use of oxygen cylinders or systems shall comply with NFPA 99, “Health Care Facilities Code” including but not limited to:

(1) Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

a. Minimum distance of 6.1 m or 20 ft;

b. Minimum distance of 1.5 m or 5 ft if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, “Standard for the Installation of Sprinkler Systems”; or

c. A gas cabinet constructed per NFPA 30, “Flammable and Combustible Liquids Code”, or NFPA 55, “Compressed Gases and Cryogenics Fluids Code”, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

(2) Cylinders shall be protected from damage by means of the following specific procedures:

a. Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

b. Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

c. Cylinders shall be protected from tampering by unauthorized individuals;

d. Cylinders or cylinder valves shall not be repaired, painted, or altered;

e. Safety relief devices in valves or cylinders shall not be tampered with;

f. Valve outlets clogged with ice shall be thawed with warm, not boiling water;

g. A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

h. Sparks and flame shall be kept away from cylinders;

i. Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

j. Large cylinders exceeding size E and containers larger than 45 kg or100 lb weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

k. Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

l. Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

(3) Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

a. Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

b. Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

c. Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

d. The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

e. Oxygen shall be referred to by its proper name, “oxygen”, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

f. Oxygen shall not be used as a substitute for compressed air;

g. The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

h. Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels or tags used for indicating cylinder status such as full, in use, or empty;

i. The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

j. Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, or heat ducts;

k. Very cold cylinders or containers shall be handled with care to avoid injury;

l. A precautionary sign, readable from a distance of 1.5 m or 5 ft, shall be displayed on each door or gate of the storage room or enclosure; and

m. The sign shall include the following wording as a minimum:

“CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING”

(f) If the licensee has chosen to allow smoking, an outside location or a room used only for smoking shall be provided which:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non-combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act, and He-P 1900.

(g) Each licensee shall develop a written fire safety plan.

(h) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, or the resident’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident.

(i) Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(j) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(k) Fire drills shall be conducted as follows:

(1) For buildings constructed to the “Residential Board and Care or One and Two Family Dwelling Chapters” of the “Life Safety Code”, NFPA 101, the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All ICF/IID facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when residents are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide residents with experience in egressing through all exits and means of escape;

e. Facilities shall complete a written record of fire drills that includes the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At n time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. At least annually, the facility shall conduct a resident “Fire Safety Evacuation Scoring System” (FSES) as listed in NFPA 101A, “Alternatives to Life Safety”, to determine the resident’s needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, and residents ability to evacuate on their own and choose an alternate exit; and

h. The fire drills for facilities built to the “Residential Board and Care chapter of the Life Safety Code”, NFPA 101, shall be permitted to be announced, in advance, to the residents just prior to the drill;

(2) For all ICF/IID’s that were originally constructed to meet the “Health Care Occupancy Chapter of Life Safety Code”, NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and the rules and regulations adopted and enforced by the state fire marshal’s office or the municipality or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office and the department to meet the “Health Care Occupancy Chapter”, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the “Health Care Occupancy Chapter of the Life Safety Code”;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. If the facility has an approved defend or shelter in place plan, then all personnel, residents, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that residents shall be given the experience of evacuating to the appropriate location or exiting through all exists;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including residents, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(3) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.23 Emergency Preparedness

(a) Each licensee shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the licensee’s administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members;

(3) A description of how the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

(12) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

(14) Include the management of residents, particularly with respect to physical and clinical issues, including:

a. Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(f) The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills and exercises shall be monitored by at least one designated evaluator who has

knowledge of the licensee’s plan and who is not involved in the exercise;

(2) The designated evaluator shall evaluate, through the drills and exercises, the program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise with all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued by the designated evaluator to identify areas for improvement, deficiencies, and opportunities for improvement, and be incorporated in the licensee’s improvement plan.

(g) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Potable water for a 3-day period.

(h) Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

(1) Assumptions for calculations of food and water supplies to include:

a. The maximum number of staff and residents;

b. Source of water supply, either tap or commercial;

c. Expiration in months, tracking of supplies, and rotation of products; and

d. Contracts and memorandums of understanding with food and water suppliers;

(2) Storage location(s); and

(3) Back-up supplies.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.24 Resident Records

(a) The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the ICF/IID.

(b) At a minimum, resident records shall contain the following:

(1) A copy of the resident’s admission agreement and all documents required by He-P 815.15(f);

(2) Identification data, including:

a. Vital information including the resident’s name, date of birth, and parent or guardian contact information;

b. Resident or resident’s family’s religious preference, if known;

c. If an adult, the resident’s veteran status, if known, and marital status; and

d. Name, address, and telephone number of an emergency contact person;

(3) The name and telephone number of the resident’s licensed practitioner(s);

(4) Resident’s health insurance information;

(5) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A or RSA 463, a durable power of attorney for healthcare, or a living will;

(6) A record of the health examination(s) in accordance with He-P 815.15(k);

(7) Written, dated, and signed orders for the following:

a. All medications, treatments, and special diets; and

b. Laboratory services and consultations;

(8) Results of any laboratory tests, or consultations;

(9) All assessments and care plans, and documentation that the resident and the guardian or agent, if any, have been given the opportunity or has participated in the development of the care plan;

(10) Documentation of informed consent;

(11) All admission and progress notes;

(12) Documentation of any alteration in the resident’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including practitioner notification;

(13) Documentation of any medical or specialized care;

(14) Documentation of unusual incidents;

(15) The consent for release of information signed by the resident, guardian, or agent, if any;

(16) Discharge planning and referrals as applicable;

(17) Transfer or discharge documentation, including notification to the resident, guardian, or agent, if any, of transfer or discharge;

(18) Room change documentation, including notification to the resident, guardian, or agent, if any, and if applicable;

(19) The medication record as required by He-P 815.16(y) and (ac);

(20) Documentation of a resident’s refusal of any care or services; and

(21) Code status.

(c) Resident records and resident information shall be kept confidential and only provided in accordance with law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

(e) Resident records shall be available to health care workers and any other person authorized by law or rule to review such records.

(f) When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

(g) Records shall be retained for 7 years after discharge, except for records of Medicaid residents, which shall be retained for 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6-year period, whichever is longer.

(h) The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the ICF/IID ceases operation.

History

• #13568, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 815.25 Food Services

(a) The licensee shall provide food services that:

(1) Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), available as noted in Appendix A;

(2) Provide the nutritional needs of each resident;

(3) Meet the special dietary needs associated with health or medical conditions for each resident as identified by the health examination required by He-P 815.15(j);

(4) Employ a food service manager who shall;

a. Be responsible for the day to day operation of the kitchen;

b. Have knowledge of the nutritional requirements for residents and of the planning and preparation of prescribed diets; and

c. Have all the required competencies as per the licensee’s policy;

(5) Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

(6) Include dining facilities that have eating areas sufficient in size to provide seating for at least 50% of the licensed capacity.

(b) Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident’s care plan.

(c) Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident’s care plan.

(d) If a resident refuses the item(s) on the menu, a substitute shall be offered.

(e) Menus, including beverages for regular and therapeutic diets, shall be planned and written for at least 2 weeks in advance of serving.

(f) Each day’s menu shall be posted in a place accessible to food service personnel and residents.

(g) A listing of the diet orders and allowed foods for each resident shall be available to personnel.

(h) A dated record of menus as served shall be maintained for at least 3 months.

(i) The licensee shall provide therapeutic diets to residents only as directed by a licensed practitioner or other professional with prescriptive authority.

(j) Residents requiring therapeutic diets shall have an assessment of nutritional status by a qualified dietitian or dietary technician at least quarterly and with any significant weight loss or weight gain.

(k) If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record along with education relating to non-compliance with prescribed diet, and notify the resident’s licensed practitioner.

(l) All food and drink provided to the residents shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

(3) Served at the proper temperatures;

(4) Labeled, dated, and stored at proper temperatures; and

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

(m) The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

(n) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(o) All work surfaces shall be cleaned and sanitized after each use.

(p) All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(q) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(r) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(s) Garbage or trash in the kitchen area shall be placed in lined containers with covers.

(t) All personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

(u) Regularly scheduled training programs including sanitation and safety shall be made available to personnel. Information as to the content and length of this training shall be documented and kept in employee records.

History

• #13568, eff 2-25-23

Part He-P 816 Educational Health Centers

N.H. Code Admin. R. Ann. He-P 816.01 Purpose

The purpose of this part is to set forth the licensing requirements for all educational health centers (EHC) licensed pursuant to RSA 151:2, I(a).

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.02 Scope

This part shall apply to any individual, agency, partnership, corporation, association, or legal entity other than a governmental unit operating an educational health center, except:

(a) All facilities listed in RSA 151:2, II(a)-(g);

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h); and

(c) All clinics whose sole source of funding for services is from a contract with the department of health and human services.

History

• #5516, eff 11-25-92; amd by #5984, eff 2-4-95; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (d)(2) EXPIRED: 2-4-03
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a student;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a student; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a student with or without his or her informed consent.

(b) “Academic program” means a course of study, offered by the licensee, in subjects such as English, social studies, the arts, mathematics, language, and science.

(c) “Administer” means “administer” as defined by RSA 318:1.

(d) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

(e) “Admission” means accepted by a licensee for the provision of services to a student.

(f) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an EHC pursuant to RSA 151:2, I(a).

(g) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 816, or other federal or state requirements.

(h) “Chemical restraint” means any medication prescribed to control a student’s behavior or emotional state without a supporting diagnosis or for the convenience of personnel.

(i) “Change of ownership” means a change in the controlling interest in an EHC to a successor business entity.

(j) “Continuing education” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(k) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(l) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(m) “Days” means calendar days unless otherwise specified in the rule.

(n) “Department” means the New Hampshire department of health and human services.

(o) “Direct care personnel” means any person providing hands-on care or services to a student.

(p) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct areas of non-compliance.

(q) “Educational health center (EHC)” means a facility that provides health care services to students of a residential educational institution, including but not limited to, private schools and colleges.

(r) “Educational institution” means an established institution, other than an institution operated by a government entity, whose purpose is to impart knowledge or skills.

(s) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(t) “Exploitation” means the illegal use of a person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a person through the use of undue influence, harassment, duress, deception, or fraud.

(u) “Guardian” means the parent of a student under the age of 18 or a person appointed under RSA 463.

(v) “Guideline” means a written statement that specifies the assessment and treatment to be provided to a student of the EHC for a specific medical condition.

(w) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(x) “Infectious waste” means those items specified by Env-Wm 2604.

(y) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 816 or to respond to allegations of non-compliance with RSA 151 or He-P 816.

(z) “License” means the document issued by the department to an applicant at the start of operation as an EHC which authorizes operation in accordance with RSA 151 and He-P 816, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

(aa) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the EHC is licensed.

(ab) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Licensed advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ac) “Licensed premises” means the facility that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

(ad) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151 and He-P 816.

(ae) “Licensing classification” means the specific category of services authorized by a license.

(af) “Mechanical restraint” means locked, secured, or alarmed EHCs or units within an EHC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a student from freely exiting the EHC or unit within.

(ag) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, or an APRN licensed in accordance with RSA 326-B, who is responsible for overseeing the quality of medical care and services at the EHC.

(ah) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ai) “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a student.

(aj) “Nurse” means a person licensed in accordance with RSA 326-B as either an APRN, registered nurse (RN), or a licensed practical nurse (LPN).

(ak) “Orders” means written prescriptions, instructions for treatments, special diets, or therapies given by a licensed practitioner.

(al) “Patient rights” means the privileges and responsibilities possessed by each student provided by RSA 151:21.

(am) “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct or indirect care or services, or both, to a student(s).

(an) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the student’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

(ao) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(ap) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(aq) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(ar) “Reportable incident” means an occurrence of any of the following while the student is either in the EHC or in the care of EHC personnel:

(1) The unanticipated death of the student; or

(2) An injury to a student that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the student.

(as) “Student” means any person enrolled at the educational institution, or any faculty, staff, or visitor of the educational institution, who is admitted to or is in any way receiving care, services, or both from an EHC licensed in accordance with RSA 151 and He-P 816.

(at) “Student record” means the documentation of all care and services, which includes all documentation required by RSA 151, He-P 816, and any other federal and state requirements.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential Care or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers affirming and certifying the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

b. For any EHC to be newly licensed on or after July 1, 2016:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any EHC to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”; and

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed under He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), until the Commissioner of the Department of Health and Human Services makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”

(2) A floor plan of the prospective EHC;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable $500 fee in accordance with RSA 151:5, XVI, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the name and qualifications of the EHC administrator;

(6) Copies of applicable licenses for the EHC administrator;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the appropriate occupancy chapter of National Fire Protection Association (NFPA 101), as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; or

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(8) If the EHC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

(9) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, and administrator.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5516, eff 11-25-92; amd by #5984, eff 2-4-95; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (a)(3) EXPIRED: 2-4-03
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 816.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 816.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 816.13(b) if, after reviewing the information in He-P 816.18(b)-(d), it determines that the applicant, licensee, administrator, or medical director, as applicable:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety or well-being of students.

(f) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(g) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

(h) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 816.

(i) If an applicant is found not to be in compliance with RSA 151 and He-P 816 after a second onsite inspection, the application shall be denied and a new application with the applicable fee shall be required.

(j) If the applicant does not provide the items required by the written notice in (b) above within 90 days of the notice, the application shall be closed and a new application with applicable fees shall be required.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 816.04(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The materials required by He-P 816.04(a)(1) and (4);

(2) The current license number;

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 816.10(f), as applicable;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 816.18(d); and

(5) A statement identifying any variances applied for or granted by the state fire marshal.

(d) In addition to (c) above, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates, or documentation that the EHC is on a municipal water system.

(e) Following an inspection, as described in He-P 816.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) and (d) above, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 816 at the renewal inspection.

(f) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 816.04.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.07 EHC Construction, Modifications or Renovations

(a) Notice and accurate architectural plans or drawings that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

(1) A new building;

(2) Additions to a building;

(3) Alterations that require approval from local or state authorities; and

(4) Modifications that affect compliance with the health and safety, fire or building codes, including but not limited to, fire suppression, detection systems and means of egress.

(b) Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

(c) Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department documentation of fire marshal approval for such methods.

(d) The department shall review plans for construction, modifications, or structural alterations of an EHC for compliance with all applicable sections of RSA 151 and He-P 816 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

(e) Department approval shall not be required prior to initiating construction, modifications, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at his or her own risk.

(f) The EHC shall comply with all applicable licensing regulations when doing construction, modifications, or alterations.

(g) A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

(1) The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) Local rules, regulations, and ordinances.

(h) All EHCs newly constructed after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Common Elements for Non-Residential Support Facilities chapter, 2014 edition, as available as noted in Appendix A.

(i) Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reasons or circumstances for the waivers change.

(j) Exceptions or variances pertaining to the state fire code referenced in (g)(1) above shall be granted only by the state fire marshal.

(k) The completed building shall be subject to an inspection pursuant to He-P 816.09 prior to its use.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.08 EHC Requirements for Organizational Changes

(a) The EHC shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) The number of beds authorized under the current license.

(b) The EHC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in the number of beds authorized under the current license.

(c) When there is a change in address without a change in location, the EHC shall provide the department with a copy of the notification from the local, state or federal agency that requires the address change.

(d) When there is a change in the name, the EHC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

(2) The physical location;

(3) An increase in the number of participants; or

(4) A change in licensing classification.

(f) A new license shall be issued for a change in ownership or physical location.

(g) A revised license and license certificate shall be issued for a change in name.

(h) A license certificate shall be issued at the time of initial licensure.

(i) A revised license certificate shall be issued for any of the following:

(1) A change in administrator;

(2) An increase or decrease in the number of students;

(3) A change in the scope of services provided;

(4) A change in address without a change in physical location; or

(5) When a waiver has been granted.

(j) The EHC shall notify the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator; and

(2) Copies of applicable licenses, certificates, or both, for the new administrator.

(k) Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 816.15(a)(1).

(l) If the department determines that the new administrator does not meet the qualifications for their position as specified in (k) above, it shall so notify the EHC in writing so that a waiver can be sought or the EHC can search for a qualified candidate.

(m) A restructuring of an established EHC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

(o) The EHC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(p) If a licensee chooses to cease the operation of the EHC, the licensee shall submit written notification to the department at least 30 days in advance.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 816, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the EHC; and

(3) Any records required by RSA 151 and He-P 816.

(b) The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151, He-P 816, and other federal or state requirements prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed under He-P 816.08(g)(1);

(3) A change in the physical location of the EHC;

(4) A change in the licensing classification;

(5) A change in the number of beds;

(6) Occupation of space after construction, modifications, or structural alterations; or

(7) The renewal of a license.

(c) In addition to (b) above the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the EHC is in violation of any of the provisions of He-P 816, RSA 151, or other federal or state requirements.

(e) If deficiencies were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 816.12(c), within 21 days of the date on the letter that transmits the inspection report.

(f) A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (b) above that the prospective premises is not in full compliance with RSA 151 and He-P 816.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 816 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and students as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

(1) Meet the objective or intent of the rule;

(2) Do not negatively impact public health or the health or safety of the students; and

(3) Do not negatively affect the quality of student services.

(d) The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (c) through (e) above.

History

• #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.11 Complaints

(a) The department shall investigate any complaint that meet the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 816.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the EHC or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 816.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant and have probative value; and

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

(d) For the licensed EHC, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 816.12(c) if the inspection results in areas of non-compliance being cited.

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 816; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any administrative or judicial proceedings relative to the licensee.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 816, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below; or

(3) Imposing conditions upon a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a student will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 816;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 816 as a result of the implementation of the POC;

d. Identifies the position of the employee responsible for the corrective action; and

e. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

2. The department determines that the health, safety or wellbeing of a resident will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 816.13(c)(11);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 816.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 816.13(c)(12).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection or investigation, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the students and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such later date as is applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 816.13(b); or

(3) Revoke the license in accordance with He-P 816.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or the notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to revoke, deny, or refuse to issue or renew a license.

History

• #9193, eff 6-26-08, ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 816 in a manner which poses a risk of harm to a student’s health, safety, or well being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 816.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) A licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 816.12(c), (d), and (e);

(7) A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 816.12(c)(5) and has not submitted a revised POC as required by He-P 816.12(c)(5);

(8) A licensee is cited a third time under RSA 151 or He-P 816 for the same violations within the last 5 inspections;

(9) A licensee or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Upon inspection, the applicant’s premise is not in full compliance with RSA 151 or He-P 816;

(11) The department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 816.14(h), the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

(4) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 816.11(e), the fine shall be $500.00;

(5) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 816.06(b), the fine for a license shall be $100.00;

(6) For a failure to notify the department prior to a change of ownership, in violation of He-P 816.08(a)(1), the fine shall be $500.00;

(7) For a failure to notify the department prior to a change in the physical location, in violation of He-P 816.08(a)(2), the fine for a licensee shall be $1000.00;

(8) For a failure to notify the department of a change in e-mail address, in violation of He-P 816.08(q), the fine shall be $100.00;

(9) For a failure to allow access by the department to the EHC’s premises in violation of He-P 816.09(a)(1) and (2), the fine for an applicant, individual or licensee shall be $2000.00;

(10) For a failure to provide to the department any records maintained by the licensee and required by He-P 816.09(a)(3), the fine for a licenses shall be $2000.00;

(11) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits statment of findings or notice to correct, or by the date of an extension as granted, in violation of He-P 816.12(c)(2) and (5), the fine for a licensee shall be $500.00;

(12) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 816.12(c)(8), the fine for a licensee shall be $1000.00;

(13) For a failure to establish, implement, or comply with licensee policies, in violation of He-P 816.14(b), (d), (w), and (x), the fine for a licensee shall be $500.00;

(14) For a failure to provide services or programs required by the licensing classification and specified by He-P 816.15(f) - (j), the fine for a licensee shall be $500.00;

(15) For exceeding the licensed capacity, if applicable, in violation of He-P 816.14(n), the fine for a licensee shall be $500.00 per day multiplied by the number of unauthorized students present;

(16) For providing false or misleading information or documentation to the department, in violation of He-P 816.14(g), the fine shall be $1000.00 per offense;

(17) For a failure to meet the needs of the student, in violation of He-P 816.14(j)(2), the fine for a licensee shall be $1000.00;

(18) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 816.15(a), (c), and (e) and He-P 816.18(h) and (i), the fine for a licensee shall be $500.00;

(19) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 816.09(a), the fine shall be $2000.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 816.07(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities as required by He-P 816.09(b)(6), the fine shall be $500, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(22) When an inspection determines that there is a violation of RSA 151 or He-P 816 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliancey is cited within 2 years of the original area of non-compliance, the fine shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

(23) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 816 shall constitute a separate violation and shall be fined in accordance with He-P 816.13(c); and

(24) If the applicant or licensee is making good faith efforts to comply with (4) or (18) above, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well being of students is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 816 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When an EHC’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the program, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years from:

(1) The date the department’s decision to revoke or deny the license became effective, if no request for an administrative hearing is requested; or

(2) The date an order is issued upholding the action of the department, if a request for an administrative hearing was made and a hearing was held.

(k) Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 816.

(l) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 816.

(m) Any violations cited for the fire code may be appealed to the state fire marshal, pursuant to RSA 151:6-a, II.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

(b) In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of students receiving services at the EHC, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21 “Patients’ Bill of Rights” are upheld.

(c) The licensee shall define, in writing, the scope and type of services to be provided at the EHC.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided at the EHC.

(e) All policies and procedures shall be reviewed annually and revised as needed.

(f) The licensee shall assess and monitor the quality of care and services it provides to students on an ongoing basis.

(g) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(h) The licensee shall not advertise or otherwise represent the EHC as having residential care or health care programs or services for which it is not licensed to provide.

(i) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(j) Licensees shall:

(1) Manage and operate the EHC;

(2) Meet the needs of the students during the hours that the students are in the care of the EHC;

(3) Initiate action to maintain the EHC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the EHC;

(5) Appoint an onsite administrator;

(6) Appoint a director of nursing;

(7) Appoint a medical director;

(8) Verify the qualifications of all personnel;

(9) Provide sufficient numbers of personnel who are present in the EHC and are qualified to meet the needs of students during all hours of operation;

(10) Provide the EHC with sufficient supplies, equipment, and lighting to ensure that the needs of students are met;

(11) Implement any POC that has been accepted or issued by the department; and

(12) Require that all personnel follow the orders of the licensed practitioner for each student and encourage the students to follow the licensed practitioner’s orders.

(k) The licensee shall consider all students to be competent and capable of making health care decisions unless the student is under 18 years of age.

(l) The licensee shall only admit or treat a student whose needs can be met by the EHC.

(m) If the licensee has a student whose needs cannot be met by the programs and services offered at the EHC, the licensee shall transfer the student to a hospital or other appropriately licensed facility.

(n) The licensee shall not occupy more beds or exceed the maximum number of students to be cared for each day as authorized by NFPA 101 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the license certificate issued by the department.

(o) If the licensee accepts a student who is known to have a disease reportable under He-P 301, or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the students, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(p) The licensee shall report all positive tuberculosis (TB) test results for personnel to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(q) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license issued in accordance with RSA 151:2;

(2) All clinical inspection reports for the last 12 months in accordance with He-P 816.09(d) and He-P 816.11(d)(1);

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of students’ rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345;

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits; and

(7) The EHC’s hours of operation.

(r) Licensees shall:

(1) Fax to 271-5574 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

a. The EHC name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of the student(s) or person(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the emergency contact or guardian, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the student’s primary care licensed practitioner was notified, if applicable;

(2) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(3) Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above to report the death of any student or the death of any student who dies within 10 days of a reportable incident;

(4) Provide the information required by (3) above in writing within 72 hours of the death of any student or the death of any student who dies within 10 days of an reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

(5) Submit any further information requested by the department.

(s) The licensee shall admit and allow any department representative to inspect the EHC and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 816, as authorized by RSA 151:6 and RSA 151:6-a.

(t) Applicants, licensees, and personnel shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 816, including allowing representatives of the department to:

(1) Enter and complete an inspection of the premises;

(2) Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

(3) Interview personnel and students of the EHC.

(u) The licensee shall, upon request, provide a student or their guardian, if applicable, with a copy of his or her student record pursuant to the provisions of RSA 151:21, X.

(v) All records required for licensing shall be legible, current, and accurate and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(w) Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of students and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to students and personnel; and

(3) Systems to prevent tampering with information pertaining to students and personnel.

(x) The licensee shall develop policies and procedures regarding the release of information contained in student records.

(y) The licensee shall provide housekeeping and maintenance services, as needed to protect students, personnel, and the public.

(z) The EHC shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

(aa) If the EHC is not on a public water supply, the water used in the EHC shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.15 Required Health Care Services

(a) The licensee shall appoint an administrator who:

(1) Has a bachelor’s degree in a health-related field, or is a registered nurse;

(2) Is responsible for the day to day operations of the EHC;

(3) Shall, directly or through delegation, notify the student’s contact person or guardian, if any, and primary care licensed practitioner in the event of any reportable incident involving the student;

(4) Shall make available and assure delivery of the following required services:

a. Counseling, including psychological services;

b. Education on communicable diseases, chemical dependency, and promotion of good health;

c. Medical follow up; and

d. Nursing assessment and intervention; and

(5) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence.

(b) The administrator described in (a) above shall be permitted to hold more than one position at the EHC if the individual meets the qualifications of the positions.

(c) The licensee shall appoint a medical director who meets one of the following qualifications:

(1) Is a physician currently licensed in the state of New Hampshire; or

(2) Is an APRN currently licensed in the state of New Hampshire.

(d) The medical director in (c) above shall:

(1) Participate in the development of and approve all policies and procedures, standing orders, and guidelines for student care;

(2) Participate as a member of the quality improvement committee;

(3) Provide medical direction and consultation to the professional staff; and

(4) Stock medications and physician’s samples as authorized by his or her practice act.

(e) The licensee shall appoint a director of nursing who:

(1) Is an RN or an APRN licensed to practice in the state of New Hampshire in accordance with RSA 326-B;

(2) Is employed full time when the academic program is in session;

(3) Shall be permitted to hold more than one position at the EHC if the individual meets the qualifications of the positions; and

(4) Shall:

a. Make available and assure delivery of nursing care and services;

b. Provide nursing direction and supervision to the direct care staff;

c. Provide coverage by a licensed nurse, except that if it is an LPN, an RN shall be available for consultation and supervision via telephone;

d. Notify the administrator in the event that there is insufficient nursing staff to meet the needs of the ECH’s students;

e. Participate in the development of the EHC’s nursing policies and guidelines; and

f. Establish a system for referrals for any services needed by the student but are not available at the EHC.

(f) The licensee shall provide nursing and direct care personnel to meet the needs of students.

(g) The licensee shall provide counseling services to meet the needs of the students, which may be provided directly by the licensee or by contract.

(h) The licensee shall provide the following:

(1) Nursing care, in accordance with (e)(4)a. above and as authorized by RSA 326, including, but not limited to:

a. Medication administration;

b. Wound care;

c. Initial and ongoing assessments of the client’s pain level, vital signs, and physical, cognitive, and behavioral status; and

d. Assessment as to how the student is adapting psychologically to their social environment if a student presents with this type of problem;

(2) Nutritional monitoring;

(3) Case management; and

(4) Referrals to community service agencies when necessary.

(i) If the EHC has licensed beds, the licensee shall have:

(1) A kitchen within the EHC if meals are prepared in the EHC; or

(2) A refrigerator and microwave oven if meals are prepared off site.

(j) In addition to (i) above, the licensee shall provide dietary services appropriate to meet the needs of students.

History

• #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.16 Student Services

(a) Prior to providing services at the EHC, the EHC shall:

(1) Provide, in writing, to the student, or guardian if applicable, the EHC’s policies on student rights and responsibilities and its complaint procedure and rules;

(2) Obtain written confirmation acknowledging receipt and understanding of the policies in (a)(1) above;

(3) Collect and record, in the student’s record, the following information:

a. Student’s name, home address, home telephone number, and date of birth;

b. Name, address, and telephone number of an emergency contact; and

c. Student’s insurance information, if applicable for billing purposes; and

(4) For students in grades K-12, confirm, by reviewing received documentation, that the student has had a physical examination prior to or within 90 days following the start of classes that includes:

a. Diagnosis, if applicable;

b. Medical history;

c Medical findings, including the presence or absence of communicable diseases;

d. Identification of all current medications;

e. Allergies;

f. Dietary needs, if applicable; and

g. A completed immunization record, as required by He-P 301.

(b) The EHC shall develop a policy, in coordination with the educational institution of which it is a part, with regard to TB testing of students from areas designated as a high risk area by the United States Centers for Disease Control and Infection (CDC), including, at a minimum, the following:

(1) The EHC shall require that any student from an area designated as a high risk area by the CDC shall have a TB test, Mantoux method, or other method approved by the CDC, prior to the start of classes; and

(2) The frequency and timeframe of required TB testing of students who travel to and return from a high risk area.

(c) Any student with a positive TB test shall be tracked as directed by the department’s bureau of disease control.

(d) If the EHC is an integrated service provider such as providing education, counseling, or dietary services in addition to nursing, and an RN is not available by telephone, radio, or pager to respond within 15 minutes, the EHC may continue to provide the integrated services if it has a written plan in place to refer students for emergency care and the integrated service providers have documented annual training to exercise the plan.

(e) Notwithstanding (d) above, an EHC may offer counseling and education services during off-hours or when it is closed due to the unavailability of an RN.

(f) When an RN has assessed a student and determined that the student needs periodic medical care, nursing observation, or monitoring, the RN shall:

(1) Document the findings of a nursing assessment, including, but not limited to, the following, as applicable:

a. Obtaining a history regarding what brought the student to the EHC;

b. An assessment of the student’s pain level;

c. The student’s vital signs;

d. The student’s physical, cognitive, and behavioral status; and

e. How the student is adapting psychologically to their social environment; and

(2) Determine if the student should remain in his or her dormitory room, be monitored at the EHC, or be admitted to the EHC if the EHC has licensed beds.

(g) When an RN has assessed a student and determined that the student requires continuous nursing observation, monitoring, and/or medical care, the RN shall:

(1) Admit the student to the EHC if the EHC has licensed beds, and maintain awake nursing personnel for as long as the student requires continuous nursing observation, monitoring, and/or medical care; or

(2) Transfer the student to a facility licensed to provide the necessary student services.

(h) For any student that is admitted to a bed in the EHC, the RN shall complete the following written documents:

(1) A nursing assessment, as specified in (f)(1) above;

(2) Daily progress notes, if applicable; and

(3) A discharge summary and discharge instructions, if applicable.

(i) In the event of a medical emergency concerning a student, the nurse in charge shall promptly notify the administrator, or his or her designee, and the medical director of the event and document all information involving the emergency and notifications in the student record.

(j) Physical or chemical restraints shall be prohibited except as allowed by RSA 151:21, IX.

(k) Immediately after the use of physical or chemical restraints, the EHC shall make the following notifications:

(1) To the student’s guardian, if any, as soon as is practicable and in no case longer than 24 hours; and

(2) To the department’s health facilities licensing unit within 48 hours by fax, at (603) 271-5574, or by electronic means.

(l) The EHC shall:

(1) Have policies and procedures on:

a. What type of physical or chemical restraint can be used;

b. When physical or chemical restraint can be used; and

c. What professional personnel may authorize the use of restraints; and

(2) Provide personnel authorized by (1)c. above with education and training on the limitations and the correct use of restraints.

(m) The use of mechanical restraints shall be prohibited.

(n) For each student accepted for care and services at the EHC, a current and accurate record shall be maintained and include, at a minimum:

(1) All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

(2) Results of any laboratory tests, X-rays or consultations performed at the EHC;

(3) All admission notes;

(4) All assessments;

(5) All care and services provided at the EHC including the:

a. Date and time of the care or service;

b. Description of the care or service;

c. Daily progress notes, if applicable;

d. Student’s response to the care and services provided; and

e. Signature and title of the person providing the care or service;

(6) All medication records required by He-P 816.17(ah);

(7) Documentation of nurse delegation, if applicable;

(8) If services are provided at the EHC by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

(9) Documentation of reportable incidents involving the student, including the information required by He-P 816.14(r); and

(10) Documentation of the refusal of a student to follow the prescribed orders of the licensed practitioner, including the date and time the licensed practitioner was notified of the refusal.

(o) Student records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets, except when being used by the EHC’s personnel.

(p) Student records and information shall be kept confidential and only provided in accordance with law.

(q) The licensee shall develop and implement written policy and procedures that specify the method by which release of information from a student’s record shall occur.

(r) Records shall be retained for a minimum of 4 years.

(s) The licensee shall arrange for storage of, and access to, student records as required by (r) above in the event the EHC ceases operation.

(t) If anyone other than a licensed provider, RN, or LPN trained in phlebotomy collects human specimens from students for laboratory testing, the EHC shall also be licensed as a collection station in accordance with He-P 817.

(u) If the EHC tests human specimens it shall be licensed as a laboratory in accordance with He-P 808, and, if in possession of a laboratory license under He-P 808, it shall not be required to have the collection station license referenced in (t) above.

(v) Not withstanding (u) above, the EHC may perform the following Clinical Laboratory Improvement Amendments (CLIA) waived tests, as per 42 CFR Part 493.15, without having a NH state laboratory or collecting station license, required by He-P 808 and He-P 817, respectively:

(1) Rapid strep testing;

(2) Urine dip-stick testing;

(3) Finger stick glucose testing;

(4) Rapid flu testing;

(5) Rapid HIV testing; and

(6) Urine pregnancy testing.

(w) The performance of CLIA moderate or high complexity testing including microscopic testing such as potassium hydroxide or wet prep analysis requires that the EHC also be licensed as a laboratory under He-P 808.

(x) The EHC shall hold the appropriate CLIA certificate to perform any laboratory tests.

History

• #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.17 Medication Services

(a) If the licensee maintains a pharmacy on the licensed premises, it shall comply with RSA 318.

(b) All procedures for managing and distributing medication(s) shall comply with all applicable federal and state laws and rules.

(c) The licensee shall develop and implement written policies and procedures governing the management and distribution of student medications provided by the EHC.

(d) The written policies and procedures shall include, but not be limited to, the following:

(1) How medication is provided to students;

(2) What type of medications students are allowed to keep on their person, including number of doses;

(3) What personnel of the educational institution, such as teachers and residential staff, are allowed to assist students with medications when not given at the EHC;

(4) What training such personnel of the educational institution who can assist students with medication will receive from EHC personnel; and

(5) How EHC personnel shall:

a. Administer medication; and

b. Facilitate medication delivery if a student self-administers off the premises of the EHC or is assisted by or has his or her medication administered by educational facility personnel, in compliance with RSA 326-B.

(e) All medications shall be administered in accordance with the orders of the licensed practitioner or other individual authorized by law.

(f) EHC nursing staff shall follow their nurse practice act when administering medications or filling pill planners for students.

(g) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the EHC;

(2) Obtain any routine medications required within 24 hours for use at the EHC;

(3) Reorder medications for use at the EHC;

(4) Receive new medication orders; and

(5) Report any observed adverse reactions to medication, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error to the student’s licensed provider and guardian, if applicable.

(h) For each prescription medication being taken by a student in grades K-12 and all other students while under the care of the EHC, the licensee shall maintain in the student’s record, one of the following:

(1) The original written order, signed by a licensed practitioner or other individual authorized by law; or

(2) A copy of the original written order, signed by a licensed practitioner or other individual authorized by law.

(i) Each prescription medication shall legibly display the following information:

(1) The student’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications; and

(5) The dated signature of the ordering practitioner.

(j) The label of all medication containers maintained in the EHC shall match the current written orders of the licensed practitioner.

(k) Pharmaceutical samples shall be:

(1) Used in accordance with the licensed practitioner’s written order;

(2) Labeled with the participant’s name by the licensed practitioner, the licensee, or their designee; and

(3) Exempt from (i)(2)-(5) above.

(l) Only a pharmacist or other licensed practitioner shall make changes to the labels on prescription medication container labels.

(m) Any change or discontinuation of prescription medications taken at the EHC shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

(n) When the licensed practitioner or other individual authorized by law changes the dose of a medication and the personnel of the EHC are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the EHC’s written procedure indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed:

a. For a maximum of 90 days from the date of the new medication order;

b. Until the medications in the marked container are exhausted; or

c. In the case of PRN medication, until the expiration date on the container, whichever occurs first.

(o) Prescription medication that is not ordered, approved or labeled for a specific student, including but not limited to pharmaceutical samples, may be kept at the EHC provided that these medications are dispensed to the student only upon the order of an authorized licensed practitioner. A signed copy of the order shall be filed in the student’s medical record within 3 business days following the order.

(p) The medication in (o) above shall be the responsibility of the medical director.

(q) Only a licensed nurse or other licensed health care professional shall take telephone orders for medications, treatments, and diets, if such action is within the scope of their practice act.

(r) Telephone orders specified in (q) above shall be:

(1) Immediately transcribed and signed by the individual receiving the order; and

(2) Counter-signed by the authorized prescriber within 30 days.

(s) All medications taken by a student at the EHC shall require written approval for its use by a licensed practitioner.

(t) The medication storage area or units shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each student's medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(u) All medication at the EHC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use, except as allowed by (o) above.

(v) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner as to prevent cross contamination.

(w) If controlled substances, as defined by RSA 318-B:1, VI, are stored in the EHC they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(x) Except as required below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, at the end date of a licensed practitioner’s orders, or if the medication becomes contaminated, whichever occurs first.

(y) If the licensee employs or contracts with a pharmacist who has been designated an agent of the NH pharmacy board, then controlled medications shall be destroyed in accordance with the pharmacy board rules Ph 707.

(z) Destruction of controlled drugs shall:

(1) Be destroyed only in accordance with state law;

(2) Be accomplished in the presence of at least 2 EHC personnel; and

(3) Be documented in the record of the student for whom the drug was prescribed.

(aa) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(ab) The department shall order a licensee to obtain the routine services of a consultant pharmacist for 12 months if medication deficiencies which present a risk to the student’s health and safety are identified during any inspection.

(ac) When a student leaves the educational institution, the student or their guardian may take any current medication(s) with them.

(ad) Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 704.07.

(ae) Medications left at the EHC upon the student leaving the educational institution, either permanently or for an extended absence, shall be destroyed and documented in the student’s record.

(af) Students shall receive their medications in accordance with the policies of the EHC developed in accordance with (c) above

(ag) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse and delegatee shall comply with the rules of medication delegation in accordance with Nur 404, as applicable, and RSA 326-B.

(ah) The licensee shall maintain a written record for each medication taken by the student at the EHC that contains the following information:

(1) Any allergies or adverse reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature and identifiable initials and job title of the person administering the medication or supervising the student taking his or her medication;

(5) For PRN medications, the reason the student required the medication and the effect of the PRN medication, if known;

(6) Documented reason for any medication refused or omitted; and

(7) Observed side effects and adverse reactions.

(ai) Personnel who are not otherwise licensed practitioners, and nurses who assist with observing a student self-administer medication, shall complete an orientation class taught by the EHC nurse which shall include the review of the policies and procedures set forth by the EHC for medication observation.

(aj) Non-prescription stock medications may be kept at the EHC.

(ak) An EHC shall use emergency drug kits only in accordance with NH pharmacy board rule, Ph 705.03, under circumstances where the EHC:

(1) Has a director of nursing who is an RN licensed in accordance with RSA 326-B;

(2) Has contractual agreements with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318; and

(3) Has the contents approved, in writing, by the licensee’s medical director.

(al) The emergency drug kit in (ak) above shall be accessed only by the licensed nurse or licensed practitioner on duty.

(am) The licensee shall develop and implement a system for reporting to the student’s primary care licensed practitioner any adverse reactions to medications, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

(an) The written documentation of the report in (am) above shall be maintained in the student’s record.

(ao) The licensee shall conduct an annual review of its policies and procedures relative to medications.

History

• #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.18 Personnel

(a) The licensee shall develop a job description for each position at the EHC containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Education and experience requirements of the position.

(b) For all applicants for employment, and for all volunteers and independent contractors who will have direct contact with participants, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

(2) Review the results of the criminal records check in (1) above in accordance with (c) below; and

(3) Verify the qualifications of all applicants prior to employment.

(c) Unless a waiver is granted in accordance with He-P 816.10 and (d) below, the licensee shall not offer employment for any position if the individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

(3) Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of students.

(d) The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of students.

(e) If the information identified in (c) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department.

(f) The department shall review the information in (c) above and notify the licensee that the individual can no longer be employed if, after investigation, it determines that the individual poses a threat to the health, safety, or well-being of a student.

(g) All personnel shall:

(1) Meet the educational and physical qualifications of the position as listed in their job description;

(2) Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department;

(3) Be licensed, registered, or certified as required by state statute;

(4) Receive an orientation within the first 3 days of work that includes:

a. The EHC’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The EHC’s policies, procedures, and guidelines;

d. The EHC’s infection control program;

e. The EHC’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

f. Mandatory reporting requirements such as those found in RSA 169-C:29; and

(5) Complete mandatory annual in-service education, which includes a review of the EHC’s:

a. Polices and procedures on student rights and responsibilities;

b. Infection control program;

c. Education program on fire and emergency procedures; and

d. Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

(h) All direct care staff shall have current certifications in adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association.

(i) Prior to having contact with students, personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the United States Centers for Disease Control and Prevention, conducted not more than 12 months prior to employment;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(j) Personnel, volunteers. or independent contractors hired by the licensee who will have direct contact with students who have a history of TB or a positive skin test shall have a symptomatology screen of a TB test.

(k) All licensees using the services of independent clinical contractors at the EHC, such as psychologists, shall ensure that these personnel have:

(1) Been oriented in accordance with (g)(4) above;

(2) Submitted results of tuberculosis testing, either Mantoux method or blood assay, conducted not more than 12 months prior to employment;

(3) Provided a copy of any license required by law; and

(4) A written agreement that describes the services that will be provided.

(l) All personnel shall follow the orders of the licensed practitioner for each student and shall encourage students to follow the practitioner’s orders.

(m) Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the EHC or the administrative office for all EHC personnel and independent clinical contractors.

(n) The personnel file required by (m) above shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data, including date of birth; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the EHC’s policy setting forth the student’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (g)(4) above and any required annual continuing education, if any;

(5) A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

(6) Documentation that the required physical examination, or health screening and, TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Copies of current CPR certifications;

(8) Documentation of annual in-service education as required by (g)(5) above;

(9) Information as to the general content and length of all continuing education or educational programs attended;

(10) For unlicensed personnel that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine the personnel member is competent to administer medications;

(11) A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a student; and

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; and

(12) Documentation of the criminal records check.

(o) An individual need not re-disclose any of the matters in (n)(11) and (12) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

(p) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

History

• #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.19 Quality Improvement

(a) The EHC shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The licensee shall determine the size and composition of the quality improvement committee based on the size of the EHC and the care and services offered.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored, which at a minimum shall include;

a. Reportable incidents;

b. Complaints, to include student, family, guardian, and staff concerns;

c. Health care needs, trends, and infection rates of students;

d. Student and staff conflicts; and

e. Medication delivery;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the licensee; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

(e) The quality improvement committee shall meet at least twice per year, once during the fall and once during the spring.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.20 Infection Control

(a) The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of students with infectious or communicable diseases or illnesses;

(4) The handling, transport and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Cause of infection;

(2) Effect of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in the EHC until they are no longer contagious.

(e) Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(f) Personnel with an open wound who work in the EHC shall cover such wound at all times by an impermeable, durable, tight fitting bandage.

(g) Personnel infected with scabies or lice/pediculosis shall not provide direct care to students until such time as they are no longer infected.

(h) If the EHC has an incident of an infectious disease reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(i) Any EHCs caring for students with infectious or communicable diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified in the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.21 Sanitation

(a) The EHC shall maintain a clean, safe, and sanitary environment throughout the EHC licensed premises.

(b) All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) The EHC shall maintain a supply of potable water available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times, and precautions such as temperature regulation shall be taken to prevent a scalding injury to the students.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, program supplies, and other cleaning materials.

(g) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(h) Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(i) Bathrooms and laundry rooms, if present, shall have non-porous floors.

(j) There shall be a designated soiled workroom that contains a sink and storage area for soiled materials and linens.

(k) If equipment or supplies need to be sterilized in order to prevent contamination, the EHC shall develop and maintain written procedures for cleaning, packaging, and sterilization that includes:

(1) Testing and documenting sterilization processes used;

(2) Documentation when supplies are outdated; and

(3) Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

(l) The sterilization system required in (k) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented.

(m) Sterile and clean supplies and equipment shall:

(1) Be stored in dust-proof, moisture-free storage areas; and

(2) Not be mixed with soiled supplies.

(n) All student bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination, but at least:

(1) For bedpans, urinals, commodes, and other student equipment as follows:

a. After each use if used by more than one student; or

b. Daily if used by only one student;

(2) For showers or tubs after each use by a different person; and

(3) For basin, fixtures, and toilets at least once a day, and more often when soiled regardless of the number of people.

(o) Any EHC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services shall notify the department of health and human services upon receipt of notice of a failed water test.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.22 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of students and personnel, including reasonable accommodations for students and personnel with mobility limitations.

(b) Equipment providing heat within an EHC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit if student(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(2) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in personnel areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Unvented fuel-fired heaters shall not be used in any EHC.

(f) Plumbing shall be sized, installed, and maintained in accordance with the provisions of the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

(g) Ventilation shall be provided throughout the entire building by means of a mechanical ventilation system or with one or more screened windows that can be opened.

(h) Screens shall be provided for doors, windows, or other openings to the outside.

(i) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (h) above.

(j) The EHC shall have a telephone to which the students have access.

(k) There shall be a reception and waiting area that includes chairs, tables, and sufficient lighting.

(l) In accordance with RSA 155:66, I, smoking shall be prohibited in the EHC.

(m) All EHCs shall have access within the EHC to a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels or a hand-drying device providing heated air, and hot and cold running water.

(n) All bathrooms doors shall have a side hinge door and not a folding or sliding door or a curtain.

(o) There shall be sufficient space and equipment for the services provided at the EHC.

(p) If the EHC does not have licensed beds it shall provide standard twin size, or larger, bed(s) in a room designated specifically for rest or sleep to accommodate each student who may require rest or sleep during the time they are present during the day.

(q) All beds shall be changed with clean linens between use by different students.

(r) The licensee shall provide students with continuous access to a device or means that will signal EHC personnel when they are in need of assistance.

(s) In addition to (m) above, EHC’s with licensed beds shall have a bathroom equipped with tub or shower facilities sufficient to meet the needs of students.

(t) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(u) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(v) Each room containing a licensed bed(s) shall:

(1) Provide at least 100 square feet per room with one bed and at least 160 square feet per room with 2 beds exclusive of space required for closets, wardrobes, and toilet room, except those licensed rooms existing on the date that this section takes effect shall provide at least 80 square feet for rooms with one bed and 140 square feet for rooms with 2 beds;

(2) Have a door that shall be of the side hinge type and not a folding door or a curtain;

(3) Have its own separate entry, which permits a student to reach the room without passing through another patient room;

(4) Have at least 3 feet of clear aisle space leading from one side of any bed to the door;

(5) Contain the following:

a. A minimum of one, but no more than 2, beds with mattresses;

b. A pillow, linens, and blankets for each bed; and

c. One bedside table and a lamp or light for each bed;

(6) Have at least one over the bed table per room;

(7) Have window blinds or curtains that provide privacy;

(8) A privacy partition, curtain, or screen between beds in semiprivate rooms; and

(9) Have natural lighting directly from outside windows of a size equivalent to or greater than 8% of the room’s gross square footage.

(w) All mattresses and new upholstered furniture or draperies shall comply with Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(x) The licensee shall be permitted to be licensed for more than one classification, but if the licensee has overnight beds for more than one licensing classification, physically separate and distinct units shall be required for each such classification and a different fire code chapter shall be enforced for each classification, as applicable.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.23 Fire Safety

(a) All EHCs shall meet the requirements of the appropriate chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(b) All EHCs that have overnight beds shall have:

(1) Smoke detectors on every level and in every sleeping room that are interconnected to the building’s fire alarm system and either hardwired, powered by the EHC’s electrical service, or AC 120 volt wireless, as approved by the state fire marshal;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC, installed on every level of the building, and which meets the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) An emergency and fire safety program shall be developed and implemented to provide for the safety of students and personnel.

(d) The EHC shall immediately notify the department by phone, fax, or electronic mail within 24 hours and in writing within 72 hours of any fire or situation, excluding a false alarm, that requires either an emergency response to the EHC or the evacuation of the licensed premises.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injuries to students or personnel or damage sustained by the EHC;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or students who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or students who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) For the use and storage of oxygen and other related gases, EHCs shall comply with NFPA 99 as adopted by the commissioner of the department of safety as Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft (6.1 m);

2. A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

(5) Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

(g) Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

(h) Evacuation drills shall be conducted monthly if the EHC has licensed beds or quarterly if it does not have beds and vary in time to include all personnel.

(i) All personnel shall participate in at least one drill quarterly.

(j) For personnel who are unable to participate in the scheduled drill described in (i) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

(k) Personnel who are unable to participate in a drill in accordance with (i) above shall participate in a drill within the next quarter.

(l) Per-diem or temporary personnel shall not be the only person on duty unless they have:

(1) Participated in at least one actual fire drill in the facility in the past year; and

(2) Participated in the facility’s orientation program pursuant to He-P 816.18(g)(5).

(m) All emergency and evacuation drills shall be documented and include the following information:

(1) The names of the personnel and students involved in the evacuation;

(2) The time, including AM or PM, date, month, and year the drill was conducted;

(3) The exits utilized;

(4) The total time necessary to evacuate the EHC;

(5) The time needed to complete the drill; and

(6) Any problems encountered and corrective actions taken to rectify problems.

History

• #9193, eff 6-26-08, EXPIRED: 6-26-16
• #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17
• #12197, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 816.24 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(7) Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

(8) Include the management of particpants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

(9) Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(f) The facility shall contact the local emergency management director annually to determine if any revisions are needed based upon current trends in emergency management, local policy changes, and hazard changes.

(g) Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

(h) The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

(i) Notwithstanding (a)-(f) above, when an EHC is a part of a larger educational institution which has a comprehensive emergency preparedness plan, the EHC may use the institution’s plan, and if so, it shall:

(1) Identify the portions of the plan that pertain to the EHC in a separate document for use by EHC personnel;

(2) Provide annual training to prepare personnel in its application as required by (g) above; and

(3) Review and update the plan as required by (h) above.

History

• #12197, eff 6-2-17

Part He-P 817 Collection Station Rules

N.H. Code Admin. R. Ann. He-P 817.01 Purpose

The purpose of this part is to set forth the licensing requirements for all collection stations pursuant to RSA 151:2, I(c).

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a collection station, except:

(a) All facilities listed in RSA 151:2, II(a)-(g);

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h);

(c) All collection stations that collect specimens from humans solely for forensic purposes, pursuant to RSA 151:2, II(h);

(d) All entities which are licensed in accordance with RSA 153-A by the New Hampshire department of safety as providers of transporting or non-transporting emergency medical care;

(e) Entities which are currently licensed under He-P 808 Laboratories and Laboratory Services Rules; and

(f) Entities which are currently licensed under He-P 806 Non-Emergency Walk-In Care Centers.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15; amd by #13214, EMERGENCY RULE, eff 6-17-21, EXPIRED: 12-14-21

N.H. Code Admin. R. Ann. He-P 817.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving clients with or without his or her informed consent.

(b) “Administrator” means the licensee or an individual appointed by the licensee who has responsibility for all aspects of the daily operations of the collection station.

(c) “Applicant” means an individual, agency, partnership, corporation, federal, state, county, or local government entity, association, or other legal entity seeking a license for the operation of a collection station pursuant to RSA 151:2, I(c).

(d) “Change of ownership” means a change in the controlling interest of an established collection station to a successor business entity.

(e) “Client” means any person admitted to or in any way receiving care, services, or both from a collection station licensed in accordance with RSA 151 and He-P 817.

(f) “Client record” means the documentation of all care and services, which includes all documentation required by RSA 151 and He-P 817 and any other applicable federal and state requirements.

(g) “Collection station” means any building, place, or mobile collection station van used for the purpose of receiving or obtaining specimens from the human body for laboratory examination.

(h) “Commissioner” means the commissioner of the NH department of health and human services, or his or her designee.

(i) “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 817, or other federal and state requirements.

(j) “Department” means the New Hampshire department of health and human services.

(k) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified deficiencies.

(l) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(m) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception or fraud.

(n) “Inspection” means the process used by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 817 or to respond to allegations of non-compliance with RSA 151 and He-P 817.

(o) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He- P 817.

(p) “Licensed premises” means the facility that comprises the physical location, including mobile collection station vans, that the department has approved for the licensee to conduct operations in accordance with its license. It does not include the private residence of a client receiving services from an agency licensed under the authority of RSA 151.

(q) “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151 and He-P 817.

(r) “Licensing classification” means the specific category of services authorized by a license.

(s) “Mobile collection station van” means a vehicle capable of traveling under its own power or being towed from site to site and which is fully equipped to meet all the requirements specified in section He-P 817.21.

(t) “Neglect” means an act or omission, which results, or could result, in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a client.

(u) “Owner” means a person or organization who has controlling interest in the collection station.

(v) “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct care or services to a client.

(w) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(x) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(y) “Qualification” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(z) “Reportable incident” means an occurrence of an error, a negative outcome, or an accident, which occurs while the client is in the care of the licensee, and has resulted in injury that requires examination or treatment by a licensed practitioner.

(aa) “Specimen” means a portion of tissue, body fluid, or material from a human body.

(ab) “Statement of findings” means a document issued by the department following an inspection or investigation identifying areas in which the licensee is not in compliance with He-P 817 or RSA 151 and which sets forth the evidence that supports the findings of noncompliance.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.04 License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a, and submit the following to the department, except that subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile collection station vans:

(1) A completed application form entitled “Application for Residential or Health Care License (Laboratories and Collecting Stations)” (10/25/2011), signed by the applicant or 2 of the corporate officers, affirming the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”

(2) A floor plan of the prospective collection station;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability company; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee, in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee, made payable to the “Treasurer of the State of New Hampshire”;

(5) A resume identifying the qualifications and copies of applicable licenses for the collection station administrator;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, including the business chapter of NFPA 101 as adopted by the department of safety, and local fire ordinances applicable for a collection station; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(7) If the collection station uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 313.01 and 314.01, or if a public water supply, a copy of a water bill; and

(8) The results of a criminal records check from the NH department of safety for the applicant, including the licensee and administrator, as applicable.

(b) The applicant shall mail or hand deliver the documents in (a) above to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be deemed to be complete when the department determines that all items required by He-P 817.04(a), or He-P 817.21 for mobile collection station vans, have been received.

(b) If an application does not contain all of the items required by He-P 817.04(a) or He-P 817.21, the department shall notify the applicant in writing of the items required to be submitted before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) The department shall deny a licensing request if, after reviewing the information in He-P 817.04(a)(8), it determines that the applicant, licensee, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(f) Following an inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 817.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable, including licenses issued for mobile collection station vans.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month in which it was issued.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 817.04(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The information required by He-P 817.04(a)(1) including current license number;

(2) The licensing fee, prescribed by RSA 151:5, IX;

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 817.10(f), if applicable;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 817.17(c); and

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03 - 6005.04.

(d) In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Ws 313.01 for bacteria and Env-Ws 314.01 for nitrates.

(e) Following an inspection as described in He-P 817.09, a license renewal shall be issued if the department determines that the licensee:

(1) Has submitted an application containing all the items required by (c) and (d) above, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if deficiencies were cited at the last licensing inspection or investigation; and

(3) The licensee is found to be in compliance with RSA 151 and He-P 817 at the renewal inspection.

(f) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 817.04.

(g) If a licensee chooses to cease the operation of the collection station, the licensee shall submit written notification to the department at least 45 days in advance.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.07 Collection Station Construction, Modifications, or Structural Alterations

(a) Architectural plans or drawings shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

(1) A new building;

(2) Additions to a building;

(3) Alterations that require approval from local or state authorities; and

(4) Modifications that might affect compliance with the health and safety, fire, or building codes, including but not limited to, fire suppression, detection systems and means of egress.

(b) Architectural sprinkler and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10, (b)IV.

(c) Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(d) The department shall review plans for construction, modifications, or structural alterations for compliance with all applicable sections of RSA 151 and He-P 817 and notify the applicant or licensee as to whether the proposed plans comply with these requirements.

(e) Department approval shall not be required prior to initiating construction, renovations, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

(f) A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

(1) The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) Local rules, regulations, and ordinances.

(g) Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(h) Exceptions or variances pertaining to the state fire code referenced in (f)(1) above shall be granted only by the state fire marshal.

(i) The completed building shall be subject to an inspection pursuant to He-P 817.09 prior to the use of the newly constructed or modified facility.

(j) He-P 817.07 shall not apply to mobile collection station vans.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.08 Collection Station Requirements for Organizational Changes

(a) The collection station shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address; or

(4) Name.

(b) When there is a change in the name, the collection station shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(c) The collection station shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership; or

(2) A change in the physical location.

(d) When there is a change in address without a change in location the collection station shall provide the department with a copy of the notification from the local, state or federal agency that requires the change.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of noncompliance was submitted and accepted by the department; or

(2) The physical location.

(f) A new license shall be issued for a change in ownership or a change in physical location.

(g) A revised license and license certificate shall be issued for changes in the collection station name.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator; or

(2) When a waiver has been granted.

(i) The collection station shall inform the department in writing as soon as practicable when there is a change in administrator and provide the department with the following:

(1) The information specified in He-P 817.04(e); and

(2) A resume identifying the name and qualifications of the new administrator.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator:

(1) Is disqualified by the information submitted in response to (i)(1) above; or

(2) Meets the qualifications for the position as specified in He-P 817.17 (h).

(k) If the department determines that the new administrator does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

(l) A restructuring of an established collection station that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(m) Licenses issued for a change in ownership shall expire on the date the license issued to the previous owner would have expired.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• INTERIM, #10830, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 817, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the collection station; and

(3) Any records required by RSA 151 and He-P 817.

(b) The department shall conduct a clinical inspection and life safety inspection, as appropriate, to determine full compliance with RSA 151 and He-P 817 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed in He-P 817.08(a)(3);

(3) A change in the licensee’s physical location, except for mobile collection station vans;

(4) The renewal of a license;

(5) The issuance of a mobile collection station van license; or

(6) Occupation of space after construction, modifications, or structural alterations.

(c) The department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) Following the inspections described in (b) and (c) above, the department shall provide the licensee with a written inspection report.

(e) A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 817.

(f) If deficiencies were cited in the inspection report described in (d) above, the licensee shall submit a written POC, in accordance with He-P 817.12(c), within 21 days of the date on the letter that transmits the inspection report.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 817 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the clients; and

(3) Does not affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew the waiver beyond the approved period of time, the licensee shall apply for a new waiver at least 60 days prior to the expiration of the existing waiver by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.11 Complaints and Investigations

(a) The department shall respond to any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 817.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address, if known, of the collection station, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 817.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant and have probative value; and

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

(d) The following shall apply for a licensed collection station:

(1) The department shall provide written notification of the results of the investigation to the licensee along with an inspection report if deficiencies were found as a result of the investigation;

(2) The department shall notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) If the department determines that the complaint is unfounded or does not violate any statutes or rules, the department shall notify the licensee in writing and take no further action; and

(4) If the investigation results in deficiencies being cited, the licensee shall be required to submit a POC in accordance with He-P 817.12(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above the department shall issue a written warning to immediately comply with RSA 151 and He-P 817; and

(4) Any person or entity who fails to comply after receiving a warning as described in (i) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 817, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below; or

(4) Imposing fines upon an unlicensed individual, applicant, or licensee in accordance with (e) below.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules;

(2) Identifies the specific remedy(s) that has been proposed; and

(3) Provides the following information:

a. The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the imposition of fines; and

b. The automatic reduction of a fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the deficiency has been corrected, or a POC has been accepted and approved by the department.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings, or a notice to correct, the licensee shall submit its POC for each item, written in the appropriate space on the notice and containing:

a. How the licensee intends to correct each deficiency;

b. What measures will be put in place, or what system changes will be made to ensure that the deficiency does not recur; and

c. The date by which each deficiency shall be corrected;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the inspection or investigation report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of clients will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 817;

b. Addresses all deficiencies and deficient practices as cited in the inspection or investigation report;

c. Prevents a new violation of RSA 151 or He-P 817 as a result of the implementation of the POC; and

d. Specifies the date upon which the deficiencies will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

2. The department determines that the health, safety, or well being of a client will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(9) below;

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date , at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 817.12(b) above; and

b. Issue a directed POC in accordance with He-P 817.12(d) and a fine in accordance with He-P 817.12(f)(10).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of noncompliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 817.13; or

(3) Revoke the license in accordance with He-P 817.13.

(f) The department shall impose fines as follows:

(1) For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine for an unlicensed individual or a licensee shall be $2000.00;

(2) For failure to cease operation after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an unlicensed individual or a licensee shall be $500.00;

(4) For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a, the fine for an unlicensed provider or a licensee shall be $500.00;

(5) For submitting a renewal application for a license less than 120 days prior to the expiration date, in violation of He-P 817.06(b), the fine for a licensee shall be $100.00;

(6) For failure to notify the department prior to a change of ownership, in violation of He-P 817.08(a), the fine for a licensee shall be $500.00;

(7) For failure to notify the department, prior to a change of physical location, in violation of He-P 817.08(c), the fine for a licensee shall be $500.00;

(8) For a failure to allow access by the department to the collection station’s premises, programs, services, or records, in violation of He-P 817.14(g)-(h), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

(9) For failure to submit a POC or a revised POC, within 21 days or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 817.12(c)(2) and (5) the fine for a licensee shall be $100.00;

(10) For a failure to implement any POC that has been accepted or issued by the department, in violation of He-P 817.12(c)(8), the fine for a licensee shall be $1000.00;

(11) For falsification of information contained on the application or of any records required to be maintained for licensing in violation of He-P 817.14(d), the fine for an applicant or licensee shall be $500.00 per offense;

(12) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 817.07(a), the fine for a licensed facility shall be $500.00;

(13) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He -P 817.17(b)(1), the fine for a licensee shall be $500.00;

(14) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 817 shall constitute a separate violation warranting additional fines in accordance with He-P 817.12;

(15) When an inspection or investigation determines that a violation of RSA 151 or He-P 817 that is subject to a fine has occurred, repeat violations or failure to correct a previously cited violation, which occurs within 2 years of the date of the original violation, the fine for a licensee shall be $2000.00; and

(16) If the applicant or licensee is making good faith efforts to comply with (4) or (13) above, the department shall not issue a daily fine.

(g) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.13 Enforcement Actions and Hearings

(a) Prior to taking action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department; and

(3) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant for an initial license is in violation of RSA 151 or He-P 817;

(2) A licensee is in violation of RSA 151 or He-P 817 which poses a risk of harm to a client’s health, safety, or well-being;

(3) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(4) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(5) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 817.04;

(6) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false information to the department;

b. Prevents or interferes with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(7) A licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 817.12(c) or (d);

(8) A licensee has submitted a POC that has been rejected by the department in accordance with He-P 817.12(c)(5) and has not submitted a revised POC as required by He-P 817.12(c)(5);

(9) The licensee is cited a third time under RSA 151 or He-P 817 for the same violation within the last 5 inspections;

(10) A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5 year prohibition period;

(11) An inspection of the applicant’s premises does not find full compliance with RSA 151 or He-P 817; or

(12) The owner(s), licensee, or administrator has been found guilty of or plead guilty to a felony assault, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department.

(c) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(d) If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

(e) The department shall order the immediate suspension of a license, and the cessation of operations, when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

(f) If the immediate suspension of a license is ordered:

(1) The licensee shall immediately cease to operate; and

(2) The department shall hold a hearing within 10 working days of the date the order was issued.

(g) If an immediate suspension is upheld at the hearing described in (f)(2) above, the licensee shall not operate until the department determines through inspection that compliance with RSA 151 and He-P 817 is achieved.

(h) Hearings and appeals of department decisions under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(i) When a collection station’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the denial or revocation pertained to their role in the collection station.

(j) The 5 year period referenced in (i) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(k) Notwithstanding (i) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 817.

(l) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 817.

(m) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with a deficiency cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(n) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(o) The department will change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide notice to the applicant or licensee of the determination.

(p) The deadline to submit a POC in accordance with He-P 817.12(c)(2) shall not apply until the notice of the determination to not make a change to the statement of findings in (o) above has been provided to the applicant or licensee.

(q) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has initiated action to suspend, revoke, deny or refuse to issue or renew a license.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(b) The licensee shall have a written policy and procedure setting forth the rights and responsibilities of clients receiving services at the facility in accordance with RSA 151:20.

(c) The licensee shall define, in writing, the scope and type of services to be provided at the collection station or mobile collection station van.

(d) The licensee shall not falsify or omit any information contained in:

(1) The “Application for Residential or Health Care License,” or any other documents required for the licensing of a collection station; or

(2) The records maintained for the clients and personnel of the collection station.

(e) The licensee shall have responsibility and authority for:

(1) Managing, controlling and operating the collection station;

(2) Developing and implementing written policies and procedures governing all of the operations and services provided, and for reviewing said policies and procedures annually and revising them as needed;

(3) Initiating action to maintain the collection station in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establishing, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the collection station;

(5) Appointing an administrator who shall be responsible for the day-to day operations of the collection station;

(6) Providing sufficient numbers of personnel who are present in the collection station and are qualified to perform the services stated in the collection station’s scope of services;

(7) Providing sufficient supplies, equipment, and lighting to ensure all services are provided in a safe and timely manner;

(8) Reporting all positive tuberculosis test (TB) results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02 and 301.03; and

(9) Implementing any POC that has been accepted or issued by the department.

(f) The licensee shall ensure that all specimen collection and storage requirements are met and only provide phlebotomy collection services:

(1) At their licensed premises, including in a licensed mobile collection station van under the oversight of the collection station;

(2) At a client’s place of residence; and

(3) At a senior center, adult day care center, or an outpatient mental health facility provided that collection occurs no more than one day per week at this location.

(g) The licensee shall post the following documents in an area of the licensed premises that is conspicuous and open to clients and the general public:

(1) The current license issued in accordance with RSA 151:2;

(2) All inspection and investigation reports issued in accordance with He-P 817.09(c) and He-P 817.11(d)(2)a. for the previous 12 months;

(3) Any notice of pending hearing or order as required by RSA 151:29, II, pertaining to the licensee issued by the department, or a court during the previous 24 months;

(4) A copy of the patients’ bill of rights specified by RSA 151:21 or RSA 151:21-b;

(5) A notice as required by RSA 151:29 stating complaints may be submitted to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

(6) The licensee’s evacuation floor plan identifying the location of, and access to, all fire exits, except that mobile collection station vans shall be exempt from this requirement.

(h) The licensee shall ensure that all personnel read and comply with the patients’ bill of rights as set forth in RSA 151:21.

(i) The licensee shall admit and allow any department representative to inspect the licensed premises and all programs and services of any licensee that is providing collection station services at any time for the purpose of determining compliance with RSA 151 and He-P 817 as authorized by RSA 151:6 and RSA 151:6-a.

(j) All records required for licensing shall be:

(1) Available to the department during any inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

(2) Legible, current, and accurate.

(k) For reportable incidents, the licensee shall:

(1) Convey by electronic or regular mail the following information to the department within 48 hours of a reportable incident as defined in He-P 817.03(z):

a. The collection station name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of client(s) involved in the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident; and

g. If medical intervention was required, by whom and the date and time; and

(2) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if these were not submitted in the initial report.

(l) Any licensee maintaining electronic records shall develop a system with written policies and procedures to protect the privacy of clients and staff that, at a minimum, include:

(1) Procedures for backing up files to prevent deletion;

(2) Safeguards to ensure the confidentiality of the information on clients and staff; and

(3) Systems to prevent the tampering of information on clients and staff.

(m) The licensee shall provide a client or their legal representative with a copy of his or her client record, pursuant to the provisions of RSA 151:21, X, upon request.

(n) The licensee shall develop written policies and procedures that will ensure that only the client and the ordering licensed practitioner are allowed to receive a copy of the laboratory tests results unless the collection station has written consent from the client to release the test results to others.

(o) Mobile collection station vans shall maintain a log on-site documenting that all on-board water used for drinking and washing was obtained from a verifiable potable source.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.15 Collection Station Standards

(a) Except as allowed by (b) below, the collection station shall collect or receive specimens only at the written or electronic request of a physician, dentist, chiropractor, court of law, or any other person authorized by state statute to order and receive laboratory tests.

(b) The collection station shall follow up with all telephone requests for the collection or receipt of specimens with a written confirmation within 30 days.

(c) At a minimum, the written or electronic test request required by (a) above, shall include:

(1) The client’s identifier;

(2) The client’s sex and age or date of birth;

(3) The specific test(s) to be performed;

(4) The name or unique identification such as an account number of the authorized person requesting the tests;

(5) The date of specimen collection;

(6) The name or other identifier such as test code number of the test requested;

(7) The time of specimen collection when required by the collection procedure; and

(8) The body source of the specimen when required by the collection procedure.

(d) At a minimum, written documentation for the collection or receipt of a specimen shall be maintained and include the following information:

(1) The unique identifier assigned to the specimen;

(2) The date of specimen receipt;

(3) The time of specimen receipt when required by the collection procedure; and

(4) Information contained on the test request as described in (c) above.

(e) At a minimum, the specimen label shall include the patient name and birth date, date and time of collection, and the initials of the person collecting the sample.

(f) The collection station shall have documentation of the specimen collection, handling, and processing requirements, from the laboratory performing the test, for all analytes collected, to include requirements pertaining to storage, temperature, transport, collection media, preservatives, centrifuge speed, light protection, and any other special collection or handling requirements of the laboratories test system.

(g) Recordings of refrigerator and freezer temperatures shall be done each day the collection station operates and shall fall within the following ranges:

(1) Refrigerator temperatures shall be between 2 and 8 degrees centigrade; and

(2) Freezer temperatures shall be colder than minus 10 degrees centigrade.

(h) Centrifuge speed, for spinning blood samples, shall:

(1) Fall between 2800 and 3500 revolutions per minute or as specified by the manufacturer and be verified by tachometer on an annual basis; and

(2) For mobile collection station vans, be verified whenever the van is moved.

(i) No expired specimen collection equipment and reagents, such as vacutainer tubes and glucola, shall be retained in the station or used for specimen collection.

(j) Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the collection station.

(k) All clinical equipment shall be:

(1) In good working order; and

(2) Serviced in accordance with manufacturers’ instructions and a written record of the service maintained by the collection station.

(l) Sharps containers shall be secured so as to prevent unauthorized access, tampering, or both.

(m) Collection stations performing waived glucose screening by glucometer tests shall:

(1) Acquire and maintain a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver, pursuant to 42 CFR 493.15;

(2) Perform quality controls each day of testing;

(3) Have a written procedure for the collection station response to a high patient glucometer reading that clearly identifies the response required, who to notify, and any other actions required by collection station personnel; and

(4) Clean the glucometer between patients with an appropriate cleaner.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.16 Client Records, Test Requisitions, and Test Reports

(a) All test requisitions and test reports shall be completed and maintained in accordance with 42 CFR § 493.

(b) Each collection station shall keep a client record which shall contain, at a minimum, the information required by He-P 817.15(c).

(c) All records, requisitions, and reports shall be safeguarded against loss, damage, tampering, and unauthorized access and retained for a minimum of 4 years.

(d) Prior to ceasing operation, the licensee shall arrange for the storage of and access to records, requisitions and reports for a minimum of 4 years.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.17 Personnel

(a) For all applicants for employment, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety; and

(2) Review the results of the criminal records check in accordance with (b) below and verify the qualifications of all applicants prior to employment.

(b) Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment for any position if the individual:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

(3) Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(c) The department shall grant a waiver of (b) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

(d) No employee shall be permitted to maintain their employment if he or she has been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or has had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department.

(e) The licensee shall check, prior to hiring, the names of all prospective employees against the department’s bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-W 720.

(f) The licensee shall not make a final offer of employment to any prospective employee listed on the BEAS state registry unless a waiver is granted by the bureau of elderly and adult services.

(g) The licensee shall develop a job description for each position in the collection station containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Education requirements of the position.

(h) The licensee shall hire an administrator who has a minimum of 2 years administrative experience in a health care facility, who has phlebotomy experience, and meets one of the following criteria:

(1) Is a licensed New Hampshire:

a. Physician;

b. Physician’s assistant;

c. Advanced practice registered nurse;

d. Dentist;

e. Optometrist;

f. Naturopath;

g. Respiratory therapist; or

h. Registered nurse;

(2) Is a medical technologist certified by a nationally recognized certification board, such as the American Society of Clinical Pathology;

(3) Is an emergency medical technician (EMT) registered by the National Registry of Emergency Medical Technicians; or

(4) Has a minimum of an associate’s degree in a life science.

(i) All personnel shall:

(1) Meet the requirements of the position as listed in the job description described in (g) above;

(2) Be licensed, registered, or certified if required by state statute;

(3) Receive an orientation within the first 7 days of work that includes:

a. The collection station’s policies on patient’s rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position;

c. The collection station’s policies, procedures, and guidelines;

d. The collection station’s infection control program;

e. The collection station’s fire and emergency plans; and

f. The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29;

(4) Submit results of a physical examination or health screening conducted not more than 12 months prior to employment, including at a minimum the following:

a. The name of the examinee;

b. The date of the examination;

c. Whether or not the examinee has a contagious illness or any other illness which would affect the examinee’s ability to perform their job duties;

d. Results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control (CDC);

e. Medications currently prescribed for the examinee which might affect the examinee’s ability to perform their job duties;

f. Evidence of current alcohol or drug abuse by the examinee, which might affect the examinee’s ability to perform their job duties;

g. Impairment of vision or hearing which might affect the examinee’s ability to perform their job duties;

h. Evidence of current mental illness or emotional disorder which affect the examinee’s ability to perform their job duties; and

i. The dated signature of the licensed health practitioner; and

(5) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious TB or has a positive TB test.

(j) All personnel shall complete annual in-service education in the collection station’s:

(1) Policies and procedures on patient’s rights and responsibilities;

(2) Infection control program;

(3) Fire and emergency procedures; and

(4) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(k) The personnel of the collection station shall consist of phlebotomists or other personnel who are instructed in the collection of specimens from the human body.

(l) The instruction required in (k) above, shall be accomplished by:

(1) A formal education program; or

(2) On the job training.

(m) All licensees using the service of independent clinical contractors shall:

(1) Provide the clinical contractors with an orientation as specified in (i)(3) above;

(2) Maintain a copy of a physical examination or health screen and TB testing, mantoux method, that was conducted no more than 12 months prior to employment for each clinical contractor;

(3) Maintain a copy of the clinical contractors’ licenses as required by (i)(2) above, if applicable; and

(4) Have a written agreement with each clinical contractor that describes the services that will be provided and agreement to comply with (1) through (3) above.

(n) Current and complete personnel files shall be maintained at the licensed premises for all personnel except as allowed by (r) below.

(o) The personnel file required by (n) above, shall include:

(1) A completed application for employment or a resume;

(2) Qualifications and work experience;

(3) A signed statement acknowledging the receipt of the licensee’s policy setting forth the clients rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

(4) A copy of the results of the criminal record check as described in (a) above;

(5) A signed statement acknowledging compliance with (p) below;

(6) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(7) Record of satisfactory completion of the orientation program required by (i)(3) above;

(8) A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

(9) Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(10) Documentation of annual in-service education as required by (j) above; and

(11) The statement(s) required by (p) below.

(p) Unless a waiver has been granted in accordance with (c) above, all personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a client; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

(q) Personnel records shall be:

(1) Maintained on an individual basis, separate and distinct from other employees and contain only information relating to the specific personnel member; and

(2) Stored in locked containers or cabinets or in a locked room on the premises.

(r) Personnel records may be stored in a central location provided that:

(1) The personnel record is available to the department at the licensed premises within 30 minutes of being requested; and

(2) The records are maintained in accordance with (o) above.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.18 Quality Assessment

The collection station or mobile collection station van shall develop and implement a quality assessment program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.19 Infection Control

(a) The collection station shall develop and implement an infection control program.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of clients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Wm 2604; and

(5) The reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through contact, fomites, or droplets shall not have contact with clients until they are no longer contagious.

(e) Only sterile equipment and containers such as needles, syringes, test tubes, and urine containers used for cultures shall be used when collecting specimens.

(f) The handling, storing, transporting, or disposing of those items specified as infectious waste in Env-Wm 2604.01 shall be done in accordance with Env-Wm 2604.

(g) There shall be no use of tobacco products, smoking, eating, drinking, or applying of cosmetics in the areas where specimen collection takes place or where specimens are processed in accordance with 29 CFR § 1910.1030.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.20 Physical Environment, Emergency and Fire Safety

(a) The collection station shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

(1) Building or mobile collection station vans, as applicable;

(2) Health;

(3) Fire; and

(4) Waste disposal.

(b) The collection station, including mobile collection station vans, shall have all entrances and exits to the licensed premises accessible at all times.

(c) The collection station shall be clean and maintained in a safe manner and good repair and kept free of hazards.

(d) All supplies shall be stored in an enclosed storage space.

(e) All corridors shall be free from obstruction.

(f) The collection station shall have:

(1) If performing venipuncture, a blood collection chair with a device to prevent client falls or a reclining chair;

(2) If performing venipuncture, a cot or an alternative method that allows a client to lie down in the event of dizziness or illness;

(3) A specimen collection area that:

a. Is separate from the reception area, except for mobile collection station vans that admit only one client at a time;

b. Contains a work counter and hand washing facilities;

c. Measures, at a minimum, 36 square feet (ft.); and

d. Maintains client confidentiality and privacy;

(4) A processing area that, at a minimum, has 6 linear ft. of counter space;

(5) A reception area that includes a desk or counter, chairs, and lighting; and

(6) Access to bathrooms that contain at least one toilet and one hand-washing sink with:

a. A supply of hot and cold running water;

b. Soap dispensers;

c. Paper towels or a hand drying device providing heated air; and

d. Non-porous floors.

(g) Sterile supplies and equipment shall not be mixed with unsterile supplies and shall be stored in dust-proof, moisture-free storage areas.

(h) All cleaning supplies shall be stored separately from client supplies.

(i) Cleaning solutions, compounds, and substances which might be considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be:

(1) Distinctly labeled and legibly marked so as to identify the contents;

(2) Stored in a place separate from food and supplies; and

(3) Kept in an enclosed section separated from other cleaning materials.

(j) Toxic materials shall not be used in a way that contaminates equipment or in any way that constitutes a hazard to personnel or other persons, or in any way other than in full compliance with the manufacturer’s labeling.

(k) The collection station shall notify the department by phone, fax, or e-mail within 24 hours and in writing within 72 hours, of any fire or situation, excluding a false alarm, which requires the evacuation of the licensed premises.

(l) The written notification under (k) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any damage;

(3) A description of events preceding and following the incident;

(4) The name of any person evacuated as a result of the incident, if applicable;

(5) The name of any personnel who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(m) A written emergency plan for fire safety and evacuation shall be adopted and posted in multiple locations throughout the collection station.

(n) The collection station shall have a fire extinguisher inspected annually by the local fire authority or a certified fire extinguisher maintenance company.

(o) If the collection station is located in a building where fire evacuation drills are required under Saf-C 6000 or any other state or local ordinance, then the collection station shall participate in those drills.

(p) If the collection station chooses to remain open during an emergency or disaster, it shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency which shall at a minimum:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to a bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources; and

g. Communications systems;

(8) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(9) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

History

• #5775, eff 1-24-94, EXPIRED: 1-24-00
• #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

N.H. Code Admin. R. Ann. He-P 817.21 Mobile Collection Station Vans

(a) Mobile collection station vans shall be eligible for licensure only if they are:

(1) Operated by a collection station or laboratory that is located in a building or other permanent structure; and

(2) The collection station or laboratory has a valid license issued by the department.

(b) Each applicant shall comply with He-P 817, except for He-P 817.07(a)-(e) and:

(1) In lieu of He-P 817.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

a. A copy of the applicant’s current collection station or laboratory license;

b. A valid New Hampshire motor vehicle registration for the mobile collection station van;

c. The VIN of the mobile collection station van; and

d. A space utilization diagram for the mobile collection station van; and

(2) Personnel, client, and facility records that are stored off site shall be available for inspection at the licensed premises upon request of licensing staff within 30 minutes of being requested.

(c) The collection station portions of the mobile collection station van shall have a non-porous floor.

(d) Detailed written documentation of travel dates, times and locations, including periods of non-use, shall be maintained for the mobile collection station van.

History

• #8853, eff 3-24-07, EXPIRED: 3-24-15
• #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

Part He-P 818 Adult Day Programs

N.H. Code Admin. R. Ann. He-P 818.01 Purpose

The purpose of this part is to set forth the licensing requirements for all adult day programs (ADPs) pursuant to RSA 151:2, I(f).

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an ADP, except:

(a) All facilities listed in RSA 151:2, II(a)-(g); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a participant;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a participant; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a participant with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

(c) “Administer” means “administer” as defined by RSA 318:1.

(d) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

(e) “Admission” means accepted by a licensee for the provision of services to a participant.

(f) “Adult Day Program (ADP)” means a program that provides one or more of the following services, for fewer than 12 hours a day, to participants 18 years of age and older:

(1) Supervision;

(2) Assistance with ADL;

(3) Nursing care;

(4) Rehabilitation;

(5) Recreational, social, cognitive, and physical stimulation; and

(6) Nutrition.

(g) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J.

(h) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ADP pursuant to RSA 151:2, I(f).

(i) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 818, or other federal or state requirements.

(j) “Assessment” means an evaluation of the participant to determine the care and services that are needed.

(k) “Care plan” means a written guide developed by the licensee, in consultation with personnel, the participant, and the participant’s guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(l) “Change of ownership” means a change in the controlling interest in an ADP to a successor business entity.

(m) “Chemical restraint” means any medication prescribed to control a participant’s behavior or emotional state without a supporting diagnosis or when used for the convenience of personnel.

(n) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(o) “Core services” means those minimal services to be provided by the licensee that are included in the basic rate.

(p) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(q) “Days” means calendar days unless otherwise specified in the rule.

(r) “Department” means the New Hampshire department of health and human services.

(s) “Direct care personnel” means any person providing hands-on care or services to a participant.

(t) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(u) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(v) “Exploitation” means the illegal use of a participant’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a participant through the use of undue influence, harassment, duress, deception, or fraud.

(w) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the participant’s health care and other personal needs.

(x) “Household member” means the caregiver, all family members, and any other individuals age 17 or older, who is not a participant, who have resided at the licensed premises for more than 30 days.

(y) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(z) “Infectious waste” means those items specified by Env-Sw 103.28.

(aa) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 818, or to respond to allegations of non-compliance with RSA 151 or He-P 818.

(ab) “License” means the document issued by the department to an applicant at the start of operation as an ADP which authorizes operation in accordance with RSA 151 and He-P 818, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

(ac) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the ADP is licensed.

(ad) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician's assistant;

(3) Licensed advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ae) “Licensed premises,” means the building, or portion(s) thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

(af) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151 and He-P 818.

(ag) “Licensing classification” means the specific category of services authorized by a license.

(ah) “Mechanical restraint” means locked, secured, or alarmed ADPs or units within an ADP, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a participant from freely exiting the ADP or unit within.

(ai) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(aj) “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a participant.

(ak) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a participant.

(al) “Orders” means written prescriptions, instructions for treatments, special diets, or therapies given by a licensed practitioner, or other professional with prescriptive powers.

(am) “Over-the-counter medications” means non-prescription medications.

(an) “Participant” means any person, over the age of 18, admitted to or in any way receiving care, services, or both, from an ADP licensed in accordance with RSA 151 and He-P 818.

(ao) “Participant record” means a separate file maintained for each person receiving care and services, which includes all documentation required by RSA 151 and He-P 818, and all documentation received relative to the participant as required by other federal and state requirements.

(ap) “Patient rights” means the privileges and responsibilities possessed by each participant provided by RSA 151:21. This term includes “participant rights.”

(aq) “Personal assistance” means providing or assisting a participant in carrying out activities of daily living.

(ar) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the participant for a specific, limited purpose, or for the general purpose of assisting a participant in the exercise of any rights.

(as) “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct or indirect care or services or both to a participant.

(at) “Physical restraint” means the use of a hands-on or other physically applied technique to physically limit the participant’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

(au) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(av) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(aw) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(ax) “Protective care” means the provision of participant monitoring services, including but not limited to:

(1) Knowledge of participant whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(ay) “Reportable incident” means an occurrence of any of the following while the participant is either in the ADP or in the care of ADP personnel:

(1) The unanticipated death of the participant;

(2) An injury to a participant, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the particpant; or

(3) The elopement or unexplained absence of a participant from the ADP.

(az) “Self administration of medication with assistance” means the participant takes his or her own medication(s) after being prompted by personnel but without requiring physical assistance from others.

(ba) “Self administration of medication without assistance” means the participant is able to take his or her own medication(s) without the assistance of personnel, including prompting.

(bb) “Self-directed medication administration” means a participant, who has a physical limitation that prohibits him or her from self administration of medication, with or without assistance, directs personnel to physically assist in the medication process which shall not include assisting with injections or filling insulin syringes.

(bc) “Senior center” means a community based entity that provides meals, recreational activities, wellness programs, transportation, or other services for seniors but provides no services that require licensure under RSA 151.

(bd) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a participant.

(be) “Significant change” means a change in a participant’s cognitive or physical capabilities that decreases his or her ability to care for himself or herself beyond an episodic event.

(bf) “Unexplained absence” means an incident involving a participant leaving the premises of the ADP without the knowledge of the ADP personnel.

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

b. For any ADP to be newly licensed on or after July 1, 2016:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any ADP to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

(2) A floor plan of the prospective ADP;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee in accordance with RSA 151:5, XX, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the name and qualifications of the ADP administrator;

(6) Copies of applicable licenses, certificates, or both, for the ADP administrator;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the day-care occupancies chapter of National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(8) If the ADP uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

(9) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and household members.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 818.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 818.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 818.13(b) if, after reviewing the information in He-P 818.19(b)-(d), it determines that the applicant, administrator, or any household member:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety or well-being of participants.

(f) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(g) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 818.

(h) If an applicant is still found not to be in compliance with RSA 151 and He-P 818 after a second onsite inspection, the application shall be denied and a new application with the applicable fee shall be required.

(i) If the applicant does not provide the items required by the written notice in (b) above within 90 days of the notice, the application shall be closed and a new application with applicable fees shall be required.

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 818.04(a)(1) at least 120 days prior to the expiration of the current license.

(c) The licensee shall submit with the renewal application:

(1) The materials required by He-P 818.04(a)(1) and (4);

(2) The current license number;

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 818.10(f), as applicable;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 818.19(e); and

(5) A statement identifying any variances applied for or granted by the state fire marshal.

(d) In addition to (c) above, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(e) Following an inspection as described in He-P 818.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) above, and (d) above as applicable, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 818 at the renewal inspection.

(f) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 818.04.

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.07 ADP Construction, Modifications, or Structural Alterations

(a) Notice and accurate architectural plans or drawings that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

(1) A new building;

(2) Additions to a building;

(3) Alterations that require approval from local or state authorities; and

(4) Modifications that might affect compliance with the health and safety, fire, or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

(b) Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

(c) Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(d) The department shall review plans for construction, modifications, or structural alterations of an ADP for compliance with all applicable sections of RSA 151 and He-P 818 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

(e) Department approval shall not be required prior to initiating construction, modifications, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

(f) The ADP shall comply with all applicable licensing regulations when doing construction, modifications, or alterations.

(g) A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

(1) The state fire code, Saf-C 6000, including but not limited to the day care chapter of NFPA 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3) Local rules, regulations, and ordinances.

(h) All ADPs newly constructed after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Adult Day Care chapter, 2014 edition, as available as noted in Appendix A.

(i) Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(j) Exceptions or variances pertaining to the state fire code referenced in (g)(1) above shall be granted only by the state fire marshal.

(k) The completed building shall be subject to an inspection pursuant to He-P 818.09 prior to its use.

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.08 ADP Requirements for Organizational Changes

(a) The ADP shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name; or

(5) Capacity.

(b) The ADP shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in the number of participants beyond what was authorized under the initial license.

(c) When there is a change in address without a change in location, the ADP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the ADP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

(2) The physical location;

(3) An increase in the number of participants; or

(4) A change in licensing classification.

(f) A new license shall be issued for a change in ownership or physical location.

(g) A revised license and license certificate shall be issued for a change in name.

(h) A license certificate shall be issued at the time of initial licensure.

(i) A revised license certificate shall be issued for any of the following:

(1) A change in administrator;

(2) An increase or decrease in the number of participants;

(3) A change in the scope of services provided;

(4) A change in address without a change in physical location; or

(5) When a waiver has been granted.

(j) The ADP shall notify the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator; and

(2) Copies of applicable licenses, certificates, or both, for the new administrator.

(k) Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 818.15(a)(1).

(l) If the department determines that the new administrator does not meet the qualifications for their position as specified in (k) above, it shall so notify the ADP in writing so that a waiver can be sought or the ADP can search for a qualified candidate.

(m) A restructuring of an established ADP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

(o) The ADP shall inform the department in writing via e-mail, fax or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(p) If a licensee chooses to cease the operation of the ADP, the licensee shall submit written notification to the department at least 30 days in advance.

History

• #5517, eff 11-25-92; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99
• #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 818, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the ADP; and

(3) Any records required by RSA 151 and He-P 818.

(b) The department shall conduct a clinical and life safety code inspection as necessary to determine full compliance with RSA 151, He-P 818, and other federal or state requirements prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 818.08(g)(1);

(3) A change in the licensee’s physical location;

(4) An increase in the number of participants beyond what was authorized under the current license;

(5) Occupation of space after construction, modifications, or structural alterations; or

(6) The renewal of a license.

(c) In addition to (b) above the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ADP is in violation of any of the provisions of He-P 818, RSA 151, or other federal or state requirements.

(e) If deficiencies were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 818.12(c) within 21 days of the date on the letter that transmits the inspection report.

(f) A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection in (b) above that the prospective premises is not in full compliance with RSA 151 and He-P 818.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 818 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and participants as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the participants; and

(3) Does not affect the quality of participant services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (c) through (e) above.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 818.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the ADP, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 818.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant;

(2) A physical inspection of the premises;

(3) Review of any records that might be relevant and have probative value; and

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

(d) For the licensed ADP, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 818.12(c) if the inspection results in areas of non-compliance being cited.

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above the department shall issue a written warning to immediately comply with RSA 151 and He-P 818; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 818, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a licensee in accordance with (k) below.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a participant will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 818;

b. Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 818 as a result of the implementation of the POC;

d. Identifies the position of the employee responsible for the corrective action; and

e. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

2. The department determines that the health, safety or wellbeing of a resident will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 818.13(c)(12);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 818.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 818.13(c)(13).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the participants and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 818.13(b); or

(3) Revoke the license in accordance with He-P 818.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or the notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to revoke, deny, or refuse to issue or renew a license.

(k) The department shall impose state monitoring under the following conditions:

(1) The department determines that repeated poor compliance on the part of the facility in areas that may impact the health, safety, or well-being of participants; or

(2) Concern that the conditions in the ADP have the potential to worsen.

History

• #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 818 which poses a risk of harm to a participant’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 818.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 818.12(c), (d), and (e);

(7) The licensee is cited a third time under RSA 151 or He-P 818 for the same violation(s) within the last 5 inspections;

(8) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (k) below;

(9) Upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 818;

(10) The department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(11) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(12) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 818.14(h), the fine for an applicant, licensee or unlicensed provider shall be $500.00;

(4) For a failure to transfer a participant whose needs exceeds the services or programs provided by the ADP, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 818.11(f), the fine shall be $500.00;

(6) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 818.06(b), the fine shall be $100.00;

(7) For a failure to notify the department prior to a change of ownership, in violation of He-P 818.08(a)(1), the fine shall be $500.00;

(8) For a failure to notify the department prior to a change in the physical location, in violation of He-P 818.08(a)(2), the fine shall be $1000.00;

(9) For a failure to notify the department of a change in e-mail address, in violation of He-P 818.08(q), the fine shall be $100.00;

(10) For a failure to allow access by the department to the ADP’s premises, programs, services or records, in violation of He-P 818.09(a), the fine for an applicant, individual, or licensee shall be $2000.00;

(11) For a failure to provide to the department any records maintained by the licensee and required by He-P 818.14(u), the fine for a licensee shall be $2000.00;

(12) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the statment of findings or notice to correct, or by the date of an extension as granted, in violation of He-P 818.12(c)(2) and (5), the fine for a licensee shall be $500.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 818.12(c)(8), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement or comply with licensee policies, in violation of He-P 818.14(d), the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified by He-P 818.14(c), the fine for a licensee shall be $500.00;

(16) For exceeding the maximum number of occupants, in violation of He-P 818.14(l), the fine for a licensee shall be $500.00;

(17) For providing false or misleading information or documentation in violation of He-P 818.14(g), the fine shall be $1000.00 per offense;

(18) For a failure to meet the needs of a participant or participants, in violation of He-P 818.14(j)(1), the fine for a licensee shall be $1000.00 per participant;

(19) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 818.15(a)(1), the fine for a licensee shall be $500.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 818.07(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities as required by He-P 818.09(b)(5), the fine shall be $500, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(22) When an inspection determines that a violation of RSA 151 or He-P 818 has the potential to jeopardize the health, safety or well-being of a participant, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00 per area of non-compliance;

(23) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 818 shall constitute a separate violation and shall be fined in accordance with He-P 818.13(c); and

(24) If the applicant or licensee is making good faith efforts to comply with (4), (5) or (19) above the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of participants is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 818 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When an ADP’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years, if the enforcement action pertained to their role in the ADP.

(k) The 5 year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 818.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) RSA 541 shall goern further appeals of department decisions under this section.

(o) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 818.

(p) Any violations cited for the fire code may be appealed to the state fire marshal, pursuant to RSA 151:6-a, II.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and He-E 720.

(b) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:20, II.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the ADP, which shall include, at a minimum, the core services listed in He-P 818.15.

(d) The licensee shall develop and implement written polices and procedures governing the operation and all services provided by the ADP.

(e) All policies and procedures shall be reviewed annually and revised as needed.

(f) The licensee shall assess and monitor the quality of care and service provided to participants on an ongoing basis.

(g) The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

(h) The licensee shall not:

(1) Advertise or otherwise represent the program as operating an ADP, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(i) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(j) Licensees shall:

(1) Meet the needs of the participants during those hours that the participants are in the care of the ADP;

(2) Initiate action to maintain the ADP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ADP;

(4) Appoint an administrator;

(5) Verify the qualifications of all personnel;

(6) Provide sufficient numbers of personnel who are present in the ADP and are qualified to meet the needs of participants during all hours of operation;

(7) Provide the ADP with sufficient supplies, equipment, and lighting to meet the needs of the participants; and

(8) Implement any POC that has been accepted or issued by the department.

(k) The licensee shall consider all participants to be competent and capable of making health care decisions unless the participant:

(1) Has a guardian appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated.

(l) The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the licensing certificate.

(m) The licensee shall not admit a participant whose needs exceed the program and services offered by the ADP.

(n) If the licensee accepts a participant who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the participants, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(o) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(p) Any licensee who admits or who has a participant with a diagnosis of dementia, Alzheimer’s disease, or a primary or secondary diagnosis of mental illness shall:

(1) Require all direct care personnel caring for the participant to be trained in the special care needs of participants with dementia, Alzheimer's disease, or mental illness; and

(2) Provide a physical environment that has a safety and security system that prevents a participant from leaving the premises without the knowledge of staff, if the participant:

a. Has wandered from the ADP in the last 60 days;

b. Has had a change in their wandering behavior as determined by the nursing assessment completed in accordance with He-P 818.16(a)(4); or

c. Is a danger to self or to others.

(q) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All clinical inspection reports issued in accordance with He-P 818.09(d) and He-P 818.11(d)(1), for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345; and

(5) The licensee’s evacuation floor plan identifying the location of and access to all fire exits.

(r) The licensee shall admit and allow any department representative to inspect the ADP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 818 as authorized by RSA 151:6 and RSA 151:6-a.

(s) Licensees shall:

(1) Fax to 271-5574 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

a. The ADP name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of participant(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the participant’s guardian or agent, if any, or personal representative was notified; and

i. The signature of the person reporting the reportable incident;

(2) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(3) Contact the department immediately by telephone, fax, or e-mail to report the death of any participant or the death of any participant who dies within 10 days of a reportable incident;

(4) Provide the information required by (3) above in writing within 72 hours of the death of any participant if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made;

(5) Immediately notify the local police department, the department, guardian, agent, or personal representative if any, when a participant has an unexplained absence after the licensee has searched the building and the grounds of the ADP; and

(6) Submit additional information if required by the department.

(t) A licensee shall, upon request, provide a participant or the participant’s guardian or agent, if any, with a copy of his or her participant record pursuant to the provisions of RSA 151:21, X.

(u) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(v) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of participants and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to participants and staff; and

(3) Systems to prevent tampering with information pertaining to participants and staff.

(w) The licensee shall develop policies and procedures regarding the release of information contained in participant records.

(x) The licensee shall provide cleaning and maintenance services, as needed to protect participants, personnel, and the public.

(y) The building housing the ADP shall comply with all state and local:

(1) Health requirements;

(2) Building ordinances;

(3) Fire ordinances; and

(4) Zoning ordinances.

(z) If the ADP is not on a public water supply, the water used in the ADP shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

(aa) The licensee shall determine whether smoking will be allowed at the ADP.

(ab) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:68 and RSA 155:69.

(ac) If the licensee holds or manages a participant’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other participants, or other household members.

(ad) At the time of admission the licensee shall give a participant and the participant’s guardian, agent, or personal representative, if applicable, a listing of all ADP’s charges and identify what care and services are included in the charge.

(ae) The charge for core services described in He-P 818.15 shall be included in the basic rate and shall not be charged separately.

(af) The licensee shall give a participant and the participant’s guardian, agent, or personal representative, if applicable, a 30-day written notice before any increase is imposed in the cost or fees for any ADP services.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.15 Required Services

Each ADP shall provide, at a minimum, the following core services and programs:

(a) Administrative services that include the appointment of a full time administrator who:

(1) Is at least 21 years of age;

(2) Has one of the following combinations of education and experience:

a. A bachelor’s degree from an accredited institution and at least 2 years of experience working in a health-related field;

b. A registered nurse (RN), licensed in New Hampshire, or a registered nurse with a multi-state compact license, with at least one year of experience working in a health related field;

c. A licensed practical nurse (LPN) with at least 2 years of experience working in a health related field; or

d. An associate’s degree from an accredited institution plus 4 years of experience in a health related field;

(3) Is responsible, directly or through delegation, for notifying the department as specified in He-P 818.14(s) of any reportable incident involving a participant(s);

(4) Shall be permitted to also hold the position of:

a. Licensed nurse, as specified in (b) below, if the person is a licensed nurse; or

b. Activities coordinator, as specified in (c) below, if the ADP is limited by its license to 6 or fewer participants per day;

(5) Designates, in writing, an alternate staff person who shall assume the responsibilities of the administrator in his or her absence; and

(6) Hires support staff necessary to assist the administrator in maintaining regulatory compliance;

(b) Nursing services that:

(1) Include the employment or contracted services of a part-time or full-time licensed nurse who:

a. Is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact;

b. Has at least one year of experience working with geriatric individuals or persons with disabilities;

c. Gives direction to the staff members that provide personal care, such as assistance with and supervision of ADLs, to the participants; and

d. Shall be directly or indirectly supervised by an RN if the person is a licensed practical nurse (LPN);

(2) Include the provision of initial and ongoing assessments of the participant’s pain level, vital signs, and physical, cognitive. and behavioral status, as well as assessments of how the participant is adapting psychologically to their social environment; and

(3) Provide the following:

a. Nursing care as authorized by RSA 326 that includes medication administration and wound care;

b. Nutritional monitoring;

c. Care management or referral to a case manager;

d. Referrals to community service agencies when necessary; and

e. Assistance with therapeutic monitoring of capillary blood glucose levels and capillary blood Prothrombin Time, International Normalized Ratio (PT-INR) testing using a Clinical Laboratory Improvement Amendments (CLIA) approved waived testing system, per 42 CFR Part 493.15. The ADP shall be exempt from licensing under He-P 808 and He-P 817 for performance of these 2 tests;

(c) Recreational activity services that include:

(1) The employment of an activities coordinator who has 2 years of experience working with geriatric individuals or persons with disabilities; and

(2) Purposeful activities designed to meet the needs and interests of participants, including but not limited to activities that are cultural, economic, emotional, intellectual, physical, social, and spiritual;

(d) Personal care services that include:

(1) Assistance with and supervision of ADLs when needed by participants; and

(2) Minimum staffing ratios, which may be met by both nursing and activities personnel, as follows:

a. When fewer than 8 participants are in attendance, at least one paid personnel member shall be present at all times;

b. When there are 8 to 16 participants in attendance, there shall be at least 2 personnel present at all times, at least one of which shall be a paid personnel member;

c. When there are more than 16 participants in attendance, there shall be a minimum of one personnel member for each additional 8 participants or part thereof; and

d. Notwithstanding a. through c. above, ratios shall be sufficient to meet the needs of all participants at all times;

(e) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the participant is at the ADP, that include:

(1) Monitoring the participants’ functioning, safety, and whereabouts;

(2) Monitoring the participants’ health status, and providing intervention, if required; and

(3) Emergency response and crisis intervention;

(f) Social services, which shall be provided by the administrator, licensed nurse, or a social worker and include:

(1) The compilation of a social history and conducting participant psychosocial assessments;

(2) The provision of emotional support to participants and families or caregivers as needed;

(3) Assistance with the participant’s adaptation to the ADP and involvement in the plan of care;

(4) Advocacy for the participant by assisting the participant to assert his or her human and civil rights; and

(5) The provision of discharge planning and assisting in participant transition to other programs or facilities; and

(g) Dietary services that include:

(1) A minimum of one meal equaling 1/3 of an adult’s recommended dietary allowances as set forth by the US Department of Agriculture’s “2015-2020 Dietary Guidelines for Americans,” available as noted in Appendix A;

(2) Diets that are in accordance with the orders of participants’ licensed practitioners;

(3) Snacks and fluids that are offered and available to the participants throughout the day so that no more than 3 hours elapses between meals and offered snacks according to a participant’s number of hours in attendance;

(4) Substitutions if a participant refuses the items offered; and

(5) Food and drink that is provided to the participants that is:

a. Safe for human consumption and free of spoilage or other contamination;

b. Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300; and

c. Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

History

• #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.16 Care Requirements

(a) At the time of admission, personnel of the ADP shall:

(1) Provide, both verbally and in writing, to the participant, guardian, agent, and personal representative, as applicable:

a. The ADP’s policies on participant rights and responsibilities;

b. The scope and type of services to be provided by the ADP;

c. The ADP’s complaint procedure and rules; and

d. Obtain written confirmation acknowledging receipt of these policies and rules;

(2) Collect and record in the participant record the following information:

a. Participant’s name, home address, home telephone number, and date of birth;

b. Name, address, and telephone number of an emergency contact;

c. Participant’s primary licensed practitioner’s name, address, and phone number;

d. Copies of any executed legal directives such as guardianship orders for health care issues under RSA 464-A, durable power of attorney, or a living will; and

e. The name of the participant’s guardian, agent, or personal representative, if any;

(3) Require the participant to have a physical examination by a licensed practitioner that has been completed no more than one year prior to admission or within 72 hours after admission and includes:

a. Diagnoses, if any;

b. The medical history;

c. Medical findings, including the presence of communicable disease;

d. Vital signs;

e. Prescribed and over-the-counter medications;

f. Allergies, if any;

g. Dietary needs, if any; and

h. Functional abilities and limitations;

(4) Have the RN, or LPN who is directly or indirectly supervised by an RN, complete a nursing assessment within 7 days of attendance to determine the level of services required by the participant;

(5) Have the administrator, licensed nurse, or activities coordinator complete a recreational assessment;

(6) Have the administrator, licensed nurse, or social worker complete a social history;

(7) Complete an emergency data sheet that, at a minimum, lists the following information:

a. The participant's full name, address, telephone number, and date of birth;

b. The name, address, and telephone number of the participant's family or the person legally responsible for the participant;

c. The participant’s diagnosis;

d. Medications administered to or by the participant at the ADP, including the last dose taken and when;

e. Any known allergies;

f. The participant's functional level and needs requirements as assessed by the ADP staff;

g. Copies of any advanced directives, guardianship, or durable powers of attorney, if applicable;

h. The participant’s health insurance information; and

i. Any other pertinent information not specified in a.-h. above; and

(8) Obtain orders from a licensed practitioner for medications, prescriptions, and diets.

(b) A written daily medication record shall be utilized for all medication taken by participants at the ADP.

(c) A care plan shall be completed within the first 30 days of attendance based upon the results of all of the participant’s assessments listed above and shall include:

(1) The date any specific problem or need was identified;

(2) A description of services to let caregivers and personnel know what problem(s) or need(s) was identified as a result of the assessments;

(3) The goals for the participant;

(4) The action or approach to be taken by the ADP to meet needs identified by the assessment(s);

(5) The party responsible for implementing the action or approach to be taken;

(6) The date the next re-evaluation is to occur; and

(7) Written documentation to verify that the participant, family, or caregiver was offered the opportunity to be involved in the development of the care plan and any revisions made thereafter.

(d) The licensed nurse and other personnel as deemed necessary by the licensed nurse shall review the care plan at least every 6 months and revise it whenever necessary.

(e) The care plan referenced in (c) above shall be:

(1) Reviewed and updated within 5 business days following the completion of each future assessment; and

(2) Made available to personnel who assist participants in the implementation of the plan.

(f) If the nursing assessment, developed in accordance with (a)(4) above, or the care plan, developed in accordance with (c) above, is completed by an LPN, the assessment and care plan shall be reviewed and co-signed by an RN or physician that is supervising the LPN prior to the implementation of the participant’s care plan.

(g) The direct care personnel of the ADP shall implement the care plan.

(h) The participant record shall contain written notes as follows:

(1) Notes on all medical, nursing, rehabilitative, or therapeutic care and services provided at the ADP shall include the:

a. Date and time that the care or services were provided;

b. Description of the care or services provided;

c. Participant’s response to the care or services provided; and

d. Signature and title of the person providing the care or service;

(2) Progress notes shall include at a minimum:

a. Care plan outcomes;

b. Changes in the participant’s physical, functional, and mental abilities;

c. Changes in behavior;

d. Summary of protective care that has been provided; and

e. Summary of assistance provided with ADLs; and

(3) Progress notes in (2) above shall be written at least every 30 days for the first 90 days and then quarterly thereafter.

(i) The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX.

(j) Immediately after the use of a physical or chemical restraint, the participant’s guardian or agent, if any, and the department shall be notified of the use of such restraints.

(k) The ADP shall:

(1) Have policies and procedures on the use of restraints in an emergency:

a. What type of restraints may be used;

b. When restraints may be used; and

c. What personnel may authorize the use of restraints, which shall be limited to the administrator, medical director, director of nursing, and other licensed personnel; and

(2) Provide personnel with education and training on the limitations and the correct use of restraints.

(l) The use of mechanical restraints shall be allowed.

(m) The participant shall be discharged, as defined under RSA 151:19, I-a, in accordance with RSA 151:26 and RSA 151:21, V.

(n) The licensee shall develop a discharge plan for each participant with the input of the participant and the guardian or agent, if any.

(o) Transfers to a medical facility for emergency medical treatment may occur without prior notification to the guardian, agent pursuant to an activated POA, or the licensed practitioner, when the participant is in need of immediate emergency care.

(p) For each participant accepted for care and services at the ADP, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by He-P 818.16(a)(1);

(2) The identification data required by He-P 818.16(a)(2);

(3) Consent and medical release forms, as applicable;

(4) The record of a physical examination as required by He-P 818.16(a)(3);

(5) All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

(6) All assessments;

(7) All care plans, including documentation that the participant or person legally responsible participated in the development of the care plan if they chose to;

(8) All written notes required by He-P 818.16(h);

(9) All daily medication records;

(10) A discharge plan as required by He-P 818.16(n);

(11) The emergency data sheet required by He-P 818.16(a)(7);

(12) Documentation of reportable incidents involving the participant, including the information required by He-P 818.14(s); and

(13) Documentation of the refusal of a participant to follow the prescribed orders of the licensed practitioner including the date and time the licensed practitioner was notified of the refusal.

(q) Participant records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the ADP’s personnel.

(r) Participant records shall be retained for a minimum of 4 years after discharge.

(s) Prior to the ADP cessation of operations, it shall arrange for the storage of and access to participant records for 4 years after the date of closure, which shall be made available to the department and past participants, their designees, or both upon request.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.17 ADP Located in Senior Centers, Nursing Homes, Assisted Living Residence –Residential Care (ALR-RC), or Supported Residential Health Care Facilities (SRHCF)

(a) In addition to complying with all other rules in He-P 818, an ADP that is physically located in a senior center, nursing home, ALR-RC, or SRHCF shall meet the following physical environment requirements:

(1) At least one room in the senior center, nursing home, ALR-RC, or SRHCF physical environment shall be designated as the licensed ADP; and

(2) The room(s) in the senior center, nursing home, ALR-RC, or SRHCF that has been designated as the licensed ADP shall:

a. Be of a size no less than 200 square feet;

b. Be used exclusively by the participants and staff of the ADP;

c. Have a designated medication storage area;

d. Have a designated storage area for medical supplies and equipment; and

e. Have a bathroom that:

1. Is handicapped accessible;

2. Contains a toilet, hand-washing sink, paper towels or hand drying blower, soap dispenser, and a shower; and

3. Is located on the same floor as the ADP.

(b) In addition to the requirements in (a) above, all ADPs located in a senior center, nursing home, ALR-SRHC, or SRHCF shall provide a recliner or a regular or twin sized bed that is designated specifically for rest or sleep and available in an area that is used exclusively for ADP participants to accommodate each participant who requires rest or sleep during the time they are present throughout the day.

(c) All beds shall be changed with clean linens between uses when used by different participants or, if using recliners, sanitized and disinfected as needed if soiled.

(d) Required services provided by an ADP that is physically located in a senior center, nursing home, ALR-SRHC, or SRHCF shall be provided by ADP personnel in the room(s) designated as the licensed ADP.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.18 Medication Services

(a) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

(b) Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the participant within 24 hours or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the ADP;

(2) Reorder medications for use at the ADP;

(3) Receive and record new medication orders; and

(4) Report any observed adverse reactions to medication, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error to the paticipant’s licensed provider and guardian, if applicable.

(d) For each prescription medication being taken by a participant, the licensee shall maintain one of the following:

(1) The original written order in the participant’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

(2) A copy of the original written order in the participant’s record, signed by a licensed practitioner or other professional with prescriptive powers.

(e) Each medication order shall display the following information:

(1) The participant’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications; and

(5) The dated signature of the ordering practitioner.

(f) The label of all medication containers maintained in the ADP shall match the current written orders of the licensed practitioner.

(g) Pharmaceutical samples shall be:

(1) Used in accordance with the licensed practitioner’s written order;

(2) Labeled with the participant’s name by the licensed practitioner, the licensee, or their designee; and

(3) Exempt from (e)(2)-(5) above.

(h) Only a pharmacist shall make changes to the labels on prescription medication container labels.

(i) Any change or discontinuation of medications taken at the ADP shall be pursuant to a written order from a licensed practitioner or other professional with prescriptive powers.

(j) When the licensed practitioner or other professional with prescriptive powers changes the dose of a medication and the personnel of the ADP are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker, that does not cover the pharmacy label, in a manner consistent with the ADP’s written procedure indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1)-(2) above shall be allowed:

a. For a maximum of 90 days from the date of the new medication order;

b. Until the medications in the marked container are exhausted; or

c. In the case of PRN medication, until the expiration date on the container, whichever occurs first.

(k) If the ADP has a medical director, either on staff or otherwise contracted, prescription medication that is not ordered, approved, or labeled for a specific participant, including but not limited to pharmaceutical samples, may be kept at the ADP.

(l) The medication in (k) above shall be the responsibility of the medical director.

(m) Only a licensed nurse or other licensed health care professional shall take telephone orders for medications, treatments, and diets, if such action is within the scope of their practice act.

(n) Telephone orders specified in (m) above shall be:

(1) Immediately transcribed and signed by the individual receiving the order; and

(2) Counter-signed by the authorized prescriber within 30 days.

(o) OTC medications shall be handled in the following manner:

(1) The licensee shall obtain written approval from the participant’s licensed practitioner annually; and

(2) OTC medication containers shall be marked, with the name of the participant using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(p) The medication storage area for medications shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each participant's medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(q) All medication taken by participants at the ADP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(r) A licensed nurse may organize participant medications for use in the participant’s home as allowed by RSA 318:42, XIV.

(s) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products does not occur.

(t) If controlled drugs, as defined by RSA 318-B:1, VI, are stored in a central storage area in the ADP, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(u) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(v) Except as required by (x) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, at the end date of a licensed practitioner’s orders, or when the medication becomes contaminated, whichever occurs first.

(w) Controlled drugs shall be destroyed only in accordance with state law.

(x) Destruction of controlled drugs under (w) above shall:

(1) Be accomplished in the presence of at least 2 people; and

(2) Be documented in the participant’s medication record for whom the drug was prescribed.

(y) Upon discharge, a participant, or the participant’s guardian or agent, may take the participant’s current medication(s) with them.

(z) Neither the licensee nor any other personnel working for the ADP shall accept money, goods, or services for free or below cost as compensation or inducement for supplying the participant’s medications.

(aa) A written order from a licensed practitioner shall be required annually for any participant who is authorized to carry and self-administer without assistance emergency medications such as nitroglycerine or inhalers.

(ab) Participants shall receive their medications in one of the following manners:

(1) Self administration of medication without assistance;

(2) Self-directed medication administration;

(3) Self administration of medication with assistance; or

(4) Administered by individuals authorized by law.

(ac) For participants who self administer medication without assistance, as defined in He-P 818.03(ba), the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the participant to self administer medications without assistance;

b. Authorizing the participant to store the medications in their possession; and

c. Identifying the medications that may be kept by the participant;

(2) Evaluate the participant every 6 months or sooner, based on a significant change in the participant, to ensure they maintain the physical and mental ability to self-administer medication without assistance;

(3) Have the participant store the medication(s) in a manner that prohibits other people from accessing the medications and in a manner that will maintain the medications at proper temperatures; and

(4) Allow the participant to fill and utilize a medication system that does not require medication to remain in the container as dispensed by the pharmacist.

(ad) The licensee shall allow the participant to self-direct medication administration, as defined in He-P 818.03(bb), if the participant:

(1) Has a physical limitation due to a diagnosis that prevents the participant from self administration of medication, with or without assistance;

(2) Receives evaluations every 6 months or sooner based on a significant change in the participant, to ensure the participant maintains the physical and mental ability to self-direct medication administration;

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from the participant’s licensed practitioner and requests the ADP to file the verification in their participant record; and

(4) Verbally directs personnel to:

a. Assist the participant with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

b. Assist the participant to apply, ingest, or instill the ordered dose of medication.

(ae) Personnel assisting with self-directed medication administration, other than those permitted by their licensing board to administer medications, shall not be permitted to assist with injections or filling insulin syringes.

(af) If a participant self-administers medication with assistance, as defined by He-P 818.03(az), personnel shall be permitted to:

(1) Remind the participant to take the correct dose of his or her medication at the correct time;

(2) Open the medication container and place the medication container within reach of the participant;

(3) Remain with the participant to observe them taking the prescribed dose and type of medication as ordered by the licensed practitioner;

(4) Record on the participant’s medication record that they have supervised the participant taking their medication; and

(5) Document in the participant record any observed or reported side effects or adverse reactions, any refusal to take medications, and any medications not taken.

(ag) If a participant self-administers medication with assistance, personnel shall not be permitted to physically handle the medication in any manner.

(ah) Medication administered by individuals authorized by law to administer medication shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B.

(ai) Personnel shall remain with the participant until the participant has taken all of the medication.

(aj) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall:

(1) Only delegate medications that are administered by mouth;

(2) Document in the individual’s personnel file the evaluation method and tools used to determine that the individual receiving the delegation of medication administration has the necessary skills to administer medication;

(3) Document in the individual’s personnel file that the individual continues to be delegated the task of administering medication, based on the nurse’s ongoing evaluation;

(4) Document in the individual’s personnel file any notice that the delegation of medication administration has been rescinded, if applicable; and

(5) Document in the participant record the:

a. Specific medication to be administered;

b. Dosage, route, and specific time that the medication is to be administered;

c. The names of personnel to whom the nurse has delegated responsibility for the administration of medications; and

d. The results of the nurse’s assessment, completed no more than 30 days prior to the delegation occurring, that determined that the participant’s condition is stable and that the participant is appropriate for receipt of medication administration via nurse delegation.

(ak) A licensed nursing assistant (LNA) may administer the following when under the direction of the licensed nurse employed by the ADP:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

(3) Medicated topical products to intact skin as ordered by the licensed practitioner.

(al) Except for those participants who self-administer medication without assistance, the licensee shall maintain a written record for each medication taken by the participant at the ADP that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers or assists the participant taking medication;

(5) For PRN medications, the reason the participant required the medication and the effect of the PRN medications; and

(6) Documented reason for any medication refusal or omission.

(am) Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a participant with self administration of medication with assistance, self-directed medication administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

(an) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, or other person who has undergone training by a licensed nurse, licensed practitioner, or pharmacist.

(ao) The medication supervision education program required by (am) above shall include:

(1) Infection control and proper hand washing techniques;

(2) The “5 rights” of medication administration which are:

a. The right participant;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. Administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as anti-hypertensives or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(ap) The administrator may accept documentation of training required by (am) above if it was previously obtained by the applicant for employment at another facility licensed under RSA 151.

(aq) Non-prescription stock medication may be kept at the ADP, but it shall be accessed and administered only by the licensed nurse or medication nurse assistant on duty.

(ar) An ADP shall use emergency drug kits only in accordance with NH pharmacy board rules, Ph 705.03, under circumstances where the ADP:

(1) Has a director of nursing who is a registered nurse licensed in accordance with RSA 326-B;

(2) Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318; and

(3) Has the contents approved in writing by the licensed medical director.

(as) The licensee shall conduct an annual review of its policies and procedures for self administration of medication without assistance, self administration of medication with assistance, and self-directed medication administration.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.19 Personnel

(a) The licensee shall develop a job description for each position in the ADP containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Education and experience requirements of the position.

(b) All applicants for a license shall obtain a criminal record check from the New Hampshire department of safety in accordance with RSA 151:2-d.

(c) For all applicants for employment, except, pursuant to RSA 151:2-d, VI, those licensed by the New Hampshire board of nursing, for all volunteers and independent contractors who will have direct contact with participants, and for all household members, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety;

(2) Review the results of the criminal records check in accordance with (d) below; and

(3) Verify the qualifications of all applicants prior to employment.

(d) Unless a waiver is granted in accordance with (e) below, the licensee shall not offer employment for any position or allow a household member to continue to reside in the ADP if the individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

(3) Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of participants.

(e) The department shall grant a waiver of (d) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of participants.

(f) If the information identified in (d) above is learned after the person is hired or after an individual becomes a household member, the licensee shall immediately notify the department.

(g) The department shall review the information in (d) above and notify the licensee that the individual can no longer be employed or, if a household member, can no longer reside at the premises if, after investigation, it determines that the individual poses a threat to the health, safety, or well-being of a participant.

(h) The licensee shall check the names of the following people against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-W 720, and against the NH board of nursing, nursing assistant registry, maintained pursuant RSA 326-B:26 and 42 CFR 483.156:

(1) All household members;

(2) All volunteers and independent contractors prior to having any direct contact with participants; and

(3) All prospective employees, prior to hiring.

(i) The licensee shall not permit any volunteer or independent contractor to have direct contact with participants or make a final offer of employment to any prospective employee listed on the BEAS state registry or the NH board of nursing, nursing assistant registry unless a waiver is granted by BEAS or the NH board of nursing, respectively.

(j) All personnel including volunteers and independent contractors shall:

(1) Meet the requirements of the position as listed in the job description described in (a) above, as applicable;

(2) Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department;

(3) Be licensed, registered, or certified as required by state statute;

(4) Be at least 18 years of age if working as direct care personnel unless they are:

a. A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

b. Involved in an established educational program working under the supervision of a nurse; and

(5) Receive an orientation within the first 3 days of work including:

a. The ADP’s policies on participant rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The ADP’s policies, procedures, and guidelines;

d. The ADP’s infection control program;

e. The ADP’s fire and emergency plans; and

f. Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

(k) All personnel shall complete annual continuing education, including a review of the ADP’s:

(1) Policies and procedures relative to participant rights and complaint procedures as required by RSA 151:20;

(2) Infection control program;

(3) Education program on fire and emergency procedures; and

(4) Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

(l) There shall be at least one personnel member on duty who has current certification in adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association whenever the ADP is in operation.

(m) Prior to having contact with participants or food, personnel, including volunteers and independent contractors, shall:

(1) Submit to the licensee the results of a physical examination or a health screening and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(n) In lieu of (m)(1) above, independent contractors hired by the ADP may provide the ADP with a signed statement that they have complied with (m)(1) and (3) above for their employees working at the ADP.

(o) All licensees using the services of independent clinical contractors, such as a podiatrist, shall:

(1) Have a written agreement with each clinical contractor that describes the services that will be provided; and

(2) Maintain a copy of the clinical contractors’ licenses as required by (j)(3) above if applicable.

(p) All personnel shall follow the orders of the licensed practitioner for each participant and encourage participants to follow the practitioner’s orders.

(q) Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the licensed ADP premises for all personnel of the ADP.

(r) The personnel file required by (q) above shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data, including date of birth; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the ADP’s policy setting forth the participant rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (j)(5) above;

(5) A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

(6) Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Copies of current CPR certifications;

(8) Information as to the general content and length of all continuing education or educational programs attended;

(9) Documentation of annual continuing education as required by (k) above;

(10) A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation;

c. Have not been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect or exploitation of any person; and

d. Do not otherwise pose a threat to the health, safety or well-being of participants; and

(11) Documentation of the criminal records check.

(s) An individual need not re-disclose any of the matters in (r)(10) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

(t) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

History

• #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.20 Quality Improvement

(a) The ADP shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The licensee shall determine the size and composition of the quality improvement committee based on the size of the ADP and the care and services offered.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored, which at a minimum shall include;

a. Reportable incidents;

b. Complaints, to include resident, family, guardian, and staff concerns;

c. Falls;

d. Participant and staff conflicts; and

e. Medication delivery;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the ADP; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

(e) If the ADP utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review, including:

(1) The participant average daily census;

(2) The number of unlicensed personnel administering medications via nurse delegation;

(3) Categories of medications administered;

(4) Route of administration; and

(5) Any incidents or medication errors and actions taken.

(f) The quality improvement committee shall meet at least quarterly.

(g) The quality improvement committee shall generate dated, written minutes after each meeting.

(h) Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.21 Infection Control

(a) The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of participants with infectious or contagious diseases or illnesses who can safely participate in the program;

(4) The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 103.28; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Cause of infection;

(2) Effect of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, saliva, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to participants or work in food services until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the individual is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(h) In accordance with RSA 151:9-b, the licensee shall:

(1) Arrange for or provide all consenting participants an immunization for influenza and pneumococcal disease;

(2) Arrange for or provide all consenting personnel an immunization for influenza; and

(3) Report immunization data to the department’s division of public health services, bureau of infectious disease control as required by RSA 151:9-b, III.

(i) If the ADP has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.22 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed ADP premises.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the participants.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All participant bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and program supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

(l) Trash receptacles in food service area shall be covered at all time.

(m) If the ADP provides laundry services, the following requirements shall be met:

(1) The laundry room shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

(p) Any ADP that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services, shall notify the department upon receipt of notice of a failed water test.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.23 Physical Environment

(a) The licensed premises shall be maintained so as to provide for the health, safety, well-being, and comfort of participants and personnel, including reasonable accommodations for participants and personnel with mobility limitations.

(b) Equipment providing heat within an ADP including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature of at least 70 degrees Fahrenheit during the day if participant(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(c) Electric heating systems shall be exempt from (b)(2) above.

(d) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(e) Unvented fuel-fired heaters shall not be used in any ADP.

(f) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

(g) Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

(h) Screens shall be provided for doors, windows, or other openings to the outside.

(i) Doors that are self-closing and remain closed when not in use are exempt from the requirement in (h) above.

(j) Lighting shall be available to allow participants to partake in activities such as reading, needlework, or handicrafts.

(k) The ADP shall have dining facilities to accommodate each participant.

(l) The ADP shall have a telephone to which the participants have access.

(m) All ADPs shall have at least one toilet and one hand sink and as many additional toilets and sinks as are necessary to meet the needs of the participants in the program.

(n) Each bathroom shall be equipped with:

(1) Soap dispensers;

(2) Paper towels or a hand-drying device providing heated air;

(3) Hot and cold running water; and

(4) Grab bars next to toilets.

(o) All showers and tubs shall have grab bars and slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(p) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(q) All ADPs newly licensed after 3/18/2008 shall have at least one shower or bathing facility and as many additional showers or bathing facilities as are necessary to meet the needs of the participants in the program.

(r) There shall be sufficient space and equipment for the services provided at the ADP, as follows:

(1) Furniture to allow for each participant to sit comfortably as necessary throughout the day;

(2) Tables and chairs to assure that each participant has a seat at a table for each meal or snack and for doing activities such as crafts or puzzles; and

(3) Supplies such as plates, cups, glasses, silverware, liquid soap for hand washing, toilet tissue, and paper towels in a supply to accommodate the number of participants authorized by the license.

(s) In addition to the requirements in (r) above, all ADPs shall provide a recliner, cot, or bed available in an area designated specifically for rest or sleep to accommodate each participant who requires rest or sleep during the time they are present throughout the day.

(t) All cots or beds shall be changed with clean linens between uses when used by different participants or, if using recliners, sanitized and disinfected as needed if soiled.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.24 Fire Safety

(a) All ADPs shall meet the requirements of the day care chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(b) All ADPs shall have:

(1) Smoke detectors on every level that are interconnected and either hardwired, powered by the ADP’s electrical service, or wireless, as approved by the state fire marshal;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC, installed on every level of the building, and which meets the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

(3) A carbon monoxide monitor on every level.

(c) An emergency and fire safety program shall be developed and implemented to provide for the safety of participants and personnel.

(d) Immediately following any fire or emergency situation, licensees shall notify the department by phone and follow-up with written notification within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) EMS transport related to known pre-existing conditions.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injuries to participants or personnel or damage sustained by the ADP;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or participants who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or participants who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) All freestanding tanks of compressed gases shall be firmly secured to the adjacent wall or secured in a stand or rack.

(g) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(h) Pursuant to RSA 155:68 and 69, if the licensee has chosen to allow smoking, a designated smoking area shall be provided which, at a minimum:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non-combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64–77, the Indoor Smoking Act.

(i) Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

(j) Evacuation drills shall be conducted monthly and vary in time to include all personnel.

(k) All personnel shall participate in at least one drill quarterly.

(l) For personnel who are unable to participate in the scheduled drill described in (k) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

(m) Personnel who are unable to participate in a drill in accordance with (j) and (k) above shall participate in a drill within the next quarter.

(n) Per-diem or temporary personnel shall not be the only person on duty unless they have:

(1) Participated in at least 2 actual fire drills in the facility in the past year; and

(2) Participated in the facility’s orientation program pursuant to He-P 818.19(j)(4).

(o) All emergency and evacuation drills shall be documented and include the following information:

(1) The names of the personnel and participants involved in the evacuation;

(2) The time, date, month, and year the drill was conducted;

(3) The exits utilized if the ADP does not comply with the health care chapter of the state fire code;

(4) The total time necessary to evacuate the ADP, if required;

(5) The time needed to complete the drill; and

(6) Any problems encountered and corrective actions taken to rectify problems.

History

• #9106, eff 3-18-08, EXPIRED: 3-18-16
• #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17
• #12198, eff 6-2-17

N.H. Code Admin. R. Ann. He-P 818.25 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members;

(3) How the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(7) Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

(8) Include the management of particpants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

(9) Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

(f) The facility shall contact the local emergency management director annually to determine if any revisions are needed based upon current trends in emergency management, local policy changes, and hazard changes.

(g) Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

(h) The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

(i) Notwithstanding (a)-(f) above, when an ADP is a part of a larger institution which has a comprehensive emergency preparedness plan, the ADP may use the institution’s plan, and if so, it shall:

(1) Identify the portions of the plan that pertain to the ADP in a separate document for use by ADP personnel;

(2) Provide annual training to prepare personnel in its application as required by (g) above; and

(3) Review and update the plan as required by (h) above.

History

• #12198, eff 6-2-17

Part He-P 819 Case Management Agencies

N.H. Code Admin. R. Ann. He-P 819.01 Purpose

The purpose of this part is to set forth the licensing requirements for all case management agencies (CMA) pursuant to RSA 151:2, I(b).

History

• #5633, eff 5-27-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.02 Scope

This part shall apply to any agency, partnership, corporation, government entity, association, or other legal entity providing case management services in a client’s place of residence and operating as a case management agency, except:

(a) All facilities listed in RSA 151:2, II(a)-(i);

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i);

(c) All licensed healthcare entities, whether residential or non-residential, where case management is a component of the services provided, to include but not limited to hospitals, nursing homes, home health agencies, assisted living facilities, residential rehabilitation, residential psychiatric treatment, substance use disorder residential facilities, non-emergency walk-in care centers, ambulatory surgical centers, end stage renal dialysis centers, community residences, adult day care centers, and hospice care;

(d) Community mental health programs approved in accordance with He-M 403, where case management is a component of the services provided; and

(e) Area agencies designated in accordance with He-M 505, where case management is a component of the services provided.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving clients without their informed consent.

(b) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the CMA.

(c) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker as identified under RSA 137-J:35.

(d) “Applicant” means an, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a CMA pursuant to RSA 151.

(e) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 819, or any other federal or state requirements.

(f) “Assessment” means an evaluation of the client to determine the care and services that are needed.

(g) “Branch office” means a location physically separate from the primary location that provides client services under the administration and supervision of the primary location of the CMA.

(h) “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the client, and the client’s guardian, agent, or personal representative, as a result of the assessment process for the provision of care and services as required by He-P 819.15(b)(2).

(i) “Case management agency (CMA)” means an organization in consultation with the client in the client’s place of residence, arranges for and coordinates the delivery of care and services to meet the physical, emotional, medical, nursing, financial, legal, and social services needs of the client.

(j) “Case manager” means a person who provides case management services for an eligible individual and who is responsible for the ongoing assessment, coordination and monitoring of services to a client and is employed by a case management agency.

(k) “Case management supervision” means the provision of professional oversight and guidance of case manager performance by:

(1) Monitoring and oversight of case manager interactions and courses of action with the individuals for whom the case manager provides case management services;

(2) Monitoring and oversight of a case manager’s service implementation activities including a review of all complex clients at least once per quarter;

(3) Written evaluation of a case manager’s performance at least annually;

(4) Identifying corrective action to improve a case manager’s performance; and

(5) Teaching and training case managers to enhance quality of case management service delivery as well as providing current choices for independence (CFI) program information.

(l) “Change of ownership” means the transfer in the controlling interest of an established CMA to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(m) “Client” means any person admitted to or in any way receiving services from a CMA licensed in accordance with RSA 151 and He-P 819.

(n) “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

(o) “Client record” means a separate file maintained for each client, which includes all documentation required by RSA 151, He-P 819, and any other federal and state law.

(p) “Commissioner” means the commissioner of the New Hampshire department of health and human services or their designee.

(q) “Community residence” means a facility of 4 or more individuals that is both certified by the department under RSA 126-A and licensed by the department under RSA 151, and that is operating in accordance with He-M 1001 or He-M 1002.

(r) “Days” means calendar days unless otherwise specified in the rule.

(s) “Department” means the New Hampshire department of health and human services.

(t) “Direct care” means the provision of hands-on care or services to a client.

(u) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee shall take to correct identified deficiencies.

(v) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(w) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 819.

(x) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, or fraud.

(y) “Facility” means “facility” as defined in RSA 151:19, II.

(z) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and other personal needs.

(aa) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 819 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 819.

(ab) “License” means the document issued to an applicant or licensee of an CMA which authorizes operation in accordance with RSA 151 and He-P 819, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

(ac) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized that the CMA is licensed for.

(ad) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ae) “Licensed premises” means the building that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices but does not include the private residences of a client receiving services from a CMA.

(af) “Licensing classification” means the specific category of services authorized by a license.

(ag) “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the mental, emotional or physical health and safety of a client.

(ah) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(ai) “Personal representative” means a person designated in accordance with RSA 151:19 to assist the client for a specific, limited purpose or for the general purpose of assisting a client in the exercise of any rights.

(aj) “Personnel” means individual(s) who provide case management services to a client.

(ak) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(al) “Primary location” means the principle site for the CMA where the business office and administrative staff are located.

(am) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(an) “Psychosocial history” means information about an individual’s past and present functioning in the areas of:

(1) Physical health and capabilities;

(2) Psychological health including emotional and coping abilities;

(3) Social environment, including interactive skills, activities, and supports;

(4) Decision making abilities;

(5) Social and family interactions;

(6) Employment and financial management;

(7) Financial considerations;

(8) Vocational interests and activities, including spiritual preferences; and

(9) Other areas of significance, including, but not limited to, substance abuse or misuse, and involvement with the behavioral health care system, the developmental disability system, or the legal system.

(ao) “Reportable incident” means an occurrence of any of the following while the client is either in the CMA or in the care of CMA personnel:

(1) The unanticipated death of the client; or

(2) An injury to a client that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client.

(ap) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

(aq) “State Fire Code” means “New Hampshire Fire Code” or “state fire code” as defined in RSA 153:1, VI-a, namely, “the adoption by reference of the Life Safety Code NFPA 101 and the Uniform Fire Code NFPA 1, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5. The provisions of any other national code, model code, or standard referred to within a code listed in this definition shall be included in the state fire code unless amended in accordance with RSA 153:5.”

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.04 Residential Care and Health Facility Rules

Initial License Application Requirements.

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III (a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (February 2023), signed by the applicant or 2 of the corporate officers affirming the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

(2) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability company; or

c. “Certificate of Trade Name,” where applicable;

(3) The applicable fee, in accordance with RSA 151:5, XXII payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(4) A resume identifying the qualifications of the CMA administrator;

(5) Copies of applicable licenses for the CMA administrator;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code and local fire ordinances; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of application based on the local official’s review of the building plans and again upon completion of the construction project; and

(7) For the applicant(s), licensee, and administrator, the results of a criminal records check. Results shall include criminal history from the state of New Hampshire.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Bureau of Licensing and Certification

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 819.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 819.04, the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 819.13(b) if it determines that the applicant, licensee, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(f) Following an inspection, as described in He-P 819.09, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 819.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) written notification of denial, pursuant to He-P 819.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 819.05(f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 819, or any applicable federal, state, or local law, regulation, or code.

(i) A written notification of denial, pursuant to He-P 819.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 819.04(a)(1) at least 120 days prior to the expiration of the current license and shall include the following:

(1) The materials required by He-P 819.04(a)(1), and (3);

(2) The current license number;

(3) A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 819.10(f), if applicable;

(4) A list of any current employees for which a waiver was previously granted according to He-P 819.17(c); and

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with the state fire code.

(c) Following an inspection, as described in He-P 819.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

(2) Submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 819 at the renewal inspection.

(d) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 819.04 be subject to a fine in accordance with He-P 819.13(c)(5).

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.07 Branch Offices

(a) CMAs may establish branch offices.

(b) The CMA shall notify the department in writing prior to operating at an additional location(s).

(c) The CMA shall submit to the department the information required by He-P 819.04(a)(5) for branch offices.

(d) Upon receipt of the information required by (b) and (c) above, the department shall issue a revised annual license certificate to reflect the addition of the branch offices provided the additions do not violate RSA 151 or He-P 819.

(e) All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.08 CMA Requirements for Organizational Changes

(a) The CMA shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Primary physical location of the licensed premises;

(3) Address;

(4) Branch locations;

(5) Name; or

(6) Services.

(b) If there is a name change, the CMA shall submit to the department, a copy of the certificate or amendment from the New Hampshire secretary of state, if applicable.

(c) The CMA shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

(1) A change in ownership; or

(2) A change in the physical location.

(d) When there is a change in address without a change in location, the CMA shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(e) When there is a change in address due to a physical location change, the CMA shall provide the department with:

(1) A letter which contains the license number, new address, and date of the move; and

(2) Local approval form as specified in He-P 819.04(a)(6).

(f) An inspection by the department shall be conducted prior to operation when there is a change in the following:

(1) The ownership, unless the current licensee is in full compliance, then an inspection shall be conducted as soon as practical by the department; or

(2) A change in services.

(g) A new license shall be issued for a change in ownership or a change in physical location.

(h) A revised license and license certificate shall be issued for a change in name.

(i) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) When a waiver has been granted;

(3) A change in the scope of services; or

(4) When a branch office has been added.

(j) The CMA shall inform the department in writing no later than 5 days prior to a change of administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring a change of administrator, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) Copies of applicable licenses for the new administrator;

(3) The results of a criminal records check for the new administrator. Results shall include criminal history from the state of New Hampshire;

(4) The results of a bureau and elderly adult services registry check; and

(5) A signed attestation per He-P 819.17(j)(8)a-d.

(k) Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as outlined in He-P 819.15(a).

(l) If the department determines that the new administrator does not meet the qualifications of the position, as specified in He-P 819.15(a) it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(m) A restructuring of an established CMA that does not result in a transfer of the controlling interest of the CMA, but which might result in a change in the name of the CMA, shall not constitute a change in ownership and a new license shall not be required.

(n) The CMA shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable but in no case later than 10 days after the change. The CMA’s email address shall be the primary method of correspondence used for all emergency notifications to the CMA.

(o) If a licensee chooses to cease the operation of a CMA, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 819, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the CMA; and

(3) Any records required by RSA 151 and He-P 819.

(b) The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 819 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 819.08(g)(1);

(3) The renewal of a license; or

(4) The verification of the implementation of any POC accepted or issued by the department as part of an annual or follow-up inspection.

(c) A statement of findings for inspections shall be issued when, as a result of any inspection, the department determines that the CMA is in violation of any of the provisions in He-P 819, RSA 151, or any other federal or state requirement.

(d) If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 819.12(c), within 21 days of the date of the letter that transmitted the inspection report.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 819 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought; and

(4) The period of time for which the waiver is sought if less than permanent.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the clients; and

(3) Does not affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.11 Complaints

(a) The department shall investigate complaints that meet the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 819.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the CMA, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 819.

(c) Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including:

(1) Requests for additional information from the complainant or the licensee;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For the licensed CMA, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation; and

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate; and

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 819, or does not violate any statutes, rules, or regulations; and

(4) Require the licensee to submit a POC in accordance with He-P 819.12(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

(3) If the response described in (e)(2) is not received within 7 days from the date of receipt of

the notice described in (e)(1) and in accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 819;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the CMA; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 819.13.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 819 or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area of non-compliance; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings, the licensee shall submit a written POC which shall contain the following:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area(s) of non-compliance does not recur; to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 819;

b. Addresses all areas of non-compliance as cited in the statement of findings;

c. Prevents a new violation of RSA 151 or He-P 819 as a result of the implementation of the POC; and

d. Specifies the date upon which the deficiencies shall be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, either verbally or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

(8) If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 819.13;

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an on-site follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 819.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 819.13.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 819.13; or

(3) Revoke the license in accordance with He-P 819.13(b)(6).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department in a statement of findings, provided that the applicant or licensee submits a written request for informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with He-P 819.12(c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Informal dispute resolution shall not be available to any applicant or licensee against whom the department has imposed an administrative fine or initiated an action to revoke, deny, or refuse to issue or renew a license.

(k) The department shall impose state monitoring if repeated non-compliance on the part of the agency occurs in areas that negatively impact the health, safety, or well-being of clients.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of a fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area(s) of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated RSA 151 or He-P 819, in a manner that posed a risk of harm to a client’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of, and given an opportunity to supply missing information, or schedule an initial inspection an applicant or licensee fails to submit an application that meets the requirements of He-P 819.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 819.12(c), (d) and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 819.12(c)(5) and has not submitted a revised POC as required by He-P 819.12(c)(5);

(8) The licensee is cited a third time under RSA 151 or He-P 819 for the same violation(s) within the last 5 inspections;

(9) A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (i) and (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 819;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of, or plead guilty to, felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or has had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant or licensee has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

(1) For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, licensee, or unlicensed entity shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 819.11(e)(4), the fine for an unlicensed entity or licensee shall be $500.00;

(5) For failure to submit a renewal application for a license prior to its expiration date, in violation of He-P 819.06(d), the fine shall be $100.00;

(6) For failure to notify the department prior to a change of ownership, in violation of He-P 819.08(a)(1), the fine shall be $500.00;

(7) For failure to notify the department prior to a change in the physical location, in violation of He-P 819.08(a)(2), the fine shall be $1000.00;

(8) For failure to notify the department of a change in e-mail address, in violation of He-P 819.08(o), the fine shall be $100.00;

(9) For failure to allow the department access to the CMA’s premises, programs, services, or records, in violation of He-P 819.09(a), the fine for an applicant, licensee , or unlicensed entity shall be $2000.00;

(10) For failure to submit a POC within 21 days of the date on the letter that transmits the inspection report or a revised POC within 14 days of the date of a granted extension, in violation of He-P 819.12(c)(2) or He-P 819.12(c)(5), the fine for a licensee shall be $500;

(11) For failure to implement or maintain the corrective action set forth in any POC or revised POC that has been accepted or issued by the department, in violation of He-P 819.12(c)(8), the fine for a licensee shall be $1000.00;

(12) For failure to establish, implement, or comply with licensee policies, as required by He-P 819.14 (e), the fine for a licensee shall be $500.00;

(13) For providing false or misleading information or documentation to the department, in violation of He-P 819.14(g), the fine shall be $1000.00 per offense;

(14) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver, in violation of He-P 819.15(a) or He-P 819.17(g), the fine for a licensee shall be $500.00;

(15) When an inspection determines that a violation of RSA 151 or He-P 819 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same areas of non-compliance is cited within 2 years of the original areas of non-compliance the fine for a licensee shall be $1000; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

(16) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 819 shall constitute a separate violation and shall be fined in accordance with He-P 819.13(f); and

(17) If the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 819 as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment to the department of any imposed fine(s) shall meet the following requirements:

(1) Payment shall be made in the form of check or money order, made payable to the “Treasurer, State of New Hampshire”, or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 819 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) RSA 541 shall govern further appeals of department decisions under this section.

(k) When a CMA’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the enforcement action pertained to their role in the CMA.

(l) The 5 year period referenced in (k) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no request for a hearing is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(m) Notwithstanding (l) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and

He-P 819.

(n) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(o) No ongoing enforcement action shall preclude the imposition of any other remedy available to the department under RSA 151, RSA 541-A, or He-P 819.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.14 Duties and Responsibilities of All Licensees

(a) The CMA shall not provide direct care to any client unless it is also:

(1) Certified by the department as an other qualified agency in accordance with RSA 161-H and He-E 601; or

(2) Licensed by the department as a home care service provider or a home health care provider in accordance with RSA 151 and He-P 822 or He-P 809, respectively.

(b) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable.

(c) The licensee shall comply with the home care clients’ bill of rights as set forth in RSA 151:21-b.

(d) The licensee shall define, in writing, the scope and type of services to be provided by the CMA.

(e) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the CMA to include but not limited to:

(1) Complaint policy;

(2) Documentation and records management;

(3) Release of information;

(4) Case management supervision protocol;

(5) Evaluation, training, and competency of personnel;

(6) Case management practice and services; and

(7) Quality improvement program, as required by He-P 819.18.

(f) All policies and procedures shall be reviewed annually and revised as needed.

(g) The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

(h) The licensee shall not:

(1) Advertise or otherwise represent the program as operating a CMA, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(i) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(j) Licensees shall:

(1) Initiate action to maintain the CMA in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(2) Appoint an administrator; and

(3) Implement any POC that has been accepted or issued by the department.

(k) The licensee shall consider all clients competent and capable of making health care decisions unless the client:

(1) Has a guardian appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated.

(l) A licensee shall provide a client or their guardian, agent, or personal representative with a copy of their client record pursuant to the provisions of RSA 151:21-b, II(i), upon request.

(m) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(n) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

(3) Systems to prevent tampering with information pertaining to clients and staff.

(o) Client records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the CMA’s personnel.

(p) Client records shall be retained for a minimum of 4 years after discharge.

(q) Prior to the CMA ceasing operation, it shall arrange for the storage of and access to client records for 4 years after the date of closure, which shall be made available to the department and past clients upon request.

(r) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 819.09(b) and He-P 819.11(c), for the previous 12 months;

(3) A copy of the home care clients’ bill of rights specified by RSA 151:21-b;

(4) A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the CMA’s website if available;

(5) A copy of the licensee’s policies and procedures relative to the implementation of client rights and responsibilities;

(6) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to:

Department of Health and Human Services

Bureau of Licensing and Certification

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 603-271-9039; and

(7) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

(s) The licensee shall admit and allow any department representative to inspect the CMA and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 819 as authorized by RSA 151:6 and RSA 151:6-a.

(t) At the time of admission, the licensee shall give a client and their guardian, agent, or personal representative, if applicable, a listing of all CMA’s charges and identify what services are included in the charge.

(u) The licensee shall give a client a written notice before any increase is imposed in the cost or fees for any CMA services.

(v) In the event of an emergency, the CMA shall inform local emergency officials of clients in need of evacuation.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.15 Required Services

(a) The licensee shall provide an administrator who:

(1) Is at least 21 years of age;

(2) Has one of the following combinations of education and experience:

a. A bachelor’s degree from an accredited institution in business or a health care field such as nursing or social work and at least 2 years of related experience; or

b. Is a registered nurse (RN), licensed in New Hampshire, with at least 2 years of related experience;

(3) Is responsible for the day to day operation of the CMA services; and

(4) Hires staff necessary to assist in maintaining regulatory compliance.

(b) Case managers shall be responsible:

(1) For the completion of an assessment that includes a psychosocial history;

(2) For the development of a care plan in conjunction with the client and their agent, if applicable;

(3) For the coordination of services identified in the care plan and ensuring that providers hold all required licenses or registrations, as applicable;

(4) For the monitoring of services to determine that services identified in the care plan are provided according to the timeframes and frequencies identified in the care plan and are meeting the client’s needs;

(5) To document changes in a client’s needs and to develop recommendations for changes in the care plan as appropriate;

(6) For conducting a risk assessment for any client whose condition, behavior or other circumstances represent a risk to the individual, person(s) providing services or others; and

(7) For documenting all case management services provided and their outcomes.

(c) For reportable incidents, the licensee shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 603-271-4968 or, if a fax machine is not available, convey by electronic mail to hfa-licensing@dhhs.nh.gov, or regular mail, the following information to the bureau of licensing and certification within 48 hours of a reportable incident:

a. The CMA name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the

reportable incident;

d. The name of the client(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom, and the date and time;

h. When the clients’ guardian, agent, or personal representative, was notified;

i. The signature of the person reporting the reportable incident;

j. The date and time the client’s licensed practitioner was notified, if applicable; and

k. The date the CMA performed the investigation required by (1) above;

(3) As soon as practicable, notify the guardian, agent, or personal representative; and

(4) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.16 Client Services

(a) At the time of admission, personnel of the CMA shall:

(1) Provide, both orally and in writing, to the client, guardian, agent, and personal representative, as applicable:

a. A copy of the home care clients’ bill of rights;

b. The CMA’s complaint procedure and rules; and

c. Documentation to verify receipt of these policies and rules; and

(2) Collect and record the following information:

a. Client’s name, home address, and home telephone number;

b. Client’s date of birth;

c. Name, address, and telephone number of an emergency contact;

d. Name of client’s primary care provider with the address and telephone number;

e. Copies of all legal directives such as durable power of attorney, legal guardian, living will, or documentation of the request; and

f. Written and signed consent for the delivery of services and the release of information.

(b) Each client shall have an initial assessment prior to the development of the care plan.

(c) Each client shall have a review of needs whenever the case manager, client, or guardian, agent or personal representative determine that the services provided are no longer required or not meeting the client’s needs.

(d) The care plan shall be developed by the case manager and the client or client’s guardian, agent or personal representative.

(e) For each client accepted for care and services by the CMA, a current and accurate record shall be maintained that includes, at a minimum:

(1) The written confirmation required by (a)(1) above;

(2) The identification data required by (a)(2) above;

(3) Consent and medical release forms, as required by (a)(2)f. above;

(4) The record of assessments and reviews as required by (b) and (c) above;

(5) All care plans, including documentation that the client, guardian, agent or personal representative participated in the development of the care plan if they choose to;

(6) A copy, initialed by the client and/or the client’s guardian, agent or personal representative, of all charges and services to be provided as required by He-P 819.14(r); and

(7) Documentation of all contacts with the client and/or the client’s guardian, agent or personal representative, with service providers identified in the client’s care plan, and with anyone else involved with the client’s care plan.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.17 Personnel

(a) The licensee shall develop a job description for each position in the CMA containing:

(1) Duties of the position; and

(2) Education and experience requirements of the position.

(b) For all applicants for employment, the licensee shall:

(1) Obtain and review a criminal records check in accordance with RSA 151:2-d. Results shall include criminal history from the state of New Hampshire ;

(2) Verify that the potential employee is not listed on the State Registry maintained by the department’s bureau of elderly and adult services (BEAS) per RSA 161-F:49. The licensee shall not employ any person who is listed on the BEAS state registry unless a waiver is granted by BEAS;

(3) Require the employee to submit the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(4) Allow the employee to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

(5) Comply with the requirements of the United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition) available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(c) Unless a waiver is granted in accordance with (d) below, the licensee shall not offer employment for any position if the individual:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(d) The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

(e) Waivers granted under (d) above shall be permanent as long as the individual is employed by the CMA.

(f) All personnel shall:

(1) Meet the requirements of the position as listed in the job description required by (a) above;

(2) Be licensed, registered, or certified as required by state statute; and

(3) Receive an orientation within the first 3 business days of work that includes:

a. The CMA’s policies on client rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The CMA’s policies, procedures, and guidelines;

d. The CMA’s emergency plans; and

e. Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

(g) Comply with all dementia training requirements pursuant to RSA 151:47-49, including continuing education, as applicable.

(h) Such continuing education in (g) above shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

(2) A minimum of 4 hours of ongoing training each calendar year.

(i) All personnel shall complete annual continuing education, which shall include a review of the CMA’s policies and procedures relative to client rights and complaint procedures.

(j) Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the licensed premises for all personnel of the CMA.

(k) The personnel file required by (j) above shall include the following:

(1) A completed application for employment or a resume;

(2) A signed statement acknowledging the receipt of the CMA’s policy setting forth the client’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) Record of satisfactory completion of the orientation program required by (f)(3) above;

(4) A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

(5) Documentation that the required TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(6) Documentation of annual continuing education as required by (j) above;

(7) Documentation of the BEAS state registry check and the criminal record check; and

(8) A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

a. Do not have a felony conviction in this or any other state;

b. Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft abuse, neglect, or exploitation;

c. Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; and

d. Do not pose a threat to the health, safety, or well-being of a client.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23

N.H. Code Admin. R. Ann. He-P 819.18 Quality Improvement

(a) The CMA shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established containing a minimum of the administrator and one employee.

(c) The quality improvement committee shall:

(1) Determine the indicators to be monitored and ensure that indicators reflect the clinical requirements of He-P 819;

(2) Determine the frequency with which information shall be reviewed;

(3) Evaluate the information that is gathered;

(4) Develop and implement the action necessary to correct identified problems; and

(5) Evaluate the effectiveness of the corrective actions.

(d) The quality improvement committee shall meet at least annually and record the minutes of each meeting.

(e) Documentation of all quality improvement activities, including minutes of meetings, shall be confidential in accordance with RSA 151:13-b.

He‑P 819.19 Physical Environment and Fire Safety.

(a) The licensee shall comply with all applicable federal, state, and local laws, rules, codes, and ordinances for:

(1) Building;

(2) Health, including waste disposal and water;

(3) Fire; and

(4) Zoning.

(b) The CMA shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

(c) The CMA shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

(d) Each licensee shall develop a written emergency plan that covers any situation that prevents the CMA from safely providing client services and which:

(1) Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, a bomb threat;

(2) Is available to all personnel;

(3) Is based on realistic conceptual events;

(4) Includes the CMA's response to both short-term and long-term interruptions in the availability of utility service for the licensed premises during the disaster or emergency, including establishing contingency plans for continuum of care:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources; and

f. Communications systems;

(5) Includes a plan for alerting and managing personnel in a disaster;

(6) Includes a policy detailing the responsibilities of personnel for responding to an emergency during provision of case management services;

(7) Includes an educational, competency-based program for personnel to provide an overview of the components of the emergency management program and the personnel’s specific duties and responsibilities; and

(8) If the CMA is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

(e) Each licensee shall annually review and revise, as needed, its emergency plan.

History

• #10260, eff 1-25-13; ss by #13709, eff 8-1-23
• #13709, eff 8-1-23

Part He-P 820 Individual Home Care Service Providers

N.H. Code Admin. R. Ann. He-P 820.01 Purpose

The purpose of this part is to set forth the mandatory registration requirements for all individuals who solicit and provide health support services, personal care services, or homemaker services for compensation pursuant to RSA 151:2-b, V.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.02 Scope

(a) This part shall apply to any individual who solicits and provides health support services, personal care services, or homemaker services except:

(1) Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H and He-P 601;

(2) Home care service provider agencies that are licensed under He-P 822;

(3) Agencies or entities that are licensed under He-P 809;

(4) Persons providing only meal services in an individual’s permanent or temporary residence;

(5) Persons furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment and educate the user on its proper use;

(6) Persons who provide health support services, personal care services, or homemaker services without compensation;

(7) Persons who provide health support services, personal care services, or homemaker services for compensation, but who do not solicit those services;

(8) Persons who provide health support services, personal care services, or homemaker services only to a family member(s); and

(9) Persons under the age of 18 who provide health support services, personal care services, or homemaker services.

(b) Employees of an agency in (a)(1)-(3) above who solicit and provide health support services, personal care services, or homemaker services for compensation outside the scope of their employment shall not be exempt from registration as an individual home care service provider.

(c) Because RSA 151:2, V, requires registration for an individual home care service provider to operate, and RSA 541-A:1, VIII, defines a “license” as a “form of permission required by law”, even if called “registration”, then requirements in RSA 151 which refer specifically to “license” or “licensing” shall also apply to the registration of individual home care service providers.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a client;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a client; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a client with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) “Administrative remedy” means a corrective action imposed upon a registrant in response to non-compliance with RSA 151 or He-P 820.

(d) “Applicant” means an individual who is seeking a “registration certificate” in order to operate as a registered individual home care service provider under RSA 151:2-b, V.

(e) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a registrant to be out of compliance with RSA 151, He-P 820, or other federal or state requirements.

(f) “Client” means any person receiving services from an individual who is registered in accordance with RSA 151 and He-P 820.

(g) “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

(h) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(i) “Days” means calendar days unless otherwise specified in the rule.

(j) “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

(k) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation, or suspension of a license in response to non-compliance with RSA 151 or He-P 820.

(l) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

(m) “Health support services” means non-medical supportive services that can be taught to the IHCSP by a client or caregiver, and do not require the skills of a licensed individual.

(n) “Homemaker” means an individual whose scope of services is limited to providing homemaker services as reflected on the registration certificate.

(o) “Homemaker services” means non-medical services that are of a supportive nature that do not require hands-on contact with a client other than to maintain the client’s safety. Such services include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, and companion services.

(p) “Individual home care service provider (IHCSP)” means “individual homecare service provider” as defined in RSA 151:2-b, V, namely “any individual not employed by a home health care provider licensed under RSA 151:2, I(b) who solicits and provides health support services, personal care services, or homemaker services for compensation to clients in their places of residence; provided that the client is not a family member.” This term includes a registered individual home care service provider under RSA 151:2, V.

(q) “Investigation” means the process followed by the department to respond to allegations pursuant to RSA 151:6 of non-compliance with RSA 151 and He-P 820.

(r) “Neglect” means an act or omission which results, or could result, in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a client.

(s) “Personal care services” means non-medical, hands-on services provided to a client, including, but not limited to, helping with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the client to take medications.

(t) “Registration” means the mandatory requirement established by RSA 151:9-a, XII, that an individual shall give notice to the department that he or she plans to solicit and provide personal care services or homemaker services for compensation. The “registration” is certified on a document called a “registration certificate” that authorizes the individual to provide these services for compensation.

(u) “Registration certificate” means the document issued by the department to an applicant or registrant that includes the name of the registrant and his or her physical address, the effective date and the registration number, any waivers granted to the registrant, upon renewal of a registration the new effective date of the registration, and at the registrant’s option, the registrant’s business name.

(v) “Solicit” or “solicits” means to advertise through any channel of communication, including, but not limited to audio, video, print, or electronic media, or by word of mouth as an individual home care service provider as defined in RSA 151:2-b, V, and He-P 820, or to actively seek or request compensation for providing individual home care services to a client as defined in RSA 151:2-b, V, and He-P 820.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.04 Initial Registration Application Requirements

(a) Each applicant for registration shall comply with the requirements of RSA 151:9-a, XII, and submit the following to the department:

(1) A completed application form entitled “Application for Individual Home Care Service Provider Registration” (January 2023) that is signed by the applicant and which states:

“I affirm that I am familiar with and in full compliance with the provisions of RSA 151:2, V, and He-P 820. I also affirm that I have not been convicted of a felony in this or any other state, have not been convicted for sexual assault, other violent crime, assault, fraud, abuse, neglect, exploitation or any other criminal offense that suggests that they may pose a threat to the health, safety or well-being of a client, and have not been found to have committed assault, fraud, abuse, neglect or exploitation by the department or any other administrative agency in this or any other state. I understand that providing false information shall be grounds for denial or revocation of my registration and the imposition of a fine.”;

(2) The applicable fee, in accordance with RSA 151:5, XI, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire.”;

(3) The results of a criminal records check, for the applicant. Results shall include the criminal history from the state of New Hampshire;

(4) The results of the state registry check, which is maintained by the department’s bureau of elderly and adult services pursuant to RSA 161-F:49;

(5) Qualifications, including education, experience and copies of all applicable licenses for the administrator; and

(6) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable.

(b) The application in He-P 820.04(a)(1) shall include the following advisory:

“Advisory: The New Hampshire Department of Health and Human Services is authorized to require all licensed home care providers to read and understand the Home Care Clients’ Bill of Rights set forth in RSA 151:21-b, and to distribute the law to all of their clients. The Department recommends that all individual homecare service providers read and understand the Home Care Clients’ Bill of Rights and share the information with their clients.”

(c) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.05 Processing of Applications and Issuance of Registrations

(a) An application for an initial registration shall be complete when the department determines that all items required by He-P 820.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 820.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any registration fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Registration fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted in accordance with He-P 820.08, the department shall deny a registration request if it determines that the applicant or registrant:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(f) Following receipt and review of the application, the registration certificate signed by the commissioner shall be issued to the applicant if the department determines that the application meets all of the requirements in He-P 820.04(a) above.

(g) Upon receipt of the registration certificate, the individual:

(1) May use the title “registered individual home care service provider”; and

(2) Shall not use the title “licensed individual home care service provider”.

(h) All registrations issued in accordance with RSA 151 shall be non-transferable by person.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.06 Registration Expirations and Procedures for Renewals

(a) A registration shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

(b) Each registrant shall complete and submit to the department an application form for renewal pursuant to He-P 820.04(a)(1) at least 120 days prior to the expiration date of the current registration.

(c) Following receipt and review of the renewal application, a registrant shall be renewed if the department determines that the application meets all of the requirements in (b) above.

(d) Any registrant who does not submit a complete application for renewal prior to the expiration of an existing registration shall be required to submit an application for initial registration pursuant to He-P 820.04.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.07 Requirements for Organizational or Service Changes

(a) The registrant shall provide the department with written notice that includes his or her current registration number no later than 30 days after any of the following changes:

(1) Physical address of the registered individual;

(2) Mailing address of the business if different than the physical address in (1) above; and

(3) Name of the individual.

(b) Upon receipt of the notice set forth in (a) above, the department shall issue a revised registration certificate to the registrant that includes the relevant changes.

(c) A revised registration certificate shall also be issued when a new waiver has been granted.

(d) Registration certificates issued under (c) above shall be valid for one year from the date of issuance.

(e) The IHCSP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the IHCSP.

(f) If a registrant chooses to cease operation of a IHCSP, the registrant shall submit written notification to the department at least 45 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.08 Waivers

(a) Applicants or registrants seeking waivers of specific rules in He-P 820 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or registrant, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the granting of the waiver will not negatively impact the health, safety, or well-being of clients, or that the waiver is not being granted to one applicant or registrant who is in the same situation as another applicant or registrant whose waiver has been denied.

(d) Waivers shall not be transferable.

(e) When a registrant wishes to renew a non-permanent waiver beyond the approved period of time, the registrant shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(f) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.09 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s) if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 820.

(b) When practical, the complaint shall be in writing and contain the following information:

(1) The name and address, if known, of the IHCSP, or the alleged unregistered individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 820.

(c) Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the IHCSP;

(2) Physical inspection of the premises;

(3) Review of relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a registered individual, the department shall:

(1) Provide written notification of the results of the investigation to the registrant;

(2) Provide written notification to the registrant of the corrective action that must be taken to resolve the issues underlying the complaint; and

(3) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, if appropriate.

(e) For an unregistered individual, the department shall provide written notification of the results of the investigation that includes:

(1) The date of investigation;

(2) The reasons for the investigation; and

(3) Whether or not the investigation resulted in a determination that the services being provided require registration under RSA 151:2, V.

(f) If an individual does not respond to a written notice within 30 days of the date it was sent, or if the department does not agree with the individual’s response, the department shall:

(1) Issue a written warning to immediately comply with RSA 151 and He-P 820; and

(2) Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III.

(g) Any individual who fails to comply after receiving a warning as described in (f) above shall be subject to an action by the department for injunctive relief under RSA 151:17.

(h) The fact that the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 820, or other applicable laws.

(i) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the registrant solely for the purposes of the adjudicative action.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.10 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 820, or other applicable rules, including:

(1) Requiring a registrant to submit a plan of correction (POC) in accordance with (c) below;

(2) Imposing a directed POC upon a registrant in accordance with (d) below;

(3) Imposing a fine upon an unregistered individual, applicant, or a registrant;

(4) Monitoring of a registrant; or

(5) Revocation of a registration.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the registrant is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that have been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings, the registrant shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the registrant intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The registrant shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the statement of findings or notice to correct unless the registrant requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The registrant demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 820;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 820 as a result of the implementation of the POC; and

d. Specifies the date upon which the deficiencies will be corrected;

(4) If the POC is acceptable, the department shall issue a registration certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the registrant in writing within 14 days of the reason for rejecting the POC;

(6) The registrant shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the registrant requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The registrant demonstrates that the registrant has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the waiver;

(7) The revised POC shall comply with (1) above and be reviewed in accordance with (3) above;

(8) If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the registrant shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 820.11(c)(7);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the registrant;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the registrant in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the registrant shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 820.11(c)(7).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the registrant to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department; or

(3) A revised POC submitted by the registrant or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine according to He-P 820.11(c)(7);

(3) Deny the application for a renewal of a registration in accordance with He-P 820.11(b)(6); or

(4) Revoke or suspend the registration in accordance with He-P 820.11(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or registrant who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or registrant submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, registrant, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or registrant of the determination.

(i) An informal dispute resolution shall not be available for any applicant or registrant against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a registration.

(j) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the IHCSP in areas that impact the health, safety, or well-being of clients; or

(2) The presence of conditions in the IHCSP that negatively impact the health, safety, or well-being of clients.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.11 Enforcement Actions and Hearings

(a) Prior to imposing a fine, or denying or revoking a registration, the department shall send to the applicant or registrant a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or registrant to a hearing shall be conducted in the same manner as a registrant in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable.

(b) The department shall deny an application or revoke a registration if:

(1) An applicant or a registrant violated any of the provisions of RSA 151 or He-P 820 in a manner which poses a risk of harm to a client’s health, safety, or well-being;

(2) An applicant or a registrant has failed to pay a fine imposed under administrative remedies;

(3) An applicant or a registrant has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or registrant fails to submit an application that meets the requirements of He-P 820.04;

(5) An applicant, registrant, or any representative of the applicant or registrant:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) A registrant has had a registration revoked and submits an application during the 5-year prohibition period specified in (g) below;

(7) The registrant failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 820.10(d) and (e);

(8) The registrant has submitted a POC that has not been accepted by the department in accordance with He-P 820.10(c)(5) and has not submitted a revised POC as required by He-P 820.10(c)(5);

(9) A registrant, has had a registration revoked and submits an application during the 5-year prohibition period specified in (h) below;

(10) Unless a waiver has been granted the department makes a determination that the registrant has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state; or

(11) The applicant has had a registration revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unregistered services after being notified by the department of the need for a registration, in violation of RSA 151:2, the fine shall be $200.00 for an applicant or unregistered provider;

(2) For a failure to cease operations after a denial of a registration or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant or unregistered provider or a registrant shall be $200.00;

(3) For advertising services or otherwise representing themselves as having a registration to provide services that they are not registered to provide, in violation of RSA 151:2, III, the fine for an applicant or unregistered provider shall be $50.00;

(4) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 820.09(f), the fine for an unregistered provider or a registrant shall be $50.00;

(5) For a failure to submit a renewal application for a registration prior to the expiration date, in violation of He-P 820.06(b), the fine for a registrant shall be $10.00;

(6) For a failure to allow access by the department to the IHCSP programs, services, patients or records, in violation of He-P 820.09(a)(1)-(3), the fine for an applicant, unregistered individual, or registrant shall be $2000.00;

(7) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 820.10(c)(2) and (6), the fine for a registrant shall be $100.00;

(8) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 820.10(c)(11), the fine for a registrant shall be $1000.00;

(9) For falsification of information contained on an application, the fine for an applicant or registrant shall be $50.00 per offense;

(10) When an inspection determines that a violation of RSA 151 or He-P 820 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a registrant shall be double the original fine, but not to exceed $1000.00; and

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a registrant shall be triple the original fine, but not to exceed $2000.00; and

(11) Each day that the registrant continues to be in violation of the provisions of RSA 151 or HeP 820 shall constitute a separate violation and shall be fined in accordance with He-P 820.10.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or registrant has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or registrant shall have 30 days after issuance of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate revocation of a registration, the cessation of services, and the transfer of care of clients when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(i) When an individual’s registration has been denied or revoked, the applicant or registrant shall not be eligible to reapply for a registration for 5 years from:

(1) The date of the department’s decision to revoke or deny the registration became effective, if no request for an administrative hearing is requested; or

(2) The date an order is issued upholding the action of the department, if a request for an administrative hearing was made and a hearing was held.

(j) The 5-year period referenced in (i) above shall begin on:

(1) The date the department’s decision to revoke or deny the registration, if not filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an administrative hearing was made and a hearing was held.

(k) Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant should be awarded a waiver under He-P 820.08.

(l) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 820.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 820.12 Duties and Responsibilities of All Registrants

(a) The registrant shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

(b) The registrant shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(c) The registrant shall consider all clients to be competent and capable of making all decisions relative to their own service needs unless the client:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J.

(d) Registrants may remind clients to take their medications, place medication container(s), including pill planners, within client reach, and open the medication container(s).

(e) The registrant shall comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education that shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

(2) A minimum of 4 hours of ongoing training each calendar year.

(f) The registrant shall not falsify any documentation or provide false or misleading information to the department.

(g) The registrant shall not advertise or otherwise represent themselves as providing services not registered to provide, pursuant to RSA 151:2, III.

History

• #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

Part He-P 822 Home Care Service Provider Agencies (hcspa)

N.H. Code Admin. R. Ann. He-P 822.01 Purpose

The purpose of this part is to set forth the licensing requirements for all home care service provider agencies (HCSPA) pursuant to RSA 151:9-a, XI.

History

• #5629, eff 5-26-93; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99
• #9522, eff 7-25-09, EXPIRED 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.02 Scope

This part shall apply to any organization, business entity, partnership, corporation, government entity, association, or other legal entity providing personal care services or homemaker services through personal care service providers or homemakers employed by an agency, except:

(a) All facilities listed in RSA 151:2, II (a)-(i);

(b) Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H;

(c) Entities that are licensed under He-P 809;

(d) Persons providing only meal services in an individual’s permanent or temporary residence;

(e) Persons, who are not employers of personal care or homemaker service workers, who are personally providing personal care or homemaker services through a direct agreement with the recipient of services in the recipient’s permanent or temporary residence, and who are registered under He-P 820; and

(f) Persons furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment, and educate the user on its proper use.

History

• #9522, eff 7-25-09; ss by #10013, eff 10-22-11, EXPIRED: 10-22-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” which means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a client;

(2) “Physical abuse” which means the misuse of physical force which results or could result in physical injury to a client; or

(3) “Sexual abuse” which means contact or interaction of a sexual nature involving a client with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as grooming, eating, transferring, toileting, bathing, dressing, and self-management of medications.

(c) “Administer” means an act, by an individual authorized by law, whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.

(d) “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HCSPA.

(e) “Admission” means accepted by a licensee for the provision of services to a client.

(f) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(g) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a HCSPA pursuant to RSA 151.

(h) “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 822, or other federal or state requirements.

(i) “Assessment” means an in-person evaluation to determine the services that are needed.

(j) “Branch office” means a location physically separate from the primary location of the HCSPA and that:

(1) Provides oversight for employees who provide direct care services to clients in their residential setting; and

(2) Is under the administration and supervision of the primary location of the HCSPA.

(k) “Change of ownership” means a change in the controlling interest of an established HCSPA to a successor business entity.

(l) “Client” means any person admitted to or in any way receiving services from a HCSPA licensed in accordance with RSA 151 and He-P 822. “Client” includes “patient” as used in RSA 151:20 and RSA 151:21.

(m) “Client record” means the documentation of all services, which includes all documentation required by RSA 151 and He-P 822 and any other applicable federal and state requirements.

(n) “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

(o) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(p) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(q) “Days” means calendar days unless otherwise specified in the rule.

(r) “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151 or He-P 822.

(s) “Department” means the New Hampshire department of health and human services.

(t) “Direct care” means hands-on care and services provided to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(u) “Direct care personnel” means any person providing hands-on services to a client.

(v) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

(w) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(x) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, or fraud.

(y) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and other personal needs.

(z) “Home care service provider agency (HCSPA)” means any organization or business entity, except as identified in He-P 822.02(e), whether public or private, whether operated for profit or not, which is engaged in providing, through its employees, personal care services or homemaker services which may be of a supportive nature to persons in their places of residence.

(aa) “Homemaker” means an employee of a home care service provider agency whose scope of services is limited to providing homemaker services as reflected on the license certificate.

(ab) “Homemaker services” means non-medical services that are of a supportive nature that do not require hands-on contact with a client other than to maintain the client’s safety. Such services can include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, and companion services.

(ac) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries, and is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ad) “Infectious disease” means any disease caused by the growth of microorganisms in the body which might or might not be contagious.

(ae) “Infectious waste” means those items specified by Env-Sw 904.

(af) “In‑service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(ag) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 822 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 822.

(ah) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 822.

(ai) “License” means the document issued by the department to an applicant at the start of operation as a HCSPA which authorizes operation in accordance with RSA 151 and He-P 822, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and the license number.

(aj) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which the HCSPA is licensed for.

(ak) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(al) “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices. This term does not include the private residence of a client receiving services from a HCSPA.

(am) “Licensing classification” means the specific category of services authorized by a license.

(an) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ao) “Neglect” means an act or omission, that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a client.

(ap) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(aq) “Personal care” means personal care services that are non-medical, hands-on services provided to a client to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the client to take medications.

(ar) “Personal care service provider” means a person who provides non-medical hands-on assistance to a client, to help with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding a client to take medications.

(as) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the client for a specific, limited purpose or for the general purpose of assisting the client in the exercise of any rights.

(at) “Personnel” means an individual who is employed by the HCSPA, who is a volunteer, or who is an independent contractor and provides direct care, personal care services, homemaker services, or all to a client(s).

(au) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(av) “Primary location” means the principle site for the HCSPA where the business office and administrative staff are located.

(aw) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(ax) “Professional staff” means:

(1) Physicians;

(2) Physician assistants;

(3) Advanced practice registered nurses (APRN);

(4) Registered nurses;

(5) Registered physical therapists;

(6) Speech therapists;

(7) Licensed practical nurses;

(8) Licensed respiratory therapists;

(9) Occupational therapists;

(10) Medical social workers; and

(11) Dietitians.

(ay) “Reportable incident” means an occurrence of any of the following while the client is in the care of HCSPA personnel:

(1) The unanticipated death of the client; or

(2) An injury to a client that is potentially due to abuse or neglect.

(az) “Service plan” means a written guide developed by the licensee, or its personnel, in consultation with the client, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services as required by He-P 822.15(l)-(n).

(ba) “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability of the client.

(bb) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #9522, eff 7-25-09; amd by #10013, eff 10-22-11; paras. (a)-(y), (ab)-(am), (ao)-(ap), (ar)-(ay) EXPIRED: 7-25-17; amd by #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License” (December 2018 edition) which is signed by the applicant or 2 of the corporate officers affirming the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

b. For any HCSPA to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any HCSPA to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

a. A certificate of authority, if a corporation;

b. A certificate of formation, if a limited liability company; or

c. A certificate of trade name, where applicable;

(3) The applicable fee in accordance with RSA 151:5 if HCSPA serves less than 10 clients or $250 fee if HCSPA serves more than 10 clients, in accordance with RSA 151:5 payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(4) A resume identifying the qualifications for the HCSPA administrator;

(5) Written local approvals as follows:

a. For the proposed licensed premises, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements;

2. The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control and local fire ordinances applicable for a business; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project; and

(6) If the HCSPA uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

(7) The results of a criminal records check from the NH department of safety for the applicant(s), licensee, and administrator.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 822.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 822.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted in accordance with He-P 822.10, the department shall deny a licensing request in accordance with He-P 822.13(b), if it determines that the applicant, licensee, or administrator:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(f) An inspection shall be completed in accordance with He-P 822.09 prior to the issuance of a license.

(g) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

(h) Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 822.

(i) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(j) A license issued in accordance with RSA 151 and He-P 822 shall be for one of the following licensing classifications:

(1) Personal care services; or

(2) Homemaker services.

(k) A written notification of denial, pursuant to He-P 822.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 822.

(l) A written notification of denial, pursuant to He-P 822.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall:

(1) Complete and submit to the department an application form pursuant to He-P 822.04(a)(1) at least 120 days prior to the expiration of the current license; and submit:

a. The materials required by He-P 822.04(a);

b. The current license number;

c. A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 822.10(f), as applicable. If such a request is not received the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

d. A list of any current employees who have a permanent waiver granted in accordance with He-P 822.17(c); and

e. A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(c) Following an inspection as described in He-P 822.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 822 at the renewal inspection.

(d) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 822.04 and shall be subject to a fine in accordance with He-P 822.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.07 Branch Offices

(a) The HCSPA may establish branch offices.

(b) The HCSPA shall notify the department in writing prior to establishing or operating branch offices with the following information:

(1) The branch office address;

(2) The branch office phone number; and

(3) The license number of the HCSPA.

(c) The HCSPA shall submit to the department the information required by He-P 822.04(a) (5) for branch offices.

(d) Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 822.

(e) All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.08 HCSPA Requirements for Organizational or Service Changes

(a) The HCSPA shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location of the licensed premises;

(3) Address; or

(4) Name.

(b) The HCSPA shall complete and submit a new application and obtain a new license and license certificate prior to:

(1) A change in ownership; or

(2) A change in licensing classification.

(c) When there is a change in address without a change in location, the HCSPA shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in address due to a physical location change, the HCSPA shall provide the department with:

(1) A letter which contains the license number, new address, and date of the move; and

(2) Local approval form as specified in He-P 822.04(a) (5).

(e) When there is a change in the name, the HCSPA shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(f) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance then an inspection will be conducted as soon as practical by department; or

(2) A change in licensing classification.

(g) A new license and license certificate shall be issued for a change in ownership.

(h) A revised license and license certificate shall be issued for a change in address.

(i) A revised license and license certificate shall be issued for a change in name.

(j) A revised license certificate shall be issued for any of the following:

(1) A change in administrator;

(2) When a waiver has been granted;

(3) When there is a change in services; or

(4) When a branch office has been added.

(k) The HCSPA shall inform the department in writing no later than 5 business days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) Copies of applicable licenses for the new administrator;

(3) The results of a criminal records check from the NH department of safety for the new administrator; and

(4) Results of a bureau and elderly adult (BEAS) registry check.

(l) Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 822.15(d).

(m) If the department determines that the new administrator does not meet the qualifications, for his or her position, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(n) A restructuring of an established HCSPA that does not result in a transfer of the controlling interest of the HCSPA, but which might result in a change in the name of the HCSPA or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) The HCSPA shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the HCSPA.

(p) If a licensee chooses to cease operation of a HCSPA, the licensee shall submit written notification to the department at least 45 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 822, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the HCSPA; and

(3) Any records required by RSA 151 and He-P 822.

(b) The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 822 prior to:

(1) The issuance of an initial license;

(2) A change in ownership except as allowed by He-P 822.08(f) (1);

(3) A change in licensing classification; or

(4) The renewal of a license.

(c) In addition to (b) above the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings shall be issued when, as a result of an inspection, the department determines that the HCSPA is in violation of any of the provisions of He-P 822, RSA 151, or other federal or state requirements.

(e) If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 822.12(c), within 21 days of the date of the letter that transmits the inspection report.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 822 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) Waivers shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the clients; and

(3) Does not negatively affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s); if proven to be true would constitute a violation of any of the provisions of RSA 151 or He-P 822.

(b) When practical, the complaint shall be in writing and contain the following information:

(1) The name and address, if known, of the HCSPA, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 822.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the HCSPA;

(2) Physical inspection of the premises;

(3) Review of relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed HCSPA, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 822.

(e) The following shall apply for an unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed HCSPA does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 822; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P822.13(c).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 822, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC; in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing;

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

b. The department determines that the health, safety, and well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 822;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 822 as a result of this implementation; and

d. Specifies the date upon which the deficiencies will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable;

a. The department shall notify the licensee in writing within 14days of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period,the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

2. The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension;

c. The revised POC shall comply with (c) (1) above and be reviewed in accordance with (c) (3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14days of the date of the written notification from the department that states the original POC was rejected,, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 822.13(c) (12) below unless the department has granted an extension;

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with He-P 822.12(b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 822.13(c) (13) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 822.13(b); or

(3) Revoke the license in accordance with He-P 822.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with He-P 822.12(c) shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) An informal dispute resolution shall not be available for any applicant or licensee against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(k) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the HCSPA in areas that impact the health, safety, or well-being of clients; or

(2) The presence of conditions in the HCSPA that negatively impact the health, safety, or well-being of clients.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 822 in a manner which poses a risk of harm to a client’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, or schedule an initial inspection, an applicant or licensee fails to submit an application that meets the requirements of He-P 822.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 822.12(c),(d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 822.12(c)(5) and has not submitted a revised POC as required by He-P 822.12(c)(5)d.;

(8) The licensee is cited a third time under RSA 151 or He-P 822 for the same violations within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premises are not in compliance with RSA 151 or He-P 822;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member of a licensee has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and 822.14(g), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a client whose needs exceed the services or programs provided by the HCSPA, in violation of RSA 151:5-a,II the fine for a licensee shall be $500.00;

(5) For admission of a client whose needs at the time of admission exceed the services or programs authorized by the HCSPA, in violation of RSA 151:5-a,II, the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 822.11(d) and (e), the fine for an unlicensed provider or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 822.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 822.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 822.08(a)(2), the fine for a licensee shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 822.08(o), the fine shall be $100.00;

(11) For a failure to allow access by the department to the HCSPA’s premises, programs, services, or records, in violation of He-P 822.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(12) For a failure to submit a POC or revised POC, within 21 or 14days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, , in violation of He-P 822.12(c), the fine for a licensee shall be $500.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 822.12(c), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement, or comply with licensee policies, as required by He-P 822.14(d), the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified as required by He-P 822.14(c), the fine for a licensee shall be $500.00;

(16) For providing false or misleading information or documentation in violation of He-P 822.14, the fine for a licensee shall be $1000.00 per offense;

(17) For a failure to meet the needs of the client, as described in He-P 822.15, the fine for a licensee shall be $1000.00 per client;

(18) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department, in accordance with He-P 822.14, the fine for a licensee shall be $500.00;

(19) When an inspection determines that there is a violation of RSA 151 or He-P 822 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines shall be assessed as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

(20) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 822 shall constitute a separate violation and shall be fined in accordance with He-P 822.13(c); and

(21) If the applicant or licensee is making good faith efforts to comply with He-P 822.13 (c)(1)-(19), as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license, and the cessation of services, when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30.

(h) If an immediate suspension is upheld the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 822 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a HCSPA’s license has been denied or revoked, the applicant, licensee, or administrator, shall not be eligible to apply for a license or be employed as an administrator for at least 5 years if the denial or revocation specifically pertained to their role in the program.

(k) The 5 year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 822.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 822.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49, and rules promulgated thereunder, as applicable.

(b) The licensee shall have written policies and procedures to include:

(1) The rights and responsibilities of admitted clients in accordance with the “Home Care Clients’ Bill of Rights” under RSA 151:21-b;

(2) The policies described in He-P 822; and

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the HCSPA.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HCSPA and for:

(1) Reviewing the policies and procedures every 2 years; and

(2) Revising them as needed.

(e) The licensee shall assess and monitor the quality of service provided to clients on an ongoing basis.

(f) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(g) The licensee shall not advertise or otherwise represent the HCSPA as providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) Licensees shall:

(1) Manage and operate the HCSPA;

(2) Meet the needs, as determined by the care plan, of the client during those hours that the HCSPA personnel is in the client’s home;

(3) Initiate action to maintain the HCSPA in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HCSPA;

(5) Appoint an administrator;

(6) Verify the qualifications of all personnel;

(7) Accept new clients based upon the availability of personnel to meet the clients requested service needs; and

(8) Implement any POC that has been accepted or issued by the department.

(j) The licensee shall consider all clients to be competent and capable of making all decisions relative to their own service needs unless the client:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(k) The licensee shall only accept a client whose needs can be met through the program and services offered under the current license.

(l) If the licensee accepts a client who is known to have a disease reportable under He-P 301 or an infectious disease, , the licensee shall follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(m) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(n) The licensee shall post the following documents in a public area:

(1) The license and current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports for the last 12 months issued in accordance with He-P 822.09(d) and He-P 822.11(d)(1);

(3) A copy of the “Home Care Clients’ Bill of Rights” specified by RSA 151:21-b;

(4) A copy of the licensee’s policies and procedures relative to the implementation of client rights and responsibilities;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the;

Department of Health and Human Services,

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street,

Concord, NH 03301 or by calling 1-800-852-3345; and

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

(o) For reportable incidents, the licensees shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 271-4968 or, if a fax machine is not available, electronically via webmail at https://www.dhhs.nh.gov/oos/bhfa/contact.htm and click on the e-mail link, convey by electronic or regular mail, the following information to the department within 48 business hours of a reportable incident:

a. The HCSPA name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of the client involved and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the client’s guardian, agent, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the client’s licensed practitioner was notified;

(3) Notify the department with a written report within 5 business days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(4) Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any client who dies within 10 days of a reportable incident;

(5) Provide the information required by (3) above in writing within 72 hours of the unexpected death of any client or the death of any client who dies within 10 business days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

(6) Submit any further information requested by the department.

(p) The licensee shall admit and allow any department representative to inspect the HCSPA and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 822 as authorized by RSA 151:6 and RSA 151:6-a.

(q) The licensee shall, upon request, provide a client or their guardian or agent or surrogate decision-maker, if applicable, with a copy of his or her client record, pursuant to the provisions of RSA 151:21, X.

(r) All records required for licensing shall be legible, current, accurate, and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(s) Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of clients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and personnel; and

(3) Systems to prevent tampering with information pertaining to clients and personnel.

(t) At the time of admission the licensee shall give a client and their guardian, agent, or surrogate decision-maker, if applicable, a listing of all applicable HCSPA charges and identify what care and services are included in the charge.

(u) The licensee shall give the client a written notice at least 30 days before any increase is imposed in the cost or fees, for any HCSPA services, except for clients receiving Medicaid whose financial liability is determined by the state’s standard of need, or clients funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.15 Required Services

(a) The licensee shall have a written contractual agreement for all services provided by arrangement.

(b) Any contractual agreement to provide services shall:

(1) Identify the services to be provided;

(2) Specify the qualifications of the personnel that will be providing the services;

(3) Require that the HCSPA must authorize the services;

(4) Stipulate the HCSPA retains professional responsibility for all services provided; and

(5) Be limited to the types of services allowed under the HCSPA level of services.

(c) The licensee shall provide staff for the following positions:

(1) An administrator to oversee the HCSPA, except as allowed by (e)(1) below; and

(2) A director of client services.

(d) Any new administrator shall possess:

(1) An associate degree from an accredited school and at least 2 years of relevant HCSPA experience;

(2) A bachelor’s degree from an accredited school and one year of relevant experience; or

(3) A high school diploma or equivalent and a minimum of 5 years relevant HCSPA experience.

(e) The administrator shall:

(1) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(2) Be permitted to hold more than one position at the HCSPA if:

a. The individual meets the qualifications of all positions; and

b. The duties and responsibilities of the positions can be accomplished by one individual.

(f) Any new director of client services shall have at least a high school diploma and 2 years’ experience supervising personnel or providing personal care services.

(g) The director of client services or designee shall:

(1) Be responsible for the overall delivery of client services;

(2) Provide sufficient qualified personnel to meet the needs of the clients; and

(3) Supervise the overall delivery of client services.

(h) At the time of admission, personnel of the HCSPA shall:

(1) Provide, both orally and in writing, to the client, or the client’s guardian or agent, if applicable, the HCSPA’s:

a. Policy on client rights and responsibilities, including a copy of the Home Care Clients’ Bill of Rights, pursuant to RSA 151:21-b;

b. Complaint procedure;

c. List of services that are to be provided by the HCSPA; and

d. List of care and services to be provided by an independent contractor, if appropriate;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the client, or the client’s guardian or agent, or surrogate decision-maker, if applicable;

(3) Collect and record the following information:

a. Client’s name, home address, home telephone number, and date of birth;

b. Name and telephone number of an emergency contact and guardian or agent, if applicable;

c. Name of client’s primary care provider and the provider’s address and telephone number as applicable;

d. Written and signed consent for the provision of care and services; and

e. Copies of all legal directives such as durable power of attorney, guardianship, or living will, as applicable; and

(4) Obtain documentation of informed consent and consent for release of information.

(i) Each client shall have an assessment conducted by an HCSPA nurse, the director of client services or designee to determine the services required by the client, except as allowed in (j) below:

(1) Prior to initiating services;

(2) At least every 6 months thereafter; and

(3) Whenever there is a significant change in the client’s condition.

(j) The assessment required by (i) above shall contain at a minimum the following:

(1) Pertinent diagnoses including mental status, as related by the client or the client’s agent, as appropriate;

(2) Any equipment required;

(3) Functional limitations;

(4) Activities that are limited;

(5) Dietary requirements; and

(6) Any safety precautions.

(k) Clients receiving only homemaker services shall not require an assessment or a service plan.

(l) For clients receiving only personal care services, the assessment in (i) above shall be performed initially and every 6 months thereafter by a registered nurse, licensed practical nurse (LPN), the director of client services or designee to determine the services required.

(m) The licensee shall develop a service plan within 3 business days of admission or prior to the initiation of services, if later, that is based on the results of the assessments required by (i) above.

(n) The service plan required by (l) above shall include:

(1) The date of the assessment;

(2) A description of the client’s needs;

(3) The services to be provided by HCSPA personnel;

(4) The responsible person(s) or position;

(5) The date of changes to the service plan; and

(6) Documentation that the client and their legal representative, if applicable, were involved in the development of the service plan and any revisions made to the plan.

(o) The licensee shall develop a discharge plan, pursuant to RSA 151:26, with the input of the client or the client’s legal representative, if any, including:

(1) Date and reason for discharge;

(2) Discharge instructions and referrals, if applicable;

(3) Discharge or transfer summary; and

(4) An order for discharge, if applicable.

(p) Written notes shall be documented in the client’s record at the time of each visit for:

(1) All services provided by the HCSPA and shall include the:

a. Date and time of the service;

b. Description of the service;

c. Progress notes including, as applicable:

1. Observable changes in the client’s functional, cognitive, or daily activity abilities; and

2. Changes in the client’s behaviors such as eating or sleeping patterns; and

d. Signature and title of the person providing the service;

(2) Any reportable incident involving the client when HCSPA personnel are in the client’s home; and

(3) Discharge or transfer documentation, if applicable, that shall include the date and reason for discharge or transfer.

(q) For each client accepted for care and services by the HCSPA, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by (h)(2) above;

(2) The identification data required by (h)(3) above;

(3) Consent forms, as applicable;

(4) Consent for release of information, as applicable;

(5) The record of the assessment required by (i) above;

(6) All service plans required by (l) above including documentation that the client or their legal representative participated in the development of the service plan;

(7) All written notes required by (p) above; and

(8) Discharge documentation as required by (p)(3) above.

(r) Client records shall be available to:

(1) The client, the client’s guardian, or the client’s agent;

(2) HCSPA personnel as required by their job responsibilities and subject to the licensee’s policy on confidentiality;

(3) Any individual given written authorization by the client, the client’s guardian, client’s agent, or the patient's surrogate decision-maker;

(4) Any individual authorized by a court of competent jurisdiction; and

(5) The department or any individual authorized by law.

(s) The licensee shall develop and implement a method for the written release of information in client records that is consistent with federal and state laws.

(t) The HCSPA shall store all paper and electronic backup files of client records in the primary or branch office except when they are being utilized by authorized personnel.

(u) Paper records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by authorized personnel.

(v) Electronic records shall be maintained as required by He-P 822.14(t).

(w) Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

(x) The HCSPA shall arrange for storage of, and access to, client records as required by (u) and (v) above in the event that the HCSPA ceases operation.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.16 Medication Services

(a) The HCSPA personnel, who are not authorized by law to administer medications, may remind and prompt clients to take their medications at the proper time, place medication container or pill planners within client’s reach, and open the medication container or pill planner(s) when the client is present, as per the service plan without requiring documentation of specific medications taken.

(b) If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.17 Personnel

(a) The licensee shall develop a job description for each position in the HCSPA containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Qualifications and educational requirements of the position.

(b) For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care or personal care services to clients the licensee shall:

(1) Obtain a criminal record check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

(2) Review the results of the criminal records check (1) above in accordance with (c)(1)-(3) below;

(3) Verify the qualifications of all applicants prior to employment; and

(4) Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

(c) Unless a waiver is granted in accordance with He-P 822.10 and (d) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, for any position if the individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(d) The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

(e) If the information identified in (c) above regarding any person identified in (b) above, is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (c) above.

(f) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

(2) Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

(g) The licensee shall:

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the licensing site with the New Hampshire board of nursing or with a compact state.

(h) In lieu of (b) and (g) above, the licensee may accept from independent agencies contracted by the licensee to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) and (g) above and do not meet the criteria in (c) and (g) above.

(i) All personnel shall:

(1) Meet the educational and physical qualifications of the position as listed on their job description;

(2) Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(3) Be licensed, registered, or certified if required by state statute;

(4) Receive an orientation prior to contact with a client that includes:

a. The HCSPA’s policy on client rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The HCSPA’s policies, procedures, and guidelines;

d. The HCSPA’s infection control program;

e. The HCSPA’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency;

f. The mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31; and

g. Body mechanics training;

(5) Complete mandatory annual in-service education, which includes a review of the HCSPA’s:

a. Policies and procedures on client rights and responsibilities;

b. Infection control program;

c. Fire and emergency procedures; and

d. Mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

(6) Be at least 18 years of age if working as direct care personnel unless they are:

a. A licensed nursing assistant (LNA) working under the supervision of an RN in accordance with Nur 700; or

b. Part of an established educational program working under the supervision of an RN;

(7) Prior to contact with clients or food, submit to the HCSPA the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis (TB) testing, mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(8) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

(9) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(j) In lieu of (i)(8) above, independent agencies contracted by the HCSPA to provide direct care or personal care services shall provide the licensee with a signed statement that the agency’s employees have complied with (i)(8) and (10) above before working at the HCSPA.

(k) The scope of services provided by a homemaker shall be limited to those services as defined in He-P 822.03(ab) and shall not include those services described in (l)(1)-(5) below.

(l) The scope of services provided by a personal care service provider shall be as follows:

(1) Basic personal care and grooming to include:

a. Sponge bathing;

b. Gathering and handing the client materials related to bathing;

c. Regulating the bath or shower water temperature and running the water;

d. Hair care including shampooing;

e. Skin care to include application of preventive skin care products;

f. Filing of nails;

g. Assisting with oral hygiene;

h. Shaving of client using an electric razor; and

i. Dressing to include putting on or removing clothing, shoes, and stockings;

(2) Transfer assistance as follows:

a. Weight bearing assistance such as steadying the client and arranging items to assist the transfer of the client; and

b. Non-weight bearing assistance on a case-by-case basis as specified by the HCSPA;

(3) Assistance with toileting and toileting hygiene measures as follows:

a. Assistance with the use of the toilet, commode, bedpan, and urinal;

b. Assistance with the use of products related to hygiene care such as disposable incontinent briefs or pads;

c. Assistance with cleaning after elimination;

d. Assisting with cleaning the client after instances of vomiting, diarrhea, and incontinence;

e. Assistance with ostomy care in a long term, well healed, trouble free ostomy, limited to assisting in application of the stoma bag on a case-by-case basis as individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate professional staff; and

f. Assistance with catheter care to include emptying the urinary drainage bag or switching from a leg bag or a night bag or vice versa on a case-by-case basis as individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate professional staff ;

(4) Assistance with personal appliances as follows:

a. Insertion and cleaning dentures;

b. Insertion and cleaning hearing aids;

c. Cleaning and putting on eye glasses; and

d. Assisting with application of some types of braces, splints, slings, and prostheses on a case-by-case basis as determined by the HCSPA and individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate staff;

(5) Assistance with nutrition, hydration, and meal preparation as follows:

a. Preparation of the meal;

b. Arranging food including cutting up or mashing the food;

c. Filling the client’s fork or spoon;

d. Encouraging the client to eat or drink; and

e. Feeding the client by mouth on a case-by-case basis as determined by the agency; and

(6) Homemaker services.

(m) The HCSPA shall determine the client-related training required by the personal care services provider in addition to the basic training described in (o) below, in order to provide the personal care services which are on a case-by-case basis as described in (l) above.

(n) Prior to assisting clients with transfers, feeding, bathing, or dressing, personal care service providers, whose duties include the aforementioned tasks, shall attend a minimum 8-hour training in the performance of these duties, director of client services or designee who has been trained by the appropriate professional staff.

(o) The training in (n) above shall include at a minimum:

(1) Orientation to home care including the role of the personal care services provider and the general orientation required by (i) above;

(2) Training in communication with clients, and understanding client needs;

(3) Training in personal and home safety including environmental safety and emergency response;

(4) Training in personal care skills including:

a. Supervision and verbal prompting;

b. Assisting in bathing, dressing, grooming, mouth care, hair care, and skin care;

c. Assisting in elimination including cleaning the client after elimination and use of products related to hygiene care;

d. Moving and transferring clients;

e. Nutrition, the mechanics of eating, hydration, and how to prepare, serve, and encourage the client to eat and drink;

f. Use of assistance devices;

g. Fall prevention; and

h. Medication reminder training; and

(5) Training in responsibility, accountability, and recordkeeping.

(p) LNAs who are working as personal care service providers shall be deemed as already having received the training required in (o) above but shall be required to receive the training required by (i)(4) above.

(q) The HCSPA shall maintain a record for training of each personal care service provider.

(r) The HCSPA shall provide supervision of the personal care service provider every 6 months.

(s) The director of client services or designee shall:

(1) Coordinate the individual training required for personal care services provided on a case-by-case basis;

(2) Observe the performance of the personal care services provider on a quarterly basis;

(3) Assure that the plan of care is being carried out; and

(4) Perform an annual evaluation.

(t) All personnel shall sign a statement at the time the initial offer of employment is accepted and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a client; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(u) Personnel, volunteers, or independent contractors, hired by the licensee, who have a history of TB or a positive skin test and who will have direct care contact with clients or food shall have a symptomatology screen in lieu of a TB test.

(v) Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HCSPA licensed premises.

(w) The personnel records required by (v) above shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data, including date of birth; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the HCSPA’s policy setting forth the clients’ rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (i)(4) above and any required continuing education program;

(5) A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

(6) Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Documentation of annual in-service education as required by (i)(4) above;

(8) The statement signed at the time the initial offer of employment is accepted and renewed annually thereafter by all personnel as required by (t) above;

(9) Documentation of the criminal records check; and

(10) Documentation that the elder abuse registry checks required by (g) above.

(x) The HCSPA shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services for clients within the facility, as follows:

(1) For volunteers, the information in (w)(2) and (6)-(10) above; and

(2) For independent contractors, the information in (w)(2), and (4)-(10) above, except that the letter in (j) above may be substituted for (w)(5), (8), and (9) above, if applicable.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.18 Quality Improvement

(a) The HCSPA shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of the HCSPA’s quality improvement program, a quality improvement committee shall be established.

(c) The HCSPA shall determine the size and composition of the quality improvement committee based on the services provided.

(d) The quality improvement committee shall:

(1) Determine the indicators to be monitored;

(2) Evaluate the information that is gathered;

(3) Determine the action that is necessary to correct identified problems;

(4) Recommend corrective actions to the licensee; and

(5) Evaluate the effectiveness of the corrective actions.

(e) The quality improvement committee shall meet at least every 6 months.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.19 Infection Control and Sanitation

(a) The HCSPA shall develop and implement an infection control program that educates and provides procedures for the prevention and control and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of clients with infectious or contagious diseases or illnesses; and

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 904.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious as determined by a licensed practitioner unless they utilize appropriate infection control equipment as required by the HCSPA policy and procedures on infection control.

(e) Pursuant to RSA 141-C:1, personnel with a newly positive mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(f) Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable and durable, bandage with secure edges.

(g) Personnel infected with scabies or lice pediculosis shall not provide direct care to clients or prepare food until such time as they are no longer infected as determined by a licensed practitioner.

(h) If equipment needs to be cleaned in order to prevent contamination, the HCSPA shall develop and maintain written procedures for safe and effective cleaning of the equipment.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

N.H. Code Admin. R. Ann. He-P 822.20 Physical Environment and Emergency Preparedness

(a) The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

(1) Building;

(2) Health, including waste disposal and water;

(3) Fire; and

(4) Zoning.

(b) The HCSPA shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

(c) The HCSPA shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

(d) Each licensee shall develop a written emergency plan that covers any situation that prevents the HCSPA from providing client services and which:

(1) Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

(2) Is approved by the local emergency management director or fire department, as appropriate;

(3) Is available to all personnel;

(4) Is based on realistic conceptual events;

(5) Is modeled on the ICS in coordination with local emergency response agencies;

(6) Provides that all personnel designated or involved in the emergency preparedness plan of the HCSPA shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Includes the HCSPA's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources; and

f. Communications systems;

(8) Includes a plan for alerting and managing personnel in a disaster, and accessing CISM, if necessary;

(9) Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a client;

(10) Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

(11) If the HCSPA is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

(e) Each licensee shall annually review and revise, as needed, its emergency plan.

History

• #9522, eff 7-25-09, EXPIRED: 7-25-17
• #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18
• #12702, eff 1-3-19

Part He-P 823 Home Hospice Care Provider

N.H. Code Admin. R. Ann. He-P 823.01 Purpose

The purpose of this part is to set forth the licensing requirements for all home hospice care providers (HHCPs), pursuant to RSA 151:2, I(b).

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a HHCP, except:

(a) All facilities listed in RSA 151:2, II(a)-(g);

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h);

(c) Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H; and

(d) All homemaker services that provide only the following services:

(1) Housekeeping or housecleaning;

(2) Companionship;

(3) Shopping; or

(4) Preparation of meals that are not therapeutic diets ordered by a licensed practitioner.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a patient;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a patient; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a patient with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, self-management, and monitoring or supervision of medications.

(c) “Administer” means “administer” as defined by RSA 318:1, I, namely “an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.”

(d) “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HHCP.

(e) “Admission” means accepted by a licensee for the provision of services to a patient.

(f) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(g) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an HHCP pursuant to RSA 151.

(h) “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 823, or other federal or state requirements.

(i) “Assessment” means an evaluation of the patient to determine the care and services that are needed.

(j) “Branch office” means a location physically separate from the primary location of the HHCP and that:

(1) Provides oversight for employees who provide direct care services to patients in their cliental setting; and

(2) Is under the administration and supervision of the primary location of the HHCP.

(k) “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(l) “Change of ownership” means a change in the controlling interest of an established HHCP to a successor business entity.

(m) “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

(n) “Coordinator” means a person from the HHCP who coordinates the care and services necessary to provide optimum health care management for the patient.

(o) “Core services” means those services provided by the licensee that are included in the basic rate.

(p) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(q) “Days” means calendar days unless otherwise specified in the rule.

(r) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

(s) “Department” means the New Hampshire department of health and human services.

(t) “Direct care” means hands-on care and services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(u) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

(v) “Do not resuscitate order (DNR order)” means an order that, in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. The term includes “do not attempt resuscitation order (DNAR order)”.

(w) “Drop site” means a location, which does not meet the definition of a branch office, where materials, equipment, and supplies used in the provision of hospice services may be temporarily stored.

(x) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(y) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(z) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to thepatient ’s health care and other personal needs.

(aa) “Home hospice care provider (HHCP)” means an agency which provides hospice services to patients and their families in the patient’s residence.

(ab) “Hospice” means a specialized program of care and supportive services, which provides a combination of medical, social and spiritual services to terminally ill patients and their families.

(ac) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ad) “Infectious waste” means those items specified by Env-Sw 904.

(ae) “In‑service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(af) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 823 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 823.

(ag) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 823.

(ah) “License” means the document issued by the department to an applicant at the start of operation as an HHCP which authorizes operation in accordance with RSA 151 and He-P 823, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

(ai) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which the HHCP is licensed.

(aj) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ak) “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices. This term does not include the private residence of a patient receiving services from a HHCP.

(al) “Licensing classification” means the specific category of services authorized by a license.

(am) “Medical director” means a New Hampshire licensed practitioner, licensed in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the HHCP.

(an) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ao) “Neglect” means an act or omission that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional or physical health and safety of a patient .

(ap) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a patient.

(aq) “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(ar) “Over-the-counter medications” means non-prescription medications.

(as) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(at) “Patient” means any person admitted to or in any way receiving care, services, or both from a HHCP licensed in accordance with RSA 151 and He-P 823.

(au) “Patient record” means the documentation of all care and services, which includes all documentation required by RSA 151, He-P 823, and any other applicable federal and state requirements.

(av) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21-b.

(aw) “Personal care” means personal care services that are non-medical, hands-on services provided to a patient including, but not limited to, assistance with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the patient to take medications.

(ax) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.

(ay) “Personnel” means an individual who is employed by the HHCP, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to clients.

(az) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the patient’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

(ba) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bb) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

(bc) “Point of care devices” means testing involving a system of devices, typically including:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip to apply the blood sample; or

(3) A meter or monitor to calculate and show the results including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or

c. Cholesterol meter.

(bd) “Primary location” means the principle site for the HHCP where the business office and administrative staff are located.

(be) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(bf) “Procedure” means a licensee's written, standardized method of performing duties and providing services.

(bg) “Professional management responsibility” means that the professional staff of the HHCP provider continues to provide guidance and services to the patient regardless of the location of the patient.

(bh) “Professional staff” means:

(1) Physicians;

(2) Physician assistants;

(3) Advanced practice registered nurses;

(4) Registered nurses;

(5) Registered physical therapists;

(6) Speech therapists;

(7) Licensed practical nurse;

(8) Licensed respiratory therapists;

(9) Occupational therapists;

(10) Medical social workers;

(11) Dietitians;

(12) Spiritual care coordinator;

(13) Bereavement counselors; and

(14) Volunteer coordinators.

(bi) “Reportable incident” means an occurrence of any of the following while the patient is in the care of HHCP personnel:

(1) The unanticipated death of the patient; or

(2) An injury to a patient that is potentially due to abuse or neglect.

(bj) Self-administration of medication with assistance” means an act whereby the patient takes his or her own medication after being prompted by personnel but without requiring physical assistance from others beyond placing the container within reach, opening the medication container, reading the medication label to the patient, and utilizing hand over hand technique pursuant to Nur 404.03(b).

(bk) “Self-administration of medication without assistance” means the patient takes his or her own medication(s) without the assistance of personnel, including prompting.

(bl) “Self-directed medication administration” means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication, with or without assistance, directs personnel to physically assist in the medication process which shall not include assisting with injections or filling insulin syringes.

(bm) “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability or limitations of the patient.

(bn) “Volunteer” means an unpaid person, screened and trained by agency, who provides assistance to patients and families with companionship, household chores, shopping, transportation, et cetera, who does not provide direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a) and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License,” (September 2018 edition) signed by the applicant or 2 of the corporate officers, affirming and certifying to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

b. For any HHCP to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any HHCP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) If applicable, proof of authorization from the secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(3) The applicable fee of $250 in accordance with RSA 151:5, X(b), payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(4) A resume identifying the qualifications of and copies of applicable licenses for the HHCP administrator and medical director;

(5) Written local approvals as follows:

a. For an existing administrative building, not including a patient’s home where care is being provided, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health,drinking water, and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the health care chapter of NFPA 101 as adopted by the commissioner of the department of safety, under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a business; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project; and

(6) The results of a criminal records check from the New Hampshire department of safety for the applicant(s), licensee, if different than the applicant, licensee, administrator, and medical director.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 823.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 823.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 823.13(b) if it determines that the applicant, licensee, administrator, or medical director:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) An inspection shall be completed in accordance with He-P 823.09 prior to the issuance of a license.

(g) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the New Hampshire department of safety for all current personnel.

(h) Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 823.

(i) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(j) A written notification of denial, pursuant to He-P 823.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 823.

(k) A written notification of denial, pursuant to He-P 823.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 90 days of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall:

(1) Complete and submit to the department an application form pursuant to He-P 823.04(a)(1) at least 120 days prior to the expiration of the current license;

(2) The current license number;

(3) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 823.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(4) A list of any current employees who have a permanent waiver granted in accordance with He-P 823.18(d); and

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal.

(c) Following an inspection, as described in He-P 823.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

(3) Is found to be in compliance with RSA 151 and He-P 823 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

(d) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license, and does not intend to cease operation, shall be required to submit an application for initial license pursuant to He-P 823.04 and shall be subject to a fine in accordance with He-P 823.13(c)(5).

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIREd: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.07 Branch Offices and Drop Sites

(a) The HHCP may establish branch offices and drop sites provided that no direct patient care is provided to a patient at the drop site.

(b) The HHCP shall notify the department in writing prior to establishing or operating branch offices with the following information:

(1) The branch office address;

(2) The branch office phone number; and

(3) The license number of the HHCP.

(c) The HHCP shall submit to the department the information required by He-P 823.04(a)(5) for branch offices.

(d) Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 823.

(e) All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.08 HHCP Requirements for Organizational or Service Changes

(a) The HHCP shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location of the licensed premises;

(3) Address; or

(4) Name.

(b) The HHCP shall complete and submit a new application and obtain a new license and license certificate prior to:

(1) A change in ownership; or

(2) A change in licensing classification.

(c) When there is a change in address without a change in location, the HHCP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in address due to a physical location change , the HHCP shall provide the department with:

(1) A letter which contains the license number, new address, and date of the move; and

(2) Local approval form as specified in He-P 823.04(a)(5).

(e) When there is a change in the name, the HHCP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(f) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance then an inspection shall be conducted as soon as practical by department; or

(2) A change in licensing classification.

(g) A new license and license certificate shall be issued for a change in ownership.

(h) A revised license and license certificate shall be issued for a change in name.

(i) A license and license certificate shall be issued at the time of initial licensure.

(j) A revised license certificate shall be issued for any of the following:

(1) A change in administrator;

(2) When a waiver has been granted;

(3) When there is a change in services; or

(4) When a branch office has been added.

(k) The HHCP shall inform the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal records check from the NH department of safety for the new administrator; and

(4) Results of bureau and elderly adult registry Check.

(l) Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 823.15(g).

(m) If the department determines that the new administrator or medical director does not meet the qualifications for his or her position as specified in (l) above, it shall so notify the licensee in writing, within 14 days, so that a waiver can be sought or the licensee can search for a qualified candidate.

(n) A restructuring of an established HHCP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) The HHCP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(p) If a licensee chooses to cease operation of an HHCP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 823, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the HHCP; and

(3) Any records required by RSA 151 and He-P 823.

(b) The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 823, and other federal or state requirements prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 823.08(f)(1);

(3) A change in the licensing classification; or

(4) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings shall be issued when, as a result of an inspection, the department determines that the HHCP is in violation of any of the provisions of He-P 823, RSA 151, or other federal or state requirements.

(e) If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 823.12(c) , within 21 days of the date on the letter that transmits the inspection report.

History

• #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 823 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above:

(g) The request to renew a waiver shall be subject to (c) through (f) above.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 823.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the HHCP, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 823.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint as follows:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the licensed premises;

(3) Review of relevantrecords; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed HHCP, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 823.12(c) if the inspection results in areas of non-compliance being cited.

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 823; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine in accordance with He-P 823.13(c)(1).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an administrative or judicial proceeding relative to the licensee.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 823, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area of non-compliance; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings , the licensee shall submit a written POC for each item, written in the appropriate place on the statement and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 823;

b. Addresses all areas of non-compliance as cited in the statement of findings;

c. Prevents a new violation of RSA 151 or He-P 823 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever applies;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

2. The department determines that the health, safety, or wellbeing of a patient will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 823.13(c)(11);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an on-site follow-up inspection; or

c. Reviewing compliance during the next inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 823.12(b); and

b. Issued a directed POC in accordance with (d) below and a fine in accordance with He-P 823.13(c)(12).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients or personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 823.13(b); or

(3) Revoke the license in accordance with He-P 823.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with He-P823.12(c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to revoke, deny, or refuse to issue or renew a license.

(k) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

(2) The presence of conditions in the facility that negatively impact the health, safety, or well-being of patients.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 823 in a manner which poses a risk of harm to a patient’s health, safety, or well-being;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, or schedule an initial inspection the applicant or licensee fails to submit an application that meets the requirements of He-P 823.04;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) A licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 823.12(c),(d), and (e);

(7) A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 823.12(c)(5) and has not submitted a revised POC as required by He-P 823.12(c)(5);

(8) The licensee is cited a third time under RSA 151 or He-P 823 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

(10) Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 823;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, for an applicant, unlicensed entity, or a licensee the fine shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 823.14(g) the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 823.11(e)(4), the fine for an unlicensed provider or a licensee shall be $500.00;

(5) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 823.06(e), the fine for a licensee shall be $100.00;

(6) For a failure to notify the department prior to a change of ownership, in violation of He-P 823.08(a)(1), the fine for a licensee shall be $500.00;

(7) For a failure to notify the department prior to a change in the physical location, in violation of He-P 823.08(a)(2), the fine for a licensee shall be $1000.00;

(8) For a failure to notify the department of a change in e-mail address, in violation of He-P 823.08(o), the fine shall be $100.00;

(9) For a failure to allow access by the department to the HHCP’s premises, programs, services, patients, or records, in violation of He-P 823.09(a)(1)-(3), the fine for an applicant, unlicensed individual or licensee shall be $2000.00;

(10) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 823.12(c)(2) and (5), the fine for a licensee shall be $100.00;

(11) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 823.12(c)(8), the fine for a licensee shall be $1000.00;

(12) For a failure to establish, implement or comply with licensee policies, as required by He-P 823.14(b), (d), and (s), the fine for a licensee shall be $500.00;

(13) For a failure to provide services or programs required by the licensing classification and specified by He-P 823.14(c), the fine for a licensee shall be $500.00;

(14) For a failure to transfer a patient whose needs exceeds the services or programs provided by the HHCP, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(15) For providing false or misleading information or documentation to the department, in violation of He-P 823.14(f), the fine shall be $1000.00 per offense;

(16) For a failure to meet the needs of the patient, in violation of He-P 823.15(e), the fine for a licensee shall be $1000.00 per patient;

(17) For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 823.14(i)(5)-(6), the fine for a licensee shall be $500.00;

(18) When an inspection determines that a violation of RSA 151 or He-P 823 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the original fine, but not to exceed $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

(19) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 823 shall constitute a separate violation and shall be fined in accordance with He-P 823.13(c); and

(20) If the applicant or licensee is making good faith efforts to comply with (14) or (16) above, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of a patient is in jeopardy and emergency action is required in accordance with RSA 541:A-30.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 823 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When an HHCP’s license has been denied or revoked, the applicant, family member, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

(k) The 5-year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 823.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 823.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all federal, state and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, as applicable.

(b) The licensee shall have a written policies and procedures to include:

(1) The rights and responsibilities of admitted patients in accordance with the “Home Care Clients’ Bill of Rights” under RSA 151:21-b;

(2) The policies described in He-P 823; and

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the HHCP, which shall include at a minimum, the core services listed in He-P 823.15.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HHCP and for:

(1) Reviewing the policies and procedures every 2 years; and

(2) Revising them as needed.

(e) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(f) The licensee or HHCP personnel shall not falsify documentation or provide false or misleading information to the department.

(g) The licensee shall not advertise or otherwise represent the program as operating an HHCP, or providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

(h) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(i) The licensee shall:

(1) Manage and operate the HHCP;

(2) Meet the needs of the patients during those hours that the patient is in the care of the HHCP;

(3) Initiate action to maintain the HHCP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(4) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HHCP;

(5) Appoint an administrator and a medical director;

(6) Verify the qualifications of all personnel;

(7) Provide sufficient numbers of qualified personnel who are available to meet the needs of patients during all hours that the HHCP has contracted with patients to provide service;

(8) Provide personnel with sufficient supplies and equipment to meet the needs of the patients;

(9) Require all personnel to follow the orders of the licensed practitioner for every patient and encourage the patient to follow the licensed practitioner’s orders; and

(10) Implement any POC that has been accepted or issued by the department.

(j) The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction; or

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(k) The licensee shall only accept a patient whose needs can be met through the program and services offered under the current license.

(l) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patient, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

(m) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

(n) The licensee shall post the following documents in a public area:

(1) The license and current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports for the last 12 months issued in accordance with He-P 823.09(d) and He-P 823.11(d)(4);

(3) A copy of the “Home Care Clients’ Bill of Rights” specified by RSA 151:21-b;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

(6) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

(o) For reportable incidents, the licensees shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2 business days of a reportable incident:

a. The HHCP name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of patientinvolved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the patient’s guardian, agent, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the patient’s licensed practitioner was notified;

(3) Immediately notify the guardian, agent, or personal representative, if any;

(4) If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(5) Contact the department immediately by telephone, fax, or e-mail to report the information required by (2) above in the case of the death of any patient who dies within 10 days of a reportable incident;

(6) Provide the information required by (4) above in writing within 72 hours of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

(7) Submit any further information requested by the department.

(p) The licensee shall admit and allow any department representative to inspect the HHCP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 823 as authorized by RSA 151:6 and RSA 151:6-a.

(q) A licensee shall, upon request, provide a patientor their legal guardian or agent, or surrogate decision-maker if applicable, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

(r) All records required for licensing shall be legible, current, accurate and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(s) Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

(3) Systems to prevent tampering with information pertaining to patients and personnel.

(t) At the time of admission the licensee shall give a patient and their legal guardian agent, or surrogate decision-maker if applicable, a listing of all HHCP’s charges and identify what care and services are included in the charge.

(u) At the time of admission the licensee shall give a patient and their guardian, agent, or surrogate decision-maker if applicable, a listing of all applicable HHCP charges and identify what care and services are included in the charge.

(v) The licensee shall provide all personnel with education in hospice philosophy and hospice care.

(w) No patient shall receive any direct patient care at the HHCP primary location, branch office, or drop site(s).

(x) The HHCP shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18; amd by #12928, eff 11-26-19

N.H. Code Admin. R. Ann. He-P 823.15 Required Services

(a) The licensee shall provide the following core hospice care services:

(1) Nursing services sufficient to meet the nursing needs of the patient, which are:

a. Determined by the patient’s care plan;

b. Available, as needed, 24 hours a day; and

c. Supervised by a registered nurse.

(2) Home health aide and personal care services that are provided either directly or by contract as the needs of the patient dictate and as determined by the patient’s care plan;

(3) Assisting patients to acquire pharmaceutical services such as equipment, appliances, medical supplies, and other pharmaceutical services as the needs of the patient dictate and as determined by the patient’s care plan;

(4) Hospice care social services such as assessment of the social environment and financial issues supervised by a social worker;

(5) Hospice volunteer services;

(6) Nutritional counseling, physical or occupational therapy, and speech therapy that are provided or arranged for as needed in accordance with patient’s care plan;

(7) Spiritual services which are offered in accordance with the patient’s and family's beliefs and values; and

(8) Bereavement services that are available to the family for up to one year following the death of the patient.

(b) If, on a temporary basis, not to exceed 90 days, the HHCP cannot provide any of the core care and services in (a) above, the HHCP shall have a written agreement with another agency to provide the required services.

(c) Any contractual agreement to provide care and services shall:

(1) Identify the care and services to be provided;

(2) Specify the qualifications of the personnel that will be providing the care and services;

(3) Require that the HHCP must authorize the services; and

(4) Stipulate the HHCP retains professional responsibility for all care and services provided.

(d) The HHCP shall provide or arrange for the provision of short-term in-patient stays in a hospital, nursing home, or hospice house during those times when the patient’s pain or symptoms are unable to be managed in the home.

(e) The HHCP shall retain professional management responsibility for all services that are provided including contracted services when a hospice patient is in another licensed facility. These responsibilities shall be defined in a written contractual agreement.

(f) The licensee shall provide staff for the following positions:

(1) An administrator to oversee the HHCP, except as allowed by 823.15(g)(1) below;

(2) A full time director of patient services;

(3) A medical director;

(4) A volunteer coordinator;

(5) A social services coordinator; and

(6) Spiritual and or bereavement coordinator.

(g) Any administrator shall have at least a bachelor's degree in business or a health-related field with a minimum of one year’s experience in hospice care or be a registered nurse and:

(1) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(2) Be permitted to hold more than one position at the HHCP if:

a. The individual meets the qualifications of all positions; and

b. The duties and responsibilities of the positions can be accomplished by one individual; and

(3) Be responsible for maintaining the HHCP in full compliance with all federal, state, and local laws, rules, codes, and ordinances at all times.

(h) Any director of patient services shall:

(1) Be a New Hampshire-licensed or compact-registered nurse;

(2) Be a New Hampshire-licensed advanced practice registered nurse; or

(3) Have a bachelor's degree in a health field related to hospice care.

(i) The director of patient services shall:

(1) Be responsible for the overall delivery of patient care and services;

(2) Provide sufficient nursing personnel to meet the need of the patients;

(3) Supervise the overall delivery of patient care and services; and

(4) Coordinate the supervision of licensed nurse aides (LNA) at least every 2 weeks by a registered nurse at the patient’s home to determine if the LNA is providing care and services in accordance with the patient’s care plan. The LNA shall not have to be present during this visit.

(j) The medical director shall be a licensed provider and shall be responsible for:

(1) The overall medical component of the hospice plan of care;

(2) Participating on the interdisciplinary patient care team;

(3) Determining, in consultation with the interdisciplinary team, that an individual is appropriate for hospice care services; and

(4) Consultative physician visits for hospice and palliative care patients as requested by physicians.

(k) Volunteer services shall be provided under the direction of a coordinator of volunteer services who:

(1) Implements a direct service volunteer program;

(2) Coordinates the orientation, education, support, and supervision of direct service volunteers; and

(3) Coordinates the utilization of direct service volunteers with other hospice staff.

(l) All volunteers shall be oriented and educated relative to their prescribed function according to the hospice care provider’s policies and procedures.

(m) The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

(1) Recruitment and retention;

(2) Screening;

(3) Orientation;

(4) Scope of function;

(5) Supervision;

(6) Ongoing training and support;

(7) Records of volunteer activities; and

(8) Criminal record checks.

(n) The social services coordinator shall have:

(1) At least a master’s degree from a graduate school of social work; or

(2) A bachelor’s degree in a related health or human services field, have at least 2 years experience as a social worker and have established a consultative relationship with a person who qualifies in (1) above.

(o) The social services coordinator shall:

(1) Participate in the development of the care plan; and

(2) Work in conjunction with the director of patient services to coordinate all social services required by the care plan and ensure their delivery.

(p) The spiritual and or bereavement coordinator shall be a person who has at least a bachelor's degree in an applicable field such as theology of education, psychology, or counseling and who has completed at least 8 additional hours in death and dying, grief, and bereavement.

(q) Persons providing bereavement services shall have education in death and dying, grief, and bereavement.

(r) The spiritual and or bereavement coordinator shall be responsible for providing an organized program of bereavement services for up to 12 months after the death of the patient including:

(1) Counseling to families after the patient’s death;

(2) Developing a care plan that reflects the needs of the patient’s family; and

(3) Others services necessary to aid in the bereavement process.

(s) If the licensee collects human specimens for laboratory testing, it shall follow the manufacturer's instructions and/or the reference laboratory's instructions for collection and storage of human specimens.

(t) If the licensee test human specimens, it shall be licensed as a laboratory in accordance with He-P 808, except the licensee may perform the following CLIA-waiverd point of care test without obtaining a laboratory license in accordance with He-P 808:

(1) Glucose;

(2) PT/INR;

(3) Dipstick urinalysis; and

(4) Occult blood.

(u) The licensee shall hold the appropriate CLIA certificate to perform any laboratory tests.

(v) Licensee collecting human specimens for laboratory testing shall require a collecting station license in accordance with He-P 817 except when collected by a trained registered nurse or licensed nursing assistant.

(w) Training shall consist of collection, storage, and transport of the specimens.

(x) Training shall be done by a registered nurse trained in the collection, storage and transport of human specimens.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.16 Patient Services

(a) The licensee shall only admit those patients whose needs can be met by the HHCP.

(b) At the time of admission, personnel of the HHCP shall:

(1) Provide, both orally and in writing, to the patient, or the patient’s guardian, agent, or surrogate decision-maker, if applicable the HHCP’s:

a. Policy on patient rights and responsibilities, including a copy of the home care clients’ Bill of Rights, pursuant to RSA 151:21-b;

b. Complaint procedure;

c. List of care and services that are provided directly by the HHCP; and

d. List of the care and services that are provided by contract;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, their guardian, agent, or surrogate decision-maker if applicable;

(3) Collect and record the following information:

a. Patient’s name, home address, home telephone number, and date of birth;

b. Name, address and telephone number of an emergency contact and guardian, agent, or surrogate decision-maker if applicable;

c. Name of patient’s primary care provider and their address and telephone number;

d. Copies of all legal directives such as durable power of attorney, legal guardian, or living will; and

e. Written and signed consent for the provision of care and services; and

(4) Obtain documentation of informed consent and consent for release of information.

(c) The hospice care provider shall ensure that medical direction is provided either from the patients’ attending licensed practitioner or the hospice medical director.

(d) Patients who are admitted or accepted for services shall:

(1) Be evaluated and assessed by professional staff within 48 hours of admission; and

(2) Have an order for any service for which such order is required by the practice acts of the person providing care.

(e) Patients who are accepted for services shall have a nursing assessment at the following intervals to determine the level of care and services required by the patient:

(1) Within 48 hours of admission; and

(2) Thereafter as required by the CMS conditions of participation or at least every 90 days at a minimum.

(f) The assessment required by (e) above shall contain, at a minimum, the following:

(1) Pertinent diagnoses including mental status;

(2) A pain assessment, including symptom control and vital signs;

(3) A physical assessment;

(4) A cognition and mental status assessment;

(5) A behavioral assessment;

(6) A psychosocial assessment;

(7) Medications and treatment needs;

(8) Functional limitations;

(9) Nutritional requirements;

(10) Estimated duration and frequency of care and services;

(11) Any equipment required; and

(12) Any safety precautions.

(g) In addition to the information in (e) and (f) above, the initial nursing assessment shall include:

(1) Reactions of the patient and family members to terminal illness;

(2) History of the patient’s and family coping strengths and weaknesses;

(3) Social and financial concerns; and

(4) Spiritual beliefs and desires of the patient.

(h) The licensee shall establish an interdisciplinary hospice care team composed of at least:

(1) A licensed practitioner;

(2) A registered nurse;

(3) A social worker; and

(4) A spiritual and or bereavement counselor.

(i) The interdisciplinary hospice care team shall:

(1) Establish the care plan;

(2) Be the primary care delivery team for a patient and his or her family through the total duration of hospice care; and

(3) Be responsible for supervising any patient care and services provided by others.

(j) The interdisciplinary team shall, in conjunction with the patient and the patient’s personal representative, and their family, develop an individualized care plan, which reflects the changing care needs of the patient and family.

(k) The care plan required by (j) above shall include:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal for the patient;

(4) The action or approach to be taken by HHCP personnel;

(5) The responsible person(s) or position; and

(6) The interventions used to address problems identified in the assessment including:

a. Medications ordered;

b. Pain control interventions, both pharmacological and non-pharmacological;

c. Symptom management treatment; and

d. Services required including frequency of visits.

(l) The care plan required by (j) above shall be:

(1) Developed in conjunction with the patient and their guardian, agent, or surrogate decision maker;

(2) Completed no later than5 days after completion of the assessment;

(3) Reviewed and revised every 15 days by the interdisciplinary team following the completion of each assessment; and

(4) Made available to all personnel that assist the patients.

(m) The patient, the patient’s family and guardian , agent, or surrogate decision maker shall be notified in advance of all interdisciplinary team meetings and be given the opportunity to participate in such meetings.

(n) The patient and their family shall be encouraged to participate in all components of care, including:

(1) Assessment and problem identification;

(2) Implementation of the care plan; and

(3) Evaluation and revision of the care plan, as needed.

(o) The care plan shall contain documentation of the patient’s or the patient’s guardian, agent, or surrogate decision-makers' acceptance or rejection of the initial care plan and all subsequent revisions or updates.

(p) All staff of the HHCP shall carry out the goals stated in the care plan.

(q) The licensee shall develop a discharge plan with the input of the patient and the guardian, agent, or surrogate decision-maker if any.

(r) Copies of the following documents shall accompany the transferred patient:

(1) The emergency data sheet;

(2) A copy of the care plan; and

(3) A summary that includes:

a. The date and time the patient was transferred from the HHCP;

b. The place to which the patient was transferred or discharged; and

c. The condition of the patient at the time of transfer or discharge.

(s) Transfers may occur without prior notification to the guardian or agent pursuant to an activated POA or the licensed practitioner when the patient is in need of immediate emergency care.

(t) Progress notes shall be written by personnel, as appropriate, at the time of each visit and shall include at a minimum:

(1) Changes in the pateint’s physical, functional, and mental abilities;

(2) Changes in the patient’s behaviors such as eating or sleeping patterns;

(3) The patient’s relief of pain, if applicable; and

(4) Newly identified needs of the patient and their family.

(u) Written notes shall be documented in the patient’s record for:

(1) All care and services provided by personnel and include the following:

a. Date and time of the care or service;

b. Description of the care or service;

c. Progress notes as required by (t) above; and

d. Signature and title of the person providing care or services; and

(2) Any reportable incident or occurrence involving the patient when HHCP personnel are in the patient home, which shall include the information required by He-P 823.14(o).

(v) For each patient accepted for care and services by the HHCP, a current and accurate record shall be maintained, including, at a minimum:

(1) The written confirmation required by He-P 823.16(b)(2);

(2) The identification data required by He-P 823.16(b)(3);

(3) Consent and medical release forms, as applicable;

(4) Pertinent medical information:

(5) Al orders from a licensed practitioner, including the date and signature of the licensed practitioner required by He-P 823.16(c);

(6) Copy of order activating durable power of attorney, if applicable;

(7) Copy of DNR order, if applicable;

(8) All assessments required by He-P 823.16(d) and (e);

(9) All care plans required by He-P 823.16(j)-(l) including documentation that the patient or patient’s guardian, agent, or surrogate decision-maker, if applicable, participated in the development of the care plan;

(10) All written notes required by He-P 823.16(u);

(11) All progress notes as required by He-P 823.16(t);

(12) All daily medication records required by He-P 823.17(d)(9);

(13) A discharge plan or transfer summary as required by He-P 823.16(q) and (r)(3);

(14) Discharge documentation, which shall include:

a. In the case of patient death:

1. Date and place of death; and

2. Bereavement follow-up plan; and

b. In the case of discharge other than patient death:

1. Date and time of patient discharge;

2. The physical, mental, and medical condition of patient at discharge;

3. Discharge instruction and referral;

4. Discharge summary; and

5. Signed licensed practitioner’s order for discharge, if applicable; and

(15) Documentation of any patient refusal of any care or services.

(w) Patient records shall be available to:

(1) The patient, their guardian, agent, or surrogate decision-maker;

(2) HHCP personnel as required by their job responsibilities and subject to the licensee's policy on confidentiality;

(3) Any individual given written authorization by the patient or their guardian ,agent and surrogate decision maker;

(4) Any individual authorized by a court of competent jurisdiction; and

(5) The department or any individual authorized by law.

(x) The licensee shall develop and implement a method for the written release of information in the patient record that is consistent with federal and state statute.

(y) The HHCP shall store the patient record in the primary or branch office except when they are being utilized by the supervisory and direct care staff.

(z) Records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by direct care staff.

(aa) Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

(ab) The HHCP shall arrange for storage of, and access to, patient records as required by (aa) above in the event that the HHCP ceases operation.

(ac) If the HHCP is providing any of the following services, they shall be licensed in accordance with the applicable rules:

(1) Home health care provider agency; or

(2) Case management provider agency.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.17 Medications

(a) HHCP personnel who are not authorized by law to administer medications may remind and prompt patients to take their medications at the proper time, place medication container(s), including pill planners, within patient reach, and open the medication container(s) when the patient is present, reading the medication label to the patient and utilizing hand over hand technique if the patient is competent and stable, as per the care plan.

(b) If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse, and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

(c) A licensed nursing assistant (LNA) may perform hand over hand assistance by following the care plan, as delegated by a licensed nurse, to a competent and stable patient pursuant to RSA 326-B.

(d) If personnel, who are authorized by law, administer medication(s), delegate medication administration, or prepare medication in advance for administration in accordance with RSA 318:42, XIII and XIV, the HHCP shall:

(1) Maintain a list of medications currently being taken by the patient;

(2) Administer all medications in accordance with the written and signed orders of the licensed practitioner;

(3) Maintain a written and signed order, or a copy thereof, in the patient’s record that includes:

a. The patient’s name;

b. The medication name, strength, prescribed dose, and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Only use medications that have been kept in the original containers, as dispensed by the pharmacy, licensed practioner’s samples, or over the counter medications;

(5) Require that any change or discontinuation of medications shall be pursuant to a written and signed order from a licensed practitioner or other individual authorized by law;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner as soon as possible and with a documented reason if signed more than 30 days after the telephone order being taken;

(7) Require that the medication to be administered by HHCP personnel be:

a. Prepared immediately prior to administration; and

b. Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B;

(8) Require that when personnel are assisting or administering medication, they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

(9) Maintain documentation for all medications either assisted by or administered by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication was taken;

e. The signature and identifiable initials and job title of:

1. The person assisting or administering the medication; or

2. The person administering or assisting the patient taking his or her medication;

f. Documented reason for any medication refusal or omission; and

g. For PRN medications, the reason the patient required the medication and the effect of the PRN medication at the time of the next patient contact; and

(10) Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

a. Observed adverse reactions to or side effects of medication; and

b. Medication errors such as incorrect medications.

(e) If the HHCP provides “self-administration of medication with assistance” medication services to a patients defined by He-P 823.03(bk), the HHCP shall:

(1) Maintain, in the home, a list of medications currently being taken by the patient;

(2) Assist with self-administration of medications in accordance with the written and signed orders of the licensed practitioner;

(3) Maintain either the original written and signed order, or a copy thereof, in the patient’s record that includes:

a. The patient’s name;

b. The medication name, strength, prescribed dose, and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Not allow personnel to assist with self-administration of medications if anyone other than a pharmacist has changed prescription medication container labels except as allowed by (e)(7)f. below;

(5) Require that any change or discontinuation of medications shall be pursuant to a written and signed order;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner within 30 days or with a documented reason if more than 30 days;

(7) Allow a patient to self-administer medication with assistance by personnel, as directed by the care plan, and which personnel shall be required to:

a. Remind the patient to take the correct dose of his or her medication at the correct time from the original medication bottle;

b. Place the medication container within reach of the patient;

c. Remain with the patient to observe them taking the appropriate number and type of medication as ordered by the licensed practitioner;

d. Record that they have supervised the patient taking their medication on the patient’s daily medication record;

e. Document in the patient’s record any observed or reported side effects, adverse reactions, refusal to take medications, and medications not taken; and

f. Require that if the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HHCP are unable to obtain a new prescription label:

1. The RN shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HHCP’s written procedure, indicating that there has been a change in the medication order;

2. The RN shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

3. The change in dosage, without a change in prescription label as described in (e)(7)f.1. and (e)(7)f.2.above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first;

(8) Permit personnel who assist a patient that self-administers medication with assistance to open the medication container and place it within reach of the patient, but not permit that person to physically handle the medication in any manner;

(9) Require that when personnel are assisting that they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

(10) Maintain documentation for all medications assisted by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication, including PRN medications, was taken;

e. The signature, identifiable initials, and job title of the person assisting the patient taking his or her medication; and

f. Documented reason for any medication refusal or omission;

(11) Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

a. Observed adverse reactions to or side effects of medication; or

b. Medication errors such as incorrect medications; and

(12) Require LNAs who assist patients with self-administration of medications to comply with the board of nursing requirements according to RSA 326-B.

(f) A home health personal care service provider shall successfully complete a medication assistance education program taught by a licensed nurse, licensed practitioner, or pharmacist, whether in person or through other means such as electronic media, prior to assisting a patient with self-administration of medication with assistance, self-directed medication administration, or administration via nurse delegation.

(g) The medication assistance education program required by (f) above shall, at a minimum, include training on the following subjects:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights, including:

a. The right patient;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. Administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as antihypertensives or antibiotics;

(5) Desired effects and potential side effects versus adverse effects of medications; and

(6) Medication precautions and interactions.

(h) For patients who qualify for the use of therapeutic cannabis, the licensee shall keep a copy of the registry identification card in the patient’s record.

(i) The licensee shall develop, maintain, and implement a patient specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be handled and administered to the patient.

(j) If allowed by the policy in (k) above, cannabis shall be treated in a manner similar to controlled medications with respect to assisting qualifying patients with the therapeutic use of cannabis.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.18 Personnel

(a) The licensee shall develop a job description for each position in the HHCP containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Qualifications and educational requirements of the position.

(b) For all applicants for employment, volunteers, and independent contractors who will provide direct care or personal care services to patients, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

(2) Review the results of the criminal records check in (1) above in accordance with (c)(1)-(3) below; and

(3) Verify the qualifications of applicants prior to employment.

(c) Unless a waiver is granted in accordance with He-P 823.10 and (d) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, for any position if the individual:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(d) If the information identified in (c) above regarding any person identified in (b) above, is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (c) above.

(e) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, after investigation, if it determines that the person poses a threat to the health, safety, or well-being of a patient; or

(2) Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(f) The licensee shall:

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing.

(g) In lieu of (b) and (f) above, the licensee may accept, from independent agencies contracted by the licensee to provide direct care or personal care services, a signed statement that the agency’s employees have complied with (b) and (f) above and do not meet the criteria in (c) and (f) above.

(h) All personnel shall:

(1) Meet the educational and physical qualifications of the position as listed on their job description;

(2) Be licensed, registered, or certified as required by state statute;

(3) Receive an orientation prior to contact with a patient that includes:

a. The HHCP’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

b. The duties and responsibilities of the position they were hired for;

c. The HHCP’s policies, procedures and guidelines;

d. The HHCP’s infection control program;

e. The HHCP’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

f. The mandatory reporting requirements such as RSA 161:F: 46-48 and RSA 169-C: 29-31;

(4) Within the first 3 months of employment, receive an orientation to hospice philosophy relative to the delivery of care and services to hospice patients and their families;

(5) Complete mandatory annual in-service education, which includes a review of the HCCP’s:

a. Policies and procedures on patient rights and responsibilities;

b. Infection control program; and

c. Fire and emergency procedures;

(6) Be at least 18 years of age if working as direct care personnel unless they are:

a. A licensed nursing assistant working under the supervision of a registered nurse in accordance with Nur 700; or

b. Part of an established educational program working under the supervision of a registered nurse;

(7) Prior to contact with patients or food, submit to the HHCP the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2-step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

(8) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

(9) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. Tuberculosis in Health Care Settings (2005 edition),available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(i) In lieu of (h)(8) above, independent agencies contracted by the facility to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (h)(7) and (9) above before working at the HHCP.

(j) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(k) Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients or food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

(l) All personnel shall follow the orders of the licensed practitioner for each patient and encourage patients to follow the practitioner’s order.

(m) Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HHCP licensed premises.

(n) The employee file required by (m) above shall include the following:

(1) A completed application for employment or a resume, including:

a. Identification data, including date of birth; and

b. The education and work experience of the employee;

(2) A signed statement acknowledging the receipt of the HHCP’s policy setting forth the patients’ rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

(3) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(4) Record of satisfactory completion of the orientation program required by (h)(4)and (5) above and any required continuing education program;

(5) A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

(6) Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(7) Documentation of annual in-service education as required by (h)(5) above;

(8) For unlicensed personnel that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine that the personnel member is competent to administer medications;

(9) A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel as required by (j) above;

(10) Documentation of the criminal records check;

(11) The results of the registry checks in (f) above; and

(12) Copy of certification of (h)(7) above.

(o) The HHCP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (n)(1), (2), (4), and (6)-(11) above; and

(2) For independent contractors, the information in (n)(2), and (4)-(11) above, except that the letter in (g) and (i) above may be substituted for (n)(6), (10), and (11) above, if applicable.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.19 Quality Improvement

(a) The HHCP shall develop and implement a quality improvement program that reviews policies and all care and services provided to patients and maximizes quality by preventing or correcting identified problems.

(b) As part of the HHCP quality improvement program, a quality improvement committee shall be established.

(c) The HHCP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the licensee; and

(7) Evaluate the effectiveness of the corrective actions.

(e) If the HHCP utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review:

(1) The patient census;

(2) The number of unlicensed personnel administering medications via nurse delegation;

(3) Categories of medications administered;

(4) Route of administration; and

(5) Any incidents or medication errors and actions taken.

(f) The quality improvement committee shall meet at least quarterly.

(g) The quality improvement committee shall generate dated, written minutes after each meeting.

(h) Documentation of all quality improvement activities shall be maintained on-site at the primary location for at least 2 years.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.20 Infection Control

(a) The HHCP shall develop and implement an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand-washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation and disposal of those items identified as infectious waste in Env-Sw 904; and

(5) Reporting of infectious and communicable diseases as required by He-P 301.

(c) The HHCP shall appoint an individual who will oversee the development and implementation of the infection control program.

(d) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(e) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

(g) Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight fitting bandage.

(h) Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

(i) If the HHCP has an incident of an infectious disease reported in (b)(5) above, the HHCP shall contact the public health nurse in the county in which the patient resides and follow the instructions and guidance of the nurse.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-29-17, EXPIRES: 10-26-17
• #12642, eff 10-9-18

N.H. Code Admin. R. Ann. He-P 823.21 Physical Environment and Emergency Preparedness

(a) The licensee shall comply with all federal, state and local laws, rules, codes and ordinances for:

(1) Building;

(2) Health, including waste disposal and water;

(3) Fire; and

(4) Zoning;

(b) The HHCP shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

(c) The HHCP shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

(d) Each HHCP shall develop a written emergency plan that covers any situation that could prevent the HHCP from providing patient services and which:

(1) Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

(2) Is approved by the local emergency management director and/or fire department, as appropriate;

(3) Is available to all personnel;

(4) Is based on realistic conceptual events;

(5) Is modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provides that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Includes the HHCP's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources; and

f. Communications systems;

(8) Includes a plan for alerting and managing personnel in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(9) Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a patient;

(10) Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

(11) If the HHCP is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

(e) Each licensee shall annually review and revise, as needed, its emergency plan.

History

• #9292, eff 10-9-08, EXPIRED: 10-9-16
• #12168, INTERIM, eff 4-28-17, EXPIRED: 10-26-17
• #12642, eff 10-9-18

Part He-P 824 Hospice House

N.H. Code Admin. R. Ann. He-P 824.01 Purpose

The purpose of this part is to set forth the licensing requirements for all hospice houses (HH), pursuant to RSA 151.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a HH, except:

(a) All facilities listed in RSA 151:2, II(a)-(i); and

(b) All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

(3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and self-management, monitoring, or supervision of medications.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrative remedy” means a corrective action imposed upon a licensee in response to non-compliance with RSA 151 or He-P 824.

(f) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(g) “Admission” means acceptance by a licensee for the provision of care and services to a patient and when the patient physically moves into the HH.

(h) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

(i) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

(j) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA 137-J:34-37.

(k) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an HH pursuant to RSA 151.

(l) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.

(m) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

(n) “Care plan” means a written guide developed by the licensee or their personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(o) “Change of ownership” means the transfer of the controlling interest of an established HH to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(p) “Chemical restraints” means a drug or medication that is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

(q) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(r) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(s) “Contracted employee” means a temporary employee working under the direct supervision of the HH but employed by an outside agency.

(t) “Coordinator” means a person from the HH who coordinates the care and services necessary to provide optimum health care management for the patient.

(u) “Core services” means those services provided by the licensee that are included in the facility’s basic rate.

(v) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(w) “Days” means calendar days unless otherwise specified in the rule.

(x) “Department” means the New Hampshire department of health and human services.

(y) “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(z) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(aa) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified deficiencies.

(ab) “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.

(ac) “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ad) “Elopement” means when a patient who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

(ae) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.

(af) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(ag) “Employee” means anyone employed by the HH and for whom the HH has direct supervisory authority.

(ah) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 824.

(ai) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(aj) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(ak) “Facility” means “facility” as defined in RSA 151:19, II.

(al) “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(am) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and other personal needs.

(an) “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s control.

(ao) “Hospice” means a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

(ap) “Hospice house (HH)” means a residential setting providing a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

(aq) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ar) “Infectious waste” means those items specified by Env-Sw 103.28.

(as) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(at) “Informed consent” means the decision by a patient, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the patient, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(au) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He‑P 824 or to respond to allegations of non‑compliance with RSA 151 and He-P 824.

(av) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

(aw) “License” means the document issued to an applicant or licensee of an HH which authorizes operation in accordance with RSA 151 and He-P 824, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

(ax) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds that the HH is licensed for.

(ay) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse;

(4) Doctor of osteopathy; or

(5) Doctor of naturopathic medicine.

(az) “Licensed premises” means the building(s) that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(ba) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(bb) “Licensing classification” means the specific category of services authorized by a license.

(bc) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bd) “Mechanical restraint” means locked, secured, or alarmed HH or units within an HH, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a patient from freely exiting the HH or unit within.

(be) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the HH.

(bf) “Medication” means a substance available with or without a prescription, used as a curative or remedial substance.

(bg) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bh) “Neglect” means an act or omission, which results, or could result, in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.

(bi) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bj) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bk) “Over-the-counter medications” means non-prescription medications.

(bl) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bm) “Patient” means any person admitted to or in any way receiving care, services, or both from a HH licensed in accordance with RSA 151 and He-P 824.

(bn) “Patient record” means documents maintained for each patient receiving care and services, which includes all documentation required by RSA 151 and He-P 824 and all documentation compiled relative to the patient as required by other federal and state requirements.

(bo) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(bp) “Personal assistance” means providing or assisting a patient in obtaining one or more services as determined by their patient assessment.

(bq) “Personal representative” means a person designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose, or for the general purpose of assisting the patient in the exercise of any rights.

(br) “Personnel” means an individual, who is employed by, a volunteer of, or an independent contractor of the HH who provides services to patient(s).

(bs) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the patient’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.

(bt) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bu) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bv) “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

(1) A lancing or finger stick device to obtain blood specimen;

(2) A test strip or reagents to apply a specimen to for testing; or

(3) A meter or monitor to calculate and show the results, including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

c. A Cholesterol meter.

(bw) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(bx) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(by) “Professional management responsibility” means that the professional staff of the HH provider continues to provide guidance and services to the patient regardless of the location of the patient.

(bz) “Professional staff” means:

(1) Physicians;

(2) Physician assistants;

(3) Advanced registered nurse practitioners;

(4) Registered nurses;

(5) Registered physical therapists;

(6) Speech therapists;

(7) Licensed practical nurses;

(8) Licensed respiratory therapists;

(9) Occupational therapists;

(10) Medical social workers;

(11) Dietitians;

(12) Spiritual care coordinators;

(13) Bereavement counselors; and

(14) Volunteer coordinators.

(ca) “Protective care” means the provision of patient monitoring services, including but not limited to:

(1) Knowledge of patient whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(cb) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(cc) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cd) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(ce) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cf) “Reportable incident” means an occurrence of any of the following while the patient is either in the HH or in the care of HH personnel:

(1) The unanticipated death of a patient which is not related to their diagnosis or underlying condition;

(2) An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and has resulted in an injury that requires treatment in an emergency room by a licensed practitioner; or

(3) An elopement from the HH or other circumstances that resulted in the notification or involvement of law enforcement or safety officials.

(cg) “Self-administration of medication” means an act whereby the patient takes his or her own medication(s) without the assistance of another person.

(ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.

(ci) “Significant change” means a decline or improvement in a patient’s status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the patient’s health status; and

(3) Requires interdisciplinary review or revision of the care plan.

(cj) “State Fire Code” means the edition of the Life Safety Code 101 and Fire Code NFPA 1 adopted and amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(ck) “State Building Code” means the edition of the International Building Code, the International Existing Building Code, the International Plumbing Code, the International Mechanical Code, the International Energy Conservation Code, the International Swimming Pool and Spa Code, and the International Residential Code, as published by the International Code Council, and the National Electrical Code adopted and amended by the state building code review board and ratified by the legislature in accordance with RSA 155-A:10.

(cl) “State monitoring” means the placement of individuals by the department at an HH to monitor the operation and conditions of the facility.

(cm) “Temporary manager” means a person appointed by the department to assume responsibility for the day-to-day operation and administration of an HH.

(cn) “Transfer” means moving a patient from one licensed facility or entity to another licensed facility or entity.

(co) “Underwriters Laboratories (UL) Listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(cp) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a) and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care License or Special Health Care Service” (February 2023) signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted there under and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

(2) A floor plan of the prospective HH;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee, in accordance with RSA 151:5, VII, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire;”;

(5) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances applicable for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

(6) If the HH uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02 or, if a public water supply is used, a copy of a water bill;

(7) A resume identifying the qualifications of the HH administrator and medical director;

(8) Copies of applicable licenses for the HH administrator and medical director;

(9) The results of a criminal records check, for the applicant, licensee if different than the applicant, administrator and medical director which includes criminal history from the state of New Hampshire;

(10) A copy of the criminal attestation as described in He-P 824.19(k)(7) for the administrator and medical director; and

(11) The results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 824.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 824.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 824.13(b), when it determines that the applicant, licensee, administrator, or medical director:

(1) Has been convicted of any felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this of any other state;

(3) Has had a finding by the department or any other administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) Following both a clinical and life safety inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 824.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 824.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 824.

(i) A written notification of denial, shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 824.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 824.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 824.10(f), if applicable. If such request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(4) A list of current employees who have a permanent waiver granted in accordance with He-P 824.17(e)(2); and

(5) A copy of any temporary, new or existing variances or waivers applied for or granted by the state fire marshal in accordance with RSA 153:5 and Saf-C 6005.

(c) In addition to He-P 824.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by He-P 824.06(b) and (c), as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 824, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.07 HH Construction, Modifications or Renovations

(a) For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including stamped architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 824 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) The HH shall comply with all applicable state laws, rules, and local ordinances when

undertaking construction or rehabilitation.

(g) A licensee or applicant undertaking construction, repairs, renovations, rehabilitation or modifications of a building shall comply with the appropriate chapters and sections of the state fire code and state building code.

(h) All HHs newly constructed or rehabilitated after the 2022 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), as applicable, available as noted in Appendix A.

(i) Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), available as noted in Appendix A.

(j) The department shall be the authority having jurisdiction for the requirements in He-P 824.07(h)-(i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 824.10 as appropriate.

(k) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

(l) Waivers granted by the department for construction or rehabilitation under the FGI guidelines

above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(m) Exceptions or variances pertaining to the state fire code referenced in He-P 824.07(g) shall be granted only by the state fire marshal.

(n) Exceptions or variances pertaining to the state building code shall be granted by the local building official or the state fire marshal if in a state owned building.

(o) The building, including all construction and rehabilitated spaces, shall be inspected pursuant to He-P 824.09 prior to its use.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.08 HH Requirements for Organizational or Service Changes

(a) The HH shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds authorized under the current license; or

(6) Services.

(b) The HH shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of beds authorized under the current license; or

(4) A change in services.

(c) When there is a change in the address without a change in location, the HH shall provide the department with a copy of the notification from the local, state or federal agency that requires the address change.

(d) When there is a change in the name, the HH shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

(2) The physical location;

(3) A change in the number of beds or patients authorized under the current license;

(4) A change in licensing classification; or

(5) A change that places the facility under a different life safe code occupancy chapter.

(f) A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

(g) A revised license and license certificate shall be issued for changes in the HH’s name or a change in addresses without a change in physical location.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) An increase or decrease in the number of beds;

(3) A change in the scope of services provided; or

(4) When a waiver has been granted in accordance with He-P 824.10.

(i) The HH shall inform the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal background check for the new administrator or medical director;

(4) A copy of the criminal attestation as described in He-P 824.19(k) for the new administrator or medical director; and

(5) The results of a BEAS registry check from the bureau of elderly and adult services for the new administrator or medical director.

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 824.03(al) and He-P 824.15(h).

(k) If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

(l) When there is to be a change in the services provided, prior to providing the additional services the HH shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, will be made to the physical environment.

(m) The department shall review the information submitted under (h) above and determine if the added services can be provided under the HH’s current license.

(n) The HH shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

(o) A restructuring of an established HH that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) If a licensee chooses to cease operation of an HH, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRES: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 824, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the HH; and

(3) Any records required by RSA 151 and He-P 824.

(b) The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 824 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 824.08(e)(1);

(3) A change in the physical location of the HH;

(4) An increase in the number of beds;

(5) Occupation of space after construction, renovations or alterations;

(6) A change in the licensing classification; or

(7) The renewal of a non-certified HH license.

(c) In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the HH is in violation of any of the provisions of He-P 824, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 824, within 21 days of the date on the letter that transmits the inspection report.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 824 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainants’ first-hand knowledge regarding the allegations or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient, specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 824.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the HH, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 824.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed HH, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 824.

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department may issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 824;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 824.13.

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 824, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a license.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the state notice detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur; to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a patient will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 824;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 824 as a result of this implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

b. The department determines that the health, safety or well-being of a patient will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 824.12(d) and a fine in accordance with He-P 824.13(c)(12);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with He-P 824.12(b); and

b. Issued a directed POC in accordance with He-P 824.12(d) and a fine in accordance with He-P 824.13(f)(12).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license in accordance with He-P 824,13(b); or

(4) Revoke the license in accordance with He-P 824.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients;

(2) The presence of conditions in the HH that negatively impact the health, safety, or well-being of patients;

(3) Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules; or

(4) Conditions exist for implementation of temporary management as described in (i) below but no temporary manager can be found.

(m) The department shall appoint a temporary manager to assume operation of a HH when, following an inspection, the department determines that:

(1) The licensee has repeatedly failed to manage and operate the HH in compliance with RSA 151 and He-P 824 and such HH practices have failed to meet the needs of the patients;

(2) The licensee has failed to develop or implement policies and procedures for infection control, sanitation or life safety codes, imposing harm or the potential for harm to the patients; or

(3) The health, safety and well-being of the patients are at risk and emergency action is required.

History

• #5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30 III as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 824 which poses a threat to the patient’s health, safety, or well-being;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

(4) After being notified of and given an opportunity to supply missing information, the applicant or licensee fails to submit an application that meets the requirements of He-P 824.04;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 824.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 824.12(c)(6) and has not submitted a revised POC in accordance with He-P 824.12(c)(6)b.;

(8) The licensee is cited a third time under RSA 151 or He-P 824 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 824;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

(4) For a failure to transfer a patient whose needs exceeds the services or programs provided by the HH, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For admission of a patient whose needs exceed the services or programs authorized by the HH licensing classification, in violation of RSA 151:5-a, II and He-P 824.15(a) and (b), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 824.11(i), the fine for an unlicensed provider or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 824.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 824.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 824.08(a)(2), the fine for a licensee shall be $500.00;

(10) For a failure to allow access by the department to the HH’s premises, programs, services, patients or records, in violation of He-P 824.09(a)(1)-(3), the fine for an applicant, unlicensed individual or licensee shall be $2000.00;

(11) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 824.08(d), the fine for a licensee shall be $100.00;

(12) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 824.12(c)(2) and (6), the fine for a licensee shall be $100.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 824.12(c)(11), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement or comply with licensee policies, the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified by He-P 824.14(d), the fine for a licensee shall be $500.00;

(16) For exceeding capacity, in violation of He-P 824.14(m), the fine for a licensee shall be $500.00;

(17) For providing false or misleading information or documentation, in violation of He-P 812.14(g), the fine shall be $1,000.00 per offense;

(18) For a failure to meet the needs of the patient, in violation of He-P 824.15(a), the fine for a licensee shall be $1000.00 per patient;

(19) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 824.10 in violation of He-P 824.18(h)-(j), the fine for a licensee shall be $500.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 824.07(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities; the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(22) When an inspection determines that a violation of RSA 151 or He-P 824 has the potential to jeopardize the health, safety or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the original fine, but not to exceed $1000.00; and

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be triple the original fine, but not to exceed $2000.00; and

(23) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 824 shall constitute a separate violation and shall be fined provided that if the applicant or licensee is making good faith efforts, as verified by documentation or other means, to comply with the provisions of RSA 151 or He-P 824, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to appeal.

(f) If a written request is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or welfare of a patient is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 824 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) RSA 541 shall govern further appeals of department decisions under this section.

(k) When an HH’s license has been denied or revoked, the applicant, licensee, administrator or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years, if the enforcement action pertained to their role in the HH.

(l) The 5-year period referenced in (k) above shall begin on:

(1) The date the department’s decision to revoke or deny the license, if not filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for an administrative hearing was made and a hearing was held.

(m) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 824.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A or He-P 824.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.14 Duties and Responsibilities of All Licensees

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

(b) Each HH shall be owned and operated by a home hospice care provider licensed in New Hampshire in accordance with RSA 151:2.

(c) The licensee shall have written policies and procedures setting forth:

(1) The rights and responsibilities of patients in accordance with the patients’ bill of rights; and

(2) The policies described in (d), (e), and (w) below.

(d) The HH shall define, in writing, the scope and type of services to be provided by the HH, which shall include at a minimum, the core services listed in He-P 824.15.

(e) The HH shall develop and implement written policies and procedures governing the operation and all services and shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(f) All policies and procedures shall be reviewed annually and revised as needed.

(g) The HH personnel shall not falsify any documentation or provide false or misleading information to the department.

(h) The HH shall not advertise or provide services that it is not licensed to provide, pursuant to RSA 151:2, III.

(i) The HH shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(j) The HH shall have responsibility and authority for:

(1) Managing, controlling, and operating the HH;

(2) Meeting the needs of the patients during those hours that the patient is in the care of the HH;

(3) Initiating action to maintain the HH in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state and local laws, rules, regulations, and ordinances;

(4) The continuity of inpatient care;

(5) Establishing, in writing, a chain of command that sets forth the line of authority for the operation of the HH;

(6) Appointing an administrator;

(7) Verifying the qualifications of all personnel;

(8) Providing sufficient numbers of qualified personnel who are available to meet the needs of patients during all hours that the HH has told the patient that they will provide service;

(9) Providing personnel with sufficient supplies and equipment to meet the needs of the patients;

(10) Requiring all personnel to follow the orders of the licensed practitioner for every patient and to encourage the patient to follow the licensed practitioner’s orders; and

(11) Implementing any POC that has been accepted or issued by the department.

(k) The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

(1) Has a guardian or conservator appointed by a court of competent jurisdiction;

(2) Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J; or

(3) Has a surrogate designated in accordance with RSA 137-J.

(l) The licensee shall only admit an individual or retain a patient whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the HH.

(m) If an individual is admitted who requires lift equipment for transfers, all direct care personnel shall have been trained in the correct operation of such equipment.

(n) A licensee shall not deny admission to any person because that person does not have a guardian or an advance directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

(o) The patient shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

(1) The patient’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

(2) The patient cannot be safely evacuated in accordance with Saf-C 6000;

(3) The patient or the patient’s guardian, if any, determines that the patient shall leave the facility; or

(4) The patients’ medical condition is no longer compatible with the facility and the services and programs offered.

(p) The licensee shall develop a discharge plan with the input of the patient and the guardian or agent, if any.

(q) The following documents shall accompany the patient upon transfer:

(1) The most recent patient assessment tool, care plan, and quarterly progress notes;

(2) The most recent nursing assessment, if applicable;

(3) The most recent multi-disciplinary care plan, if applicable;

(4) Current medication records; and

(5) A licensed practitioner’s order for transfer, if applicable.

(r) If the transfer or discharge referenced in (d) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the patient as soon as practicable prior to transfer or discharge.

(s) The licensee shall not exceed the maximum number of patients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(t) In addition to the posting requirements specified in RSA 151:29, the HH shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) All inspection reports issued in accordance with He-P 824.09(c) and He-P 824.11(d), for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) The licensee’s plan for fire safety, evacuation and emergencies, identifying the location of, and access to all fire exits; and

(6) Information on how to contact the office of the long-term care ombudsman.

(u) The HH shall admit and allow any department representative to inspect the HH and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 824 as authorized by RSA 151:6 and RSA 151:6-a.

(v) Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX. Immediately after the use of a physical or chemical restraint, the patient’s guardian or agent, if any, and the department shall be notified of the use of restraints.

(w) The HH shall:

(1) Have policies and procedures on:

a. What type of emergency restraints may be used;

b. When restraints may be used; and

c. What professional personnel may authorize the use of restraints; and

(2) Provide personnel with education and training on the limitations and the correct use of restraints.

(x) The use of mechanical restraints shall be allowed only as defined under He-P 824.03(ak).

(y) The following methods of mechanical restraints shall be prohibited:

(1) Full bed rails;

(2) Gates, if they prohibit a patient’s free movement throughout the living areas of the HH;

(3) Half doors, if they prohibit a patient’s free movement throughout the living areas of the HH;

(4) Geri chairs, when used in a manner that prevents or restricts a patient from getting out of the chair at will;

(5) Wrist or ankle restraints;

(6) Vests or pelvic restraints; and

(7) Other similar devices that prevent a patient’s free movement.

(z) For reportable incidents the licensees shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Fax to 603-271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2 business days of a reportable incident:

a. The HH name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of the patient involved and the name of any witnesses to the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom and the date and time;

h. Whether the patient’s guardian, agent, or personal representative, if any, was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the patient’s licensed practitioner was notified;

(3) If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

(4) Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any patient who dies within 10 days of a reportable incident;

(5) Provide the information required by (3) above in writing within 3 business days of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

(6) Submit any further information requested by the department.

(aa) The HH shall respond to a notice of deficiencies by providing a POC in accordance with He-P 824.12(c).

(ab) The HH shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

(ac) The HH shall, upon request, provide a patient or their legal guardian or agent, if applicable, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

(ad) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(ae) Any licensee that maintains electronic records shall develop a system with written policies and procedures designed to protect the privacy of patients and staff that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

(3) Systems to prevent tampering with information pertaining to patients and staff.

(af) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(ag) At the time of admission, the HH shall give a patient, their guardian or agent, if applicable, a listing of all HH’s charges and identify what care and services are included in the charge.

(ah) The licensee shall give a patient a written notice as follows:

(1) For an increase in the cost or fees for any HH services 30 days advance notice; or

(2) For an involuntary change in room or bed location 14 day advance notice, unless the change is required to protect the health, safety, and well-being of the patient or other patients, in such case the notice shall be as soon as practicable.

(ai) The HH shall provide all personnel with education in hospice philosophy and hospice care in compliance with the CMS conditions of participation.

(aj) The HH shall comply with all federal, state and local health, building, fire and zoning laws, rules and ordinances.

(ak) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68 and RSA 155:69 and He‑P 824.24(h).

(al) If the HH holds or manages a patient’s funds or possessions, the facility shall have written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other patients, or other household members.

(am) The HH shall not falsify any documentation required by law or provide false or misleading information to the department.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.15 Required Services

(a) The licensee shall provide the following core hospice care services:

(1) Nursing services sufficient to meet the nursing needs of the patient, which are:

a. Determined by the patient’s care plan; and

b. Available, as needed, 24 hours a day;

(2) LNA and personal care services that are provided either directly or by contract as the needs of the patient dictate and as determined by the patient’s care plan;

(3) Providing patients with pharmaceutical services such as equipment, appliances, medical supplies and other pharmaceutical services as the needs of the patient dictate and as determined by the patient’s care plan;

(4) Medical social services shall be based on the patient’s psychosocial assessment and the patient’s and family’s needs and acceptance of these services. Medical social services shall be provided by a qualified social worker;

(5) Hospice volunteer services;

(6) Nutritional counseling, physical or occupational therapy, and speech therapy that are provided or arranged for as needed in accordance with patient’s care plan;

(7) Spiritual services which are offered in accordance with the patient’s and family’s beliefs and values;

(8) Bereavement services that are available to the family for up to one year following the death of the patient;

(9) Health and safety services to minimize the likelihood of accident or injury, with care and oversight provided 24 hours a day regarding:

a. The patients’ functioning, safety, and whereabouts; and

b. The patients’ health status, including the provision of intervention as necessary or required; and

(10) Medication services in accordance with He-P 824.17.

(b) In addition to the services in (a) above the licensee shall provide the following services:

(1) Food services in accordance with He-P 824.21;

(2) Housekeeping, laundry, and maintenance services; and

(3) Basic supplies necessary for patients to maintain personnel hygiene and grooming.

(c) If, on a temporary basis, not to exceed 90 days, the hospice care provider cannot provide any of the core care and services in (a) above, the HH shall have a written agreement with another agency to provide the required services.

(d) Any contractual agreement to provide care and services shall:

(1) Identify the care and services to be provided;

(2) Specify the qualifications of the personnel that will be providing the care and services;

(3) Require that the HH must authorize the services; and

(4) Stipulate the HH retains professional responsibility for all care and services provided.

(e) The HH shall provide or arrange for the provision of short-term in-patient stays in a hospital or nursing home during those times when the patient’s pain or symptoms are unable to be managed in the HH.

(f) The HH shall retain professional management responsibility for all services that are provided including contracted services when a hospice patient is in another licensed facility. These responsibilities shall be defined in a written contractual agreement.

(g) The licensee shall ensure that the following positions are staffed at the HH location:

(1) An administrator;

(2) A director of patient services, but the administrator may also be the director of patient services if the administrator meets the qualifications of the position;

(3) A volunteer coordinator;

(4) A social services coordinator; and

(5) A spiritual and or bereavement coordinator.

(h) Any administrator shall:

(1) Have at least a bachelor’s degree in business or a health-related field with a minimum of 3 years’ experience in hospice or palliative care or;

(2) Be a registered nurse; and

(3) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence.

(i) The administrator shall be responsible for maintaining the HH in full compliance with all federal, state and local laws, rules, codes and ordinances at all times.

(j) The director of patient services shall:

(1) Be a New Hampshire-licensed registered nurse or an advanced practice registered nurse; or

(2) Have a bachelor’s degree in a health field related to hospice care.

(k) The director of patient services shall:

(1) Be responsible for the overall delivery of patient care and services;

(2) Provide sufficient nursing personnel to meet the need of the patients;

(3) Supervise the overall delivery of patient care and services; and

(4) Coordinate the supervision of licensed practical nurses (LPN), licensed nurse aides (LNA) and or personal care attendants (PCA) by a registered nurse and determine if the LNA or PCA is providing care and services in accordance with the patient’s care plan.

(l) The medical director, who shall be a physician licensed in the state of New Hampshire, shall be responsible for:

(1) The oversight of the medical component of the HH’s patient care program;

(2) Participating on the interdisciplinary patient care team if the patient’s own licensed practitioner cannot participate; and

(3) Determining, in consultation with the interdisciplinary team, that an individual is appropriate for hospice and or palliative care services.

(m) Volunteer services shall be provided under the direction of a coordinator of volunteer services who:

(1) Implements a direct service volunteer program;

(2) Coordinates the orientation, education, support, and supervision of direct service volunteers; and

(3) Coordinates the utilization of direct service volunteers with other hospice staff.

(n) All volunteers shall be oriented and educated relative to their prescribed function according to the hospice care provider’s policies and procedures.

(o) The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

(1) Recruitment and retention;

(2) Health screening and 2-step TB testing;

(3) Orientation;

(4) Scope of function;

(5) Supervision;

(6) Ongoing training and support;

(7) Records of volunteer activities; and

(8) Criminal record checks.

(p) The social services coordinator shall have:

(1) At least a master’s degree from a graduate school of social work; or

(2) A bachelor’s degree in a related health or human services field, have at least 2 years’ experience as a social worker and have established a consultative relationship with a person who qualifies in (1) above.

(q) The social services coordinator shall:

(1) Participate in the development of the care plan; and

(2) Work in conjunction with the director of patient services to coordinate all social services required by the care plan and ensure their delivery.

(r) The coordinator of bereavement and spiritual care services shall be a person who has at least a bachelor’s degree in an applicable field such as theology of education, psychology or counseling and who has education in death and dying, grief, and bereavement.

(s) Persons providing bereavement services shall have education in death and dying, grief and bereavement.

(t) The coordinator of bereavement and spiritual care services shall be responsible for providing an organized program of bereavement services for up to 12 months after the death of the patient that includes but is not limited to:

(1) Counseling to families after the patient’s death; and

(2) Developing a care plan that reflects the needs of the patient’s family.

(u) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.

(v) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and

(2) Develop and implement a point of care testing policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(w) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(x) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.16 Patient Admission Criteria, Temporary Absence, Transfer and Discharge

(a) At the time of admission, personnel of the HH shall:

(1) Provide, both orally and in writing, to the patient, their guardian or agent, if applicable, the HH’s:

a. Policy on patient rights and responsibilities;

b. Complaint procedure;

c. List of care and services that are provided directly by the HH; and

d. List of the care and services that are provided by contract;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, their guardian or agent, if applicable;

(3) Collect and record the following information:

a. Patient’s name, home address, home telephone number, and date of birth;

b. Name, address, and telephone number of an emergency contact and guardian and/or agent, if applicable;

c. Name of patient’s primary care provider and their address and telephone number;

d. Copies of all legal directives such as durable power of attorney, legal guardian or living will; and

e. Written and signed consent for the provision of care and services; and

(4) Obtain documentation of informed consent and consent for release of information.

(b) In addition to (a) above, at the time of admission, the licensee shall provide a written copy to the patient and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) A patient’s agreement including the following information:

a. The basic daily, weekly, and monthly fee;

b. A list of the core services required by He-P 824.15(a) and (b) that are covered by the basic fee;

c. Information regarding the timing and frequency of cost of care increases;

d. The time period covered by the admissions contract;

e. The HH’s house rules;

f. The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

g. The HH’s responsibility for patient discharge planning;

h. Information regarding nursing, other health care services or supplies not provided in the core services, to include:

1. The availability of services;

2. The HH’s responsibility for arranging services; and

3. The fee and payment for services, if known;

i. The licensee’s policies and procedures regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the patient and provided on the HH premises;

5. Handling of patient funds pursuant to RSA 151:24 and He-P 824.14(af);

6. Bed hold, in compliance with RSA 151:25;

7. Storage and loss of the patient’s personal property; and

8. Smoking;

j. The licensee’s medication management services; and

k. The list of grooming and personal hygiene supplies provided by the HH as part of the basic daily, weekly, or monthly rate;

(2) A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the HH’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the patient’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5); and

(4) The HH’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29.

(c) The hospice care provider shall ensure that medical direction is provided either from the patient’s attending licensed practitioner or the hospice medical director.

(d) Patients who are admitted or accepted for services shall:

(1) Have a nursing assessment at the following intervals to determine the level of care and services required by the patient:

a. Within 48 hours of admission; and

b. Thereafter as required by the CMS conditions of participation; and

(2) Have a signed and dated order for any service for which such order is required by the practice acts of the person providing care, renewed at least every 90 days.

(e) The assessment required by (d)(1) above shall contain, at a minimum, the following:

(1) Pertinent diagnoses including mental status;

(2) A pain assessment, including symptom control and vital signs;

(3) A physical assessment;

(4) A cognition and mental status assessment;

(5) A behavioral assessment;

(6) A psychosocial assessment;

(7) Medication and treatments;

(8) Functional limitations;

(9) Nutritional requirements;

(10) Any equipment required; and

(11) Any safety precautions.

(f) In addition to the information required in (e) above, the nursing assessment shall include:

(1) Reactions of the patient and family members to terminal illness;

(2) History of the patient’s and family coping strengths and weaknesses;

(3) Social and financial concerns; and

(4) Spiritual beliefs and desires of the patient.

(g) If the assessment required by (d) above is completed by an LPN, the assessment shall be reviewed and co-signed by the registered nurse or physician that is supervising the LPN prior to the development of the patient’s care plan.

(h) The licensee shall establish an interdisciplinary hospice care team composed of at least:

(1) A licensed practitioner;

(2) A registered nurse;

(3) A social worker; and

(4) A clergy person or counselor.

(i) The interdisciplinary hospice care team shall:

(1) Establish the care plan;

(2) Be the primary care delivery team for a patient and his or her family through the total duration of hospice care; and

(3) Be responsible for supervising any patient care and services provided by others.

(j) The interdisciplinary team shall, in conjunction with the patient, the patient’s personal representative, and their family, develop an individualized care plan, which reflects the changing care needs of the patient and family.

(k) The care plan required by (j) above shall include:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal for the patient;

(4) The action or approach to be taken by HH personnel;

(5) The responsible person(s) or position; and

(6) The interventions used to address problems identified in the assessment including:

a. Medications ordered;

b. Pain control interventions, both pharmacological and non-pharmacological;

c. Symptom management treatment; and

d. Services required including frequency of visits.

(l) The care plan required by (j) above shall be:

(1) Developed in conjunction with the patient and their guardian or agent, if applicable;

(2) Completed within 3 days after completion of the nursing assessment;

(3) Reviewed and revised at least every 30 days by the interdisciplinary team following the completion of each assessment; and

(4) Made available to all personnel that assist the patients.

(m) The patient and their family shall be encouraged to participate in all components of care, including:

(1) Assessment and problem identification;

(2) Implementation of the plan of care; and

(3) Evaluation and revision of the plan, as needed.

(n) At the time of a patient’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions and diet.

(o) A patient may refuse all care and services.

(p) When a patient refuses care or services that could result in a threat to their safety or that of others, the licensee or their designee shall:

(1) Inform the patient of the potential results of their refusal;

(2) Notify the licensed practitioner and guardian or agent if any, of the patient’s refusal of care; and

(3) Document in the patient’s record the refusal of care and the patient’s reason for the refusal.

(q) Progress notes shall be written by any member of the interdisciplinary team to document:

(1) Changes in the patient’s physical, functional and mental abilities;

(2) Changes in the patient’s behaviors such as eating or sleeping patterns; and

(3) Newly identified needs of the patient and or their family.

(r) All staff of the HH shall follow the approaches stated in the care plan.

(s) The licensee shall provide an emergency data sheet to emergency medical personnel in the event of an emergency transfer to another medical facility.

(t) The data sheet referenced in (s) above shall include:

(1) The patient’s full name and the name the patient prefers, if different;

(2) Name, address and telephone number of the patient’s next of kin, guardian or agent, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directive; and

(10) Any other pertinent information not specified in (1)-(9) above.

(u) Written notes shall be documented in the patient’s record for any unusual incident, occurrence, or explained absence involving the patient which shall include the information required by He-P 824.14(t) and the signature and title of the person reporting the incident or occurrence.

(v) For each patient accepted for care and services at the HH, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by He-P 824.16(b)(1);

(2) The identification data required by He-P 824.16(b)(2);

(3) The admission agreement required by He-P 824.16(c)(1);

(4) Consent and medical release forms, as applicable;

(5) Pertinent medical information;

(6) The emergency data sheet required by He-P 824.16(t);

(7) All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by He-P 824.16(e)(2);

(8) All assessments required by He-P 824.16(e)(1);

(9) All laboratory and x-ray reports if the tests were taken at the HH;

(10) All consults;

(11) All care plans required by He-P 824.16(k) including documentation that the patient or patient’s guardian or agent, if applicable, participated in the development of the care plan;

(12) All progress notes required by He-P 824.16(r) including the signature of the person providing the care;

(13) All written notes required by He-P 824.16(v) including the signature of the person providing the care;

(14) All daily medication records required by He-P 824.17(aa);

(15) Discharge or transfer documentation, which shall include:

a. In the case of patient death:

1. Date and place of death; and

2. Bereavement follow-up plan; and

b. In the case of discharge other than patient death or transfer:

1. Date and time of patient discharge;

2. The physical, mental, and medical condition of patient at discharge;

3. Discharge instruction and referral; and

4. Signed licensed practitioner’s order for discharge, if applicable; and

(16) Documentation of any unusual incidents involving the patient including the information required by (v) above.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.17 Patient Records

(a) The licensee shall maintain a legible, current, and accurate record for each patient based on services provided at the HH.

(b) At a minimum, patient records shall contain the following:

(1) A copy of the patient’s service agreement and/or admission contract and all documents required by He-P 824.16(c)(1);

(2) Notwithstanding (1) above, financial records may be kept in a separate file;

(3) Identification data, including:

a. Vital information including the patient’s name, date of birth, and marital status;

b. Patient’s religious preference, if known;

c. Patient’s veteran status, if known; and

d. Name, address and telephone number of an emergency contact person;

(4) The name and telephone number of the patient’s licensed practitioner(s);

(5) For individuals contracted by the HH or the patient to provide services at the HH, their name, employer, business address and telephone number;

(6) Patient’s health insurance information;

(7) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(8) A record of the health assessment in accordance with He-P 824.16(e)(1);

(9) Written, dated, and signed orders for the following:

a. All medications, treatments and special diets; and

b. Laboratory services and consultations performed at the HH;

(10) Results of any laboratory tests, X-rays, or consultations performed at the HH;

(11) All admission and progress notes;

(12) For services that are provided at the HH by individuals who are not employed by the licensee, documentation shall include the name of the agency providing the services, the date services were provided, the name of the person providing services and a brief summary of the services provided;

(13) Documentation of medical or specialized care;

(14) Documentation of reportable incidents;

(15) The consent for release of information signed by the patient, guardian or agent, if any;

(16) The medication record as required;

(17) Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner;

(18) Documentation of a patient’s refusal of any care or services; and

(19) The licensee shall arrange for and document the immunization of all consenting patients for pneumococcal disease, as applicable, and all consenting patients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

(c) Patient records and patient information shall be kept confidential and only provided in accordance with law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

(e) When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use or access.

(f) Records shall be retained for 4 years after discharge, except that when the patient is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

(g) The licensee shall arrange for storage of, and access to, patient records as required by (g) above in the event the HH ceases operation.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.18 Medications

(a) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional authorized by law.

(b) Medications, treatments, and diets ordered by the licensed practitioner or other professional authorized by law shall be available to give to the patient within 24 hours or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the HH;

(2) Reorder medications for use at the HH; and

(3) Receive and record new medication orders.

(d) Each medication order shall legibly display the following information:

(1) The patient’s name:

(2) The medication name, strength, prescribed dose and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner.

(e) For PRN medications the ordering practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

(f) For each prescription medication being taken by a patient, the licensee shall maintain either the original written order or a copy of the order in the patient’s record, signed by a licensed practitioner or other individual authorized by law.

(g) Each medication, including licensed practitioner’s samples, shall legibly display the following information:

(1) The patient’s name;

(2) The medication name, strength, the prescribed dose and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications; and

(5) The date ordered.

(h) The label of all medication containers maintained in the HH shall match the current written orders of the licensed practitioner unless authorized by (j) below.

(i) Only a pharmacist shall make changes to a prescription medication container label. Any change or discontinuation of medications taken at the HH shall be pursuant to a written order licensed practitioner or other professional authorized by law.

(j) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HH are unable to obtain a new prescription label:

(1) The licensed nurse shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HH’s written procedure, indicating that there has been a change in the medication order;

(2) Licensed nurse shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(k) The licensee shall require that all telephone orders for medications or treatments are:

(1) Taken only by a licensed health care professional if such action is within the scope of their practice act;

(2) Immediately transcribed and signed by the individual taking the order; and

(3) Be counter-signed by the authorized licensed practitioner authorized by law within 30 days.

(l) Over-the-counter medications shall be handled in the following manner:

(1) The licensee shall obtain written approval from the patient’s licensed practitioner annually; and

(2) Over-the-counter medication containers shall be marked with the name of the patient using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(m) The medication storage area for medications not stored in the patient’s room shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each patient’s medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(n) All medication at the HH shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (x)(5) below.

(o) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(p) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the HH, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(q) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(r) The destruction of contaminated, expired, or discontinued medication shall be completed within 15 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first and shall:

(1) Be accomplished in the presence of at least 2 people if a controlled substance; and

(2) Be documented in the record of the patient for whom the drug was prescribed.

(s) Upon discharge or transfer, the licensee shall make the patient’s current medications, except for controlled drugs which shall be destroyed in accordance with (r) above, available to the patient and the guardian or agent, if any.

(t) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(u) When a patient is going to be absent from the HH at the time medication is scheduled to be taken, the medication container shall be given to the patient if the patient is capable of self-administering, as described in (x) below.

(v) A written order from a licensed practitioner shall be required every 90 days for any patient who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(w) Patients shall receive their medications by one of the following methods:

(1) Self-administered medication as allowed by (x) below; or

(2) Administered by individuals authorized by law.

(x) For patients who self-administer medication as defined in He-P 824.03(bf), the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the patient to self-administer medications without supervision;

b. Authorizing the patient to store the medications in their room; and

c. Identifying the medications that may be kept in the patient’s room;

(2) Evaluate the patient’s ability to self-administer medication upon admission and whenever there is a significant change in the patient, as defined in 824.03(bg), to ensure they maintain the physical and mental ability to self-administer;

(3) Have the patient store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

(4) Have a copy of the key to access the locked medication storage area in the patient’s room; and

(5) Allow the patient to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

(y) Medication administered by individuals authorized by law to administer medications shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

(z) Personnel shall remain with the patient until the patient has taken the medication.

(aa) The licensee shall maintain a written record for each medication taken by the patient at the HH that contains the following information:

(1) Name of the patient;

(2) Any allergies or allergic reactions to medications;

(3) The name, strength dose, frequency, and route of the medication;

(4) The date and the time the medication was taken;

(5) The signature and identifiable initials and job title of the person administering the medication;

(6) Documented reason for any medication refused or omitted; and

(7) For PRN medications, the reason the patient required the medication and the effect of the PRN medication.

(ab) An LNA who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the HH:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

(3) Medicinal topical products to intact skin as ordered by the licensed practitioner.

(ac) Non-prescription stock medications shall only be accessed and administered by the licensed nurse or medication nurse assistant on duty.

(ad) An HH shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.03 under circumstances where the HH:

(1) Has a director of nursing who is a RN licensed in accordance with RSA 326-B; and

(2) Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

(ae) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

(af) If ordered by the department to do so, the HH shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient’s health and safety, as identified during an inspection or investigation.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.19 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the HH to meet the needs of patients at all times.

(b) The licensee shall develop a job description for each position in the HH containing:

(1) Duties of the position;

(2) Physical requirements of the position; and

(3) Qualifications and educational requirements of the position.

(c) All direct care personnel shall be at least 18 years of age unless they are:

(1) An LNA working under the supervision of an RN in accordance with Nur 700; or

(2) Part of an established educational program working under the supervision of a registered nurse.

(d) For all new hires, the licensee shall:

(1) Obtain and review criminal records check in accordance with RSA 151:2-d. Results must include criminal history from the state of New Hampshire;

(2) Verify the qualifications and licenses, as applicable, of all applicants prior to employment; and

(3) Verify that the applicant is not on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

(e) Unless a waiver is granted in accordance with He-P 824.10, the licensee shall not offer employment for any position if the individual:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) If the information identified in (e) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (e) above.

(g) If a waiver of (e) above is requested, the department shall review the information and the underlying circumstances in (e) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

(2) Grant a waiver of (e) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

(h) The licensee shall not employ, contract with, or engage, any person in (d) above who is listed on the BEAS state registry unless a waiver is granted by BEAS.

(i) In lieu of (d) and (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) above.

(j) Prior to having direct care contact with patients, personnel, including volunteers and independent contractors shall:

(1) Submit to the licensee the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment and for personnel other than volunteers and independent contractors, submit the results of a physical examination or a health screening;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

(4) In lieu of (1) above, independent contractors hired by the facility may provide the facility with a signed statement that they have complied with (1) and (3) above for their employees working at the HH.

(k) Within the first 7 days of employment, all personnel who have direct or indirect contact with patients, to include volunteers who have direct care contact or who prepare and serve food shall receive a tour of the HH and an orientation that includes the following:

(1) The patients’ rights in accordance with RSA 151:21;

(2) The HH’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) The HH’s infection control procedures and required by He-P 824.22;

(6) The HH’s emergency and evacuation procedures;

(7) The procedures for food safety for those personnel involved in preparation, serving, and storing of food; and

(8) The mandatory reporting requirements such as RSA 161:F: 46-48 and RSA 169-C: 29-31.

(l) Within the first 3 months of employment, all personnel who have direct or indirect contact with patients, to include volunteers who have direct care contact or who prepare and serve food shall receive an orientation to hospice philosophy relative to the delivery of care and services to hospice patients and their families.

(m) All personnel shall complete mandatory annual in-service education, which shall include a review of the information required by (k)(7) and (8) above.

(n) The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education.

(o) Such continuing education shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

(2) A minimum of 4 hours of ongoing training each calendar year.

(p) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient; and

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

(q) Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients, as defined in He-P 824.03(s), or direct contact with food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

(r) The licensee shall inform personnel of the line of authority at the HH.

(s) The personnel file for each individual shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the patient’s rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (a) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (n) above;

(7) Information as to the general content and length of all in-service or educational programs attended;

(8) Record of satisfactory completion of all required education programs and demonstrated competencies that is signed and dated by the employee;

(9) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and

(10) The statement required by (t) below.

(t) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; or

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(u) The licensee shall maintain separate personnel records that:

(1) Contain the information required by (s) above; and

(2) Are protected and stored in a secure and confidential manner.

(v) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.20 Quality Improvement

(a) The HH shall develop and implement a quality improvement program that reviews policies and all care and services provided to patients and maximize quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The HH shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the licensee;

(7) Evaluate the effectiveness of the corrective actions; and

(8) Meet quarterly.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.21 Infection Control

(a) The HH shall appoint an individual who will oversee the development and implementation an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items specified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

(5) The reporting of infectious and communicable diseases as required by He-P 301.

(c) The infection control education program shall address at a minimum the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious.

(e) Personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SRHCF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(f) Personnel with an open wound who prepare food or provide direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight-fitting bandage.

(g) Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

(h) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which means any diseases caused by the growth of microorganisms in the body which might or might not be contagious, the HH shall provide the required procedures, equipment and staff, as specified by the United States Centers for Disease Control and Prevention, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.22 Food Services

(a) The licensee shall provide food services that meet:

(1) The US Department of Agriculture recommended dietary allowance as specified in the

US Department of Agriculture’s “Dietary Guidelines for Americans” (2020-2025 edition), available as noted in Appendix A;

(2) The nutritional needs of each patient; and

(3) The special dietary needs associated with health or medical conditions for each patient as identified on the patient assessment.

(b) Each patient shall be offered at least 3 nutritious meals and snacks in each 24-hour period when the patient is in the licensed premises unless contraindicated by the patient’s care plan.

(c) Snacks shall be available between meals and at bedtime if not contraindicated by the patient’s

care plan.

(d) The licensee shall provide therapeutic diets to patients as directed by a licensed practitioner or other professional with prescriptive authority.

(e) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods maintained on the premises for the licensed capacity:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Enough drinking water for a 3-day period.

(f) All food and drink provided to the patients shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

(3) Served at the proper temperatures;

(4) Labeled, dated and stored at proper temperatures;

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling and all other sources of contamination; and

(6) The use of expired, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

(g) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(h) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(i) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(j) Trash receptacles in food service areas shall have covers and shall remain closed except when in

use.

(k) All HH personnel involved in the preparing and serving of food shall wash their hands and

exposed portions of their arms with liquid soap and running water before handling or serving food.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.23 Sanitation

(a) The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

(b) All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation, pursuant to Env-Ws 315 and 316.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All patient bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2,VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and patient supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations;

(4) Soiled linens and clothing, which are considered contaminated with infectious waste under Env-Wm 103.28 shall be, handled as infectious waste; and

(5) Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack or a covered container.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) There shall be a designated work area for soiled materials and linens that contain a work counter of at least 6 linear feet, a sink, and a storage area.

(p) Any HH that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

(q) Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.24 Physical Environment

(a) The HH shall:

(1) Have all entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and patients, including, but not limited to, hazards from falls, burns, or electrical shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take measures to prevent the presence of rodents, insects, and vermin.

(b) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, welfare and comfort of patient(s) and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(c) Equipment providing heat within an HH including, but not limited to, gas furnace or boiler, oil furnace or boiler, or wood stove or pellet stove shall:

(1) Maintain a temperature as follows, except where patients have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the patient(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any HH.

(g) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

(h) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows in each room that can be opened.

(i) Each patient bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

(j) The number of sinks, toilets, tubs or showers shall be in a ratio of at least one for every 6 patients.

(k) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable and impervious to water.

(l) All hand washing facilities shall be provided with hot and cold running water.

(m) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the patient to reach his or her bedroom without passing through the room of another patient;

(3) Have a side hinge door and not a folding or sliding door or a curtain;

(4) Provide accommodations for family members to remain with the patient throughout the night and physical space for family after a patient’s death;

(5) Be separated from halls, corridors and other rooms by floor to ceiling walls; and

(6) Be located on the same level as the bathroom facilities, if the patient has impaired mobility as identified by the HH assessment.

(n) The licensee shall provide the following for the patient’s use, as needed:

(1) A bed appropriate to the needs of the patient;

(2) A firm mattress that complies with the state fire code;

(3) Clean linens, blankets, and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) A lamp;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades or curtains that provide privacy.

(o) The patient may use his or her own personal possessions provided they do not pose a risk to the patient or others.

(p) The licensee shall provide the following rooms to meet the needs of patients:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all patients.

(q) Each licensee shall have a UL listed communication system in place so that all patients can effectively contact personnel when they need assistance with care or in an emergency.

(r) All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(s) Screens shall be provided for:

(1) Doors;

(2) Windows; and

(3) Other openings to the outside.

(t) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (s) above.

History

• #9317, eff 11-8-08, EXPIRED: 11-8-16
• #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17
• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.25 Emergency and Fire Safety

(a) All HHs shall meet the appropriate chapters of the state fire code and state building code.

(b) All HH’s shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either

hardwired, powered by the HH’s electrical service, or wireless, as approved by the state fire marshal for the HH;

(2) At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 that shall:

a. Be manually inspected when initially placed in service;

b. Be inspected either manually or by means of an electronic monitoring device/system at intervals not exceeding 31 days; and

c. Be inspected at least once per calendar month and include:

1. Documentation of the manual fire extinguisher inspections which shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation; and

2. Documentation of electronically monitored fire extinguishers which shall be provided to the department within 2 business days of the completion of the inspection or investigation; and

(3) An approved carbon monoxide monitor on every level.

(c) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) Emergency EMS transport related to pre-existing conditions.

(d) The written notification under (c) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(e) For the use and storage of oxygen and other related gases, HHs shall comply with NFPA 99, Health Care Facilities Code including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft (6.1 m);

2. A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”;

(5) Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means; and

(6) Flammable gases and liquids shall be stored in metal fire retardant cabinets.

(f) If the licensee has chosen to allow smoking, a designated smoking area shall be provided which has, at a minimum:

(1) A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Walls and furnishings constructed of non-combustible materials; and

(3) Metal waste receptacles and safe ashtrays.

(g) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the patient, or the patient’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the patient’s responsibilities shall be provided to the patient. Each patient shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(h) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(i) Fire drills shall be conducted as follows:

(1) For all HHs which are constructed to meet the Health Care Occupancy Chapter of Life Safety Code, NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300, and the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office and the department to meet the Health Care Occupancy Chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy Chapter of the Life Safety Code;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. If the facility has an approved defend or shelter in place plan, then all personnel, patients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that patients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including patients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill;

8. The names of all staff members participating in the drill; and

9. Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(2) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

History

• #13572, eff 3-1-23

N.H. Code Admin. R. Ann. He-P 824.26 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(b) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(c) The plan in (b) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to missing patients and bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats which shall be worn at all times in a visible location during the emergency;

(7) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Water;

c. Ventilation;

d. Fire protection systems;

e. Fuel sources;

f. Medical gas and vacuum systems, if applicable; and

g. Communications systems;

(8) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(9) Include the management of patients, particularly with respect to physical and clinical issues to include:

a. Relocation of patients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies and industrial and potable water; and

c. How to provide security during the disaster;

(10) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

(11) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(12) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

(13) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

(d) The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations or both.

(e) For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of patients and staff:

(1) Enough refrigerated, perishable foods for a 3-day period;

(2) Enough non-perishable foods for a 7-day period; and

(3) Potable water for a 3-day period.

History

• #13572, eff 3-1-23

Part He-P 826 Substance Use Disorder Residential Treatment Facilities

N.H. Code Admin. R. Ann. He-P 826.01 Purpose

Revision Note:

Document #12658, effective 11-1-18, adopted Part He-P 826 titled “Substance Use Disorder Residential Treatment Facilities”. Part He-P 826 had formerly been titled “Regulations for Special Hospitals—Psychiatric” but those rules, as filed under Document #5848, effective 6-22-94, had expired 6-22-00, and the number He-P 826 had been reserved since then.

The purpose of this part is to set forth the licensing requirements for all substance use disorder residential treatment facilities (SUD-RTF) pursuant to RSA 151:2, I(e).

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a SUD-RTF except:

(a) All facilities listed in RSA 151:2, II(a)-(i);

(b) Substance use disorder facilities owned or operated by the department of corrections as part of an inmate's sentencing; and

(c) All facilities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of clients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving clients without their informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, self-management, monitoring, or supervision of medications.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 826.

(f) “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.

(g) “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(h) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. The term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J, or a “surrogate decision-maker” in accordance with RSA 137-J:35.

(i) “Adverse drug reaction” means harm caused by a drug at normal doses.

(j) “Affiliated parties” means companies or individuals that serve as operators, landlords, management companies, or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders, and companies providing financial guarantees, captive or affiliated insurance companies. This term includes “related parties”.

(k) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker in accordance with RSA 137-J:35-37.

(l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a SUD-RTF pursuant to RSA 151.

(m) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause(s) a licensee to be out of compliance with RSA 151, He-P 826, or other federal and state requirements.

(n) “Change of ownership” means the transfer of the controlling interest of an established SUD-RTF to an individual, agency, partnership, corporation, government entity, association, or other legal entity.

(o) “Chemical restraints” means any medication that is used to control a client’s behavior or emotional state without a supporting diagnosis or for the convenience of program personnel.

(p) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which sets forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

(q) “Client” means any person admitted to or in any way receiving care, services, or both from a SUD-RTF licensed in accordance with RSA 151 and He-P 826. This includes children residing in a SUD-RTF with a mother who is receiving SUD-RTF services.

(r) “Client record” means documents maintained for each client receiving care and services, which includes all documentation required by RSA 151 and He-P 826 and all documentation compiled relative to the client as required by other federal and state requirements.

(s) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or their designee.

(t) “Contracted employee” means a temporary employee working under the direct supervision of the SUD-RTF but employed by an outside agency.

(u) “Controlling interest” means greater than 50% ownership interest.

(v) “Core services” means those services to be provided to any client by the licensee that are included in the basic rate.

(w) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(x) “Days” means calendar days unless otherwise specified in the rule.

(y) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided.

(z) “Department” means the New Hampshire department of health and human services.

(aa) “Direct care” means hands on care and services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(ab) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a client including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(ac) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee needs to take to correct identified areas of non-compliance.

(ad) “Discharge” means moving a client from a licensed facility or entity to a non-licensed facility or entity.

(ae) “Dietitian” means a person who is licensed under RSA 326-H.

(af) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the client will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

(ag) “Doorway” means a state of New Hampshire program that offers assistance with accessing every level of treatment.

(ah) “Drug diversion” means the use of controlled substances for anything other than the intended purpose or not administered to the person whom it was prescribed.

(ai) “Dual-diagnosis” means a client who has signs and symptoms of a concurrent substance related and mental health disorder.

(aj) “Elopement” means when a client leaves the licensed premises or a safe area unsupervised or unnoticed without the knowledge of the licensee’s personnel, if knowledge and supervision is necessary.

(ak) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.

(al) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(am) “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(an) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 826.

(ao) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

(ap) “Evaluation” means a multi-disciplinary assessment of level of function by healthcare professionals licensed or certified in the field of substance use disorder rehabilitation which enables facility staff to plan care that allows the client to reach their highest practicable level of physical, mental, and psychosocial functioning.

(aq) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

(ar) “Facility” means “facility” as defined in RSA 151:19, II.

(as) “Full medical withdrawal management” means clients who receive 24-hour nursing supervision overseen by a licensed practitioner, who may be incapable of evacuating a facility on their own or may have medical conditions that require immediate medical intervention, such as seizures, tremors, delirium, cardiac, or a danger to themselves or others.

(at) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the client’s health care and other personal needs.

(au) “Health care occupancy” means the use of a building or structure, or a portion thereof, in which care or supervision is provided to persons who are or are not capable of self-preservation without physical assistance.

(av) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(aw) “Infectious waste” means “infectious waste” as defined in Env-Sw 103.32 and described in Env-Sw 904.

(ax) “Informed consent” means the decision by a person, or their guardian, personal representative, or agent to agree to a proposed course of treatment, after they have received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(ay) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(az) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151, He-P 826, and all other federal and state requirements or to respond to allegations of non-compliance with RSA 151 or He-P 826.

(ba) “Intoxication” means a clinical state marked by dysfunctional changes in physiological functioning, psychological functioning, mood state, or cognitive process as a consequence of consumption of a psycho-active substance.

(bb) “Laboratory” means a facility or space within a facility used for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease,

(bc) “License” means the document issued by the department to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 826, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and the license number.

(bd) “Licensed clinical supervisor” means a registered nurse (RN) licensed under the state of New Hampshire pursuant to RSA 326-B, or an individual licensed by the board of licensing for alcohol and other drug use professionals pursuant to RSA 330-C, or board of mental health practice to practice pursuant to RSA 330-A, and supervise substance use counseling who meets the initial licensing qualifications set forth in RSA 330-C:18.

(be) “Licensed counselor” means a master licensed alcohol and drug counselor (MLADC), a licensed alcohol and drug counselor (LADC), or a licensed mental health professional who has demonstrated competency in the treatment of substance use disorders.

(bf) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s associate;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(bg) “Licensed premises” means the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(bh) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(bi) “Licensing classification” means the specific category of services authorized by a license.

(bj) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bk) “Limited medical withdrawal management” means clients are capable of evacuating the facility without assistance, medically cleared to participate in limited medical withdrawal management by a licensed practitioner prior to or at the time of admission, and not a danger to themselves or others. Clients may be receiving maintenance medication for the symptoms of withdrawal or side effects but do not need immediate medical intervention.

(bl) “Mechanical restraint” means locked or secured SUD-RTFs or units within a SUD-RTF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the SUD-RTF or unit within.

(bm) “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or RSA 326-B, who is responsible for overseeing the quality of medical care and services in a SUD-RTF.

(bn) “Medically cleared” means a determination made within 24 hours prior to admission by the medical director that an individual is physically capable of participating in facility activities and programming and not at risk of medical complications that would be unmanageable by the facility.

(bo) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(bp) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a client’s refusal.

(bq) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(br) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a client.

(bs) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bt) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.

(bu) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed or ordered by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bv) “Over-the-counter medications” means non-prescription medications.

(bw) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bx) “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21. This term includes “resident rights” and “client rights.”

(by) “Patient’s personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having direct or indirect ownership interest in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”. This term includes “personal representative”.

(bz) “Performance-based design” means an engineering approach to fire protection design and construction based on:

(1) Established fire safety goals and objectives;

(2) Deterministic and probabilistic analysis of fire scenarios; and

(3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

(ca) “Personal care” means personal care services that are non-medical, hands-on services provided to a client including but not limited to assistance with ADLs.

(cb) “Personnel” means and individual who is employed by the facility, a volunteer, or an independent contractor who provides direct or personal care services to clients.

(cc) “Physical restraint” means the use of hands-on or other physically applied techniques to physically limit the client’s freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques.

(cd) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(ce) “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

(1) A lancing or finger stick device to get the blood sample;

(2) A test strip or reagents to apply the blood sample for testing; or

(3) A meter or monitor to calculate and show the results; including:

a. Blood glucose meters, also called “glucometers”;

b. Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or

c. Cholesterol meter.

(cf) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of client care.

(cg) “Pro re nata (PRN) medication” means medication taken as circumstances might require in accordance with the licensed practitioner’s orders.

(ch) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(ci) “Protective care” means the provision of client monitoring services which includes:

(1) Knowledge of client whereabouts;

(2) Minimizing the likelihood of accident or injury; and

(3) Other means of ensuring client safety.

(cj) “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(ck) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(cl) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cm) “Rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

(1) Addition;

(2) Modification;

(3) Reconstruction;

(4) Renovation: and

(5) Repair.

(cn) “Removal” means requesting an individual to remove themself to an area with fewer distractions until they can participate in activities without disrupting the client’s current social environment according to a written behavioral program.

(co) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(cp) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cq) “Reportable incident” means an occurrence of any of the following while the client is either in the SUD-RTF or in the care of SUD-RTF personnel:

(1) The unanticipated death of the client;

(2) An injury to a client, that is of a suspicious nature under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client;

(3) The elopement of a client;

(4) Medication errors, which required medical intervention; and

(5) Drug diversion.

(cr) “Residential treatment” means clients receive clinical treatment for substance use disorder in a residential setting but do not require limited or full medical withdrawal management. Clients may or may not require medication supervision and general oversight with regard to knowing the clients whereabouts but do not require medications for the signs and symptoms of withdrawal. This term:

(1) Applies to:

a. Residential treatment facilities where the residence has paid staff who provide clinical services, 24-hour structure, staff available as needed, urine drug testing conducted, documentation maintained, and clinical treatment services that are required as a condition of residency and provided by the person, owner, developer, business organization, or any subsidiary thereof; and

b. Recovery housing where clinical treatment services are required as a condition of residency and provided by the person, owner, developer, business organization, or any subsidiary thereof; and

(2) Does not apply to intensive outpatient services certified pursuant to He-W 513.

(cs) “Self-administration of medication with assistance” means the client takes their own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

(ct) “Self-administration of medication without assistance” means an act whereby the client takes their own medication(s) without the assistance of another person.

(cu) “Self-directed medication administration” means an act whereby a client, who has a physical limitation that prohibits them from self-administering directs personnel to physically assist in the medication process, which does not include assisting with infusions, injections, or filling insulin syringes.

(cv) “Self-preservation capability” means the ability of a client to act on an innate desire to protect oneself from harm without staff intervention.

(cw) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

(cx) “Significant change” means a change in cognitive or physical capabilities that decreases a client's ability to care for themself beyond an episodic event.

(cy) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

(cz) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.

(da) “State monitoring” means the placement of individuals by the department at the facility to monitor the operation and conditions of the facility.

(db) “Stock medication” means over-the-counter medication available for use by more than one client.

(dc) “Substance use disorder residential treatment facility (SUD-RTF)” means a place which provides residential substance use disorder treatment relating to the individual’s medical, physical, psychosocial, vocational, and educational needs.

(dd) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the client.

(de) “Transfer” means movement of a client from one licensed facility or entity to another licensed facility or entity when the legal responsibility for the care of the client changes from the transferring to the receiving facility.

(df) “Treatment plan” means a written guide developed by the licensee, in consultation with the licensed practitioner, personnel, the client, or the client’s guardian, personal representative, or agent as a result of the evaluation process for the provision of care and services.

(dg) “Unanticipated death” means the death of a client that is not related to their diagnosis or underlying condition.

(dh) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

(di) “Unlicensed staff” means those staff working at the SUD-RTF that perform direct care to clients but do not hold a license issued by the state of New Hampshire.

(dj) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

(dk) “Withdrawal management” means a residential treatment service provided by appropriately trained staff who provide 24-hour supervision, observation, and support for clients who are intoxicated or experiencing withdrawal with prescription medication administered based on the results of an appropriate evaluation tool.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.04 License Application Submission

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a and submit the following to the department:

(1) A completed application form entitled “Application for Residential, Health Care, or Special Health Care Services” (August 2025), signed by the owner if a private entity, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming and certifying the following:

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

(2) A floor plan of the prospective SUD-RTF;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee, in accordance with RSA 151:5, VI, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the qualifications of the SUD-RTF administrator and medical director;

(6) Copies of applicable licenses for the SUD-RTF administrator and medical director;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health, drinking water, and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances applicable for a health care facility; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(8) If the SUD-RTF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485:33-43, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply, a copy of a water bill;

(9) The results of a criminal records check to include results for the state of New Hampshire for the applicant(s), licensee if different from the applicant, administrator, and medical director for which the application is submitted;

(10) A copy of the SUD-RTF’s residential service agreement;

(11) A copy of the non-conviction attestation form as described in He-P 826.18(v) for the administrator and medical director;

(12) The results of a bureau of adult and aging services (BAAS) registry check from BAAS for the administrator and medical director;

(13) Any waiver requests, exemptions, or variances to the rules by the department or the state fire marshal, if applicable;

(14) A complete description of all services provided or to be provided including a determination of which of the following tier(s) the facility falls into:

a. Tier 1- full medical withdrawal management;

b. Tier 2- limited medical withdrawal management; or

c. Tier 3- residential treatment; and

(15) If the initial application is based on a change of ownership or category, a list of all employees granted waivers for criminal background check results from the department.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 826.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 826.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 826.13(c) when it determines that the applicant, administrator, or medical director:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, assault, other violent crime, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of clients.

(f) Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 826.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person, location, or agency affiliation.

(h) A written notification of denial, pursuant to He-P 826.13(c)(10) will be sent to an applicant applying for an initial license if it has been determined by the inspection pursuant to (f) above and a maximum of 2 follow-up inspections, if needed, that the prospective premises are not in full compliance with RSA 151 and He-P 826.

(i) A written notification of denial, shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 90 days of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

(b) Each licensee shall complete and submit to the department an application form pursuant to He-P 826.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 826.10(f), if applicable;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 826.18(d); and

(4) A copy of any temporary, new, or existing non-permanent variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 826.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 826, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation, shall be required to submit an application for an initial license pursuant to He-P 826.04 and shall be subject to a fine in accordance with He-P 826.13.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.07 SUD-RTF New Construction or Existing Building Rehabilitation

(a) As required by RSA 151:6, II, any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit architectural plans and specifications to the NH division of fire safety, state fire marshal’s office 60 days prior to commencing such work.

(b) As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of safety, state fire marshal’s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal’s office.

(c) The architectural, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use.

(d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal’s office approval shall be done at the licensee’s or applicant’s own risk.

(e) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(f) A licensee or applicant undertaking new construction or renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the state fire code and state building code, state laws, rules, and local ordinances.

(g) A licensee or applicant shall receive variances to the state fire code from the state fire marshal pursuant to Saf-C 6005.

(h) All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), as applicable, available as listed in Appendix A.

(i) Applicants and licensees shall contact the state fire marshal for exceptions to the FGI guidelines.

(j) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed and approved fire system that provides an equivalent rating as provided by the original surface.

(k) All new construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 826.09 prior to its use.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.08 SUD-RTF Requirements for Organizational or Service Changes

(a) The SUD-RTF shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Number of beds; or

(6) Services, to include all services referenced in He-P 826.04(a)(14) or tier or level changes.

(b) The SUD-RTF shall complete and submit a new application and obtain a new or revised license, as applicable, prior to operating for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in number of clients or services beyond what is authorized under the current license; or

(4) A change in services.

(c) When there is a change in the address without a change in location, the SUD-RTF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the SUD-RTF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) When there is to be a change in the services provided, the SUD-RTF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

(f) The department shall review the information submitted under (e) above and determine if the added services can be provided under the SUD-RTF’s current license or if a new license category is required.

(g) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, then an inspection shall be conducted as soon as practical by the department;

(2) The physical location;

(3) An increase in the number of beds or clients;

(4) A change in license classification;

(5) A change that placed the facility under a different life safety code occupancy chapter; or

(6) A change in tier or level.

(h) A new license shall be issued for a change in ownership, classification, or a change in physical location.

(i) A revised license shall be issued for any of the following:

(1) A change in name;

(2) A change of administrator;

(3) A change in the number of clients from what is authorized under the current license, if applicable;

(4) A change in address without a change in physical location; or

(5) When a waiver has been granted in accordance with He-P 826.10.

(j) The SUD-RTF shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) The results of the criminal record check for the new administrator or medical director which shall include criminal history from the state of New Hampshire;

(3) Copies of applicable licenses for the new administrator or medical director;

(4) A copy of the non-conviction attestation as described He-P 826.18(v) for the new administrator or medical director; and

(5) The results of a BAAS registry check from the bureau of adult and aging services for the new administrator or medical director.

(k) Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 826.18(i) and (k).

(l) If the department determines that the new administrator or medical director does not meet the qualifications, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(m) The SUD-RTF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The SUD-RTF’s email address shall be the primary method of correspondence used for all emergency notifications to the facility.

(n) A restructuring of an established SUD-RTF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(o) If a licensee chooses to cease operation of a SUD-RTF, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 826, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the SUD-RTF; and

(3) Any records required by RSA 151 and He-P 826.

(b) The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 826 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 826.08(g)(1);

(3) A change in the physical location of the SUD-RTF;

(4) A change in the licensing classification;

(5) An increase in the number of beds;

(6) Occupation of space after construction or building rehabilitation; or

(7) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department as part of the annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

(d) A statement of findings for clinical inspections or notice to correct for life safety inspections shall be issued when, as a result of any inspection, the department determines that the SUD-RTF is in violation of any of the provisions of He-P 826, RSA 151, or other federal or state requirement(s).

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 826.12(c) within 21 days of the date on the letter that transmits the inspection report.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 826 shall submit a written request for a waiver to the department that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

(4) The period of time for which the waiver is sought if the waiver request is not for a permanent waiver.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the clients; and

(3) Does not negatively affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) If the request in (f) above is not received with the renewal application or at least 60 days prior to the expiration of the existing waiver, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license.

(h) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 826.

(b) When practicable, the complaint shall be in writing and contain the following information:

(1) The name and address of the SUD-RTF, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 826.

(c) Investigations shall use all techniques and methods for gathering information which are appropriate to the circumstances of the complaint including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed SUD-RTF, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 826.12(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings or submit a completed application pursuant to He-P 826.04 prior to the department’s issuance of a warning;

(3) In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6, to the owner or person responsible, requiring compliance with RSA 151 and He-P 826, if the owner of an unlicensed facility does not comply with (2) above, or if the department does not agree with the owner’s written response to the findings;

(4) The warning in (e)(3) above, shall include:

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

b. The final date by which the action(s) requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

(5) Any person or entity who fails to comply after receiving a warning as described in (e)(3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 826.13(d)(1).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 826, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a license; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of this chapter; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, detailing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 826;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 826 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance shall be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

(6) The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

a. The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14-day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(7) The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

(8) If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 826.13(d)(13);

(9) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(10) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(11) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with (b); and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 826.13(d)(14).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine;

(3) Deny the application for a renewal of a license in accordance with He-P 826.13(c); or

(4) Revoke or suspend the license in accordance with He-P 826.13.

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings provided that the applicant or licensee submits a written request for an informal dispute resolution.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department.

(h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as described in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the SUD-RTF in areas that impact health, safety, or well-being of patients;

(2) The presence of conditions in the SUD-RTF that negatively impact the health, safety, or well-being of patients; and

(3) Concern that the SUD-RTF is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.13 Enforcement Actions and Hearings

(a) As specified in this section, the department shall take the following enforcement actions for violation of RSA 151, He-P 826, or other applicable licensing rules:

(1) Issue a warning;

(2) Impose a fine in accordance with (d) below;

(3) Deny the application for a renewal of a license in accordance with (c) below;

(4) Immediately suspend a license; or

(5) Revoke the license in accordance with (c) below.

(b) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(c) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 826 which poses a threat to the health, safety, or well-being of a client;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee has failed to submit an application that meets the requirements of He-P 826.04 or has failed to schedule an inspection;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 826.12(c), (d), and (e);

(7) A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 826.12(c)(5) and has not submitted a revised POC as required by He-P 826.12(c)(6);

(8) The licensee is cited a third time under RSA 151 or He-P 826 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 826;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of, or plead guilty to, a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee fails to employ a qualified administrator or clinical director; or

(13) The applicant has had a license revoked or denied by another division or unit of the department within a 5 year period of the application.

(d) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 826.14(l), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a client whose needs exceeds the services or programs provided by the SUD-RTF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For admission of a client whose needs at the time of admission exceed the services or programs authorized by the SUD-RTF licensing classification, in violation of RSA 151:5-a, II, and He-P 826.15(a), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 826.11(e), the fine for an unlicensed entity or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 826.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 826.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 826.08(a)(2), the fine for a licensee shall be $1000.00;

(10) For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 824.08(j), the fine for a licensee shall be $100.00;

(11) For a failure to notify the department of a change in e-mail address as required by He-P 826.08(m), the fine shall be $100.00;

(12) For refusal to allow access by the department to the SUD-RTF’s premises, programs, services, or records, in violation of He-P 826.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(13) For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 826.12(c)(2), (5), and (6), the fine for a licensee shall be $500.00;

(14) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 826.12(c)(11), the fine for a licensee shall be $1000.00;

(15) For a failure to establish, implement, or comply with licensee policies, as required by He-P 826.14(b)-(d) and (u) and He-P 826.19(d), the fine for a licensee shall be $500.00;

(16) For a failure to provide services or programs required by the licensing classification and specified by He-P 826.16, the fine for a licensee shall be $500.00;

(17) For exceeding the licensed capacity, in violation of He-P 826.14(ab), the fine for a licensee shall be $500.00 per day;

(18) For providing false or misleading information or documentation in violation of He-P 826.14(k), the fine for an applicant or licensee shall be $1000.00 per offense;

(19) For a failure to meet the needs of a client(s), in violation of He-P 826.14(n)(1), the fine for a licensee shall be $1000.00 per client;

(20) For utilizing a room or space that has not been approved or licensed by the department, in violation of He-P 826.09(b)(6), the fine for a licensee shall be $500.00;

(21) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 826.10, in violation of He-P 826.18(i), the fine for a licensee shall be $500.00;

(22) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 826.09(a), the fine shall be $2000.00;

(23) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 826.07(a), the fine for a licensed facility shall be $500.00;

(24) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 826.09(b)(6), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(25) When an inspection determines that a violation of RSA 151 or He-P 826 has the potential to jeopardize the health, safety, or well-being of a client, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

(26) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 826 shall constitute a separate violation and shall be fined provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 826, as verified by documentation or other means, the department shall not issue a daily fine.

(e) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(f) An applicant, licensee, or unlicensed entity shall have 10 days after receipt of the notice of enforcement action to request a hearing to appeal.

(g) If a written request for a hearing is not made pursuant to (f) above, the action of the department shall become final.

(h) The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or welfare of a client is in jeopardy and requires emergency action in accordance with RSA 541-A:30.

(i) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 826 is achieved.

(j) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(k) When a SUD-RTF’s license has been denied or revoked, the applicant, licensee, administrator, clinical director, or medical director shall not be eligible to reapply for a license or be employed as an administrator or medical director for at least 5 years if the denial or revocation specifically pertained to their role in the program.

(l) RSA 541 shall govern further appeals of department decisions under this section.

(m) The 5-year period referenced in (k) above shall begin on:

(1) The date the department’s decision to revoke or deny the license became effective, if no appeal is filed; or

(2) The date the final decision is issued by the department upholding the action, if a request for an administrative hearing was made and a hearing was held.

(n) Notwithstanding (m) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 826.

(o) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership or management authority, the department shall deny the application.

(p) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541A:30, III, or He-P 826.

(q) Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

(b) The licensee shall have written policies and procedures to include:

(1) The rights and responsibilities of clients in accordance with the patients’ bill of rights under RSA 151:20, II and RSA 151:21;

(2) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

(3) All other policies required by He-P 826.

(c) The licensee shall define, in writing, the scope and type of services to be provided at the SUD-RTF.

(d) The licensee shall have a system to regularly identify the SUD-RTF’s daily census, including times a client is absent from the SUD-RTF.

(e) The licensee shall develop and implement a process for determining adequate staffing levels and include an assessment, to be conducted at least monthly but more frequently if required, of the appropriateness of staffing levels to ensure:

(1) Sufficient staffing of qualified personnel to meet the scheduled and reasonably foreseeable unscheduled client needs as required by the evaluation and treatment plans on a 24-hour-per-day basis; and

(2) Sufficient staffing to respond promptly and effectively to individual client emergencies and to respond to emergency, safety, and disaster situations affecting clients.

(f) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:21.

(g) The licensee shall develop and implement written policies and procedures governing the operation of the SUD-RTF to include a clinical care manual covering the policies and procedures for all clinical services provided.

(h) All policies and procedures shall be reviewed annually and revised as needed.

(i) All clinical services provided by the licensee shall:

(1) Focus on the client’s strengths;

(2) Be sensitive and relevant to the diversity of the clients;

(3) Be client and family centered;

(4) Be evidence-based by meeting one of the following:

a. The service shall be included as an evidence-based mental health and substance abuse intervention on the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Evidence-Based Practices Resource Center” available at https://www.samhsa.gov/libraries/evidence-based-practices-resource-center?f%5B0%5D=resource_topic%3A20277 , (as accessed and printed on February 24, 2026), available as noted in Appendix A;

b. The services are published in a peer reviewed journal and found to have positive effects; or

c. The treatment and support service provider shall be able to document the services effectiveness based on a theoretical model with validated research or a documented body of research generated from similar services that indicates effectiveness;

(5) Be designed to acknowledge the impact of violence and trauma on clients’ lives which shall be addressed in the services provided; and

(6) Be delivered in accordance with evidence-based methods and practices as described in (4) above.

(j) The licensee shall assess and monitor the quality of care and services it provides to clients on an ongoing basis.

(k) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(l) The licensee shall not advertise or otherwise represent the SUD-RTF as having residential care or health care programs or services for which it is not licensed to provide.

(m) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(n) Licensees shall:

(1) Meet the needs of the clients during the hours that the clients are in the care of the SUD-RTF;

(2) Initiate action to maintain the SUD-RTF in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the SUD-RTF;

(4) Appoint a medical director who shall meet the requirements of He-P 826.18(k);

(5) Appoint an administrator who shall meet the requirements of He-P 826.18(i);

(6) Verify the qualifications of all personnel;

(7) Provide sufficient numbers of personnel who are present in the SUD-RTF and are qualified to meet the needs of clients during all hours of operation;

(8) Ensure that all unlicensed clinical staff providing treatment, education, or recovery support services shall be under the direct supervision of a licensed clinical supervisor;

(9) Ensure that licensed clinical supervisors provide at least one hour of supervision for all unlicensed clinical staff for every 40 hours of direct client contact which shall include:

a. Review of case records;

b. Observation of interactions with clients;

c. Skill development;

d. Review of case management activities; and

e. The maintenance of a log of the supervision date, duration, content, and the identity of the participants;

(10) Ensure that personnel, licensed or certified, by the NH board of licensing for alcohol and other drug use professionals or any other licensing or certification board, receive supervision in accordance with the requirements set forth for the licenses or certifications held by the individual;

(11) Ensure that no LADC or MLADC shall supervise more than 12 unlicensed staff;

(12) Provide the SUD-RTF with sufficient supplies, equipment, and lighting to ensure that the needs of clients are met;

(13) Implement any POC that has been accepted or issued by the department; and

(14) Require that all personnel follow the orders of the licensed practitioner for each client and encourage the clients to follow the licensed practitioner’s orders.

(o) The licensee shall employ or contract with a nurse who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN or LPN with at least 2 year's relevant experience in substance use disorder treatment or behavioral health services.

(p) The licensee shall employ or contract with a clinical services director who is a LADC or MLADC licensed by the NH board of licensing for alcohol and other drug use professionals or an individual licensed by the board of mental health practice and who has at least 2 year's relevant experience in substance use disorder treatment or behavioral health services.

(q) The licensee shall:

(1) Make available basic supplies necessary for clients to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper. Such basic supplies shall be included in the basic rate, except that there may be an additional charge for specific brands or items required to meet individual clients’ needs or requests;

(2) Not be responsible for the cost of purchasing a specific brand of product at a client’s request;

(3) Identify in the admission agreement the cost, if any, of basic supplies or other services for which there will be a charge;

(4) Ensure that all personnel have received the training necessary to be qualified personnel to include demonstrated competency in the training given with documentation maintained in the employee personnel file;

(5) Require any paid provider providing direct care, other than an employee, to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known;

(6) Have a clearly identified policy for CPR that includes the following:

a. If CPR is not performed, the policy shall include a statement that 911 shall be called in an emergency;

b. If CPR is performed, the policy shall include a statement that 911 shall be called and there shall be either at least one person on duty per shift who is certified to perform CPR or an AED available for use; and

c. That the policy shall be signed by each client and their guardian, personal representative, or agent and be located in the client’s file with their admission agreement;

(7) Ensure that there is at least one personnel on the premises during all hours the facility is open; and

(8) Identify in the admission agreement all programs and services available to clients during and post recovery, whether from public, private, or government, to include but not limited to transportation services, outpatient services, and post treatment recovery homes.

(r) The licensee shall educate personnel about the needs and services required by the clients under their care and document such education to include demonstrated competencies.

(s) Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX.

(t) As soon as is practicable but no longer than 24 hours after the use of a physical or chemical restraint, the client’s licensed practitioner, the department, and the client’s guardian, personal representative, or agent shall be notified of the use of such restraints.

(u) The SUD-RTF shall:

(1) Have policies and procedures on:

a. What type of emergency restraints can be used;

b. When restraints can be used; and

c. Who may authorize the use of restraints; and

(2) Provide personnel with education and training on the limitations and the correct use of restraints.

(v) The use of physical restraints shall be allowed only as defined under He-P 826.03(cc).

(w) Separation from a situation may be used as an alternative to physical restraint and shall not be considered a form of restraint.

(x) For reportable incidents, licensees shall:

(1) Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Submit via fax (603) 314-8199 or electronic mail to hfa-licensing@dhhs.nh.gov the following information to the department within 48 hours of a reportable incident:

a. The SUD-RTF name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

d. The name of client(s) involved in or witnessing the reportable incident;

e. The date and time of the reportable incident;

f. The action taken in direct response to the reportable incident, including any follow-up;

g. If medical intervention was required, by whom, and the date and time;

h. When the client’s guardian, personal representative, or agent was notified;

i. The signature of the person reporting the reportable incident; and

j. The date and time the client’s licensed practitioner was notified, if applicable; and

k. The date the facility performed the investigation required by (1) above;

(3) As soon as practicable, notify the local police department, the department, and the guardian, personal representative, or agent when a client has eloped and the licensee has searched the building and the grounds without finding the client; and

(4) Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

(y) The licensee shall implement policies to ensure the safety of clients who are assessed as an elopement risk to reduce the risk and define areas recognized as safe areas on the licensed premise.

(z) The licensee shall implement policies to ensure the safety of clients who are assessed as a danger to self or others.

(aa) The licensee shall implement polices to assure the safety and supervision of all visitors.

(ab) The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(ac) The licensee shall give a client and the guardian, agent, or personal representative, as applicable, a written notice as follows:

(1) For an increase in the cost or fees for any SUD-RTF services, 30 days advance notice shall be required except for clients receiving Medicaid whose financial liability is determined by the state’s standard of need; or

(2) For an involuntary change in room or bed location, the facility shall make reasonable accommodation of individual needs and preferences and give 14 days advance notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

(ad) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a conspicuous area accessible to clients, employees, and visitors:

(1) The current license and license certificate issued in accordance with RSA 151:2;

(2) The most recent inspection reports as specified in RSA 151:6-a;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to The Department of Health and Human Services, Office of Legal and Regulatory services, Health Facilities Administration, 129 Pleasant Street, Concord, N.H. 03301 or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman;

(5) A copy of available services to support continued recovery during and post residential treatment; and

(6) The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

(ae) The licensee shall not allow smoking in the facility at any time.

(af) If smoking is allowed on the grounds of the SUD-RTF, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P 826.25.

(ag) The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other clients, or other household members

History

• #12658, eff 11-1-18; subparagraph He-P 826.14(w) amd by #12928, eff 11-26-19; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.15 Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria

(a) The licensee shall only admit an individual or retain a client who has been determined to need the level(s) of care that the facility offers, and whose needs can be met by the SUD-RTF.

(b) A licensee shall not deny admission to any person because that person does not have a guardian, personal representative, or agent, or an advance directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-J.

(c) The client shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including the following:

(1) The client’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

(2) The client cannot be safely evacuated in accordance the state fire code and state building code;

(3) The client or the client’s guardian, personal representative, or agent determines that the client shall leave the facility;

(4) The client is a danger to themself or others;

(5) Program completion or transfer based on changes in the client’s functioning relative to the American Society of Addiction Medicine’s (ASAM) criteria; and

(6) Program termination, including:

a. Administrative discharge;

b. Non-compliance with the program;

c. The client left the program before completion against advice of treatment staff; or

d. The client is inaccessible, such as the client has been jailed or hospitalized.

(d) In all cases of client discharge or transfer, the counselor shall complete a narrative discharge summary, which includes:

(1) The dates of admission and discharge or transfer;

(2) The client’s psychosocial substance use history and legal history;

(3) A summary of the client’s progress toward treatment goals in all ASAM domains;

(4) The reason for discharge or transfer;

(5) The client’s DSM 5 diagnosis and summary, to include other evaluation testing completed during treatment;

(6) A summary of the client’s physical condition at the time of discharge or transfer;

(7) A continuing care plan, including all ASAM domains;

(8) The dated signature of the counselor completing the summary; and

(9) Any other information pertinent to the client’s discharge or transfer.

(e) The discharge summary shall be completed:

(1) No later than 7 days following a client’s discharge or transfer from the program; or

(2) For withdrawal management services, by the end of the next business day following a client’s discharge or transfer from the program.

(f) If the transfer or discharge referenced in (d) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

(g) When transferring a client, either from one level of care to another or to another treatment provider, the counselor shall:

(1) Complete a progress note on the client’s treatment and progress towards treatment goals, to be included in the client’s record; and

(2) Update the client evaluation and treatment plan.

(h) When transferring a client to another treatment provider, the current provider shall forward copies of the following information to the receiving provider, only after a release of confidential information is signed by the client:

(1) The discharge summary;

(2) Client demographic information, including the client’s name, date of birth, address, telephone number; and

(3) A diagnostic evaluation statement and other evaluation information, including:

a. A record of the client’s treatment history; and

b. Documentation of any court-mandated or agency-recommended follow-up treatment.

(i) A licensed counselor shall meet with the client at the time of discharge or transfer to establish a continuing care plan that:

(1) Includes recommendations for continuing care in all ASAM domains;

(2) Addresses the use of self-help groups including, when indicated, facilitated self-help; and

(3) Assists the client in making contact with other agencies or services.

(j) A licensed counselor shall document in the client record if and why the meeting in (i) could not take place.

(k) A provider may involuntarily discharge a client from a treatment program only if:

(1) The client’s behavior on program premises is abusive, violent, or illegal;

(2) The client is non-compliant with prescription medications;

(3) Clinical staff documents therapeutic reasons for discharge; or

(4) The client violates program rules in a manner that is consistent with the provider’s progressive discipline policy.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the SUD-RTF;

(2) Works no less than 35 hours per week at the SUD-RTF, which may include day, evening, night, and weekend hours;

(3) Meets the requirements of He-P 826.18(i) and (j);

(4) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their absence. The alternate administrator shall not be required to meet the requirements of He-P 826.18(i) and (j); and

(5) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify they meet the requirements of (3) above.

(b) The clinical services director or designee shall be available for consultation at all times any client is present at the SUD-RTF.

(c) At the time of admission, the licensee shall provide the client, guardian, personal representative, or agent, a written copy, with written verification of receipt, of the following:

(1) A residential service agreement which shall include:

a. The base rate and the cost of any available services that are not included in the base rate;

b. A list of the core services required by (d) below that are covered by the base rate;

c. Information regarding the timing and frequency of cost of care increases;

d. The time period covered by the residential service agreement;

e. The SUD-RTF’s house rules;

f. The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

g. The SUD-RTF’s responsibility for client discharge planning;

h. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The SUD-RTF’s responsibility for arranging services; and

3. The fee and payment for services, if known;

i. The licensee’s policy regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third-party services, such as cable television;

3. Acting as a billing agent for third-party services;

4. Handling of client funds pursuant to RSA 151:24;

5. Storage and loss of the client’s personal property; and

6. Smoking;

j. A note that the client may need to be discharged or transferred when the facility can no longer meet the client’s evacuation capability or care needs and the responsibility of the licensee in transitioning the client to another facility if applicable;

k. The licensee’s medication management services;

l. The list of grooming and personal hygiene supplies provided by the SUD-RTFs as part of the base fee;

m. The list of available services which support recovery during and post residential treatment, whether from public, private, or government, to include but not be limited to transportation services, outpatient services, and post treatment recovery homes;

n. The amount and purpose of any advance payments required by the licensee and the policy for refund of advance payments;

o. A statement affirming that the proposed client has received the residential services agreement, that the client has read it or it has been read to the client, and that the client understands its contents; and

p. Any other disclosures or information required by RSA 151 or RSA 420-D, if applicable and any other provisions of state or federal law;

(2) A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the SUD-RTF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the client’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5);

(4) The SUD-RTF’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29; and

(5) Information on advance directives.

(d) The licensee shall provide the following core services:

(1) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight regarding:

a. The clients’ functioning, safety, and whereabouts; and

b. The clients’ health status, including the provision of intervention as necessary or required;

(2) Emergency response and crisis intervention;

(3) Assistance with taking and ordering medications as needed;

(4) Nutritious meals and snacks in accordance with He-P 826.20 unless the client chooses other options according to their admission agreement;

(5) Housekeeping, laundry, and maintenance services in accordance with the admission agreement;

(6) The availability of activities, that shall include reasonable accommodation for clients with disabilities, including television, radio, internet, games, newspapers, visitors, and music, designed to sustain and promote physical, intellectual, social, and spiritual well-being of all clients in accordance with the residential service agreement;

(7) Assistance in arranging medical and dental appointments, which shall include assistance in arranging transportation to and from such appointments and reminding the clients of the appointments;

(8) Supervision of clients when required to offset cognitive deficits that may pose a risk to self or others if the client is not supervised; and

(9) Provide referral to, and assistance in accessing, medication-assisted SUD treatment, either on site or off site, when clinically appropriate.

(e) The licensee shall provide access to the following services:

(1) A screening and assessment interview conducted or supervised by a licensed counselor to determine:

a. That the client meets the requirements for treatment of a substance use disorder; and

b. A determination of the appropriate ASAM level of care needed.

(2) If the interview in (1) above indicates a need for a clinical evaluation, an in person clinical evaluation shall be conducted by a licensed counselor in accordance with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “TAP 21: Addiction Counseling Competencies” (2017 revision) available as noted in Appendix A using an evidenced based evaluation tool and addressing all ASAM domains to determine:

a. Client biopsychosocial information;

b. If the client meets diagnostic criteria as indicated in the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)” (2022 edition), available as noted in Appendix A, for a substance use disorder or other comorbid disorders and formally documents the DSM-5 diagnosis(es) in client record;

c. The appropriate initial level of care for the client based on ASAM criteria;

d. A description of the client’s needs in each ASAM dimension; and

e. Areas to be addressed in the treatment plan;

(3) If the clinical evaluation detailed in (2) above was completed by a licensed counselor from a referring agency, the licensee should accept that clinical evaluation as satisfaction of (2) above under the following conditions:

a. The provider shall ensure any changes to ASAM dimensions that occurred after the completion of the accepted evaluation from the referring provider are recorded in the client's record within 3 days after admission, or 3 sessions, whichever is later;

b. If no evaluation from a referring provider exists, and due to geographical barriers, the potential admitting provider is unable to complete an evaluation prior to admission, the provider shall assist individuals with accessing an evaluation through their local doorway, or other appropriate provider;

c. The potential admitting provider shall make sure a new face-to-face evaluation is conducted prior to admission when:

1. An individual presents without a completed evaluation from a referring provider or doorway;

2. More than 30 days have passed since the referring provider completed the evaluation;

3. The evaluation was conducted and completed by someone other than a licensed counselor; or

4. The evaluation lacked DSM-5 diagnostic information, or a recommendation for a specific level of care based on the ASAM criteria; and

d. If an evaluation is unable to be completed prior to admission, due to circumstances beyond the provider’s control, the provider shall ensure the new clinical evaluation is completed within 3 business days after admission to treatment or 3 sessions, whichever is longer; and

(4) Behavioral health services on-site or through referral.

(f) The SUD-RTF shall perform an evaluation of each client’s needs and develop a treatment plan upon admission or within 24 hours following admission as described in (g) below.

(g) Individual treatment plans shall contain, at a minimum, the following elements:

(1) Goals, objectives, and interventions written in terms that are specific, measurable, attainable, realistic, and timely;

(2) Identifies the client’s clinical needs, treatment goals, and objectives;

(3) Identifies the client’s strengths and resources for achieving goals and objectives in (1) above;

(4) Defines the strategy for providing services to meet those needs, goals, and objectives;

(5) Identifies referral to outside providers for the purpose of achieving a specific goal or objective when the service cannot be delivered by the treatment program;

(6) Provides the criteria for terminating specific interventions;

(7) Includes specification and description of the indicators to be used to assess the client’s progress;

(8) Documentation of participation by the client in the treatment planning process or the reason why the client did not participate;

(9) Signatures of the client and the counselor agreeing to the treatment plan, or if applicable, documentation of the client’s refusal to sign the treatment plan; and

(10) Identification of the client’s discharge goals.

(h) Treatment plans shall be updated, at minimum, based upon the intervals recommended by ASAM domain or client status.

(i) Counselors shall update treatment plans, in addition to (h) above, when:

(1) Changes are made in any ASAM domain;

(2) Goals have been met and challenges have been resolved; or

(3) New goals and new challenges have been identified.

(j) The provider shall ensure there are justifications in the treatment plan updates, or progress notes, for continued stay, transfer to another level of care, or discharge from treatment, including a minimum of one of the 3 ASAM continuing service and transfer or discharge criteria described in the ASAM’s “The ASAM Criteria” (2023 edition), available as noted in Appendix A, or another clinically appropriate method of determining level of care.

(k) Treatment plan updates shall include:

(1) Documentation of the degree to which the client is meeting treatment plan goals and objectives;

(2) Modification of existing goals or addition of new goals based on changes in the client’s functioning relative to ASAM domains and treatment goals and objectives;

(3) The counselor’s evaluation of whether or not the client needs to move to a different level of care based on changes in functioning in any ASAM domain and documentation of the reasons for this evaluation; and

(4) The signature of the client and the counselor agreeing to the treatment plan updates, or if applicable, documentation of the client’s refusal to sign the treatment plan updates.

(l) In addition to the individualized treatment planning in (h) above, all providers shall provide client education on:

(1) Substance use disorders;

(2) Relapse prevention;

(3) Infectious diseases associated with injection drug use, including but not limited to, HIV, hepatitis, and tuberculosis (TB);

(4) Sexually transmitted diseases;

(5) Emotional, physical, and sexual abuse;

(6) Nicotine use disorder and cessation options; and

(7) The impact of drug and alcohol use during pregnancy, risks to the fetus, and the importance of informing medical practitioners of drug and alcohol use during pregnancy.

(m) When group education and counseling are provided as part of the treatment program, the provider shall:

(1) Maintain an outline of each educational and group therapy session provided;

(2) Limit group therapy, conducted by a licensed counselor, to 12 or fewer clients per counselor and no more than 16 clients when the counselor is joined by a second direct-care personnel member;

(3) Limit recovery support groups and educational groups, conducted by a counselor or certified recovery support worker (CRSW) operating under their scope of practice pursuant to RSA 330-C:13, to no more than 12 clients when one counselor or CRSW is present or no more than 16 clients when that CRSW is joined by a second direct-care staff-member; and

(4) Not conduct group therapy sessions or clinically based treatments outside of their scope of practice, if they are a CRSW or another non-licensed direct-care personnel.

(n) All client activities and services shall be documented in accordance with the SAMHSA’s “TAP 21: Addiction Counseling Competencies” (2017 revision), available as noted in Appendix A.

(o) At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

(p) The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the SUD-RTF.

(q) The health examination in (p) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies; and

(7) Dietary needs.

(r) The licensee shall maintain a daily shift change log which documents such things as client behavior and significant events that a subsequent shift should be made aware of.

(s) When a client refuses care or services that could result in a threat to their recovery, health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the client and guardian, personal representative, or agent, of the potential results of their refusal;

(2) Notify the licensed practitioner of the client’s refusal of care; and

(3) Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

(t) The licensee shall maintain an information data sheet in the client’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

(u) The information data sheet in (t) above shall include:

(1) Full name and the name the client prefers, if different;

(2) Name, address, and telephone number of the client’s next of kin, guardian, personal representative, or agent;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directives; and

(10) Any other pertinent information not specified in (1)-(9) above.

(v) The licensee shall only perform point of care testing (POCT), that is waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

(w) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate pursuant to 42 CFR Part 493.15; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(x) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(y) Licensees performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

(z) The licensee shall require all individuals in contact with clients to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required pursuant to RSA 151:3-b.

(aa) Upon admission, the provider shall conduct an orientation, either individually or by group, that includes:

(1) The basic daily, weekly, or monthly fee, cost-share, or co-pay, if applicable;

(2) The administrative discharge policy and the grounds for administrative discharge;

(3) When clinically appropriate, and with the written consent of the client, the availability of referrals to, and assistance in accessing, medication assisted SUD treatment, psychiatric treatment, or primary care doctors either on-site or off-site;

(4) Client rights in accordance with RSA 151:21 and how to report grievances to the department;

(5) All applicable laws regarding confidentiality, including the limits of confidentiality and mandatory reporting requirements; and

(6) All clients shall sign and date a receipt that the orientation was conducted and attended.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.17 Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner, except as allowed in (b) below.

(b) The facility shall have written approval from the client's licensed practitioner, at time of admission, of a list of approved over-the-counter (OTC) medications taken in accordance with the directions on the medication container or as ordered by the client’s licensed practitioner.

(c) Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24-hours or in accordance with the licensed practitioner’s direction.

(d) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the SUD-RTF;

(2) Reorder medications for use at the SUD-RTF;

(3) Receive, record, and reconcile new medication orders; and

(4) Administer or assist with administration of medications.

(e) For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

(f) Each medication order shall legibly display the following information:

(1) The client’s name:

(2) The medication name, strength, prescribed dose, and route, if different then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the licensed practitioner.

(g) For PRN medications, the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to the use of the medication, including the maximum allowed dose in a 24-hour period.

(h) All prescription medications brought by a client to the program shall be in their original containers and comply with (f) above.

(i) Each prescription medication shall legibly display the following information:

(1) The client’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered;

(6) The name of the prescribing licensed practitioner; and

(7) The expiration date of the medication(s).

(j) The label of all medication containers maintained in the SUD-RTF shall match the current written orders of the licensed practitioner unless authorized by (m) below.

(k) Only a pharmacist shall make changes to prescription medication container labels, unless authorized by (m) below.

(l) Any change or discontinuation of medications taken at the SUD-RTF shall be pursuant to a written order from a licensed practitioner.

(m) When the licensed practitioner changes the dose of a medication and personnel of the SUD-RTF are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the SUD-RTF’s written procedure, indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(n) Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

(o) All prescription medications, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be kept on the client’s person or stored in the client’s room, shall be stored as follows:

(1) Kept in a storage area that is:

a. Locked and accessible only to authorized personnel;

b. Organized to allow correct identification of each client’s medication(s);

c. Illuminated in a manner sufficient to allow reading of all medication labels; and

d. Equipped to maintain medication at the proper temperature;

(2) Controlled drugs, as defined by RSA 318-B:1,VI, shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel; and

(3) Topical liquids, ointments, patches, creams, and powder forms of products shall be stored in a manner such that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(p) OTC medications shall be handled in the following manner:

(1) Only original, unopened containers of OTC medications shall be allowed to be brought into the program; and

(2) OTC medication shall be stored in accordance with (o)(1) above.

(q) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(r) The SUD-RTF shall have a clearly identified policy for storage and administration of naloxone that includes the following:

(1) The process for regularly reviewing and updating the standing order for the naloxone kits on the premises;

(2) The process for ensuring regular review of naloxone kits for expiration;

(3) If naloxone is administered, the policy shall include a statement that 911 shall be called immediately; and

(4) If naloxone is not administered but an overdose is suspected, the policy shall include a statement that 911 shall be called immediately.

(s) All medications self-administered by a client, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be taken by the client without supervision, shall be supervised by the program staff, as follows:

(1) Staff shall remind the client to take the correct dose of their medication at the correct time;

(2) Staff may open the medication container but shall not be permitted to physically handle the medication itself in any manner;

(3) Staff shall remain with the client to observe them taking the prescribed dose and type of medication; and

(4) For each medication taken, staff shall document in an individual client medication log the following:

a. The medication name, strength, dose, frequency, and route of administration;

b. The date and the time the medication was taken;

c. The signature or identifiable initials of the person supervising the taking of said medication; and

d. The reason for any medication refused or omitted.

(t) Except as allowed by (v) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first.

(u) Controlled drugs shall be destroyed only in accordance with state law and;

(1) Be accomplished in the presence of at least 2 people; and

(2) Be documented in the record of the client for whom the drug was prescribed.

(v) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(w) When a client is going to be absent from the SUD-RTF at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering, as described in (s) above and (ac) below.

(x) If a client is going to be absent from the SUD-RTF at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the SUD-RTF.

(y) Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian, personal representative, or agent unless determined by a licensed practitioner, licensed clinical supervisor, or licensed counselor that the client is a risk to themselves or others.

(z) A written order from a licensed practitioner shall be required for any client who is authorized to carry emergency medications, including epi-pens, nitroglycerine, and inhalers.

(aa) Clients shall receive their medications by one of the following methods:

(1) Self-administered as described in (s) above;

(2) Self-directed administration of medication as allowed by (ac) below;

(3) Self-administered with assistance as allowed by (ad) below; or

(4) Administered by individuals authorized by law.

(ab) The licensee shall allow the client to self-direct administration of medications as defined in He-P 826.03(cu) if the client:

(1) Has a physical limitation due to a diagnosis that prevents them from self-administration;

(2) Receives evaluations every month or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-direct administration of medications;

(3) Obtains written verification of the client’s physical limitation and self-directing capabilities from their licensed practitioner and requests the SUD-RTF to file the verification in the client record; and

(4) Verbally directs personnel to:

a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

b. Assist the client to apply, ingest, or instill the ordered dose of medication.

(ac) If a client self-administers medication with assistance, as defined in He-P 826.03(cs), personnel shall:

(1) Remind the client to take the correct dose of their medication at the correct time;

(2) Place the medication container within reach of the client and open the container, if requested by the client;

(3) Remain with the client to observe the client taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the client's daily medication record that they have supervised the client taking their medication;

(5) Document in the client’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken; and

(6) Not physically handle the medication in any manner.

(ad) Medication administered by individuals authorized by law to administer medications shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

(ae) Personnel shall remain with the client until the client has taken the medication.

(af) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

(ag) The licensee shall maintain a written record for each medication taken by the client at the SUD-RTF that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the client taking medication;

(5) For PRN medications, the reason the client required the medication and the effect of the PRN medication;

(6) Documented reason for any medication refusal or omission; and

(7) Any observed or reported side effects and adverse drug reactions.

(ah) Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a client with self-administration with assistance, self-directed administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

(ai) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, whether in-person or through other means such as electronic media.

(aj) The medication supervision education program required by (ah) above shall include:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights which shall include:

a. The right client;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. Administered via the right route;

(3) Documentation requirements;

(4) General categories of medications, such as antidepressants or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(ak) The administrator may accept documentation of training required by (ah) above if it was previously obtained by the applicant for employment at another licensed facility.

(al) The licensee shall document in the client record and report any observed adverse drug reactions and side effects to the licensed practitioner, guardian, personal representative, or agent.

(am) The licensee shall document in the client record and report any medication errors that cause adverse reactions that require medical intervention to the licensed practitioner, guardian, personal representative, or agent.

(an) The licensee shall report to the department any medication error that requires medical intervention as required pursuant to He-P 826.14(x).

(ao) No medication, whether prescription medication or OTC medication, shall be borrowed from another client.

(ap) OTC medications that are not labeled for a specific client, including but not limited to pharmaceutical samples and “house stock” medications, may be kept at the facility provided that these medications are only dispensed to a client with a signed order from an authorized licensed practitioner specifying that the client may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(aq) The department shall order a facility to obtain the routine services of a consultant pharmacist for 12 months if areas of noncompliance regarding medications, which the department determines present a potential risk to client’s health, are found during any inspection or investigation.

(ar) The licensee shall provide and document in writing, an annual review of its policies and procedures for self-administration of medication without assistance, self-administration of medication with assistance, and self-directed medication administration to all direct care personnel.

History

• #12658, eff 11-1-18; subparagraph He-P 826.17(t) amd by #12928, eff 11-26-19; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the SUD-RTF to meet the needs of clients at all times.

(b) There shall be at least one awake personnel member on duty at all times while clients are in the facility.

(c) For all applicants for employment, volunteers, and independent contractors , the licensee shall:

(1) Obtain and review a criminal records check, which shall include criminal history from the state of New Hampshire;

(2) Review the results of the criminal records check in accordance with (d) below;

(3) Verify the qualifications of all applicants prior to employment; and

(4) Verify that the applicant is not listed on the BAAS registry maintained by the department’s bureau of aging and adult services.

(d) Unless a waiver is granted in accordance with (f)(2) below, the licensee shall not offer employment, contract with, or engage a person in (c) above, if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted for sexual assault, assault, other violent crime, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of the clients.

(e) If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(f) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

(g) The licensee shall not employ, contract with, or engage, any person in (c) above who is listed on the BAAS state registry unless a waiver is granted by BAAS.

(h) In lieu of (c) and (g) above, the licensee may accept from independent agencies contracted by the licensee or by an individual client to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) and (g) above.

(i) Administrators shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

(1) A bachelor’s degree from an accredited institution and one year of relevant experience working in a health related field;

(2) A New Hampshire license as an RN, with at least one year relevant experience working in a health related field;

(3) An associate’s degree from an accredited institution plus 3 years relevant experience in a health related field;

(4) A MLADC or LADC license issued by the state of New Hampshire; or

(5) Licensed by the board of mental health practice with at least one year of relevant experience working in substance use disorder treatment.

(j) All administrators shall obtain and document 12 hours of continuing education related to substance use disorder services each annual licensing period to comply with (q)(7) and (q)(8) below.

(k) The licensee shall employ or contract with a medical director who is:

(1) A licensed practitioner in the state of New Hampshire; and

(2) Has experience providing medical services to clients with behavioral health or substance use disorder needs.

(l) All direct care personnel shall be at least 18 years of age.

(m) The licensee shall inform personnel of the line of authority at the SUD-RTF.

(n) The licensee shall educate personnel about the needs and services required by the clients under their care.

(o) Prior to having direct contact with clients, personnel, including volunteers and independent contractors, shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of Mycobaterium tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(p) In lieu of (o)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (o)(1) and (3) above before working at the SUD-RTF.

(q) Prior to having contact with clients or food, personnel shall receive a tour of and orientation to the SUD-RTF that includes the following:

(1) The patients’ rights in accordance with RSA 151:21;

(2) The SUD-RTF’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 826.21;

(7) The facility confidentiality requirements;

(8) Grievance procedures for both staff and clients;

(9) The procedures for food safety for personnel involved in preparation, serving, and storing of food; and

(10) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(r) Unless the staff member who provides direct care holds a New Hampshire counseling license granted by the office of professional licensing and certification, all direct-care staff shall be trained on the following topics prior to providing direct care, as appropriate for their role based on their job description, unless they can show proof of attendance of a similar training within 2 years prior to date of hire:

(1) Trauma informed care;

(2) Suicide prevention;

(3) The 12 core functions of substance use counselors;

(4) “The Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice”, covered in SAMHSA’s “TAP 21: Addiction Counseling Competencies”, available as noted in Appendix A;

(5) The standards of practice and ethical conduct, with particular emphasis given to the staff member's role, and appropriate responsibilities, professional boundaries, and power dynamics;

(6) Standards of practice related to appropriate information security and confidentiality practices for handling protected health information (PHI) and substance use disorder treatment records as safeguarded by 42 CFR Part 2; and

(7) The ASAM criteria.

(s) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s client’s rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The provisions of 42 CFR Part 2;

(5) The licensee’s policies and procedures;

(6) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(7) The medication administration policy; and

(8) Procedures for food safety for personnel involved in preparation, serving, and storing of food.

(t) The SUD-RTF shall maintain a separate employee file for each employee, which shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that they have received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check and BAAS check;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (r) above;

(7) Information as to the general content and length of all in‑service or educational programs attended;

(8) Record of satisfactory completion of all required education programs required by (s) above;

(9) A copy of each current driver’s license, including proof of insurance, if the employee transports clients using their own vehicle;

(10) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and

(11) The statement required by (v) below,

(u) The SUD-RTF shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (t)(1), (3), (4), (6), and (8)-(11) above; and

(2) For independent contractors, the information in (t)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (o) above may be substituted for (s)(4), (10), and (11) above, if applicable.

(v) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, assault, other violent crime, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a client; or

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(w) An individual shall not have to re-disclose any of the matters in (v) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

(x) The licensee shall protect and store in a secure and confidential manner all records described in (t) and (u) above.

(y) The licensee shall provide and document evidence of immunization against influenza for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

(z) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(aa) The SUD-RTF shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team which shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are misusing substances;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance misuse, and diversion prevention policy.

(ab) The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-50.

(ac) The training required in (ab) above shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

(1) A minimum of 6 hours for initial training to covered administrative staff members and covered direct service staff members within the first 90 days of hire; and

(2) A minimum of 4 hours of continuing training each calendar year.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.19 Client Records

(a) The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the SUD-RTF.

(b) Client records shall contain the following:

(1) A copy of the client’s residential service agreement and all documents required by He-P 826.16(c);

(2) Identification data, including:

a. Vital information including the client’s name, date of birth, and marital status;

b. Religious preference, if any; and

c. Name, address, and telephone number of an emergency contact person;

(3) The name and telephone number of the client’s licensed practitioner(s);

(4) Contact information for the person referring the client for services, as applicable;

(5) The name, address, and telephone number of the behavioral health care provider, if applicable;

(6) The client’s health insurance information;

(7) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(8) A record of the health examination(s) in accordance with He-P 826.16(p) and (q);

(9) Written, dated, and signed orders for the following:

a. All medications, treatments, and special diets, as applicable; and

b. Laboratory services and consultations performed at the SUD-RTF;

(10) Results of any laboratory tests, X-rays, or consultations performed at the SUD-RTF;

(11) All evaluations and treatment plans, including documentation that the client and the guardian, personal representative, or agent, has participated in the development of the care and treatment plans;

(12) All admission and progress notes;

(13) If services are provided at the SUD-RTF by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

(14) Documentation of any alteration in the client’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including practitioner notification;

(15) Documentation of any medical or specialized care;

(16) Documentation of unusual incidents;

(17) The consent for release of information signed by the client, guardian, or agent;

(18) Discharge summary, planning, and referrals;

(19) Transfer or discharge documentation, including notification to the client, guardian, personal representative, or agent of involuntary room change, transfer, or discharge, if applicable;

(20) The information required by He-P 826.16(k) as applicable;

(21) Information data sheet, which contains the information required by He-P 826.16(t);

(22) Release of information sheet;

(23) Documentation of nurse delegation of medications as required by the nurse practice act, as applicable; and

(24) Documentation of a client’s refusal of any care or services.

(c) Client records and client information shall be kept confidential and only provided in accordance with 42 CFR Part 2, HIPAA, or any other applicable provision of law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur. For all SUD-RTF facilities, this shall include compliance with 42 CFR Part 2.

(e) When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

(f) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

(3) Systems to prevent tampering with information pertaining to clients and staff.

(g) Records shall be retained for at least 7 years after discharge.

(h) The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the SUD-RTF ceases operation.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.20 Food Services for Residential Clients

(a) The licensee shall provide food services to the clients that meets:

(1) The U.S. Department of Agriculture’s recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), available as noted in Appendix A;

(2) The nutritional needs of each client; and

(3) The special dietary needs associated with health or medical conditions for each client as identified in their client record.

(b) Each client shall be offered at least 3 nutritious meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

(c) Snacks shall be available between meals and at bedtime if not contraindicated by the client’s treatment plan.

(d) If a client refuses the item(s) on the menu, a substitute shall be offered.

(e) Each day’s menu shall be posted in a place accessible to food service personnel and clients.

(f) A dated record of menus as served shall be maintained for at least the previous 4 weeks.

(g) The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

(h) If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

(i) All food and drink provided to the clients shall be:

(1) Safe for human consumption, free of spoilage, and free from other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and Chapter 3, entitled “Food” of the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administrations’, “Food Code” (2017 edition), available as noted in Appendix A;

(3) Served at the proper temperature;

(4) Labeled, dated, and stored at proper temperatures; and

(5) Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

(j) The use of outdated, unlabeled food, or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

(k) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(l) All work surfaces shall be cleaned and sanitized after each use.

(m) All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

(n) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(o) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(p) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(q) Trash receptacles in food service areas shall have covers and remain closed except when in use.

(r) All SUD-RTF persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

(s) Regularly scheduled training programs including sanitation and safety shall be made available to food service personnel. Information as to the content and length of this training shall be documented and kept in employee records.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.21 Infection Control

(a) The SUD-RTF shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand-washing techniques;

(2) The utilization of universal precautions as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (September 2024), available as noted in Appendix A;

(3) The management of clients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.32 and regulated by Env-Sw 904;

(5) The reporting of infectious and communicable diseases as required by He-P 301; and

(6) Maintenance of a sanitary physical environment.

(c) The infection control education program shall address:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections;

(4) Prevention and containment of infections; and

(5) Use of universal precautions.

(d) Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

(e) Personnel infected with scabies, lice, pediculosis, or any communicable disease shall not provide direct care to clients or work in food services until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SUD-RTF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(h) Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (September 2024), available as listed in Appendix A.

(i) The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.22 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

(f) All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds, and substances considered hazardous waste, as defined in RSA 147-A:2,VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked closet or cabinet, separate from food, medications, and client supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

(j) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered at all times, except during food preparation and subsequent clean-up.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(3) Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

(p) Any SUD-RTF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services shall notify the department.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.23 Quality Improvement

(a) The SUD-RTF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The SUD-RTF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored:

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the SUD-RTF; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities, including minutes of meetings, shall be confidential in accordance with RSA 151:5-c

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.24 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

(b) The SUD-RTF shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and clients, including hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within an SUD-RTF including, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the client(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Unvented fuel-fired heaters shall not be used in any SUD-RTF.

(f) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(g) Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

(h) The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless personnel have separate bathroom facilities not used by clients.

(i) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(j) All hand-washing facilities shall be provided with hot and cold running water.

(k) In a SUD-RTF, there shall be at least 70 square feet per room with a single bed and 120 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

(l) In a SUD-RTF which provides full medical withdrawal management, there shall be at least 120 square feet per room for a single bed, exclusive of space required for closets, wardrobe, and toilet facilities.

(m) If a SUD-RTF was licensed as a He-P 807 residential treatment and rehabilitation facility prior to 2018, the licensee shall be exempt from (k) and (l) above.

(n) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the client to reach their bedroom without passing through the room of another client;

(3) Have a side hinge or pocket door that latches and meets applicable codes, and not a folding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors, and other rooms by floor to ceiling walls; and

(6) Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the evaluation.

(o) The licensee shall provide the following for the clients’ use, as needed:

(1) A bed appropriate to the needs of the client;

(2) A firm mattress that complies with the state fire code;

(3) Clean linens, blankets, and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) Adequate lighting;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades, or curtains that provide privacy.

(p) The client may use their own personal possessions provided they do not pose a risk to the client or others as evidenced by documented inspection for fire safety and insect infestation.

(q) The licensee shall provide the following rooms to meet the needs of clients:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all clients.

(r) Each licensee shall have an UL listed communication system in place so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

(s) Lighting shall be available to allow clients to participate in activities such as reading or handicrafts.

(t) All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(u) Screens shall be provided for doors, windows, and other openings to the outside.

(v) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (u) above.

(w) Portable space heating devices shall be prohibited, unless:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.25 Fire Safety

(a) The facility shall meet the appropriate chapter of NFPA 101, the appropriate chapters of the state fire code pursuant to RSA 153:5, and the appropriate chapters of the state building code, including but not limited to:

(1) Residential board and care occupancies for facilities in which the clients are capable of self-evacuation;

(2) Health care occupancy for facilities or portions of a facility in which the clients are not capable of self-evacuation; or

(3) If the building is being designed as a mixed-use facility, a portion of clients are capable of self-evacuation and another portion the clients are not capable of self-evacuation, then the areas shall be appropriately separated into their use groups as defined under the state fire code and state building code.

(b) All SUD-RTF’s shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the SUD-RTF’s electrical service, or wireless, as approved by the state fire marshal for the SUD-RTF;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building, and which meets the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection, or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label shall be securely attached that indicates that maintenance was performed; and

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturers listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) A written emergency and fire safety program shall be developed and implemented to provide for the safety of clients and personnel.

(d) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) If the licensee has chosen to allow smoking on the premises of the SUD-RTF, a designated smoking area shall be provided which:

(1) Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

(2) Has walls and furnishings constructed of non‑combustible materials;

(3) Has metal waste receptacles and safe ashtrays; and

(4) Is in compliance with the requirements of RSA 155:64–77.

(g) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian, personal representative, or agent, at the time of admission and a summary of the client’s responsibilities shall be provided to the client. Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(h) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The facility shall obtain initial written approval of all fire safety plans from the local fire chief; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(i) Fire drills shall be conducted as follows:

(1) For buildings constructed to the “Residential Board and Care” or “One and Two Family Dwelling” chapters of the life safety code, NFPA 101, the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All SUD-RTF Tier 1, 2, and 3 facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape;

e. Facilities shall complete a written record of fire drills that includes the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. The fire drills for facilities built to the “Residential Board and Care” chapter of the life safety code, NFPA 101, shall be permitted to be announced, in advance, to the clients just prior to the drill; and

h. Evacuation drills shall include the transmission of a fire alarm signal, and simulation of emergency fire conditions;

(2) For SUD-RTF's originally constructed to the “Health Care Occupancy” chapter of the life safety code or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the “Health Care Occupancy” chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the “Health Care Occupancy” chapter of the life safety code;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. If the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(3) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

N.H. Code Admin. R. Ann. He-P 826.26 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) The emergency management committee shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency that shall be reviewed and updated at least annually.

(d) The emergency preparedness plan in (c) above shall:

(1) Comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable;

(2) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, interruptions of any utility or services to the facility, and human-caused emergencies to include, but not be limited to, missing clients, bomb threat, and active shooter;

(3) Be approved by the local emergency management director or local authority having jurisdiction, and reviewed and approved by the local authority having jurisdiction when a change to the plan causes significant material difference;

(4) Be available to all personnel;

(5) Be based on realistic conceptual events;

(6) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility to include measures to be taken to limit or control the

consequences, extent, or severity or an incident that cannot be prevented;

(7) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Medical gas and vacuum systems, if applicable;;

h. Communications systems; and

i. Essential services, such as kitchen and laundry;

(8) Include and maintain a communication plan that includes the following:

a. Names and contact information for the following:

1. Staff;

2. Entities providing services under arrangement;

3. Resident’s licensed practitioner;

4. Other nearby facilities; and

5. Volunteers;

b. Contact information for the following:

1. Federal, state, or local emergency preparedness staff;

2. The state licensing unit;

3. The office of the state long-term care ombudsman; and

4. Other sources of assistance;

c. Primary and alternate means for communication with the facility’s staff and federal, state, or local emergency management agencies;

d. A method for sharing information and medical documentation for the residents under the facility’s care, as necessary, with other health care providers to maintain the continuity of care; and

e. A means of providing information about the facility’s occupancy, needs, and its ability to provide assistance to the authority having jurisdiction;

(9) Include the management of clients, particularly with respect to physical and clinical issues to include:

a. Relocation of clients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(10) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(11) Plans for the provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, to include, but not be limited to the following:

a. Food, water, medical, and pharmaceutical supplies calculated for the maximum number of staff and residents;

b. Source of water support, either tap or commercial;

c. Expiration dates, tracking of supplies, and rotation of products;

d. Contracts and memorandums of understanding with food and water suppliers;

e. Storage location(s);

f. Back-up supplies; and

g. Alternate sources of emergency power to maintain:

1. Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;

2. Emergency lighting;

3. Fire detection, extinguishing, and alarm systems; and

4. Sewage and waste disposal; and

(12) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

(e) The facility shall develop and maintain emergency preparedness training for all staff, individuals providing services under arrangement, and volunteers which shall include:

(1) Initial emergency preparedness training upon hire consistent with roles and specific duties and responsibilities during an emergency;

(2) Emergency preparedness training at least annually;

(3) Documentation of the training; and

(4) A demonstration of staff knowledge and competency of emergency procedures.

(f) The facility shall conduct and document exercises to test the emergency preparedness plan at least twice per year that includes the following:

(1) Participation in an annual full-scale exercise that is community-based. When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. If the facility experiences and documents an actual natural or man-made emergency that requires the activation of the emergency plan, the facility shall be exempt from engaging in another full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event;

(2) Conduct an additional annual exercise that may include, but is not limited to, the following:

a. A second full-scale exercise that is community-based or an individual, facility-based

functional exercise;

b. A mock disaster drill; or

c. A tabletop exercise or workshop that is led by a facilitator that includes a group

discussion, using a narrated, clinically relevant emergency scenario, and a set of problem

statements, directed messages, or prepared questions designed to challenge an

emergency plan; and

(3) Analyze the facility's response to and maintain documentation of all drills, tabletop

exercises, and emergency events, and revise the facility's emergency plan, as needed.

History

• #12658, eff 11-1-18; ss by #14548, eff 3-31-26, EXPIRES: 3-31-36

Part He-P 827 Freestanding Megavoltage Radiation Therapy Facility

N.H. Code Admin. R. Ann. He-P 827.01 Purpose

REVISION NOTE:

Document #12751, effective 3-26-19, adopted Part He-P 827 titled “Freestanding Megavoltage Radiation Therapy Facility.” Part He-P 827 had formerly contained rules titled “Regulations for Special Hospitals-Rehabilitation” which had been adopted by Document #5849, effective 6-22-94, but had expired 6-22-00 and were not adopted again. The rule number He-P 827 therefore became available for future rulemaking until used for the rules in Document #12751.

The purpose of this part is to set forth the special health care service licensing requirements for freestanding megavoltage radiation therapy facility (FMRTF) services pursuant to RSA 151:2-e, II(c).

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.02 Scope

This part shall apply to any organization, business entity, partnership, corporation, government entity, association or other legal entity operating megavoltage radiation therapy equipment in a free standing facility.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” which means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

(2) “Physical abuse” which means the misuse of physical force which results or could result in physical injury to patients; or

(3) “Sexual abuse” which means contact or interaction of a sexual nature involving patients without his or her informed consent.

(b) “Accredited hospital” means a hospital accredited by the organizations deemed by the Centers for Medicare and Medicaid Services (CMS) as accrediting organizations.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act, by an individual authorized by law, whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.

(e) “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the FMRTF.

(f) “Admission” means accepted by a licensee for the provision of services to a patient.

(g) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

(h) “Adverse event” means a negative consequence of care, including any misadministration as defined in He-P 4000, which results in unintended injury which might have been preventable, and which is listed in RSA 151:38.

(i) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies or other companies as the commissioner shall decide.

(j) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

(k) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a FMRTF pursuant to RSA 151:2, I(a) and RSA 151:2-e.

(l) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 827, or other federal or state requirements.

(m) “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, and/or the patient’s guardian, agent, surrogate, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(n) “Change of ownership” means a change in the controlling interest of an established FMRTF to an individual or successor business entity.

(o) “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

(p) “Core services” means those minimal services to be provided to any patient by the licensee that must be included in the basic rate.

(q) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(r) “Days” means calendar days unless otherwise specified in the rule.

(s) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard such as a certificate of completion of course material or a post-test to the training provided.

(t) “Department” means the New Hampshire department of health and human services.

(u) “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological or rehabilitative treatments.

(v) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(w) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).”

(x) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(y) “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(z) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license in response to non-compliance with RSA 151 or He-P 827.

(aa) “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

(ab) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception or fraud.

(ac) “Facility” means any hospital, building, residence, or other place or part thereof, where services are provided under the provisions of RSA 151:2-e.

(ad) “Freestanding megavoltage radiation therapy facility (FMRTF)” means a facility, geographically separate from the parent hospital(s), which is owned or operated, directly or indirectly, by the parent hospital(s) and that performs megavoltage therapy radiation services.

(ae) “Governing body” means a group of individuals who are responsible for policy direction of the licensee.

(af) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

(ag) “Hospital” means “hospital” as licensed under in RSA 151:2, I(a).

(ah) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ai) “Independent contractor” means an individual providing service to the licensee or its clients but employed by an outside agency.

(aj) “Infectious disease” means any disease caused by the growth of microorganisms in the body which might or might not be contagious.

(ak) “Infectious waste” means those items specified by Env-Sw 904.

(al) “Informed consent” means the decision by a person or his/her guardian or agent to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(am) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(an) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 827 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 827.

(ao) “License” means the document issued by the department to an applicant at the start of operation as an FMRTF which authorizes operation of an FMRTF in accordance with RSA 151 and He-P 827, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

(ap) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the FMRTF is licensed.

(aq) “Licensed practitioner” means a:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(ar) “Licensed premises” means the building(s), or portion thereof, that comprise the physical location the department has approved for the licensee to conduct operations in accordance with its license.

(as) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(at) “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(au) “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a FMRTF.

(av) “Medical staff” means those physicians and other licensed practitioners permitted by law and policies to provide patient care services independently within the scope of their practice acts.

(aw) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(ax) “Megavoltage” means energy levels equal to or greater than 1.0 million electron volts or one MeV. MeV stands for megavolts.

(ay) “Megavoltage radiation therapy equipment” means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues. The term includes but is not limited to Cobalt-60 and linear accelerator machines.

(az) “Modification” means the reconfiguration of any space; the addition, relocation, or elimination of any door or window; the addition or elimination of load-bearing elements; the reconfiguration or extension of any system; or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(ba) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional or physical health and safety of any patient.

(bb) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bc) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.

(bd) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(be) “Over-the-counter medications” means non-prescription medication.

(bf) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bg) “Parent hospital” means the hospital which owns and operates a FMRTF.

(bh) “Patient” means any person admitted to or in any way receiving care, services or both from a hospital or provider of special health care services licensed in accordance with RSA 151 and He-P 827.

(bi) “Patient record” means documents maintained for each person receiving care and services, which includes all documentation required by RSA 151, He-P 827 and all documentation compiled relative to the patient as required by other federal and state requirements.

(bj) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(bk) “Personal care” means personal care services that are non-medical, hands-on services provided to a patient to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, or walking.

(bl) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting a patient in the exercise of any rights.

(bm) “Personnel” means an individual(s), who is employed by the FMRTF, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to patients.

(bn) “Physician” means medical doctor currently licensed in the state of New Hampshire pursuant to RSA 329.

(bo) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance at the time of clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bp) “Previously operating special health care service” shall mean a special health care service as defined by RSA 151:2-e that was being offered prior to July 1, 2016 and has continued to be offered since July 1, 2016.

(bq) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(br) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bs) “Qualified personnel” means personnel that have been trained to adequately perform the tasks which they perform, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bt) “Radiographic images” means x-rays or other images which are either on film, discs, paper, or stored electronically.

(bu) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(bv) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

(bw) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(bx) “Reportable incident” means an occurrence of any of the following while the patient is either in the FMRTF or in the care of personnel:

(1) The unanticipated death of the patient; or

(2) An injury to a patient that is potentially due to abuse or neglect.

(by) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

(bz) “Special health care service” shall mean cardiac catheterization laboratory services, open heart surgery or coronary artery bypass graft surgery, or megavoltage radiation therapy.

(ca) “Staff” means those employees of the licensee who are not subject to the credentialing process.

(cb) “State monitoring” means the placement of individuals by the department at a FMRTF to monitor the operation and conditions of the facility.

(cc) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.04 License Application Submission

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I–III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License” (March 2019) signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

b. For any FMRTF to be newly licensed :

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any FMRTF to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

(2) A floor plan of the prospective FMRTF;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) A $500 fee, in accordance with RSA 151:2-e, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the qualifications of the FMRTF administrator;

(6) Copies of applicable licenses for the FMRTF administrator;

(7) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, as adopted by the commissioner of the department of safety, and local fire ordinances applicable for a business; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

(8) If the FMRTF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill;

(9) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, medical director, and administrator for which the application is submitted; and

(10) A copy of the signed and dated FMRTF’s criminal statement form for the administrator and medical director as described in He-P 827.18(t).

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

(c) A previously operating special health care service shall not be required to apply for a licensed pursuant to RSA 151:2-e.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.05 Processing of Applications and Issuance of L

icenses.

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 827.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 827.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 827.13(b) if it determines that the applicant, licensee, medical director, or administrator:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(f) At the time of initial onsite inspection, the applicant shall have the following on hand and available for inspection:

(1) A copy of the personnel records; and

(2) A copy of the FMRTF standard disclosure form.

(g) Following both clinical and life safety code inspections, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 827.

(h) All licenses issued in accordance with RSA 151 shall be non-transferable by person, location, or agency affiliation.

(i) A written notification of denial, pursuant to He-P 827.13(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (g) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 827.

(j) A written notification of denial, pursuant to He-P 827.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 827.04(a)(1) at least 120 days prior to the expiration of the current license and include with the application:

(1) The current license number;

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 827.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 827.18(e)(2); and

(4) A copy of any non-permanent or new variances applied for and granted by the state fire marshal, in accordance with Saf-C 6005.03 - 6005.04, as amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

(d) Following an inspection as described in He-P 827.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above, as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151 and He-P 827 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 827.04.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.07 FMRTF New Construction and Existing Rehabilitation

(a) For new construction and for rehabilitation, renovation, modification, reconstruction, or addition of an existing building, all construction documents, shop drawings, and architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 827 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

(f) Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

(g) The FMRTF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

(h) A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

(1) The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control; and

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V;

(i) All FMRTF newly constructed or rehabilitated after the 2019 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition), as applicable, available as noted in Appendix A.

(j) Where rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the FGI “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition), available as noted in Appendix A.

(k) Per the FGI “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the FGI “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition) available as noted in Appendix A, and notwithstanding (j) above, where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

(l) The department shall be the authority having jurisdiction for the requirements in (i)-(k) above and shall negotiate compliance and grant waivers in accordance with He-P 827.10 as appropriate.

(m) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

(n) Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(o) Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

(p) The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 827.09 prior to its use.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.08 FMRTF Requirements for Organizational or Service Changes

(a) The FMRTF shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address; or

(4) Name;

(b) The FMRTF shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

(1) A change in ownership;

(2) A change in the physical location; or

(3) An increase in number of patients or services beyond what is authorized under the current license.

(c) When there is a change in the address without a change in location, the FMRTF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

(d) When there is a change in the name, the FMRTF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) When there is to be a change in the services provided, the FMRTF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

(f) The department shall review the information submitted under (e) above and determine if the added services can be provided under the FMRTF’s current license.

(g) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, then an inspection will be conducted as soon as practicable by the department;

(2) The physical location;

(3) A change in licensing classification; or

(4) A change that places the facility under a different life safety code occupancy chapter.

(h) A new license and license certificate shall be issued for a change in ownership or a change in physical location.

(i) A revised license and license certificate shall be issued for a change in the FMRTF name.

(j) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in address without a change in physical location;

(3) A change in the number of patients from what is authorized under the current license, if applicable; or

(4) When a waiver has been granted.

(k) The FMRTF shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change or medical director change and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator or medical director;

(2) Copies of applicable licenses for the new administrator or medical director;

(3) The results of a criminal records check conducted under He-P 827.18(b)(1); and

(4) A copy of the dated and signed criminal statement as described He-P 827.18(t).

(l) Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 827.18(h).

(m) If the department determines that the new administrator does not meet the qualifications, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

(n) The FMRTF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

(o) An organizational restructuring of an established FMRTF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(p) If a licensee chooses to cease operation of a FMRTF, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 827 as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

(1) The licensed premises;

(2) All programs and services provided by the FMRTF; and

(3) Any records required by RSA 151 and He-P 827.

(b) The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 827 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 827.08(g)(1);

(3) A change in the physical location of the FMRTF;

(4) A change in the licensing classification;

(5) Occupation of space after construction, modifications, or structural alterations; or

(6) The renewal of a license.

(c) In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

(d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the FMRTF is in violation of any of the provisions of He-P 827, RSA 151, or other federal or state requirement.

(e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 827.12(c), within 21 days of the date on the letter that transmits the inspection report.

(f) A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 827.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 827 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health, safety, or well-being of the patients; and

(3) Does not negatively affect the quality of patient services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) occurred since the last onsite clinical or life safety inspection;

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first- hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 827.

(b) When practicable the complaint shall be in writing and contain the following information:

(1) The name and address of the FMRTF, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 827.

(c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of relevant records that have probative value; and

(4) Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

(d) For a licensed FMRTF, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

(3) Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

(4) Require the licensee to submit a POC in accordance with He-P 827.12(c) if the inspection results in areas of non-compliance being cited.

(e) The following shall apply to an unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2;

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

(3) If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 827; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 827.13(c)(6).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with an adjudicative proceeding relative to the licensee.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.12 Administrative Remedies

(a) The department shall impose administrative remedies for violations of RSA 151, He-P 827, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee; or

(4) Monitoring of a licensee.

(b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

(1) Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been imposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of patients will not be jeopardized as a result of granting the extension;

(3) The department shall review each POC and accept each plan that:

a. Achieves compliance with RSA 151 and He-P 827;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 827 as a result of the implementation of the POC; and

d. Specifies the date upon which the areas of non-compliance will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14- day period but has been unable to do so; and

2. The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He- P 827.13(c)(12) below;

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting an onsite follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 827.13(c)(13) below.

(d) The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

(3) A revised POC submitted by the licensee has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

(1) Impose a fine;

(2) Deny the application for a renewal of a license in accordance with He-P 827.13(b); or

(3) Revoke the license in accordance with He-P 827.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

(h) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

(i) The deadline to submit a POC in accordance with He-P 827.12(c) shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(j) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(k) An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, or initiated action to suspend, revoke, deny or refuse to issue or renew a license.

(l) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

(2) The presence of conditions in the FMRTF that negatively impact the health, safety, or well-being of patients.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee violated a provision of RSA 151 or He-P 827 which poses a risk of harm to the health, safety, or well-being of a patient;

(2) An applicant or licensee has failed to pay an administrative fine imposed by the department;

(3) An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 827.04 or fails to schedule an inspection;

(5) The applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 827.12(c), (d), and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 827.12(c)(5) and has not submitted a revised POC in accordance with He-P 827.12(c)(5)b.;

(8) The licensee is cited a third time under RSA 151 or He-P 827 for the same violation within the last 5 inspections;

(9) A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

(10) Unless a waiver has been granted, upon inspection, the applicant is not in compliance with RSA 151 or He-P 827;

(11) Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee fails to employ a qualified administrator; or

(13) The applicant has had a license revoked or denied by another division or unit of the department within a 5 year period of the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

(2) For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 827.14(h), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a patient whose needs exceed the services or programs provided by the FMRTF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

(5) For admission of a patient whose needs at the time of admission exceed the services or programs authorized by the FMRTF licensing classification, in violation of RSA 151:5-a, II, and He-P 827.16(a), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 827.11(e), the fine for an unlicensed provider or a licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 827.06(b), the fine for a licensee shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 827.08(a)(1), the fine for a licensee shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He P 827.08(a)(2), the fine for a licensee shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address as required by He-P 827.08(n), the fine for a licensee shall be $100.00;

(11) For a failure to allow access by the department to the FMRTF’s premises, programs, services, or records, in violation of He-P 827.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(12) For a failure to submit a timely POC in violation of He-P 827.12(c)(2), or a timely or acceptable revised POC in violation of He-P 827.12(c)(5), the fine for a licensee shall be $500.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 827.12(c)(8), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement, or comply with licensee policies, as required by He-P 827.14(d) and (s), 827.16(c), 827.17(c), (r), and (v), 827.18(H)(2)g. and (x), 827.19(d) and (h), and 827.20(c), (l), and (n), the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified by He-P 827.14(c), the fine for a licensee shall be $500.00;

(16) For providing false or misleading information or documentation, in violation of He-P 827.14(g), the fine for an applicant or licensee shall be $1000.00 per offense;

(17) For a failure to meet the needs of a patient, as described in He-P 827.14(j), the fine for a licensee shall be $1000.00 per patient;

(18) For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 827.10, in violation of He-P 827.18(h), the fine for a licensee shall be $500.00;

(19) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 827.07(a), the fine for a licensed facility shall be $500.00;

(20) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 827.09(b)(5), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(21) When an inspection determines that there is a violation of RSA 151 or He-P 827 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original area of non- compliance, the fine for a licensee shall be $1000.00; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in

a. above, the fine for a licensee shall be $2000.00;

(22) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 827 shall constitute a separate violation and shall be subject to fines in accordance with He-P 827.13(c); and

(23) If the applicant or licensee is making good faith efforts to comply with (4),(6), and (15) above, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a patient is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 827 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a FMRTF’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

(k) The 5-year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 827.

(m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 827.

(o) Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and

ordinances, as applicable, including RSA 161-F:49 and rules promulgated under CMS regulation at 42 CFR Part 482;

(b) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

(c) The licensee shall define, in writing, the scope and type of services to be provided by the FMRTF, which shall include, at a minimum, the required services listed in He-P 827.16.

(d) The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the facility.

(e) All policies and procedures shall be reviewed per licensee policy.

(f) The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

(g) The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

(h) Except for the requirements of RSA 151:4, III(a)(5), the licensee shall not:

(1) Advertise or otherwise represent itself as operating as a special health care service provider, unless it is licensed; and

(2) Advertise that it provides services that it is not authorized to provide.

(i) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(j) Licensees shall:

(1) Meet the needs of the patients during those hours that the patients are in the care of the special health care service provider;

(2) Initiate action to maintain the FMRFT in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

(3) Establish, in writing, a chain of command that sets forth the line of authority for the provision of FMRTF;

(4) Appoint an administrator;

(5) Appoint a medical director;

(6) Appoint a chief of radiation therapy who shall be a medical radiation oncologist or a consulting medical radiation oncologist that meets the qualifications according to He-P 4000;

(7) Appoint a radiation therapy physicist who shall be a qualified medical physicist that meets the qualifications of He-P 4000;

(8) Verify the qualifications of all personnel;

(9) Provide sufficient numbers of qualified personnel who are present in the facility and are qualified to meet the needs of patients during all hours of operation;

(10) Provide the facility with sufficient supplies, equipment, and lighting to meet the needs of the patients; and

(11) Implement any POC that has been accepted by the department.

(k) The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

(1) Has a guardian appointed by a court;

(2) Has a durable power of attorney for health care or surrogate that has been activated; or

(3) Is an un-emancipated minor.

(l) The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the licensing certificate.

(m) If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, the licensee shall follow the required procedures for the care of the patients, as specified by the Centers for Disease Control and Prevention 2007 “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007 edition), available as noted in Appendix A.

(n) The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02 and He-P 301.03.

(o) The licensee shall implement measures to ensure the safety of patients who are assessed as a danger to self or others.

(p) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2-e;

(2) All inspection reports issued in accordance with He-P 827.09(b), for the previous 12 months;

(3) A copy of the patients’ bill of rights;

(4) A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345, the address and phone number of the department to which complaints may also be made, which shall also be posted on the hospital website if available; and

(6) The licensee’s evacuation floor plan for fire safety, evacuation, and emergencies identifying the location of, and access to, all fire exits.

(q) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 827 as authorized by RSA 151:6 and RSA 151:6-a.

(r) Licensees shall, in accordance with He-P 827.15:

(1) Report all adverse events to the department as required by He-P 827.15(a)-(c);

(2) Submit additional information if required by the department; and

(3) Report the event to other agencies as required by law.

(s) The licensee shall develop policies and procedures regarding the release of information contained in patient records.

(t) The licensee shall provide cleaning and maintenance services, as needed to protect patients, personnel, and the public.

(u) The building housing the licensee shall comply with all state and local:

(1) Health requirements;

(2) Building ordinances;

(3) Fire ordinances; and

(4) Zoning ordinances.

(v) Smoking shall be prohibited in the facility as required by RSA 155:66, I(b).

(w) If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-DW 702.02 and Env-DW 704.02.

(x) If the licensee holds or manages a patient’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other patients.

(y) At the time of admission, the licensee shall give a patient and the patient’s guardian, agent, or personal representative, a listing of all known applicable charges and identify what care and services are included in the charge.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.15 Adverse Event Reporting

(a) Pursuant to RSA 151:37, the FMRTF administrator or designee, as a part of the parent hospital, shall report to the department the following adverse events:

(1) Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573, available as noted in Appendix A.

(2) Any misadministration as defined in He-P 4047.03(f); and

(3) The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker's intentional, unsafe act. An act by FMRTF staff resulting in an infection or disease shall be considered to be purposefully unsafe if it meets the following criteria:

a. There was an intentional act or reckless behavior;

b. No reasonable person with similar qualifications, training, and experience would have acted the same way under similar circumstances; and

c. There were no extenuating circumstances that could justify the act.

(b) If the licensee suspects an adverse event occurred, the administrator or designee shall send a report to the department in electronic or paper format, within working 15 days after discovery of event, including:

(1) Provider information;

(2) Patient information;

(3) Event information; and

(4) Type of occurrence as listed in (a) above.

(c) For events reported in (b) above the FMRTF shall within 60 days provide the department:

(1) An analysis that includes the type of harm and contributing factors; and

(2) A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented, and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the FMRTF determines that one is not required.

(d) Upon receipt of a report of an adverse event, the department shall:

(1) Acknowledge receipt of event and review information for completeness;

(2) Review corrective action plan for system changes that reduce the risk repeat of similar adverse events;

(3) Communicate specific concerns to the FMRTF if the department does not find the corrective action plan credible;

(4) Track and analyze adverse events for trends, underlying system problems; and

(5) Provide information and make referrals to other state agencies as appropriate.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.16 Required Services

(a) The licensee shall only provide the services that have been disclosed on its application and have been approved by the department.

(b) If the licensee wishes to provide services other than the ones it is already licensed to provide, the licensee shall submit a letter of intent to provide the additional services, prior to providing the new service(s), to the department which shall include:

(1) A listing of the additional services to be provided;

(2) The physical resources and staffing necessary to provide the additional services;

(3) Floor plans describing change(s) or architectural plans if structural changes are involved;

(4) The date the licensee wishes to start such services; and

(5) Documentation of compliance with the requirements of He-P 827 applicable to the service.

(c) The licensee shall have a policy governing CPR.

(d) The licensee shall establish health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the patient is at the FMRTF that includes:

(1) Monitoring the patients’ functioning, safety, and whereabouts; and

(2) Emergency response and crisis intervention.

(e) All FMRTF laboratories, if applicable, shall comply with He-P 808, He-P 817, and CMS 42 CFR Part 493 – Laboratory Requirements.

(f) There shall be adequate toilet and dressing rooms for patients;

(g) Radiation therapy equipment shall be registered and radioactive material shall be licensed, in accordance with RSA 125-F and shall meet all applicable requirements of He-P 4000;

(h) The technical staff employed by the FMRTF shall perform the service as assigned by the radiation oncologist for the therapeutic uses of radiation, and in accordance with He-P 4000;

(i) The licensee must appoint a chief of radiation oncology who shall be certified in radiation oncology and responsible for:

(1) Overseeing the services provided to ensure safe and quality care;

(2) Ensuring personnel are qualified to perform megavoltage radiation therapy services in accordance with He-P 4000; and

(3) Establishing procedures necessary to ensure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained and licensed commensurate to their duties in the operation and use of x-ray or radiation therapy equipment;

(j) A radiation oncologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000;

(k) A licensee providing treatment on megavoltage radiation therapy equipment shall ensure the provision of a comprehensive coordinated care plan which may include:

(1) Clinical oncology services, including chemotherapy and surgical treatment of tumors and follow-up capabilities;

(2) Services of a tumor registry;

(3) Services of a simulation capability and dose computation equipment;

(4) Services of a pathology laboratory;

(5) Services of a physics laboratory or equivalent;

(6) Computerized tomography, magnetic resonance imaging, and position emission tomography capability;

(7) Social work and counseling;

(8) Brachytherapy or a referral arrangement for provision of the service;

(9) Nutrition and dietary consultation; and

(10) In-house capabilities encompassing the full range of radiation therapy modalities, including megavoltage equipment and superficial treatment equipment and systemic therapy or referral arrangements for the provision of these services.

(l) All licensees providing megavoltage radiation therapy shall have sufficient personnel to meet the needs of the patients.

(m) No licensee shall provide megavoltage radiation therapy services unless the program will treat a minimum of 200 patients on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any twelve-month period for cognitive planning process codes;

(n) Any licensee holding a special health care service license to provide megavoltage radiation therapy services outside of a hospital shall adopt protocols for the transportation of patients for the provision of necessary support and emergency services, which shall include a written agreement for the acceptance and transfer of patients needing such emergency care, with the nearest acute care hospital or any acute care hospital within 30 minutes travel time.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.17 Medication Services

(a) All medications shall be made available to the patient in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

(b) All medications and treatments shall be reviewed and signed by a licensed practitioner at each visit or when indicated by a change in the patient’s condition.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain and store any medication ordered for use at the FMRTF;

(2) Reorder medications for use at the FMRTF; and

(3) Receive and record new medication orders.

(d) Each medication order shall legibly display the following information:

(1) The patient’s name;

(2) The medication name, strength, prescribed dose, and route, if different than by mouth;

(3) The frequency of administration;

(4) The indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner as allowed by He-P 827.03(bd).

(e) Except for pharmaceutical samples, each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient:

(1) The patient’s name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all PRN medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

(7) The expiration date of the medication(s).

(f) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee, with the patient’s name, and shall be exempt from (e)(2)-(6) above.

(g) The dosage, frequency, and route of administration on the labels of all prescription medications for each patient shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (i) or (j) below.

(h) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the FMRTF shall indicate in writing, in the medication record, the date the change in dose or the discontinuance occurred.

(i) Only a pharmacist shall make changes to prescription medication container labels except as allowed by (j) below.

(j) When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

(k) Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

(l) The transcribed order in (k) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

(m) No medications shall be given to or taken by a patient until a written order is received, except as allowed by (k) and (l) above.

(n) The medication storage area for medications shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each patient’s medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(o) All medication at the FMRTF shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(p) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(q) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the FMRTF, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(r) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(s) Except as required by (t) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

(t) Destruction of contaminated, expired, or discontinued controlled drugs shall:

(1) Be in accordance with all applicable standards of practice;

(2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

(3) Be documented in the record of the patient for whom the drug was prescribed.

(u) The licensee shall maintain a written record for each medication taken by a patient at the FMTRF that contains the following information:

(1) Any allergies or adverse reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;

(5) For PRN medications, the reason the patient required the medication, and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

(v) The facility shall have a written policy that incorporates the requirements listed in (t) through (v) for use in training and for reference by employees supervising medication administration.

(w) The licensee shall report any adverse reactions and side effects to medications or treatments, or any medication or treatment errors, to the patient’s licensed practitioner immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient’s record the reaction, the error, and date, time, and person notified.

(x) An FMRTF shall have written orders from the licensed practitioner for all medications being taken by patients while under the care of the FMRTF.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present at the FMTRF to meet the needs of patients.

(b) For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care to patients or who will be unaccompanied by an employee while performing non-direct care within the facility, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

(2) Review the results of the criminal records check in (1) above in accordance with (e) below; and

(3) Verify the qualifications of all applicants prior to employment; and

(4) Check the names of the persons in (b) above against the bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-E 720 and the NH board of nursing, nursing assistant registry, maintained pursuant to RSA 326-B:26 and 42 CFR 483.156.

(c) Unless a waiver is granted in accordance with (e)(2) below, the licensee shall not offer employment, contract with, or engage a person in (b) above if the person:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of patients.

(d) If the information identified in (c) above regarding any person in (b) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (c) above.

(e) If a waiver of (c) above is requested, the department shall review all relevant information and the underlying circumstances and either:

(1) Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of patients; or

(2) Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of patients.

(f) The licensee shall:

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the licensing site with the New Hampshire board of nursing or with a compact state.

(g) In lieu of (b) above, the licensee may accept from independent agencies contracted by the licensee a signed statement that the agency’s employees have complied with (b) and do not meet the criteria in (c) and (f)(1) above.

(h) Each FMRTF shall have a full time administrator who:

(1) Has a master’s degree from an accredited institution and at least 4 years of experience working in a health related field or has a bachelor’s degree from an accredited institution and at least 8 years of experience working in a health related field; and

(2) Shall be responsible to the governing body for the daily management and operation of the FMRTF including:

a. Management and fiscal matters;

b. The employment and termination of managers and staff necessary for the efficient operation of the FMRTF;

c. The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the FMRTF in the absence of the administrator;

d. To serve as a liaison to the parent hospital;

e. The planning, organizing, and directing of such other activities as may be delegated by the parent hospital;

f. The delegation of responsibility to subordinates as appropriate;

g. Ensuring development and implementation of hospital policies and procedures on:

1. Patient’s rights as required by RSA 151:20;

2. Advanced directives as required by RSA 137-J;

3. Discharge planning as required by RSA 151:26;

4. Withholding of resuscitative services from patients pursuant to RSA 137-H and RSA 137-J;

5. Adverse event reporting; and

6. Any other policies and procedures required by law or rule; and

h. Notifying the department, directly or through delegation, as specified in He-P 827.15 of any adverse event involving a patient.

(i) All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the FMRTF each annual licensing period, in accordance with (p) and (q) below.

(j) All direct care personnel shall be at least 18 years of age unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(2) Involved in an established educational program working under the supervision of a nurse or radiation therapist.

(k) The licensee shall inform personnel of the line of authority at the FMRTF.

(l) The licensee shall educate personnel about the needs and services required by the patients under its care.

(m) Prior to having contact with patients, personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(n) In lieu of (m)(1) and (3) above, independent agencies contracted by the facility to provide direct care may provide the licensee with a signed statement that its employees have complied with (m)(1) and (3) above before working at the FMRTF.

(o) Prior to having contact with patients, personnel shall receive a tour of and orientation to the FMRTF that includes the following:

(1) The patient’s rights in accordance with RSA 151:20;

(2) The FMRTF patient complaint procedures;

(3) The duties and responsibilities of the position;

(4) The emergency medical procedures;

(5) The emergency and evacuation procedures;

(6) The infection control procedures as required by He-P 827.20;

(7) The facility confidentiality requirements;

(8) The grievance procedures for both staff and patients; and

(9) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(p) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s patients’ rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The licensee’s policies and procedures; and

(5) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(q) The FMRTF or parent hospital shall maintain a separate employee file for each employee, which shall include the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the patient’s rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (b) above;

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (p) above;

(7) Information as to the general content and length of all in-service or educational programs attended;

(8) Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

(9) A copy of each current driver’s license, including proof of insurance, if the employee transports patients using their own vehicle;

(10) Documentation that the required physical examinations or health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(11) The statement required by (w) below; and

(12) The results of the registry checks in (h) above.

(r) Personnel records may be stored at a parent hospital provided that:

(1) The personnel record is available to the department at the licensed premises within 2 hours of being requested; and

(2) The records are maintained in accordance with (q) above.

(s) The FMRTF shall maintain the records for all volunteers, and for all independent contractors who provide direct care to patients or who will be unaccompanied by an employee while performing non-direct care services within the facility, as follows:

(1) For volunteers, the information in (q)(1), (3), (4), (6), and (8)-(12) above; and

(2) For independent contractors, the information in (q)(3), (4), (6), and (8)-(12) above, except that the letter in (g) and (n) above may be substituted for (q)(4), (10), and (12) above, if applicable.

(t) All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

(3) Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

(u) An individual shall not have to re-disclose any of the matters in (t) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

(v) The licensee shall protect and store in a secure and confidential manner all records described in (q) and (r) above.

(w) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(x) The FMRTF shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(y) The policy in (x) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are addicted;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.19 Patient Records

(a) The licensee shall maintain a legible, current, and accurate record for each patient receiving the services provided at the FMRTF.

(b) At a minimum, patient records shall contain the following:

(1) Identification data, including:

a. The patient’s name, date of birth, and marital status;

b. Home address and telephone number;

c. Name, address, and telephone number for an emergency contact person;

d. Patient’s veteran status, if known; and

e. Guardian or agent, if applicable;

(2) The name and telephone number of the patient’s licensed practitioner(s);

(3) A signed acknowledgment of receipt of patient bill of rights by the patient, guardian, or agent;

(4) If services are provided at the FMRTF by individuals not employed by the licensee, documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, and the business address and telephone number;

(5) Patient’s health insurance information;

(6) A written or electronic record of a health examination by a licensed practitioner;

(7) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

(8) Written, dated, and signed orders for the all medications, treatments, and therapeutic diets ordered at the FMRTF;

(9) Copies of the patient’s consent for treatment and DNR;

(10) Results of any laboratory tests, X-rays, or consultations performed at FMRTF;

(11) All assessments and care plans, and documentation that the patient and the guardian or agent, if any, has participated in the development of the care plan;

(12) The consent for release of information signed by the patient, guardian, or agent, if any;

(13) All consult and progress notes;

(14) Documentation of medical, nursing, or other specialized care, as applicable;

(15) Documentation of reportable incidents;

(16) The consent for release of information signed by the patient, guardian, or agent, if any;

(17) Discharge planning and referrals;

(18) The medication record as required by He-P 827.17(u);

(19) Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner; and

(20) Documentation of a patient’s refusal of any care or services.

(c) Patient records and information shall be kept confidential and only provided in accordance with all applicable federal and state law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

(e) When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use or access.

(f) A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of his or her patient record pursuant to the provisions of RSA 151:21.

(g) All personnel records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(h) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

(3) Systems to prevent tampering with information pertaining to patients and staff.

(i) Patient records shall be retained 7 years after discharge of a patient, and in the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

(j) The licensee shall arrange for storage of, and access to, patient records in the event the FMRTF ceases operation.

(k) Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

(l) If the facility uses an electronic record storage system, it shall provide computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 827 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.20 Infection Control

(a) The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The FMRTF shall appoint an individual who will oversee the development and implementation of the infection control program.

(c) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of universal precautions;

(3) The management of patients with infectious or communicable diseases or illnesses;

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Wm 2604;

(5) The reporting of infectious and communicable diseases required by He-P 301;

(6) Evaluating and revising the infection control program in accordance with current CDC recommended actions;

(7) Maintenance of a sanitary physical environment; and

(8) Infection control policies specific to each department.

(d) The infection control education program shall be completed by all new employees, all current employees, and all contracted employees on an annual basis and shall address, at a minimum, the:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(e) Personnel infected with a disease or illness transmissible through food, formites, or droplets shall not provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

(f) Personnel infected with scabies or lice shall not provide direct care to patients until such time as they are no longer infected as determined by a licensed practitioner.

(g) Pursuant to RSA 141-C:1, personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the FMRTF until a diagnosis of tuberculosis is excluded, or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(h) Personnel with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, fitted bandage.

(i) If the FMRTF has an incident of an infectious diseases reported in (c)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

(j) Each licensee caring for patients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A.

(k) If a licensee offers influenza or pneumococcal immunizations for patients or staff, the licensee shall document the administration of the immunization as applicable, and such report immunization data to the department’s immunization program.

(l) The FMRTF shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

(m) The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

(n) The licensee shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee, or patient has a communicable disease.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.21 Sanitation

(a) The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

(c) A supply of potable water shall be available for human consumption.

(d) A supply of hot and cold running water shall be available at all times, and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

(e) All patient toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(f) Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from medications and program supplies.

(g) Toxic materials shall not be used in a way that contaminates equipment or in any way other than in full compliance with the manufacturer’s labeling.

(h) Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, for rodent or cockroach control.

(i) Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, and outdoor animals.

(j) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(k) Bathrooms shall have non-porous floors.

(l) Sterile or clean supplies shall be stored in dust and moisture-free storage areas or containers.

(m) If equipment or supplies need to be sterilized in order to prevent contamination, the FMRTF shall develop and maintain written procedures for cleaning, packaging, and sterilization that includes:

(1) Testing and documenting sterilization processes used;

(2) Testing and documenting the effectiveness of sterilization equipment for adequate sterilization in accordance with the manufacturer’s recommendations or using industry acceptable quality control standards;

(3) Documentation when supplies are outdated; and

(4) Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

(n) Any FMRTF that has its own water supply and whose water has been tested and failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.22 Quality Improvement

(a) The FMRTF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

(b) The FMRTF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(c) The quality improvement committee shall:

(1) Determine the information to be monitored;

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the FMRTF;

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective action as applicable;

(8) Meet at least quarterly;

(9) Generate dated, written minutes after each meeting; and

(10) Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

(d) Mandatory monitoring of radiological safety practice standards according to He-P 4000 shall be part of the quality improvement program.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.23 Physical Environment

(a) The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

(b) The FMRTF shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to:

a. Repairing holes and caulking of pipe channels; and

b. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within an FMRTF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

(1) Maintain a temperature of at least 70 degrees fahrenheit during the day if patients are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (c)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following conditions are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any FMRTF.

(g) Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

(h) Ventilation shall be provided in all enclosed areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(i) All hand-washing facilities shall be provided with hot and cold running water.

(j) In accordance with RSA 155:66, I(b), smoking shall be prohibited in the FMRTF.

(k) Each FMRTF shall have a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels or a hand-drying device providing heated air, and hot and cold running water.

(l) Notwithstanding (k) above, if the FMRTF is located within a multi-use business or facility that has a public bathroom with a toilet and the bathroom complies with all applicable sanitation and construction regulations, the facility shall not be required to have its own bathroom but shall have its own hand washing sink with hot and cold running water, soap dispenser, and paper towels or a hand-drying device providing heated air.

(m) There shall be sufficient space and equipment for the services provided at the FMRT facility.

(n) All exam tables shall be changed with clean linens or common paper between use by different patients.

(o) The licensee shall provide patients with continuous access to a device or means that will signal FMRTF personnel when they are in need of assistance.

(p) All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(q) If available, all showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

(r) All mattresses and new upholstered furniture or draperies shall comply with the applicable portions of Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

(s) A privacy partition, curtain, or screen shall be required between patient care areas.

(t) The FMRTF facility shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

(u) The FMRTF facility shall be clean, sanitary, maintained in a safe manner and good repair, and kept free of hazards.

(v) The FMRTF facility shall provide the following:

(1) Reception and waiting areas that include a reception desk or counter, chairs, tables, and lighting adequate to read materials and complete forms as required;

(2) Public access to toilet facilities with non-porous floors;

(3) A number of examination and treatment rooms adequate to provide services to the average number of patients seen daily; and

(4) Hot water available at all times from taps available to patients and not less than 105 degrees Fahrenheit or more than 120 degrees Fahrenheit.

(w) Medical waste shall be disposed of in accordance with the requirements of Env-Sw 904.

(x) Except as described in (b) above, the FMRTF facility shall comply with all federal, state and, local health, building, fire, and zoning laws, rules, and ordinances.

(y) The water used in the FMRTF facility shall be suitable for human consumption, pursuant to Env-Ws 315 and Env-Ws 316.

(z) The licensee shall comply with all state and local codes and ordinances for:

(1) Zoning;

(2) Building;

(3) Health;

(4) Fire;

(5) Waste disposal; and

(6) Water.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.24 Fire Safety

(a) All FMRTF shall have:

(1) Smoke detectors on every level that are interconnected and either hardwired, powered by the FMRTF’s electrical service, or wireless, as approved by the state fire marshal.

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A- 10BC, installed on every level of the building, and which meets the following requirements:

a. Maximum travel distance to each extinguisher shall not exceed 50 feet;

b. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

c. Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

d. Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(b) A fire safety program shall be developed and implemented to provide for the safety of patients and personnel.

(c) Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

(1) A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

(2) Emergency EMS transport related to pre-existing conditions.

(d) The written notification required by (c) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(e) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

(f) Fire drills shall be conducted as follows:

(1) For buildings constructed to the health care occupancy chapter of the life safety code and to the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the health care occupancy chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

e. Facilities shall complete a written record of fire drills and include the following:

1. The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including patients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

(2) The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

(g) For the use and storage of oxygen and other related gases, a FMRTF shall comply with NFPA 99 as adopted by the commissioner of the department of safety under Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

(1) All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

(2) Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

(3) Oxidizing gases, such as oxygen and nitrous oxide, shall:

a. Not be stored with any flammable gas, liquid, or vapor;

b. Be separated from combustibles or incompatible materials by:

1. A minimum distance of 20 ft. (6.1 m);

2. A minimum distance of 5 ft. (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour; and

c. Shall be secured in an upright position, such as with racks or chains;

(4) A precautionary sign, readable from a distance of 5 ft. (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

(5) Precautionary signs, readable from a distance of 5 ft. (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

N.H. Code Admin. R. Ann. He-P 827.25 Emergency Preparedness

(a) Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

(b) The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

(c) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan, as described in (d) and (e) below;

(2) The roles and responsibilities of the committee members; and

(3) How the plan is implemented, exercised, and maintained;

(d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(e) The plan in (d) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, bomb threat;

(2) Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

(12) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. HVAC;

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

(14) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(15) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(16) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s

specific duties and responsibilities; and

(17) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

History

• (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

Part He-P 830 Psychiatric Residential Treatment Programs

N.H. Code Admin. R. Ann. He-P 830.01 Purpose

The purpose of this part is to set forth the classification of and licensing requirements for psychiatric treatment residential programs pursuant to RSA 151:2, I(e)(2), and as described in RSA 151:9, VII(a)(4). Psychiatric treatment programs are designed and structured to provide intensive short term, intermediate, and long-term mental health services to persons who have psychiatric disorders or are in an acute phase of their mental illness.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.02 Scope

This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a psychiatric residential treatment program, except:

(a) All facilities listed in RSA 151:2, II(a)-(i); and

(b) All entities that are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.03 Definitions

(a) “Abuse” means any one of the following:

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving clients without his or her informed consent.

(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and medication management.

(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) “Administration of medication” means the provision of one or more doses of medication to clients by licensed nurses or other personnel qualified by law or rule to administer medication.

(f) “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.

(g) “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(h) “Admission agreement” means the document signed by the client and the facility administrator detailing what both the client and the facility agree to do.

(i) “Adult” means persons 18 years or older.

(j) “Advance directive(s)” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

(k) “Adverse reaction” means a physical or mental negative change after taking medication.

(l) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

(m) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA-J:34-37.

(n) “Ambulatory” means an individual who is able to walk about and is not bedridden.

(o) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a psychiatric residential treatment program (PRTP) pursuant to RSA 151.

(p) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a license to be out of compliance with RSA 151, He-P 830, or other federal or state requirements.

(q) “Assessment” means an evaluation of the client to determine the care and services that are needed.

(r) “Change of ownership” means change in the controlling interest of an established PRTP to an individual or successor business entity.

(s) “Chemical restraint” means any medication prescribed to control a client’s behavior or emotional state without a supporting diagnosis or for the convenience of program personnel.

(t) “Child” means “child” as defined in RSA 170-E:25, I.

(u) “Client” means any person admitted to or in any way receiving care, services or both from an PRTP licensed in accordance with RSA 151 and He-P 830.

(v) “Client record” means documents maintained for each client, which includes all documentation required by RSA 151 and He-P 830, and all documentation compiled relative to the client as required by other federal or state laws.

(w) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(x) “Contracted employee” means a temporary employee working under the direct supervision of the PRTF but employed by an outside agency.

(y) “Core services” means those services provided by the licensee that are included in the basic rate.

(z) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(aa) “Days” means calendar days, unless otherwise specified.

(ab) “Department” means the New Hampshire department of health and human services.

(ac) “Direct care” means the provision of services to a patient that require some degree of interaction between the patient and the health care provider including but not limited to assessment, performing procedures, teaching, and implementation of a treatment plan.

(ad) “Direct care personnel” means any person providing direct care to a client.

(ae) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(af) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).

(ag) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

(ah) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(ai) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

(aj) “Employee” means anyone employed by the PRTP and for whom the facility has direct supervisory authority.

(ak) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 830.

(al) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services”, not to include portable refrigerators. This term includes fixtures.

(am) “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

(an) “Facility” means “facility” as defined in RSA 151:19, II.

(ao) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and personal needs.

(ap) “Health care occupancy” means an occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupant's control.

(aq) “Impaired” means when a physician or health care worker whose ability to function in his or her usual role has been reduced or otherwise compromised by any substances including but not limited to legally prescribed medications or alcohol.

(ar) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(as) “Infection Control Risk Assessment (ICRA)” means a determination of the potential risk of transmission of various infectious agents in the facility. A classification of those risks, and a list of required practices for mitigating those risks during construction or renovation.

(at) “Infectious waste” means those items specified by Env-Sw 103.28.

(au) “Informed consent” means the decision by a client, his or her guardian or agent, or surrogate decision maker to agree to a proposed course of treatment, after the client, guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(av) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(aw) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 830 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 830.

(ax) “Involuntary admission” means an order of involuntary commitment made pursuant to RSA l35-C:34-54 by a probate court.

(ay) “Involuntary emergency admission” means an order of emergency involuntary admission made pursuant to RSA 135-C:27-33.

(az) “License” means the document issued by the department to an applicant at the start of operation as a PRTP which authorizes operation as a PRTP in accordance with RSA 151 and He-P 830, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and the license number.

(ba) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the PRTP is licensed for.

(bb) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(bc) “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(bd) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

(be) “Licensing classification” means the specific category of services authorized by a license.

(bf) “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(bg) “Mechanical restraint” means locked or secured PRTPs or units within a PRTP, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the PRTP or unit within.

(bh) “Medical director” means a psychiatrist licensed in New Hampshire pursuant to RSA 329 who is responsible for the implementation of client care policies and the coordination of medical care in the facility.

(bi) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

(bj) “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “a substantial impairment of emotional processes, or of the ability to exercise conscious control of one’s actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by:

(1) Epilepsy;

(2) Intellectual disability;

(3) Continue or non-continuous periods of intoxication caused by substances such as alcohol or drugs; or

(4) Dependence upon or addiction to any substance such as alcohol or drugs”.

(bk) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(bl) “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health and safety of any client.

(bm) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bn) “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

(bo) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bp) “Over-the-counter medications” means non-prescription medications.

(bq) “Owner” means a person or organization who has controlling interest in the PRTP.

(br) “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21.

(bs) “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions.

(bt) “Personal representative” means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in writing by a client or client’s legal guardian for a specific limited purpose or for the general purpose of assisting the client in the exercise of any rights as defined by RSA 151:19, V.

(bu) “Personnel” means individual(s) employed by the facility, volunteer(s), or independent contractor(s), who provide direct care or services to a client.

(bv) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the client’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.

(bw) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bx) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand-held instruments at or near the site of client care.

(by) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

(bz) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.

(ca) “Protective care” means the provision of client monitoring services, including but not limited to:

(1) Knowledge of client whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(cb) “Psychiatric residential treatment program (PRTP)” means a non-hospital-based program which provides 24 hour, intensive short term, intermediate and long term psychiatric treatment and care to persons who have psychiatric symptoms and disorders or are in an acute phase of their mental illness. This definition includes the term “psychiatric residential treatment facility (PRTF)”.

(cc) “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(cd) “Qualified personnel” means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(ce) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cf) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(cg) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(ch) “Reportable incident” means an occurrence of any of the following while the client is either in the PRTF or in the care of the PRTF personnel:

(1) The unanticipated death of the client;

(2) An injury to a client, that is indicative of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or

(3) The unexplained absence of a client from the PRTF who is determined to be a danger to themselves or others.

(ci) “Self-evacuate” means the client can initiate and complete movement from any location in the facility to an exit with or without staff assistance.

(cj) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

(ck) “Short term” means that a client is expected to remain in the facility less than 14 days.

(cl) “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability or limitations of the client.

(cm) “Stock medications” means medications, to be determined by the medical director, that are kept onsite for use by clients and to be administered as ordered by the medical director or the clients' licensed provider.

(cn) “Surrogate decision-maker” means a health care proxy or an agent, who is an advocate for incompetent patients.

(co) “Supervision” means the process by which the client is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

(cp) “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease or clinical conditions.

(cq) “Treatment plan” means a documented guide developed, as a result of the assessment process, for the provision of care and services to a client.

(cr) “Unexplained absence” means an incident involving a client leaving the premises of the PRTP without the knowledge of the PRTP personnel.

(cs) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.04 Initial License Application Requirements

(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

(1) A completed application form entitled “Application for Residential or Health Care License” (April 2021), signed by the applicant or 2 of the corporate officers, affirming to the following:

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

b. For any new PRTP to be newly licensed:

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

c. For any PRTP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

(2) A floor plan of the prospective PRTP;

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

a. “Certificate of Authority,” if a corporation;

b. “Certificate of Formation,” if a limited liability corporation; or

c. “Certificate of Trade Name,” where applicable;

(4) The applicable fee in accordance with RSA 151:5, V, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

(5) A resume identifying the name, qualifications, and copies of applicable licenses for the PRTP administrator;

(6) Written local approvals as follows:

a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

4. The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the appropriate occupancy chapter of the life safety code 101 and the uniform fire code, NFPA 1, as published by the national fire protection association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5; and

b. For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

(7) If the PRTP uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply is used, a copy of a water bill; and

(8) The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant and the administrator for which the application is submitted.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.05 Processing of Applications and Issuance of Licenses

(a) An application for an initial license shall be complete when the department determines that all items required by He-P 830.04(a) have been received.

(b) If an application does not contain all of the items required by He-P 830.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

(c) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(d) Licensing fees shall not be transferable to any other application(s).

(e) Unless a waiver has been granted pursuant to He-P 830.10, the department shall deny a licensing request in accordance with He-P 830.13(b) if, it determines that the applicant, administrator, or proposed licensee:

(1) Has been convicted of a felony in this or any other state;

(2) Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of residents.

(f) Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 830.

(g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

(h) A written notification of denial, pursuant to He-P 830.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 830.

(i) A written notification of denial, pursuant to He-P 830.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

(j) A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 830.09(b) that the prospective premises are not in full compliance with RSA 151 and He-P 830.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.06 License Expirations and Procedures for Renewals

(a) A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

(b) Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 830.04(a)(1) at least 120 days prior to the expiration of the current license to include:

(1) The current license number;

(2) A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 830.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

(3) A list of current employees who have a permanent waiver granted in accordance with He-P 830.18(f); and

(4) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

(c) In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

(d) Following an inspection, as described in He-P 830.09, a license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

(2) Is found to be in compliance with RSA 151, He-P 830, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

(e) Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 830.04 and shall be subject to a fine in accordance with He-P 830.13.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.07 PRTP Construction, Modifications or Structural Alterations

(a) For new construction or rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, and ICRA results shall be submitted to the department at least 60 days prior to the start of such work.

(b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

(c) Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

(d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

(e) The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 830 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

(f) The PRTP shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

(g) A licensee or applicant undertaking constructing or rehabilitation of a building shall comply with the following:

(1) Saf-C 6000 and the state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300, as follows:

a. NFPA 101, Life Safety Code Residential Board and Care Occupancy Chapter; or

b. NFPA 101, Life Safety Code Health Care Occupancy Chapter; and

(2) The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

(h) All PRTPs newly constructed or renovated after the 2021 effective date of these rules shall follow the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A, and including the ANSI/ASHREA/ASHE Standard “Ventilation of Health Care Facilities” (170-2017) as incorporated in the referenced in the FGI guidelines.

(i) Where rehabilitation is done within an existing facility, all such work shall comply with the FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A.

(j) The department shall be the authority having jurisdiction for the requirements in He-P 830.07(h) and (i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 830.10 as appropriate.

(k) Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

(l) Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

(m) Exceptions or variances pertaining to the state fire code referenced in He-P 830.07(g)(1) above shall be granted only by the state fire marshal.

(n) The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 830.09 prior to its use.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.08 PRTP Requirements for Organizational Changes

(a) The PRTP shall provide the department with written notice at least 30 days prior to changes in any of the following:

(1) Ownership;

(2) Physical location;

(3) Address;

(4) Name;

(5) Bed increase; or

(6) Services.

(b) The PRTP shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

(1) A change in ownership;

(2) A change in the physical location;

(3) An increase in the number of clients beyond what is authorized under the current license; or

(4) A change in services, including a change in level of client safety, security, and environment.

(c) When there is a change in address without a change in location the PRTP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

(d) When there is a change in the name, the PRTP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

(e) An inspection by the department shall be conducted prior to operation for changes in the following:

(1) Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

(2) The physical location;

(3) A change in licensing classification;

(4) A change that places the facility under a different life safety code occupancy chapter;

(5) An increase in the number of clients beyond what is authorized under the current license; or

(6) A change in services.

(f) A new license and license certificate shall be issued for a change in ownership, classification, or a change in physical location.

(g) A revised license and license certificate shall be issued for changes in the PRTF’s name.

(h) A revised license certificate shall be issued for any of the following:

(1) A change of administrator;

(2) A change in address without a change in physical location;

(3) When a waiver has been granted in accordance with He-P 830.10; or

(4) An increase in the number of clients;

(i) The PRTP shall inform the department in writing when there is a change in administrator no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change, and provide the department with the following:

(1) A resume identifying the name and qualifications of the new administrator;

(2) The results of a NH criminal background check conducted pursuant to He-P 830.18(d)(1);

(3) Copies of applicable licenses for the new administrator; and

(4) A copy of the criminal attestation as described in He-P 830.18(t).

(j) Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 830.16(a) and He-P 830.18(i).

(k) If the department determines that the new administrator does not meet the qualifications, it shall so notify the PRTP in writing so that a waiver can be sought or the program can search for a qualified candidate.

(l) The PRTP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the licensee in the event of an emergency.

(m) A restructuring of an established PRTP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

(n) When there is to be a change in the services provided, the PRTP shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

(o) The department shall review the information submitted under (n) above and determine if the added services can be provided under the PRTP’s current license including physical plan restrictions.

(p) If a licensee chooses to cease operation of an PRTP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting that is consistent with the clinical needs of the resident based on assessment including but not limited to another PRTP, a higher level of care facility, a lower level of care facility, or a home.

(q) The licensee shall arrange for storage of, and access to, client records in the event the PRTP ceases operation.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.09 Inspections

(a) For the purpose of determining compliance with RSA 151 and He-P 830, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

(1) The proposed or licensed premises;

(2) All programs and services provided by the PRTP; and

(3) Any records required by RSA 151 and He-P 830.

(b) The department shall conduct a clinical and life safety code inspection, as necessary to determine full compliance with RSA 151 and He-P 830 prior to:

(1) The issuance of an initial license;

(2) A change in ownership, except as allowed by He-P 830.08(e)(1);

(3) A change in the licensee’s physical location;

(4) A change in licensing classification;

(5) An increase in the number of clients beyond what was authorized under the initial license;

(6) Occupation of a space after construction, renovations or structural alterations; or

(7) The renewal of a license.

(c) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the PRTP is in violation of any of the provisions of He-P 830, RSA 151, or other federal or state requirement.

(d) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 830.12(c), within 21 days of the date on the letter that transmits the inspection report.

(e) In addition to (b) above, the department shall verify the implementation of any POC accepted or issued by the department.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.10 Waivers

(a) Applicants or licensees seeking waivers of specific rules in He-P 830 shall submit a written request for a waiver to the commissioner that includes:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

(b) A waiver shall be permanent unless the department specifically places a time limit on the waiver.

(c) A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the clients; and

(3) Does not negatively affect the quality of client services.

(d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(e) Waivers shall not be transferable.

(f) When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.11 Complaints

(a) The department shall investigate any complaint that meets the following conditions:

(1) The alleged violation(s) of RSA 151 or He-P 830 occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); and

(3) There is sufficient specific information for the department to determine that the allegations(s), if proven true, would constitute a violation of any of the provisions of RSA 151 or He-P 830.

(b) The complaint shall be in writing and contain the following information:

(1) The name and address, if known of the PRTP, or the alleged unlicensed individual or entity;

(2) The name, address, and telephone number of the complainant; and

(3) A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 830.

(c) Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, which include:

(1) Requests for additional information from the complainant or the facility;

(2) A physical inspection of the premises;

(3) Review of any relevant records; and

(4) Interviews with individuals who might have information that is relevant to the investigation.

(d) For a licensed PRTP, the department shall:

(1) Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

(2) Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

(3) If the department determines the complaint is unfounded, and does not violate their statutes, rules, or regulations the licensee will be notified in writing of such determination and the department will take no further action; and

(4) If areas of non-compliance are found, require the licensee to submit a POC in accordance with He-P 830.12(c).

(e) The following shall apply for the unlicensed individual or entity:

(1) The department shall provide written notification to the owner or person responsible that includes:

a. The date of investigation;

b. The reasons for the investigation; and

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

(2) In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by He-P 830.11(e)(1) to submit a completed application for a license;

(3) If the owner of an unlicensed PRTP does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 830; and

(4) Any person or entity who fails to comply after receiving a warning as described in (3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 830.13(c)(6).

(f) Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

(1) To the department of justice when relevant to a specific investigation;

(2) To law enforcement when relevant to a specific criminal investigation;

(3) When a court of competent jurisdiction orders the department to release such information; or

(4) In connection with any adjudicative proceedings relative to the licensee.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.12 Administrative Remedies

(a) The department shall, after notice and opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 830, or other applicable licensing rules, including:

(1) Requiring a licensee to submit a POC in accordance with (c) below;

(2) Imposing a directed POC upon a licensee in accordance with (d) below;

(3) Imposing conditions upon a licensee;

(4) Monitoring of a license;

(5) Immediate suspension of a license; or

(6) Revocation of a license.

(b) When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

(1) Identifies each area of non-compliance with RSA 151 or a provision of these rules; and

(2) Identifies the specific remedy(s) that has been proposed.

(c) A POC shall be developed and enforced in the following manner:

(1) Upon receipt of a statement of findings or notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

a. How the licensee intends to correct each area of non-compliance;

b. What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

c. The date by which each area of non-compliance shall be corrected; and

d. The position of the employee responsible for the corrective action;

(2) The licensee shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

a. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

b. The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the extension;

(3) The department shall review and accept each POC that:

a. Achieves compliance with RSA 151 and He-P 830;

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

c. Prevents a new violation of RSA 151 or He-P 830 as a result of the implementation of the POC; and

d. Specifies the date upon which the deficiencies will be corrected;

(4) If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

(5) If the POC is not acceptable:

a. The department shall notify the licensee in writing of the reason for rejecting the POC;

b. The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

1. The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

2. The department determines that the health, safety or well-being of a client will not be jeopardized as a result of granting the waiver;

c. The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

d. If the revised POC is not acceptable to the department, or is not submitted within 14days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 830.13(c)(12);

(6) The department shall verify the implementation of any POC that has been submitted and accepted by:

a. Reviewing materials submitted by the licensee;

b. Conducting a follow-up inspection; or

c. Reviewing compliance during the next annual inspection;

(7) Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

(8) If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

a. Notified by the department in accordance with (b) above; and

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 830.13(c)(12).

(d) The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

(2) A revised POC is not submitted within 14 days of the written notification from the department; or

(3) A revised POC submitted by the licensee or administrator has not been accepted.

(e) If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

(1) Issue a warning that enforcement action will be taken if the POC is not implemented;

(2) Impose a fine according to He-P 830.13(c)(13);

(3) Deny the application for a renewal of a license in accordance with He-P 830.13(b)(6); or

(4) Revoke or suspend the license in accordance with He-P 830.13(b).

(f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings if the applicant or licensee submits a written request for an informal dispute resolution to the department.

(g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department and shall include any evidence that has not yet been reviewed by the department.

(h) Upon receipt of the requested informal dispute resolution made by the applicant, licensee, or administrator, the department shall review the evidence presented and, if requested within the informal dispute resolution request, meet with the applicant, licensee, or administrator, in person or via telephone.

(i) The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect.

(j) The statement of findings or notice to correct shall not be changed, if based on the evidence presented, the statement of findings is determined to be correct.

(k) The department shall provide a written notice to the applicant or licensee notifying the applicant, licensee, or administrator of such determination.

(l) The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

(m) Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

(n) An informal dispute resolution shall not be available for any applicant or licensee against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a license.

(o) The department shall impose state monitoring under the following conditions:

(1) Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of clients; or

(2) The presence of conditions in the PRTF that negatively impact the health, safety, or well-being of clients.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.13 Enforcement Actions and Hearings

(a) Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The reasons for the proposed action;

(2) The action to be taken by the department;

(3) If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

(4) The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

(b) The department shall deny an application or revoke a license if:

(1) An applicant or a licensee has violated provisions of RSA 151 or He-P 830, which poses a risk of harm a client’s health, safety, or well-being;

(2) An applicant or a licensee has failed to pay a fine imposed under administrative remedies;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 830.04;

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department;

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 830.12(d) and (e);

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 830.12(c)(5) and has not submitted a revised POC as required by He-P 830.12(c)(5);

(8) The licensee is cited a third time under RSA 151 or He-P 830 for the same violations within the last 5 inspections;

(9) A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

(10) Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 830;

(11) Unless a waiver has been granted the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

(12) The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

(c) The department shall impose fines as follows:

(1) For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

(2) For a failure to cease operations after a denial of a license and after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

(3) For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

(4) For a failure to transfer a client whose needs exceeds the services or programs provided by the PRTP, in violation of RSA 151:5-a, the fine shall be $500.00;

(5) For admission of a client whose needs at the time of registration exceed the services or programs authorized by the PRTP, in violation of RSA 151:5-a, II and He-P 830.15(b), the fine for a licensee shall be $1000.00;

(6) For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 830.11(e)(4), the fine for an unlicensed provider or licensee shall be $500.00;

(7) For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 830.06(e), the fine shall be $100.00;

(8) For a failure to notify the department prior to a change of ownership, in violation of He-P 830.08(a)(1), the fine shall be $500.00;

(9) For a failure to notify the department prior to a change in the physical location, in violation of He-P 830.08(a)(2), the fine shall be $1000.00;

(10) For a failure to notify the department of a change in e-mail address, in violation of He-P 830.08(l), the fine shall be $100.00;

(11) For a refusal to allow access by the department to the PRTP’s premises, programs, services or records, in violation of He-P 830.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

(12) For a failure to submit a POC or revised POC, within 21 or 14-days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 830.12(c)(2) and (5), the fine for a licensee shall be $500.00;

(13) For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 830.12(c)(8), the fine for a licensee shall be $1000.00;

(14) For a failure to establish, implement, or comply with licensee policies, as required by He-P 830.14(a), (d), and (e), the fine for a licensee shall be $500.00;

(15) For a failure to provide services or programs required by the licensing classification and specified by He-P 830.14(c), the fine for a licensee shall be $500.00;

(16) For providing false or misleading information or documentation, in violation of He-P 830.14(h), the fine shall be $1000.00 per offense;

(17) For failure to meet the needs of a client or clients, as described in He-P 830.18(a) and He-P 830.24(i), the fine for a licensee shall be $1000 per client;

(18) For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 830.09(b)(5), the fine for a licensee shall be $500;

(19) For employing an administrator, or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 830.10, in violation of He-P 80.16(a), the fine for a licensee shall be $500.00;

(20) For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 830.07(a), the fine for a licensed facility shall be $500.00;

(21) For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 830.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

(22) When an inspection determines that there is a violation of RSA 151 or He-P 830 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

b. If the same area of non-compliance is cited a third time within 2 years of being fined in (a) above, the fine for a licensee shall be $2000.00;

(23) For refusal to cooperate with the inspection or investigation conducted by the department the fine shall be $ 2000.00;

(24) For failure to report an unusual incident as required by He-P 830.14(w), the fine for a licensee shall be $500.00 per occurrence or;

(25) Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 830 shall constitute a separate violation and shall be fined in accordance with He-P 830.13(c), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 830, as verified by documentation or other means, the department shall not issue a daily fine.

(d) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

(2) Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

(e) An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

(f) If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

(g) The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of clients when it finds that the health, safety or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(h) If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 830 is achieved.

(i) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(j) When a PRTP’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the enforcement action pertained to their role in the PRTP.

(k) The 5-year period referenced in (j) above shall begin on:

(1) The date of the department’s decision to revoke or deny the license, if appeal is filed; or

(2) The date a final decision upholding the action of the department, if a request for a hearing is made and a hearing is held.

(l) Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 830.

(m) If the department has credible information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

(n) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 830.

(o) Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.14 Duties and Responsibilities of the Licensee

(a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes and ordinances as applicable.

(b) The licensee shall have written policies and procedures setting forth:

(1) The rights and responsibilities of clients in accordance with the patients’ bill of rights;

(2) The policies described in He-P 830.14, He-P 830.16, He-P 830.19, and He-P 830.26; and

(3) A policy that ensures the safety of all persons present on the licensed premises where

firearms are permitted.

(c) The licensee shall admit only those clients whose needs can be met by the PRTP.

(d) The licensee shall define, in writing, the scope and type of services to be provided by the PRTP.

(e) The licensee shall comply with the Patients’ Bill of Rights as set forth in RSA 151:19-30.

(f) The licensee shall develop and implement written policies and procedures governing the operation of the PRTP and all services provided by the facility and for:

(1) Reviewing the policies and procedures every 3 years; and

(2) Revising them as needed.

(g) The licensee shall assess and monitor the quality of care and service provided to clients on an ongoing basis.

(h) The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

(i) The licensee shall not:

(1) Advertise or otherwise represent itself as operating a PRTF, unless it is licensed; or

(2) Advertise that it provides services that it is not authorized to provide.

(j) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

(k) The licensee shall provide the following core services:

(1) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided regarding:

a. The clients’ functioning, safety, and whereabouts;

b. The clients’ health status, including the provision of intervention as necessary or required; and

c. Personnel safety;

(2) Emergency response and crisis intervention;

(3) Medication services in accordance with He-P 830.17;

(4) Food services in accordance with He-P 830.20;

(5) Housekeeping, laundry, and maintenance services;

(6) On-site activities designed to sustain and promote physical, intellectual, social, and spiritual well-being of all clients;

(7) Assistance in arranging medical and dental appointments, including assistance in arranging transportation to and from such appointments and reminding the clients of the appointments; and

(8) Personal supervision of clients when necessary to prevent unreasonable risks to the safety of self or others if the client is not supervised.

(l) The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(4):

(1) Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

(2) Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

(3) Behavioral health care services.

(m) Licensees shall:

(1) Appoint an administrator;

(2) Establish, in writing, a chain of command that sets forth the line of authority for the operation of the PRTP;

(3) Verify the qualifications of all personnel;

(4) Provide sufficient numbers of qualified personnel to meet the needs of adult clients;

(5) Maintain a minimum staff-to-client ratio of one staff person to 6 clients during awake hours and one staff person to 12 clients during sleeping hours, for children or youth clients;

(6) Provide additional staff when a client’s treatment plan requires a more stringent staff to client ratio than required above;

(7) Provide sufficient supplies, equipment, and lighting to meet the needs of the clients;

(8) Require all personnel to follow the orders of the licensed practitioner for every client that has such orders and encourage the client to follow the licensed practitioner’s orders;

(9) Initiate action to maintain the PRTP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, accreditations, and ordinances; and

(10) Implement any POC that has been accepted by the department.

(n) The licensee shall educate personnel about the needs and services required by the clients under their care.

(o) Physical or chemical restraints shall only be used as allowed by RSA 151:21, IX.

(p) The licensee shall consider all clients competent and capable of making health care decisions unless the client:

(1) Has a guardian appointed by a court;

(2) Has a durable power of attorney for health care or surrogate decision making that has been activated; or

(3) Is an un-emancipated minor.

(q) In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

(1) Telephone at 603-271-4496;

(2) Telephone at 603-271-5300 after business hours; or

(3) Fax to 603-271-0545.

(r) If the licensee registers and treats a client who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall:

(1) Follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A; and

(2) Have an Airborne Infection Isolation (AII) Room, compliant with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A.

(s) Immediately after the use of a physical or chemical restraint, the client’s guardian or agent, if any, and the department shall be notified of the use of restraints.

(t) The PRTP shall:

(1) Have policies and procedures on:

a. What type of emergency restraints may be used;

b. When restraints may be used; and

c. Who may authorize the use of restraints; and

(2) Provide personnel with education and training on the limitations and the correct use of restraints.

(u) The use of chemical, mechanical, or physical restraints, as defined by He-P 830.03(q), (aq), and (bb), respectively, shall only be permitted as allowed by RSA 151:21.

(v) For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property, the licensee shall have responsibility for:

(1) Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2) Faxing to 603 271-4968, or if a fax machine is not available, submitting via regular mail, postmarked within 24 hours of the incident, together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 24 hours of the reportable incident:

a. The PRTP name;

b. A description of the incident, including identification of injuries, if applicable;

c. The name of the licensee(s) or personnel involved in, witnessing or responding to the incident;

d. The name or identifying code for client(s) involved in or witnessing the incident;

e. The date and time of the incident;

f. The action taken in direct response to the incident;

g. If medical intervention was required, by whom and the date and time;

h. Whether the client’s guardian or agent, surrogate decision-maker, or personal representative, or emergency contact person was notified;

i. The signature of the person reporting the incident; and

j. The date and time the client’s licensed practitioner was notified, if applicable;

(3) Within 5 days, submitting a completed investigation report to the department containing the following information:

a. All items referenced in (1) above;

b. The names and results of interview(s) with all personnel, resident(s) or other individuals involved in the reportable incident, including all applicable statement signatures; and

c. The action taken by the licensee in direct response to the incident(s), including any and all follow-ups;

(4) Immediately notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client who has been assessed or is known as being a danger to self or others, has eloped after the licensee has searched the building and the grounds of the PRTP; and

(5) Submit additional information, if required to the department, to support the incident report referenced in (w)(3) above;

(w) The licensee shall:

(1) Provide basic supplies necessary for clients to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper; and

(2) Not be responsible for the cost of purchasing a specific brand of product at a client’s request.

(x) The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

(y) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

(1) The current license certificate issued in accordance with RSA 151:2;

(2) The most recent inspection report as specified in RSA 151:6-a; for the previous 12 months;

(3) A copy of the patients’ bill of rights specified by RSA 151:21;

(4) A copy of the licensee’s policies and procedures relative to the implementation of clients’ rights and responsibilities as required by RSA 151:20;

(5) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted in writing to the:

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street, Concord, NH 03301,

or by calling 1-800-852-3345; and

(6) The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

(z) The licensee shall give a client a written notice as follows:

(1) For an increase in the cost or fees for any PRTP services 30 days advanced notice; or

(2) For an involuntary change in room or bed location, 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

(aa) The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 830 as authorized by RSA 151:6 and RSA 151:6-a.

(ab) A licensee shall, upon request, provide a client or the client’s guardian, agent, or surrogate decision-maker if any, with a copy of his or her client record pursuant to the provisions of RSA 151:21, X.

(ac) All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

(ad) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

(3) Systems to prevent tampering with information pertaining to clients and staff.

(ae) The licensee shall develop policies and procedures regarding the release of information contained in client records.

(af) The licensed premises shall comply with all state and local:

(1) Health requirements;

(2) Building ordinances;

(3) Fire ordinances; and

(4) Zoning ordinances.

(ag) The licensee shall determine the smoking status of the PRTP.

(ah) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P

830.24(f).

(ai) The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other clients.

(aj) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

(ak) The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.15 Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria

(a) Except for emergency treatment or involuntary admissions ordered under RSA 135-C:27-54, all placements of clients in the programs and services of the PRTP shall be voluntary and shall require the documented consent of the client or guardian. Placements shall be made into those programs and services which least restrict the client's freedom of movement, ability to make decisions, and participation in his community while achieving the purposes of habilitation and treatment.

(b) The licensee shall only admit an individual or retain a client whose needs are compatible with the facility and the services and programs offered, whose needs can be met by the PRTP, and who are:

(1) Mobile and can self-evacuate. However, reasonable accommodation shall be made when possible to admit clients who have mobility impairment, provided that evacuation assistance needs can be met;

(2) A voluntary admission in accordance with He-M 405;

(3) A voluntary admission by guardian;

(4) An involuntary emergency admission (IEA) pursuant to RSA 135-C:27–33 beginning with initial custody and continuing through the day of the probable cause hearing;

(5) An IEA pursuant to RSA 135-C:27–33 for the period of such admission following the probable cause hearing; or

(6) Non-emergency involuntary admissions (IA) pursuant to RSA 135-C:34–54.

(c) At the time of admission, the licensee shall provide a written copy to the client and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions contract including the following information:

a. The basic daily or weekly fee;

b. A list of the core services required by He-P 830.14(c) that are covered by the basic fee;

c. The APRTP’s house rules;

d. The APRTP’s responsibility for client discharge planning;

e. The licensee’s policies and procedures regarding:

1. Arranging for the provision of transportation;

2. Handling of client funds pursuant to RSA 151:24 and He-P 830.14(p);

3. Storage and loss of the client’s personal property; and

4. Smoking; and

f. The licensee’s medication management services;

(2) A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the APRTP’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) The APRTP’s policy and procedure for handling reports of abuse, neglect or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169-C:29;

(4) Information on advanced directives;

(5) Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid or both; and

(6) A copy of the facility’s policy on restraint usage.

(d) A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

(e) The client shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

(1) The client’s medical or other needs exceed the services offered by the licensee;

(2) The client cannot be safely evacuated in accordance with RSA 153:1, VI-a, except as modified in Saf-FMO 300;

(3) For lack of payment for care rendered; or

(4) For documented non-compliance with the facility’s rules included in the admission agreement provided said rules are not in conflict with RSA 151:21, V.

(f) The licensee shall develop a discharge plan with the input from the client, guardian, agent, or surrogate decision maker, if any.

(g) The following documents shall accompany the client upon transfer:

(1) The most recent client assessment tool, treatment plan, and quarterly progress notes;

(2) The most recent nursing assessment, if applicable;

(3) The most recent multi-disciplinary treatment plan, if applicable;

(4) Current medication records; and

(5) A licensed practitioner’s order for transfer, if applicable.

(h) If the transfer or discharge referenced in (c) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

(i) Notwithstanding (b) and (c) above, a client receiving hospice care from a licensed home health hospice caregiver may remain in the PRTP upon written agreement with the client or his or her legal guardian and the PRTP.

History

• #6154, eff 12-29-95, EXPIRED: 12-29-03
• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.16 Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the PRTP;

(2) Meets the requirements of He-P 830.18(j);

(3) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(4) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (2) above.

(b) Upon admission or within 24 hours following admission, the APRTP shall perform a comprehensive intake assessment of each client’s needs and develop a preliminary treatment plan.

(c) The comprehensive intake assessment required by (b) above shall include, at a minimum, the following:

(1) A mental health status examination and medication review;

(2) An initial diagnostic impression;

(3) Safety risk assessment and presence or absence of communicable disease;

(4) A functional assessment of those specific skills and behaviors required for the client to be in a less restrictive setting;

(5) A statement by the treating licensed practitioner that the PRTP represents the appropriate level of treatment for the client;

(6) Serve as a basis for treatment plan;

(7) Historical and current information and assessments; and

(8) Medical, psychiatric, and social information containing the following:

a. For medical information:

1. A statement of the individual’s general physical health status;

2. Medical history, including current weight, height, blood pressure, pulse, and smoking status;

3. When applicable, medical diagnosis, and the results or any medical or neurological screenings, examinations, or tests; and

4. The name and contact information for the individual’s primary care physician;

b. For psychiatric information:

1. History of mental illness or serious emotional disturbance, including onset and severity;

2. Previous services and treatments, including medications and hospitalizations;

3. Individual’s strengths;

4. Illness self-management skills;

5. Precipitating events for current psychiatric symptoms, as applicable;

6. Documentation of medical necessity for services;

7. Current diagnosis;

8. Medication orders;

9. Current medications; and

10. Results of formalized psychiatric or psychological tests, if applicable;

c. For social information:

1. Developmental history;

2. Educational history and current status, if applicable;

3. Family history and current family status;

4. History and current family status;

5. History of trauma, including domestic violence;

6. Results of a substance use screening tool;

7. Employment history including work skills and types, and lengths of employment;

8. Military history and veteran’s status, if applicable;

9. Current living situation including type of environment and nature of relationship with any room/house mates or family;

10. Social and leisure time activities and skills;

11. Ability to develop and maintain friendships;

12. Involvement with or history of involvement with other social service agencies or the criminal justice system;

13. Guardianship, if applicable; and

14. Other legal documents.

(d) The intake assessment and updates shall be signed and dated by the person completing the assessment.

(e) A treatment plan shall:

(1) Be completed within 24 hours of the comprehensive assessment in (c) above;

(2) Be updated following the completion of each future assessment;

(3) Be made available to personnel who assist clients in the implementation of the plan; and

(4) Address the needs identified by the comprehensive assessment.

(f) The licensee shall provide each client, or their agent, the opportunity to participate in the development of the treatment plan.

(g) The treatment plan required by (e) above, shall contain, at a minimum, the following:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The objectives, which shall be measurable, attainable, realistic, and timely;

(4) The interventions, which shall be specifically provided on behalf of the program to the clients;

(5) The client’s clinical needs, treatment goals, and objectives;

(6) The client’s strengths and resources for achieving goals and objectives as identified in (3) above;

(7) The strategy for providing services to meet those needs, goals, and objectives;

(8) The specification and description of the indicators to be used to assess the client’s progress;

(9) The date of re-evaluation, review, or resolution;

(10) Psychiatric evaluation, including mental status and alcohol/substance abuse evaluations, as determined necessary by the treating licensed practitioner;

(11) Individual and group therapeutic activity directed towards stabilization of psychiatric crises or extended care;

(12) Family education, consultation, and therapy, as clinically indicated; and

(13) For children or youth clients, the determination made by a licensed practitioner, that the child or youth client is eligible for PRTF level of care.

(h) The treatment plan shall be reviewed at least every 30 days or as medically indicated.

(i) For each client, progress notes shall be written daily and include at a minimum:

(1) Any treatment plan goals addressed;

(2) Changes in the client’s physical and mental status, as applicable;

(3) Changes in behavior, such as eating habits, sleeping pattern, and relationships; and

(4) Summary of protective care that has been provided.

(j) At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

(k) All personnel shall follow the orders of the licensed practitioner for each client and encourage clients to follow the practitioner’s orders.

(l) The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the PRTP.

(m) The health examination in (l) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies;

(7) Dietary needs;

(8) Pain assessment; and

(9) Safety risk assessment.

(n) Each client shall have at least one health examination every 12 months, unless the licensed practitioner determines that an annual physical examination is not necessary and specifies in writing an alternative time frame, or the client refuses in writing.

(o) A client may refuse all care and services.

(p) When a client refuses care or services that could result in a threat to their health, safety or well-being, or that of others, the licensee or their designee shall:

(1) Inform the client and guardian of the potential results of their refusal;

(2) Notify the licensed practitioner of the client’s refusal of care; and

(3) Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

(q) The licensee shall maintain an information data sheet in the client’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

(r) The information data sheet in (q) above shall include:

(1) Full name and the name the client prefers, if different;

(2) Name, address and telephone number of the client’s next of kin, guardian or agent, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives including DNR or DNAR orders, if applicable; and

(10) Any other pertinent information not specified in (1)-(9) above.

(s) Services shall be age and developmentally appropriate.

(t) PRTP’s shall offer psychotherapeutic services.

(u) Individual psychotherapy shall:

(1) Include therapy, crisis intervention, or assessment and monitoring necessary to determine the course and progress of therapy or to stabilize an individual experiencing an acute psychiatric episode; and

(2) Be verbal, with the therapist in direct, personal, involvement with the resident to the exclusion of other residents, individuals, and duties.

(v) Group psychotherapy, per person, shall include therapy or assessment and monitoring necessary to determine the course and progress of therapy that is performed in a direct, personal involvement with the resident in a setting with other residents or individuals.

(w) Group psychotherapy shall meet the following criteria:

(1) Limit clinical groups to no more than 8 individuals with one licensed counselor present and no more than 12 individuals when that licensed counselor is joined by a second licensed counselor;

(2) Sessions shall be scheduled often enough to provide effective treatment;

(3) The group focus shall be face to face dialogue of a verbal rather than performance nature; and

(4) Individual progress notes for each session shall be recorded in each recipient’s record with specific attention directed toward goal achievement as stated in the resident’s treatment plan.

(x) Family therapy shall be:

(1) The resident and their natural or surrogate family member(s); or

(2) The natural or surrogate family member(s) without the resident present.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.17 Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

(b) Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24 hours of the order or in accordance with the licensed practitioner’s direction.

(c) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for immediate use at the PRTP;

(2) Reorder medications for use at the PRTP; and

(3) Receive and record new medication orders.

(d) For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

(e) Each medication order shall legibly display the following information:

(1) The client’s name;

(2) The medication name, strength, prescribed dose, and route of administration, if different than by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the licensed practitioner.

(f) For PRN medications the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

(g) Each prescription medication shall legibly display the following information:

(1) The client’s name;

(2) The medication name, strength, the prescribed dose and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all pro re nata (PRN) medications;

(5) The date ordered;

(6) The name of the prescribing licensed practitioner; and

(7) The expiration date of the medication(s).

(h) Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee or their designee with the client’s name and shall be exempt from (g)(2)-(6) above.

(i) The label of all medication containers maintained in the PRTP shall match the current written orders of the licensed practitioner unless authorized by (l) below.

(j) Only a pharmacist shall make changes to prescription medication container labels.

(k) Any change or discontinuation of medications taken at the PRTP shall be pursuant to a written order from a licensed practitioner.

(l) When the licensed practitioner changes the dose of a medication and personnel of the PRTP are unable to obtain a new prescription label:

(1) The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the PRTP’s written procedure, indicating that there has been a change in the medication order;

(2) Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

(3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

(m) Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

(n) Over-the-counter medications shall be handled in the following manner:

(1) The licensee shall obtain written approval from the client’s licensed practitioner annually; and

(2) Over-the-counter medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

(o) The medication storage area shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each client's medication(s); and

(3) Equipped to maintain medication at the proper temperature.

(p) All medication at the PRTP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(q) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic and parenteral products shall not occur.

(r) Schedule II substances, as defined by RSA 318-B, shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(s) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(t) Except as required by (u) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becoming contaminated, whichever occurs first.

(u) Controlled drugs shall be destroyed only in accordance with state law and:

(1) Be accomplished in the presence of at least 2 people; and

(2) Be documented in the record of the client for whom the drug was prescribed.

(v) When a client is going to be absent from the PRTP at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering medications.

(w) If a client is going to be absent from the PRTP at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the PRTP.

(x) Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian or agent, if any.

(y) Except as described in (ab) below, medications shall only be administered by individuals authorized by law to administer medications in the PRTP.

(z) Medication administered by individuals authorized by law to administer medications shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified and administered by the same person in compliance with RSA 318-B and RSA 326-B.

(aa) Personnel shall remain with the client until the client has taken the medication.

(ab) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

(ac) Nursing assessment and evaluation for the purpose of reviewing medication compliance, educations, and symptomatology shall be completed.

(ad) Comprehensive medication assessment for those medications requiring specialized therapeutic monitoring shall:

(1) Ensure that the required blood sample is drawn;

(2) Ensure that the lab values are within established limits;

(3) Record results; and

(4) Ensure appropriate does is adjusted as needed.

(ae) A licensed nursing assistant (LNA) who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the PRTP:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

(3) Medicinal topical products to intact skin as ordered by the licensed practitioner.

(af) The licensee shall maintain a written record for each medication taken by the client at the PRTP that contains the following information:

(1) Any allergies or allergic reactions to medications;

(2) The medication name, strength, dose, frequency, and route of administration;

(3) The date and the time the medication was taken;

(4) The signature, identifiable initials and job title of the person who administers, supervises, or assists the client taking medication;

(5) For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

(6) Documentation of any medication refusal or omission.

(ag) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

(ah) The written documentation of the report in (ae) above shall be maintained in the client’s record.

(ai) If multiple medication problems are identified during the department’s annual survey or other investigations in which the safety of clients might be at risk, the department shall require the facility to obtain the routine services of a consultant pharmacist as a condition of continued licensure. This requirement shall be reviewed at the next inspection to determine if consultant pharmacy services shall continue to be required.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.18 Personnel

(a) The licensee shall ensure that sufficient numbers of qualified personnel are present in the PRTP to meet the needs of clients at all times.

(b) In an acute setting or facilities approved for IEA’s there shall be at least 2 staff members on duty at all times while clients are in the facility, one of whom shall be a registered nurse.

(c) A psychiatrist shall be available to the PRTP 24 hours a day for face-to-face consultation.

(d) For all applicants for employment, volunteers, contracted employees, and independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

(1) Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

(2) Review the results of the criminal records check in accordance with (e) below;

(3) Verify that the potential employee is not listed on the state registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49;

(4) Verify that the applicant meets the qualifications of the position prior to employment; and

(5) If the applicant will be employed by a child or youth program, verify that the potential employee is not listed in the DCYF central registry.

(e) Unless a waiver is granted in accordance with (g) below, the licensee shall not offer employment, contract with, or otherwise engage a person in (d) above if the individual:

(1) Has been convicted of a felony in this of any other state;

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

(3) Has been found by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person; or

(4) Otherwise poses a threat to the health, safety, or well-being of the clients.

(f) If the information identified in (e) above regarding any person subject to (d) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

(1) Cease employing, contracting with, or engaging the person; or

(2) Request a waiver of (d) above.

(g) If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

(1) Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, or the person shall not or no longer shall reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

(2) Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

(h) The licensee shall:

(1) Not employ, contract with, or engage any person in (d) above who is listed on the BEAS state registry or DCYF central registry unless a waiver is granted by BEAS and/or DCYF; and

(2) Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

(i) Administrators appointed after the 2021 effective date of these rules shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

(1) A clinician licensed by the New Hampshire board of mental health or board of psychology practice with at least one year of relevant experience;

(2) A master’s degree in counseling, psychology, or mental health from an accredited institution and 3 years of relevant experience;

(3) A bachelor’s degree in counseling, psychology, or mental health from an accredited institution and 5 years of relevant experience working in a behavioral health related field;

(4) A New Hampshire license as an RN, with at least 5 year of relevant experience working in a behavioral health related field; or

(5) A degree which would make them eligible for licensure from the board of mental health or psychology.

(j) All personnel providing care to adult clients shall be at least 18 years of age if working as direct care personnel unless they are:

(1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

(2) Involved in an established educational program working under the supervision of a licensed clinical supervisor.

(k) All personnel providing care to children and youth shall be at least 21 years of age if working as a direct care personnel.

(l) The licensee shall inform personnel of the line of authority at the PRTP.

(m) Prior to having contact with clients or food, personnel shall:

(1) Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or licensed practitioner and submit results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

(2) Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

(3) Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the individual has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

(n) In lieu of (l)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (l)(1) and (3) above before working at the PRTF.

(o) Prior to having contact with clients or food, personnel shall receive a tour of the PRTF and an orientation that explains the following:

(1) The clients’ rights in accordance with RSA 151:20;

(2) The PRTF’s complaint procedures;

(3) The duties and responsibilities of the position;

(4) The medical emergency procedures;

(5) Education focused on treating and caring for residents with acute and persistent mental illness;

(6) The emergency and evacuation procedures;

(7) The infection control procedures as required by He-P 830.21;

(8) The facility confidentiality requirements;

(9) Grievance procedures for both staff and clients;

(10) The procedures for food safety for personnel involved in preparation, serving, and storing of food; and

(11) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

(p) The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

(1) The licensee’s clients’ rights and complaint procedures required under RSA 151;

(2) The licensee’s infection control program;

(3) The licensee’s written emergency plan;

(4) The licensee’s policies and procedures;

(5) The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29; and

(6) Education on treating and caring for residents with acute and persistent mental illness.

(q) The PRTP shall maintain a separate employee file for each employee, which includes the following:

(1) A completed application for employment or a resume;

(2) Proof that the individual meets the minimum age requirements;

(3) A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

(4) A copy of the results of the criminal record check as described in (d) above and a copy of initial and annual signed conviction statement per He-P 830.18(r);

(5) A job description signed by the individual that identifies the:

a. Position title;

b. Qualifications and experience; and

c. Duties required by the position;

(6) Record of satisfactory completion of the orientation program required by (q) above;

(7) Information as to the general content and length of all in‑service or educational programs attended;

(8) Record of satisfactory completion of all required education programs required above;

(9) A copy of a current, valid driver’s license, including proof of insurance, if the employee transports clients;

(10) Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

(11) The statement required by (u) below; and

(12) The results of the registry checks in (h) above.

(r) The PRTP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

(1) For volunteers, the information in (p)(1), (3), (4), (6), and (8)-(12) above; and

(2) For independent contractors, the information in (p)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (p) above may be substituted for (p)(4), (10), and (12) above, if applicable.

(s) Personnel records shall be maintained in a confidential manner by:

(1) Maintaining a separate file for each employee which shall contain information relating only to that employee; and

(2) Storing the file in a locked container or cabinet in the facility.

(t) All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

(1) Do not have a felony conviction in this or any other state;

(2) Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a client; or

(3) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(u) For individuals with the waiver described in (f) above, the statement required by (s) above shall cover the period of time since the waiver was granted.

(v) An individual shall not be required to re-disclose any of the matters in (r) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

(w) An individual shall disclose any new convictions, as soon as practicable, to the facility administrator. Any such convictions shall be reported to the department for review.

(x) The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

(1) That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

(2) The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

(y) Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

(z) The PRTF shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(aa) The policy in (y) above shall include provisions relating to the following:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Procedures for voluntary self-referral by employees who are misusing substances;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion of misuse or diversion by personnel exists;

(6) Employee assistance procedures;

(7) Confidentiality of investigations, reports, and resolutions of controlled drug misuse or diversion;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance misuse, and diversion prevention policy.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.19 Client Records

(a) The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the PRTP.

(b) At a minimum, client records shall contain the following:

(1) A copy of the client’s service agreement and/or admission contract and all documents required by He-P 830.16(d);

(2) Identification data, including:

a. Vital information including the client’s name, date of birth, and marital status;

b. Client’s religious preference, if known;

c. Client’s veteran status, if known;

d. Name, address, and telephone number of an emergency contact person;

(3) The name and telephone number of the client’s licensed practitioner(s);

(4) The client’s health insurance information;

(5) Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will and DNR or DNAR orders, if applicable;

(6) A record of medical clearance in accordance with He-P 830.16(n);

(7) Written, dated and signed orders for the following:

a. All medications, treatments, and special diets, as applicable; and

b. Laboratory services and consultations performed at the PRTP;

(8) Results of any laboratory tests, X-rays, or consultations performed at the PRTP;

(9) All assessments and treatment plans, including documentation that the client and the guardian or agent, if any, has participated in the development of the treatment plans;

(10) All admission and progress notes, including any use of restraints;

(11) If services are provided at the PRTP by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

(12) Documentation of any alteration in the client’s daily functioning such as:

a. Signs and symptoms of illness; and

b. Any action that was taken including practitioner notification;

(13) Documentation of any medical or specialized care;

(14) Documentation of unusual incidents;

(15) The consent for release of information signed by the client, guardian, or agent, if any;

(16) Discharge planning and referrals;

(17) Transfer or discharge documentation, including notification to the client, guardian, or agent, if any, of involuntary room change, transfer or discharge, if applicable;

(18) The information required by He-P 830.17(ad) as applicable;

(19) The information data sheet required by He-P 830.16(o) and (p);

(20) Documentation of nurse delegation of medications as required by the nurse practice act, as applicable;

(21) Documentation of a client’s refusal of any care or services; and

(22) The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

(c) Client records and client information shall be kept confidential and only provided in accordance with law.

(d) The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur. For all substance abuse rehabilitation facilities, this shall include compliance with 42 CFR Subpart 2C of the Centers for Medicare and Medicaid Services regulations.

(e) When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

(f) Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

(1) Procedures for backing up files to prevent loss of data;

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

(3) Systems to prevent tampering with information pertaining to clients and staff.

(g) Records shall be retained for at least 7 years after discharge, except that when the client is a minor, records shall be retained for at least 7 years after the minor reaches the age of majority.

(h) The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the PRTP ceases operation.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.20 Food Services

(a) The licensee shall provide food services that meet:

(1) Meet the US Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as listed in Appendix A;

(2) Meet the special dietary needs associated with health or medical conditions for each client as identified in their client record; and

(3) Offer at least 3 meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

(b) Snacks shall be available between meals and at bedtime if not contraindicated by the client’s treatment plan.

(c) If a client refuses the item(s) on the menu, a substitute shall be offered.

(d) Each day’s menu shall be posted in a place accessible to food service personnel and clients.

(e) A dated record of menus as served shall be maintained for at least the previous 4 weeks.

(f) The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

(g) If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

(h) All food and drink provided to the clients shall be:

(1) Safe for human consumption and free of spoilage or other contamination;

(2) Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300;

(3) Served at the proper temperatures;

(4) Labeled, dated, and stored at proper temperatures; and

(5) Stored to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

(i) The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

(j) All food not in the original package shall be stored in labeled and dated containers designed for food storage.

(k) All work surfaces shall be cleaned and sanitized after each use.

(l) All dishes, utensils and glassware shall be in good repair, cleaned and sanitized after each use and properly stored.

(m) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

(n) Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

(o) If soiled linen is transported through food service areas, the linen shall be in an impervious container.

(p) Garbage or trash in the kitchen area shall be placed in lined containers with covers.

(q) All PRTP persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.21 Infection Control

(a) The PRTP shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

(b) The infection control program shall include written procedures for:

(1) Proper hand washing techniques;

(2) The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

(3) The management of clients with infectious or contagious diseases or illnesses;

(4) The handling, storage, transportation and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

(5) The reporting of infectious and communicable diseases as required by He-P 301; and

(6) Maintenance of a sanitary physical environment.

(c) The infection control education program shall address:

(1) Causes of infection;

(2) Effects of infections;

(3) Transmission of infections; and

(4) Prevention and containment of infections.

(d) Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

(e) Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

(f) Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the PRTP until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

(g) Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

(h) Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by:

(1) The United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A; and

(2) The Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition) available as noted in Appendix A.

(i) The PRTP shall develop and implement a Point of Care Testing (POCT) policy, if it provides POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.22 Sanitation

(a) The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

(b) The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

(c) A supply of potable water shall be available for human consumption and food preparation.

(d) A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

(e) Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the FGI “Guidelines for the Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A, and summarized as follows:

(1) One hundred and five to 120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

(2) One hundred and twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, and may be by separate booster, unless a chemical rinse is provided; and

(3) One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

(f) All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

(g) Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and client supplies.

(h) Toxic materials shall not be used in a way that contaminates food, equipment or utensils or in any way other than in full compliance with the manufacturer’s labeling.

(i) Only individuals authorized under RSA 430:33 shall apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation or dining areas.

(j) Solid waste, garbage and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

(k) In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

(l) Trash receptacles in food service areas shall be covered at all times during except during food preparation and subsequent clean up.

(m) Laundry and laundry rooms shall meet the following requirements:

(1) Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

(2) Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

(3) Soiled materials, linens and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

(4) Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

(n) Laundry rooms and bathrooms shall have non-porous floors.

(o) Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

(p) Any PRTP that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services shall notify the department.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.23 Quality Improvement

(a) The PRTP shall develop and implement a quality improvement program that review policies and services and maximizes quality by preventing or correcting identified problems.

(b) As part of its quality improvement program, a quality improvement committee shall be established.

(c) The PRTP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

(d) The quality improvement committee shall:

(1) Determine the information to be monitored:

(2) Determine the frequency with which information will be reviewed;

(3) Determine the indicators that will apply to the information being monitored;

(4) Evaluate the information that is gathered;

(5) Determine the action that is necessary to correct identified problems;

(6) Recommend corrective actions to the PRTP; and

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

(e) The quality improvement committee shall meet at least quarterly.

(f) The quality improvement committee shall generate dated, written minutes after each meeting.

(g) Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.24 Physical Environment

(a) The physical environment shall be maintained, inside and outside, to provide for the health, safety, well-being and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

(b) The PRTP shall:

(1) Have all emergency entrances and exits accessible at all times;

(2) Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks;

(3) Be free from environmental nuisances, including excessive noise and odors;

(4) Keep all corridors free from obstructions; and

(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not be limited to:

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

b. Repairing holes and caulking of pipe channels; and

c. Extermination by a pesticide applicator licensed under RSA 430.

(c) Equipment providing heat within an PRTP including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove or pellet stove shall:

(1) Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

a. Be at least 65 degrees Fahrenheit at night; and

b. Be at least 70 degrees Fahrenheit during the day if the client(s) are present; and

(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

(d) Electric heating systems shall be exempt from (b)(2) above.

(e) Portable space heating devices shall be prohibited, unless the following are met:

(1) Such devices are used only in employee areas where personnel are present and awake at all times; and

(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.

(f) Unvented fuel-fired heaters shall not be used in any PRTP.

(g) Plumbing shall be sized, installed, and maintained in accordance with the \International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155:A:10,V.

(h) Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

(i) Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

(j) The number of sinks, toilets, tubs or showers shall be in a ratio of one for every 6 individuals, unless personnel have separate bathroom facilities not used by clients.

(k) All showers and tubs shall have slip resistant floors and surfaces, which are intact, easily cleanable, and impervious to water.

(l) All hand-washing facilities shall be provided with hot and cold running water.

(m) In a PRTP there shall be at least 100 square feet per room with a single bed and 160 (80 square feet per client) square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

(n) Each bedroom shall:

(1) Contain no more than 2 beds;

(2) Have its own separate entry to permit the client to reach his/her bedroom without passing through the room of another client;

(3) Have a side hinge or pocket door, that meets applicable codes, and not a folding door or a curtain;

(4) Not be used simultaneously for other purposes;

(5) Be separated from halls, corridors and other rooms by floor to ceiling walls;

(6) Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the assessment; and

(7) If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom within 24 hours and without requiring additional construction or renovation.

(o) The licensee shall provide the following for the clients’ use, as needed, unless clinically indicated otherwise:

(1) A bed appropriate to the needs of the client;

(2) A firm mattress that complies with the state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

(3) Clean linens, blankets and a pillow;

(4) A bureau;

(5) A mirror;

(6) A bedside table;

(7) Adequate lighting;

(8) A chair;

(9) A closet or storage space for personal belongings; and

(10) Window blinds, shades or curtains that provide privacy.

(p) The resident or guardian may indicate and the home shall document that the resident does not wish or need to have one of more of the items in (p) above and the reason for the removal.

(q) The licensee at a minimum shall provide the following rooms to meet the needs of clients:

(1) One or more living rooms or multi-purpose rooms; and

(2) Dining facilities with a seating capacity capable of meeting the needs of all clients.

(r) For PRTP licensees who will be involuntarily admitting persons a secure environment shall be provided. This may include the use of restraints in personal safety emergencies, as permitted by RSA 151:21.

(s) Doors on locked units shall comply with He-P 830.24(z).

(t) If a client is determined to be a danger to themselves or others per the assessment in He-P 830.16(c), the licensee must comply with the Facility Guideline Institute (FGI), “Guidelines for Design and Construction of Hospitals” (2018 edition) with regard to protection features, available as noted in Appendix A.

(u) Each area should be evaluated to identify the architectural details, surfaces, and furnishings and exposed mechanical and electrical devices and components in areas where clients might be such as:

(1) Seclusion rooms;

(2) Patient bedrooms and toilet rooms;

(3) An area under good supervision but dealing with unpredictable patients under initial evaluation and if under heavy medication;

(4) Activity spaces, group rooms, and treatment spaces;

(5) Dining rooms and recreation spaces, both indoor and outdoor;

(6) Corridors;

(7) Exam rooms; and

(8) Staff and support areas if accessible by clients.

(v) Each licensee shall have a communication system, such as nurse call, so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

(w) Lighting shall be available to allow clients to participate in activities such as reading.

(x) All bathroom, bedroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

(y) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (v) above.

(z) If present, seclusion rooms, shall, at a minimum be:

(1) Equipped with an observation window;

(2) Only for one client at a time;

(3) Under constant observation when clients or others are present in them; and

(4) Locked only under the following conditions:

a. If there is immediate threat of bodily harm to staff or other clients; and

b. If the reason for locking the seclusion room is documented in the client record.

(aa) Any locked door providing egress from within the PRTP, shall meet the requirements of the Residential Board and Care or Health Care Occupancy chapter, whichever chapter the facility was designed to meet based on the resident’s needs, of NFPA 101, as adopted by reference in RSA 153:1, VI-a, except as modified in Saf-FMO 300.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.25 Fire Safety

(a) All PRTPs shall meet the appropriate occupancy chapter of NFPA 101, as adopted by reference in RSA 153:1, VI-a, except as modified in Saf-FMO 300, based on the scope of services provided by the licensee.

(b) All PRTPs, including those with 3 or fewer clients, shall have:

(1) Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the PRTP’s electrical service, or wireless, as approved by the state fire marshal for the PRTP;

(2) At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building with a maximum travel distance to each extinguisher not to exceed 50 feet and maintained as follows:

a. Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

b. Records for manual inspection, or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed;

c. Annual maintenance shall be performed on each extinguisher by trained personnel, and a tag or label shall be securely attached that indicates that maintenance was performed; and

d. The components of the electronic monitoring device or system in a. above, if used, shall be tested and maintained annually in accordance with the manufacturers listed maintenance manual; and

(3) An approved carbon monoxide monitor on every level.

(c) An emergency and fire safety program shall be developed and implemented to provide for the safety of clients and personnel.

(d) Immediately following any fire or emergency, including but not limited to, gas leak or evacuation of the facility due to flooding or an explosion, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

(e) The written notification required by (d) above shall include:

(1) The date and time of the incident;

(2) A description of the location and extent of the incident, including any injury or damage;

(3) A description of events preceding and following the incident;

(4) The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

(5) The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

(f) A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian or a person with durable power of attorney (DPOA) over the client, at the time of admission and a summary of the client’s responsibilities shall be provided to the client. Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

(g) The fire safety plan shall be reviewed and approved as follows:

(1) A copy of the fire safety plan shall be made available annually, and whenever changes are made, to the local fire chief for review and approval;

(2) The local fire chief shall give written approval initially to all fire safety plans; and

(3) If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, prior to the change.

(h) Fire drills shall be conducted as follows:

(1) For buildings constructed to the residential board and care or one- and two- family dwelling chapters of the life safety code (NFPA 101), the following shall be required:

a. The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

b. Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

c. All PRTP facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

d. The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape, except as noted in c. above;

e. Facilities shall complete a written record of fire drills that include the following:

1. The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill;

f. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

g. At admission, the facility shall conduct a client Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the clients’ needs during a fire drill including mobility, assistance to evacuate, staff needed, risk of resistance, clients’ ability to evacuate on his or her own, and choosing an alternate exit; and

h. The fire drills for facilities built to the residential board and care chapter of the life safety code (NFPA 101), shall be permitted to be announced, in advance, to the clients just prior to the drill; and

(2) For PRTPs originally constructed to the health care occupancy chapter of the life safety code and to the codes, rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed engineer qualified in fire protection, the state fire marshal’s office, and the department pursuant to He-P 830.07, to meet the health care occupancy chapter, the following shall be required:

a. The facility shall develop a fire safety plan, which provides for the following:

1. Use of alarms;

2. Transmission of alarms to fire department;

3. Emergency phone call to fire department;

4. Response to alarms;

5. Isolation of fire;

6. Evacuation of immediate area;

7. Evacuation of smoke compartment;

8. Preparation of floors and building for evacuation;

9. Extinguishment of fire; and

10. Written emergency telephone numbers for key staff, fire, and police departments, poison control center, 911, and ambulance service(s);

b. Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff with the signals and emergency action required under varied conditions;

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

d. Buildings that have a shelter-in-place plan, also known as defend-in-place plan, shall have this plan approved by the department per the state fire code, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

e. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

f. If the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point, and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exits;

g. Facilities shall complete a written record of fire drills and include the following:

1. The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

2. The location of exits used;

3. The number of people, including clients, personnel, and visitors, participating at the time of the drill;

4. The amount of time taken to completely evacuate the facility to an approved area of refuge or through a horizontal exit;

5. The name and title of the person conducting the drill;

6. A list of problems and issues encountered during the drill, if any;

7. A list of improvements and resolution to the issues encountered during the fire drill; and

8. The names of all staff members participating in the drill; and

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility.

(i) Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code.

History

• #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20
• #13195, eff 4-24-21

N.H. Code Admin. R. Ann. He-P 830.26 Emergency Preparedness

(a) Each facility shall have an emergency management committee, of which the facility administrator must be a member.

(b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

(c) The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

(1) Elected state and local officials;

(2) Police, fire, civil defense, and public health professionals;

(3) Environment, transportation, and hospital officials;

(4) Facility representatives; and

(5) Representatives from community groups and the media.

(d) An emergency management program shall include, at a minimum, the following elements:

(1) The emergency management plan as described in (e) and (f) below;

(2) The roles and responsibilities of the committee members;

(3) A description of how the plan is implemented, exercised, and maintained; and

(4) Accommodation for emergency food and water supplies.

(e) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

(f) The plan in (e) above shall:

(1) Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather or human-caused emergency such as missing residents and bomb threats;

(2) Be approved by the local emergency management director and reviewed and approved, as

appropriate, by the local fire department;

(3) Be available to all personnel;

(4) Be based on realistic conceptual events;

(5) Be modeled on the ICS in coordination with local emergency response agencies;

(6) Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

(7) Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

(8) Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

(9) Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

(10) For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment including the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

(11) Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies, and to determine the outcome of prior strategies at least annually;

(12) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as

applicable:

a. Electricity;

b. Potable water;

c. Non-potable water;

d. Heating, ventilation, and air conditioning (HVAC);

e. Fire protection systems;

f. Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure

that creates a hazardous incident;

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that

creates a hazardous incident;

h. Medical gas and vacuum systems, if applicable;

i. Communications systems; and

j. Essential services, such as kitchen and laundry services;

(13) Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

(14) Include the management of residents, particularly with respect to physical and clinical issues, to include:

a. Relocation of residents, with their medical record, including the medicine administration records, if time permits;

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

c. How to provide security during the disaster;

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities;

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the New

Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP;

(19) Each license shall:

a. Annually review and revise, as needed, its emergency plan;

b. Submit its emergency plan to the local emergency management director for review and approval when initially written and whenever the plan is revised; and

c. Maintain documentation on site which establishes that the emergency plan has been approved as required under (b) above;

(20) Each PRTF that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of the PRTF’s their local community provided that:

a. It has a generator capable of supplying the entire facility;

b. It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

c. It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.

(g) The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

(1) Drills shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not otherwise involved in the drill;

(2) Drills shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

(3) The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

(4) Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

(h) For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

(1) Assumptions for calculations of food and water supplies, for maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, rotation of products, and contracts and memorandums of understanding with food and water suppliers such as;

a. Enough refrigerated, perishable foods for a 3-day period;

b. Enough non-perishable foods for a 7-day period; and

c. Potable water for a 3-day period;

(2) Designated storage location(s); and

(3) Non-food and water, back-up supplies including but not limited to medical, office, and other supplies necessary to continue operation of the facility and provide necessary care and oversight of residents during the emergency.

(i) Each PRTP that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of PRTP’s their local community provided that:

(1) It has a generator capable of supplying the entire facility;

(2) It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

(3) It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.

(j) The licensee shall annually review and revise, as needed, its emergency plan.

APPENDIX A: INCORPORATION BY REFERENCE STATEMENT

Rule

Title

Publisher; How to Obtain; and Cost

He-P 802.08(h), He-P 802.26(e), He-P 802.28(e) and (g), He-P 802.34(d)(6), and He-P 802.38(c)(3)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Hospitals”

(2022 Edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 802.26(e), He-P 802.28(e) and (g), He-P 802.34(d)(6), and He-P 802.38(c)(3)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities”

(2022 Edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 802.12(b)(1)

Centers for Medicare and Medicaid Services’ “Life safety Code & Health Care Facilities Code Requirements”

Publisher: CMS

Cost: Free of Charge

The incorporated document is available at:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/LSC

He-P 802.12(b)(2)

Centers for Medicare and Medicaid Services’, Publication #100-07 “State Operations Manual”

Publisher: CMS

Cost: Free of Charge

The incorporated document is available at:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984

He-P 802.15(p)

United States Center for Disease Control and Prevention “2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/Isolation-guidelines-H.pdf

He-P 802.16(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at:

https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx

He-P 802.18(i)(8)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 802.25(a)(1)

United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 802.35(a)

American College of Emergency Physicians (ACEP) “Emergency Department Planning and Resource Guidelines” (2021 Edition)

Publisher: American College of Emergency Physicians (ACEP)

Cost: Free of Charge

The incorporated document is available at:

https://www.acep.org/globalassets/new-pdfs/policy-statements/emergency-department-planning-and-resource-guidelines.pdf

He-P 802.40(m)

ACCF/AHA/SCAI’s “2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures” (July 2013)

Publisher: ACCF/AHA/SCAI

Cost: Free to the Public

The incorporated document is available at:

https://www.ahajournals.org/doi/full/10.1161/CIR.0b013e318299cd8a?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

He-P 803.07(e)(3), (f), (g), and (h)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 803.07(f), (g), (h), and (i)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 803.14(l)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 803.14(l) and He-P 803.23(b)(2)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 803.18(j)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 803.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 803.25(e)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities Table 2.5-1” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 804.07 (h)(3), (i), and (j)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 804.07(i)-(k)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com or http://www.fgiguidelines.org. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00.

He-P 804.18(p)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 804.21(a)(1)

“2015-2020 Dietary Guidelines for Americans”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

Available free of charge from the HHS/USDA website at: https://health.gov/dietaryguidelines/2015/guidelines/

He-P 804.21(j)(2)

US Department of Health and Human Services, Public Health Services, Food and Drug Administration, “Food Code,” 2013 edition

Available free of charge from the FDA website at:

https://www.fda.gov/downloads/food/guidanceregulation/retailfoodprotection/ foodcode/ucm374510.pdf

He-P 805.07(h)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 Edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 805.18(o)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 805.21(a)(1)

United States Department of Agriculture’s “Dietary Guidelines for Americans, 2020-2025” (Ninth Edition+

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

He-P 805.21(i)(2)

U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration’s “Food Code”, Chapter 3 “Food”, (2017 Edition)

Publisher: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration

Cost: Free of Charge

The incorporated document is available at:

https://www.fda.gov/food/fda-food-code/food-code-2017

He-P 805.22(b)(2)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/Isolation-guidelines-H.pdf

He-P 806.07(i), (j), and (k); He-P 806.20(e); and He-P 806.21(c)w

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities”

(2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 806.08(h), He-P 806.21(e), He-P 806.22(c)

Facility Guidelines Institutes’ (FGI), “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 806.14(o)

Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

He-P 806.15(q)

Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

He-P 806.16(k)(10)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 806.17(k)(10)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 807.07(g)(3), (h), and (i)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 807.14(o) and He-P 807.21(a)(2), and (g)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 807.18(o)(3)

Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 807.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 807.22(e)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities Table 2.5-1” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 808.07(i) and (j)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 Edition)

Publisher: Facility Guidelines Institute

He-P 808.17(d)

Centers for Disease Control “Guidelines for Preventing the Transmission of Tuberculosis in Health Facilities Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 808.17(d)(5)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

He-P 809.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 809.17(j)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 810.08(h)

Facility Guidelines Institutes, “Guidelines for the Design and Construction of Outpatient facilities” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/editions/

He-P 810.18(h)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 810.18(j)(2) & (n)(11)b.

American Heart Association and American Academy of Pediatrics “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines”

Available free of charge from the American Academy of Pediatrics website at: http://pediatrics.aappublications.org/content/117/5/e1029.

He-P 810.20(h)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 810.20(i)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 810.20(k)(2) and (o)(11)b.

American Heart Association and American Academy of Pediatrics’ “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines”

Publisher: American Heart Association and American Academy of Pediatrics

Cost: Free of Charge

The incorporated document is available at:

https://publications.aap.org/pediatrics/article/117/5/e1029/70083/2005-American-Heart-Association-AHA-Guidelines-for

He-P 810.20(h)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/Guideline-Isolation-H.pdf

He-P 812.07(h),(i), and (j), He-P 812.18(f)(6), He-P 812.22(e), and He-P 812.24(al)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 812.08(h), He-P 812.19(f)(6); He-P 812.23(e), He-P 812.25(af), (ag), and (al)

Facility Guidelines Institutes’ (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 812.14(l) and He-P 812.20(b)(2)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 812.15(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

He-P 812.15(n), He-P 812.21(b)(2)

Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/Guideline-Isolation-H.pdf

He-P 812.16(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

He-P 811.08(h)

Facility Guidelines Institute’s (FGI), “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 811.15(w) and He-P 811.22(h)

United States Centers for Disease Control and Prevention’s, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/Guideline-Isolation-H.pdf

He-P 811.16(d) and He-P 811.17(b)(12)e.

Association for the Advancement of Medical Instrumentation (AAMI)’s, “American National Standard for Dialysate for Hemodialysis” (RD52:2009 edition)

Publisher: Association for the Advancement of Medical Instrumentation

Cost: Free of Charge

The incorporated document is available at:

https://dialysiswatersolution.com/regulations-and-guidelines/ansiaami/rd-52-dialysate-for-hemodialysis/

He-P 811.19(j)(3)

United States Centers for Disease Control and Prevention’s, “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 811.26(f)

Facility Guidelines Institute’s (FGI), “Guidelines for Design and Construction of Outpatient Facilities, Renal Dialysis Center Chapter” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/editions/

He-P 812.17(i)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 812.18(i)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 812.24(af) and (ag)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.7 Requirements for Outpatient Surgery Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 812.24(ag)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.1 Common Elements for Outpatient Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 814.15(m)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 815.07 (h)(3), (i), and (j)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: Digital $90.00 per year/ Book $235 per copy

The incorporated document is available for purchase at

https://fgiguidelines.org/guidelines/editions/

He-P 815.14(m) and He-P 815.19(b)(2)

United States Center for Disease Control and Prevention “2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 815.17(j)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 815.25(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2020-2025” (Ninth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

He-P 816.07(h)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Common Elements for Non-Residential Support Facilities chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00. There is a no-cost, read-only version available here: http://www.fgiguidelines.org.

He-P 816.14(o) and 816.20(i)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 816.18(i)(3)

United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 817.17(i)(5)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 818.07(h)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Adult Day Care chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00. There is a no-cost, read-only version available here: http://www.fgiguidelines.org.

He-P 818.14(n)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 818.15(g)(1)

“2015-2020 Dietary Guidelines for Americans”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

Available free of charge from the HHS/USDA website at: https://health.gov/dietaryguidelines/2015/guidelines/

He-P 818.19(m)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 819.17(b)(6

United States Centers

for Disease Control

and Prevention,

“Guidelines for

Preventing the

Transmission of M.

tuberculosis in

Health-Care Settings”

(2005 edition

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e

He-P 822.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.

He-P 822.17(j)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov/tb/publications/guidelines/infectioncontrol.html.

He-P 823.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

He-P 823.18(i)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of

M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

He-P 824.07(h) and (i)

Facility Guidelines Institutes (FGI), “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition)

Publisher: Facility Guidelines Institutes

Cost: $235-multiple user/$90-single user

The incorporated document is available at:

https://fgiguidelines.org/guidelines/2022-edition/

He-P 824.19(j)(3)

United States Centers for Disease Control and Prevention, “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e

He-P 824.21(h)

United States Centers for Disease Control and Prevention, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in healthcare Settings” (June 2007 edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at: https://www.cdc.gov/coronavirus/mers/downloads/Isolation2007.pdf

He-P 824.22(a)(1)

US Department of Agriculture’s, “Dietary Guidelines for Americans” (2020-2025 edition)

Publisher: US Department of Agriculture

Cost: Free of Charge

The incorporated document is available at: https://www.dietaryguidelines.gov/

He-P 826.07(h)

Facility Guidelines Institute’s (FGI), “Guidelines for Design and Construction of Residential Health, Care, and Supported Facilities” (2022 edition)

Publisher: Facility Guidelines Institute

Cost:

Digital: $90 single-user/per year or $235 multi-user/per year

Print: $235 per copy

The incorporated document is available at: https://www.fgiguidelines.org/guidelines/editions/

He-P 826.07(i)-(k)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2018 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com or http://www.fgiguidelines.org. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00.

He-P 826.14(h)(4)a.

Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices (NREPP),

Available free of charge from the SAMSHA website at https://www.samhsa.gov/nrepp

He-P 826.14(h)(6)

Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Improvement Protocols and Technical Assistance Publications

Available free of charge from the SAMSHA website at https://www.samhsa.gov/kap/resources

He-P 826.14(h)(6)

American Society of Addiction Medicine (ASAM) Criteria, 3^rd edition (2013)

Available free of charge from the American Society of Addiction Medicine (ASAM)website at

http://www.asam.org/quality-practice/guidelines-and-consensus-documents/the-asam-criteria/about

He-P 826.14(h)(6)

National Alliance for Recovery Residences

Available free of charge from the National Alliance for Recovery Residences website at

http://narronline.org/resources/

He-P 826.14(i)(4)a.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Evidence-Based Practices Resource Center” (February 24, 2026)

Publisher: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration

Cost: Free of Charge

The incorporated document is available at:

https://www.samhsa.gov/libraries/evidence-based-practices-resource-center?f%5B0%5D=resource_topic%3A20277

or

A read-only, printed copy of the webpage is available to view at the department.

He-P 826.16(e)(2); He-P 826.16(n); and He-P 826.18(r)(4)

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “TAP 21: Addiction Counseling Competencies” (2017 Revision)

Publisher: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration

Cost: Free of Charge

The incorporated document is available at:

https://library.samhsa.gov/sites/default/files/sma12-4171.pdf

He-P 826.16(e)(2)b.

The American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision” (DSM-5-TR) (2022 Edition)

Publisher: The American Psychiatric Association

Cost:

Paperback & eBook: List Price $170; APA Member Price $136; APA Resident-Fellow Members $127.50

Hardcover: List Price $220; APA Member Price $176; APA Resident-Fellow Members $165

The incorporated document is available at:

https://www.appi.org/products/dsm

He-P 826.16(f)(2)intro. & He-P 826.16(m)

TAP 21: Addiction Counseling Competencies, (2017 revision)

Available free of charge from the SAMSHA website at http://store.samhsa.gov/product/TAP-21-Addiction-Counseling-Competencies/SMA15-4171

He-P 826.16(f)(2)a.

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision) (DSM-5)(May 2013 edition)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00

He-P 826.16(j)

American Society of Addiction Medicine’s (ASAM) “The ASAM Criteria” (2023 edition)

Publisher: American Society of Addiction Medicine

Cost:

Printed: Copies 1-9/$140 per book; Copies 20-99/$135 per book; Copies 100+/$130 per book; Copies 500+/$125 per book

Digital Subscription:

Seats 1: $180/year (1 year); $156/year (2 year); $132/year (3 year)

Seats 2-4: $156/seat/year (1 year); $132/seat/year (2 year); $120/seat/year (3 year)

Seats 5-19: $132/year (1 year); $102/seat/year (2 year); $108/seat/year (3 year)

Seats 20+: $120/year (1 year); $108/seat/year (2 year); $96/seat/year (3 year)

The incorporated document is available at:

https://www.asam.org/asam-criteria

He-P 826.18(o)(3)

United States Centers for Disease Control and Prevention’s, “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings” (2005 edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

He-P 826.20(a)(1)

United States Department of Agriculture’s “Dietary Guidelines for Americans 2020-2025” (Ninth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

He-P 826.20(h)(2)

US Department of Health and Human Services, Public Health Services, Food and Drug Administration, “Food Code” Chapter 3, 2013 edition

Available free of charge from the FDA website at:

https://www.fda.gov/downloads/food/guidanceregulation/retailfoodprotection/ foodcode/ucm374510.pdf

He-P 826.21(h)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” June 2007

Available free of charge from the CDC website at www.cdc.gov.

He-P 826.20(i)(2)

U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administrations’, “Food Code” (2017 Edition)

Publisher: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration

Cost: Free of Charge

The incorporated document is available at:

https://www.fda.gov/food/fda-food-code/food-code-2017

He-P 826.21(b)(2) and (h)

United States Centers for Disease Control and Prevention’s, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (September 2024)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/Isolation-guidelines-H.pdf

He-P 827.07(i),(j), and (k)

Facility Guideline Institutes (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 827.07(i), (j), and (k)

Facility Guideline Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities ” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 827.14(m) and He-P 827.20(j)

Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

He-P 827.15(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

He-P 827.18(m)(3)

“Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 830.07(h) and (i);

He-P 830.14(r)(2); He-P 830.21(h)(2); He-P 830.22(e); and He-P 830.24(t)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 830.14(r)(1) and He-P 830.21(b)(2); He-P 830.21(h)(1)

United States Centers for Disease Control and Prevention’s “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

He-P 830.18(m)(3)

Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 830.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

APPENDIX B

Rule

Specific State or Federal Statutes the Rule Implements

He-P 802.01 – He-P 802.03

RSA 151:9, I(a) and (b)

He-P 802.04

RSA 151:4-a, II

He-P 802.05 – He-P 802.08

RSA 151:2, I and II and RSA 151:9, I

He-P 802.09

RSA 151:9, I(a)

He-P 802.10

RSA 151:9, I(e) and RSA 151:6-a

He-P 802.11

RSA 151:9, I(a) and (b)

He-P 802.12

RSA 151:9, I(e) and RSA 151:6

He-P 802.13

RSA 151:9, I(f), (g), (l), and (m)

He-P 802.14

RSA 151:9, I(f), (h), and (l)

He-P 802.15 – He-P 802.43

RSA 151:9, I(a)

He-P 803.01 – He-P 803.03

RSA 151:9,I(a) and (b)

He-P 803.04 – He-P 803.07

RSA 151:2,I and II and RSA 151:9,I

He-P 803.08

RSA 151:9,I(a)

He-P 803.09

RSA 151:9,I(e) and RSA 151:6-a

He-P 803.10

RSA 151:9,I(a) and (b)

He-P 803.11

RSA 151:9,I(e) and RSA 151:6

He-P 803.12

RSA 151:9,I(f), (g), (l), and (m)

He-P 803.13

RSA 151:9,I(f), (h), and (l)

He-P 803.14 –He-P 803.27

RSA 151:9,I(a)

He-P 803.28

RSA 151:9,I(a)

He-P 804.01

He-P 804.01

He-P 804.02

He-P 804.02

He-P 804.03

He-P 804.03

He-P 804.04

He-P 804.04

He-P 804.05

He-P 804.05

He-P 804.06

He-P 804.06

He-P 804.07

He-P 804.07

He-P 804.08

He-P 804.08

He-P 804.09

He-P 804.09

He-P 804.10

He-P 804.10

He-P 804.11

He-P 804.11

He-P 804.12

He-P 804.12

He-P 804.13

He-P 804.13

He-P 804.14

He-P 804.14

He-P 804.15 – He-P 804.25

He-P 804.15 – He-P 804.25

He-P 804.26 – He-P 804.27

He-P 804.26 – He-P 804.27

He-P 805.01 – He-P 805.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 805.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 805.05 and He-P 805.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 805.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a); RSA 153:10-b, V

He-P 805.08 – He-P 805.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a;

RSA 151:9, I(a) & (e)

He-P 805.11

RSA 151:6, I; RSA 151:9, I(e)

He-P 805.12 and He-P 805.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h), & (l); RSA 151:16-a

He-P 805.14 – He-P 805.27

RSA 151:2, 2-b and 2, IV; RSA 151:5; RSA 151:5-a and 5-a, III; RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2); RSA 151:9-b, and b I-V; RSA 151:19; RSA 151-20; RSA 151:20, II; RSA 151:21, V & VII; RSA 151:24; RSA 151:25; RSA 151:26 and 26, II(b); RSA 151:29; RSA 151:41; RSA 151:47-49; RSA 151:50; RSA 151:52, I(e); RSA 161-F:49, VII and XII(a)

He-P 806.01 – He-P 806.03

RSA 151:9,I(a) and (b)

He-P 806.04

RSA 151:4-a, II

He-P 806.05 – He-P 806.07

RSA 151:2,I and II and RSA 151:9,I

He-P 806.08

RSA 153:10-b, V; RSA 151; RSA 153:5, I; RSA 155-A:1, IV; and RSA 155-A:10, V

He-P 806.09

RSA 151:9,I(a)

He-P 806.10

RSA 151:9,I(a)

He-P 806.11

RSA 151:9,I(e)

He-P 806.12

RSA 151:9,I(f), (g), (l), and (m)

He-P 806.13

RSA 151:9,I(f), (h), and (l)

He-P 806.14 – He-P 806.24

RSA 151:9,I(a), (f), (h), (l), and (o); RSA 151:8; RSA 541-A:30, III; RSA 151; RSA 151:2, RSA 151:5-a; RSA 151:7-a; RSA 541-A; RSA 161-F:49; RSA 151: 19-21; RSA 151:21-b; RSA 141-C:7; RSA 151:29; RSA 151:6-a; RSA 151:21, X; RSA 155:66, I(b); RSA 151:2-d; RSA 326-B:26; 42 CFR 483.156; RSA 328, I; RSA 161-F:46-48; RSA 169-C: 29-31; RSA 141-C:1; RSA 151:9-b; RSA 141-C; RSA151:33; RSA 147-A:2, VII; RSA 430:33; RSA 430:29, XXVI; RSA 430; RSA 155-A:1, IV; RSA 155-A:10, V; RSA 155:66, I(b)

He-P 807.01-He-P 807.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 807.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 807.05-He-P 807.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 807.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a)

He-P 807.08-He-P 807.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 807.11

RSA 151:6, I; RSA 151:9, I(e)

He-P 807.12-He-P 807.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) & (l); RSA 151:16-a

He-P 807.14-He-P 807.25

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 808.01 – He-P 808.03

RSA 151:2,I(c); RSA 151:2,II; RSA 151:9,I(a)&(b), 42 CFR Part 493, 42 CFR § 493.1411, 42 CFR § 493

He-P 808.04 – He-P 808.06

RSA 151:9,I

He-P 808.07 – He-P 808.08

RSA 151:9,I(a)

He-P 808.09

RSA 151:9,I(e)

He-P 808.10

RSA 151:9,I(a)

He-P 808.11

RSA 151:9,I(e)

He-P 808.12

RSA 151:9,I(f),(g),(i),(l)

He-P 808.13

RSA 151:9,I(f),(h),(l),(m)

He-P 808.14 – He-P 808.23

RSA 151:9,I(a), 42 CFR § 493.1405, 42 CFR § 493.1443, 42 CFR § 493.1417, 42 CFR § 493.1455, 42 CFR § 493.1411, 42 CFR § 493.1449, 1461and 1469, 42 CFR § 493, 29 CFR § 1910.1030

He-P 809.01

RSA 151:9, I(a),(b)

He-P 809.02

RSA 151:9, I(a) and (b); RSA 151:2, II(i)

He-P 809.03

RSA 151:9, I(a),(b)

He-P 809.04 – He-P 809.07

RSA 151:2, I and II; RSA 151:9, I

He-P 809.08

RSA 151:9, I(a)

He-P 809.09

RSA 151:9, I(e)

He-P 809.10

RSA 151:9, I(a)

He-P 809.11

RSA 151:9, I(e)

He-P 809.12

RSA 151:9, I(f),(g),(l),(m)

He-P 809.13

RSA 151:9, I(f),(h),(l)

He-P 809.14 – He-P 809.21

RSA 151:9, I(a)

He-P 810.01 - He-P 810.03

RSA 151:9, I(a) & (b)

He-P 810.04

RSA 151:4-a, II

He-P 810.05 - He-P 810.07

RSA 151:9, I(c); RSA 151:4, II and III-a; RSA 151:5, I(c)

He-P 810.08

RSA 151:9, I(a) & (e); RSA 151:9, III; RSA 151:6, II

He-P 810.09

RSA 151:9, I(a) & (f)

He-P 810.10

RSA 151:9, I(a) & (e); RSA 151:6, III; RSA 151:6-a

He-P 810.11

RSA 151:9, I(a) & (b)

He-P 810.12

RSA 151:9, I(a) & (e); RSA 151:6

He-P 810.13 – He-P 810.14

RSA 151:9, I(a), (f)-(i), (l) & (m); RSA 151:7; RSA 151:7-a;

RSA 151:8

He-P 810.15 – He-P 810.24

RSA 151:9, I(a); RSA 151:20; RSA 151:21, RSA 151:22;

RSA 151:29

He-P 810.25 – He-P 810.26

RSA 151:9, I(a); RSA 151:9, III

He-P 810.23 – He-P 810.24

RSA 151:9, I(a); RSA 151:9, III

He-P 810.23 – He-P 810.24

RSA 151:9, I(a); RSA 151:9, III

He-P 811.01 – He-P 811.03

RSA 151:9, I(a) and (b)

He-P 811.04

RSA 151:4-a

He-P 811.05 – He-P 811.07

RSA 151:2, I and II; RSA 151:9, I(c)

He-P 811.08

RSA 151:6

He-P 811.09

RSA 151:9,I(a)

He-P 811.10

RSA 151:9, I(e)

He-P 811.11

RSA 151:9, I(a)

He-P 811.12

RSA 151:9, I(e)

He-P 811.13

RSA 151:9, I(f), (g), (l) and (m)

He-P 811.14

RSA 151:9, I(f), (h) and (l)

He-P 811.15 – He-P 811.25

RSA 151:9, I(a)

He-P 811.26

42 CFR Part 494

He-P 812.01 – He-P 812.03

RSA 151:9, I(a) and (b)

He-P 812.04

RSA 151:4-a, II

He-P 812.05 – He-P 812.08

RSA 151:2, I and II and RSA 151:9,I

He-P 812.09

RSA 151:9, I(a)

He-P 812.10

RSA 151:9, I(e) and RSA 151:6-a

He-P 812.11

RSA 151:9, I(a) and (b)

He-P 812.12

RSA 151:9, I(e) and RSA 151:6

He-P 812.13

RSA 151:9, I(f), (g), (l), and (m)

He-P 812.14

RSA 151:9, I(f), (h), and (l)

He-P 812.15 – He-P 812.27

RSA 151:9, I(a)

He-P 813.01 - 813.03

RSA 151:2, IV; Section 1915(c) of the Social Security Act

He-P 813.04

RSA 151:9,VIII

He-P 813.05

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.06

RSA 151:2, IV, Section 1915(c) of the Social Security Act

He-P 813.07 - 813.08

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.09

RSA 151:6-a

He-P 813.10 - 813.23

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.24

RSA 151:9,I(b)

He-P 813.25

RSA 151:9, VIII

He-P 814.01 – He-P 814.03

RSA 151:9,I(a)(b)

He-P 814.04 – He-P 814.07

RSA 151:2,I(e); RSA 151:2,II; RSA 151:9,I(a) and (b)

He-P 814.08 – He-P 814.09

RSA 151:9,I(a)

He-P 814.10

RSA 151:9,I(e)

He-P 814.11

RSA 151:9,I(a)

He-P 814.12

RSA 151:9,I(e)

He-P 814.13

RSA 151:9,I(f)(g)(l)(m)

He-P 814.14

RSA 151:9,I(f)(h)

He-P 814.15 – He-P 814.16

RSA 151:9,I(a)

He-P 814.18 – He-P 814.22

RSA 151:9,I(a)

He-P 814.23 – He-P 814.24

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 815.01

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.02

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 815.05

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 815.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 815.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a)

He-P 815.08

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.09

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.11

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.12

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) &

(l); RSA 151:16-a

He-P 815.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) &

(l); RSA 151:16-a

He-P 815.14

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.15

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.16

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.17

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.18

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.19

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.20

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.21

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.22

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.23

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.24

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.25

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 816.01 – He-P 816.03

RSA 151:9, I(a)(b)

He-P 816.04 – He-P 816.06

RSA 151:2, I(a); RSA 151:2, II; RSA 151:9, I(a)

He-P 816.04(a)(1)b.

RSA 151:4, III(a)(5)

He-P 816.04(a)(1)c.

RSA 151:4, III(a)(6) & (7)

He-P 816.07 – He-P 816.08

RSA 151:9, I(a)

He-P 816.09

RSA 151:9, I(e)

He-P 816.10

RSA 151:9, I(a)

He-P 816.11

RSA 151:9, I(e)

He-P 816.12

RSA 151:9, I(f)(g)(l)(m)

He-P 816.13

RSA 151:9, I(f)(h)

He-P 816.14 – He-P 816.22

RSA 151:9, I(a)

He-P 816.23 – He-P 816.24

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 817.01 – 817.03

RSA 151:9, I

He-P 817.04

RSA 151:9, I(c)

He-P 817.05

RSA 151:9, I(c)

He-P 817.06

RSA 151:9, I(d)

He-P 817.07

RSA 151:3-a; RSA 151:9, I(a)

He-P 817.08

RSA 151:9, I(a)

He-P 817.09

RSA 151:6-a; RSA 151:9, I(e) and (f)

He-P 817.10

RSA 151:9, I(a)

He-P 817.11

RSA 151:6

He-P 817.12

RSA 541-A:30; RSA 151:7-a; RSA 151:9, I(f), (g) and (l); RSA 151:16-a

He-P 817.13

RSA 541-A:30; RSA 541-A:30-A; RSA 151:9, (I)(f) and (l); RSA 151:7

He-P 817.14

RSA 151:9, (I)(a); RSA 151:20; RSA 151:29

He-P 817.15

RSA 151:9, I(a); 42 CFR 493

He-P 817.16

RSA 151:9, I(a); 42 CFR 493

He-P 817.17

RSA 151:9, I(a); 42 CFR 493

He-P 817.18

RSA 151:9, I(a); 42 CFR 493

He-P 817.19

RSA 151:9, I(a); 29 CFR 1910.1030

He-P 817.20

RSA 151:9, I(a)

He-P 817.21

RSA 151:9, I(a), (c) and (d); 42 CFR 493

He-P 818.01

RSA 151:9, I(a)

He-P 818.02

RSA 151:9, I(b) and (f)

He-P 818.03

RSA 151:9, I

He-P 818.04 – 818.06

RSA 151:9, I(c) and (d)

He-P 818.04(a)(1)b.

RSA 151:4, III(a)(5)

He-P 818.04(a)(1)c.

RSA 151:4, III(a)(6) & (7)

He-P 818.07

RSA 151:9, I(a), RSA 151:9, III; RSA 153; RSA 155-a:I, IV

He-P 818.08

RSA 151:9, I(a)

He-P 818.09

RSA 151:9, I(e)

He-P 818.10

RSA 151:9, I(b)

He-P 818.11

RSA 151:9, I(e); RSA 151:6

He-P 818.12

RSA 151:6; RSA 151:6-a; RSA 151:7; RSA 151:7-a; RSA 151:8; RSA 151:8-a; RSA 159:9, I(a), (e)–(i), (l) and (m); RSA 151:16(a)

He-P 818.13

RSA 151:7; RSA 151:8; RSA 151:9, I(f) and (h)

He-P 818.14 – 818.15

RSA 151:9, I(a)

He-P 818.16

RSA 151:9, I(a); RSA 151:21; RSA 151:26

He-P 818.17

RSA 151:9, I(a)

He-P 818.18

RSA 151:9, I(a); RSA 318; RSA 318-B; RSA 326-B

He-P 818.19

RSA 151:9, I(a)

He-P 818.20

RSA 151:9, I(a)

He-P 818.21

RSA 151:9, I(a); RSA 141-C; RSA 151:9-b

He-P 818.22

RSA 151:9, I(a)

He-P 818.23

RSA 151:9, I(a); RSA 155-A

He-P 818.24 – 818.25

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 819.01 – He-P 819.03

RSA 151:9,I(a) and (b) RSA 151:2-b

He-P 819.04 – He-P 819.06

RSA 151:9,I(c) and (d)

He-P 819.07 – He-P 819.08

RSA 151:9,I(a)

He-P 819.09

RSA 151:9,I(e)

He-P 819.10

RSA 151:9,I(a) and (b)

He-P 819.11

RSA 151:9,I(e)

He-P 819.12

RSA 151:9,I(g)(l) and (m)

He-P 819.13

RSA 151:9,I(f) and (m)

He-P 819.14 – He-P 819.19

RSA 151:9,I(a), RSA 151:13-b

He-P 820.01-He-P 820.03

RSA 151:9, I(a), (b); RSA 151:2, I(b); RSA 151:2-b; RSA 151:9-a, I

He-P 820.04-He-P 820.06

RSA 151:2, I and II and RSA 151:9, I; RSA 151:9-a, I and XII

He-P 820.07-He-P 820.08

RSA 151:9, I(a); RSA 151:9-a,I and XII

He-P 820.09

RSA 151:6,I; RSA 151:9, I(e); RSA 151:9-a, VIII

He-P 820.10

RSA 151:9, I(f), (g), (l), (m); RSA 151:9-a, IX, X, and XI

He-P 820.11

RSA 151:9, I(f), (h), (l); RSA 151:16-a; RSA 151:9-a,IX

He-P 820.12

RSA 151:9, I(a); RSA 151:9-a, I and VIII

He-P 822.01

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.02

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.03

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.04 – He-P 822.07

RSA 151:2,I and II; RSA 151:9, I

He-P 822.08

RSA 151:9,I(a)

He-P 822.09

RSA 151:9,I(e)

He-P 822.10

RSA 151:9,I(a)

He-P 822.11

RSA 151:9,I(e)

He-P 822.12

RSA 151:9,I(f),(g),(l),(m)

He-P 822.13

RSA 151:9,I(f),(h),(l)

He-P 822.14 – He-P 822.20

RSA 151:9,I(a)

He-P 823.01 – He-P 823.03

RSA 151:9,I(a),(b)

He-P 823.04 – He-P 823.07

He-P 823.04 – He-P 823.07

He-P 823.08

RSA 151:9,I(a)

He-P 823.09

RSA 151:9,I(e)

He-P 823.10

RSA 151:9,I(a)

He-P 823.11

RSA 151:9,I(e)

He-P 823.12

RSA 151:9,I(f),(g),(l),(m)

He-P 823.13

RSA 151:9,I(f),(h),(l)

He-P 823.14 – He-P 823.21

RSA 151:9,I(a)

He-P 824.01 – He-P 824.03

RSA 151:9, I(a) and (b) and RSA 151:9, VII(a)(2)

He-P 824.04 – He-P 824.07

RSA 151:2, I and II and RSA 151:9, I(c) and (d)

He-P 824.08

RSA 151:9, I(a)

He-P 824.09

RSA 151:9, I(e)

He-P 824.10

RSA 151:9, I(a)

He-P 824.11

RSA 151:9, I(e)

He-P 824.12

RSA 151:9, I(f), (g), (l) and (m)

He-P 824.13

RSA 151:9, I(f), (h) and (l)

He-P 824.14 – He-P 824.26

RSA 151:9, I(a) and RSA 151:9, VII(a)(2)

He-P 826.01

RSA 151:2, I(e); RSA151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.02

RSA 151:2, II(a)-(i); RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.03

RSA 151:6-a, II; RSA 151:9, I(a); RSA 151:9, VII(a)(1); RSA 151:19, II & V; RSA 151:21

He-P 826.04 – He-P 826.06

RSA 151:9, I(c); RSA 151:9, VII(a)(1)

He-P 826.07 – He-P 826.08

RSA 151:6, II; RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.09

RSA 151:6; RSA 151:6-a; RSA 151:9, I(e); RSA 151:9, VII(a)(1)

He-P 826.10

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.11

RSA 151:7-a, II; RSA 151:9, I(e); RSA 151:9, VII(a)(1)

He-P 826.12

RSA 151:9, I(l); RSA 151:9, VII(a)(1)

He-P 826.13

RSA 151:9, I(f); RSA 151:9, VII(a)(1)

He-P 826.14 – He-P 826.26

RSA 151:5-c; RSA 151:9, I(a); RSA 151:9, VII(a)(1); RSA 151:19; RSA 151:21; RSA 151:24; RSA 151:41; RSA 151-47-50

He-P 827.01

RSA 151; RSA 151:2-e, II(c)

He-P 827.02

RSA 151:2

He-P 827.03

RSA 151; RSA 137-J; RSA 151:38; RSA 137-J; RSA 137-J:35;

RSA 151:2, I(a) and RSA 151:2-e; RSA 151:19, II; RSA 463, RSA 464-A; RSA 151:2, I(a); RSA 151:6; RSA 153; RSA 153:5, I; RSA 329;

RSA 326-B; RSA 151:6-a, II; RSA 151:21; RSA 151:19, V; RSA 329;

RSA 151:6-a; RSA 151:2-e

He-P 827.04 – He-P 827.06

RSA 151: RSA 151:4, I-III(a); 42 C.F.R. 485.610(b) and (c);

RSA 151:5, IX; RSA 485; RSA 6:11-a

He-P 827.07 – He-P 827.08

RSA 151; RSA 153:5, I; RSA 153:10-b, V; RSA 155-A:I, IV;

RSA 155-A:10, V

He-P 827.09

RSA 151

He-P 827.10

RSA 151

He-P 827.11

RSA 151; RSA 151:2; RSA 151:7-a, II; RSA 151:17; RSA 151:13

He-P 827.12

RSA 151

He-P 827.13

RSA 151; RSA 151:8; RSA 541-A:30, III; RSA 151:2; RSA 151:5-a;

RSA 151:5-a, II; RSA 151:7-a

He-P 827.14 – He-P 827.25

RSA 161-F:49; 42 CFR Part 482; RSA 151:19-21; RSA 153; RSA 153:5, I; RSA 141-C:7; RSA 151:29; RSA 151:2; RSA 151:20; RSA 151:6; RSA 151:6-a; RSA 155:66, I(b); RSA 151:24; RSA 151:21, VII; RSA 151:37; CMS 42 CFR Part 493; RSA; RSA 318 and RSA 318-B; RSA 125-F; RSA 151:2-d, VI; RSA 161-F:49; RSA 326-B:26; 42 CFR 483.156; RSA 151:20; RSA 137-J; RSA 151:26; RSA 137-H; RSA 137-J; RSA 161-F:46; RSA 169-C:29; RSA 151:9-b, IV; RSA 151:41; RSA 464-A; RSA 141-C:I; RSA 151:9-b; RSA 151:33; RSA 147-A:2, VII; RSA 430:33; RSA 430:29, XXVI; RSA 430; RSA 329-A:15; RSA 155-A; RSA 155:66, I(b); RSA 155:64-77; 42 CFR 493

He-P 830.01 – He-P 830.03

RSA 151:9, I(a) & (b)

He-P 830.04 – He-P 830.07

RSA 151:2, I & II; RSA 151:9, I

He-P 830.08

RSA 151:9, I(a)

He-P 830.09

RSA 151:9, I(e); RSA 151:6-a

He-P 830.10

RSA 151:9, I(a) & (b)

He-P 830.11

RSA 151:9, I(e); RSA 151:6

He-P 830.12

RSA 151:9, I(f), (g), (l), & (m)

He-P 830.13

RSA 151:9, I(f), (h), & (l)

He-P 830.14

RSA 151:9, I(a)

He-P 830.15 –He-P 830.25

RSA 151:9, I(a)

He-P 830.26

RSA 151:9, I(a)

History

• #13195, eff 4-24-21

Chapter He-P 900 was formerly titled “Message Therapists.” Pursuant to 2015, 276:103 and 104, effective 7-1-15, rulemaking authority under RSA 328-B:4 and RSA 328-B:11-a over massage therapy was transferred to the Executive Director of the Office of Professional Licensure and Certification (OPLC) from the Commissioner of the Department of Health and Human Services. The existing rules of the Department numbered Chapter He-P 900 and titled “Massage Therapists” were also transferred pursuant to 2015, 276:45 under RSA 310-A:1-a, III. The former Chapter He-P 900 subsequently expired 12-11-17.

Part He-P 901 General Information

N.H. Code Admin. R. Ann. He-P 901.01 Purpose

The purpose of this rule is to establish requirements for appointment, duties, and training of town health officers in the state of New Hampshire. This chapter does not apply to cities pursuant to RSA 128:7.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

N.H. Code Admin. R. Ann. He-P 901.02 Definitions

(a) “Cause” means any determination by the town for which a town recommends removal of the health officer.

(b) “Certificate of appointment” means the documentation of an official assignation of a person as a health officer or deputy health officer for a town or unorganized locality.

(c) “Commissioner” means the commissioner of the department of health and human services, or commissioner’s designee.

(d) “Department” means the department of health and human services.

(e) “Health officer” means the person appointed by the commissioner to enforce public health laws and rules in a town or unorganized locality. It includes the term “deputy health officer.”

(f) “New Hampshire Health Officers Association (NHHOA)” means the professional organization established to assist and support local health officials in meeting their responsibilities to the public through programs of education, technical assistance, representation, and resource development.

(g) “Qualified person” means an appointed health officer.

(h) “Town” means a political unit of the state other than a city. It includes the term “municipality.”

(i) “Unorganized localities” means a region of the state with no local incorporated government.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

Part He-P 902 Health Officer Appointment

N.H. Code Admin. R. Ann. He-P 902.01 Appointment Process of a Health Officer for a Town or for Several Towns

(a) The selectmen of a town shall recommend to the commissioner a person for nomination as a health officer or deputy health officer by submitting to the department a completed “Health Officer and/or Deputy Health Officer Nomination Form” (March 2023).

(b) If several towns are to use one health officer between them, then the selectmen of those towns shall recommend to the commissioner a person for nomination as a health office or deputy health officer by submitting to the department a completed “Health Officer and/or Deputy Health Officer Nomination Form” (March 2023).

(c) Each municipality shall request and obtain a criminal history record information request from the department of safety, as a prerequisite to any nomination of a health officer or deputy health officer.

(d) The results of the request shall be submitted to the commissioner or commissioner’s designee for review to determine if there are any prior convictions that:

(1) Could disqualify such person; or

(2) Interfere with the performance of their duties.

(e) The commissioner shall suspend, until action is taken pursuant to (f) below, any nomination for a town health officer if a criminal background check results in evidence of a criminal conviction for any offenses relating to:

(1) Aggregated felonious sexual assault;

(2) Felonious sexual assault;

(3) Sexual assault;

(4) First degree assault;

(5) Second degree assault;

(6) Criminal threatening;

(7) Kidnapping;

(8) Endangering the welfare of a child or incompetent;

(9) Indecent exposure or lewdness;

(10) Possession of child sex abuse images;

(11) Offenses relating to obscene matter involving a child;

(12) Controlled drug act;

(13) Any offense involving theft;

(14) Any offense involving fraud;

(15) Otherwise poses a threat to the health, safety, or well-being of residents to be served; or

(16) Any other criminal offense that interferes with the performance of a health officer’s duties.

(f) If a nominee’s criminal background check reveals a conviction for any of the criminal offenses listed above, the commissioner in consultation with the municipality, shall take into consideration the following when deciding whether to approve or deny the nomination:

(1) The municipality’s commitment to and faith in the nominee;

(2) The nominee’s explanation and circumstances;

(3) The nature and gravity of the offense;

(4) The length of time since the criminal conviction;

(5) Whether the conviction has been annulled; and

(6) Any exceptional or mitigating circumstances.

(g) If approved, the commissioner shall notify the appointee and issue a certificate of appointment within 30 days.

(h) The commissioner shall appoint any qualified person as defined in He-P 901.02(g), to act in unorganized localities as a health officer when a complaint is received by the department and requires an investigation, response, or both.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

N.H. Code Admin. R. Ann. He-P 902.02 Term of Appointment

(a) Pursuant to RSA 128:4, a health officer shall hold office for:

(1) A total of 3 years;

(2) Unless or until removed for cause as defined in He-P 901.01(a); or

(3) Until a successor is appointed.

(b) Upon the expiration of the health officer’s term, or upon his or her removal, death or resignation, or the occurrence of a vacancy in the office for any reason, the selectmen shall:

(1) Notify the commissioner; and

(2) Make a recommendation for a replacement within 15 days of the notice in (1) above.

(c) If no recommendation is made within the 15 day notice of (b)(2) above, the commissioner shall appoint the chair of the board of selectman for each town to serve for each town, subject to approval of a successful background check in He-P 902.01 above, until a recommendation is received.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

N.H. Code Admin. R. Ann. He-P 902.03 Deputy Health Officer Appointment and Term

(a) The appointed health officer shall nominate a person to serve as a deputy health officer as needed, upon approval of the selectmen and the commissioner and pursuant to He-P 902.01.

(b) The term of the deputy health officer shall expire with that of the health officer.

(c) In the event of a vacancy of a health officer, the term of the deputy health officer shall be extended with the approval of the board of selectmen, in consultation with the commissioner, until the health officer vacancy is filled.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

Part He-P 903 Duties

N.H. Code Admin. R. Ann. He-P 903.01 Duties of a Health Officer

(a) Health officers shall have the authority to:

(1) Enforce public health laws and rules; and

(2) Make sanitary investigations as directed by:

a. The local board of health; or

b. The department.

(b) Deputy health officers shall be empowered to:

(1) Enforce public health laws and rules; and

(2) Make sanitary investigations as directed by:

a. The health officer; or

b. The department.

(c) Pursuant to RSA 128:3, the health officer shall:

(1) With the board of selectman, constitute the local board of health for the town; and

(2) Be the secretary and executive officer of the local board of health for the town.

(d) This local board shall:

(1) Meet at least once every year;

(2) Review the state of local public health issues and concerns; and

(3) Provide information as requested to the department on the readiness to address public health threats identified at the local or regional levels.

(e) The department shall contact the local board of health when it receives information regarding a public health threat in order to:

(1) Determine the readiness of the local board to respond; and

(2) Provide technical assistance and resources to address the issue.

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

Part He-P 904 Training and Qualifications

N.H. Code Admin. R. Ann. He-P 904.01 Training Required

(a) Within one year of appointment, each health officer and deputy health officer shall complete a minimum of 3 hours of training on topics related to the specific laws that provide authority to health officers.

(b) The curriculum for training shall include, but not be limited to:

(1) Duties and responsibilities on rental housing standards pursuant to RSA 48-A:3, I(c);

(2) Assessment and management of health nuisances pursuant to RSA 147; and

(3) Duties pursuant to RSA 128:5.

(c) The training shall be administered at no cost to the municipality by the department in collaboration with the NHHOA.

(d) The training shall be taken either:

(1) In person; or

(2) Through a remote learning platform provided by the department.

(e) Upon completion of the training required in (a) above, each health officer and deputy health officer shall receive a certification of completion and provide a copy of the certification of completion to the department.

APPENDIX A

Rule

Specific State Statute the Rule Implements

He-P 901

RSA 128:10

He-P 902

RSA 128:1, RSA 128:2, RSA 128:4, RSA 128:5-b,

RSA 128:6, RSA 126:6-a, RSA 128:10

He-P 903

RSA 128:3, RSA 128:5, RSA 128:10, RSA 128:11

He-P 904

RSA 128: 8, RSA 128:10

History

• (See Revision Note at chapter heading for He-P 900) #13604, eff 3-28-23

Chapter He-P 1600 Lead Poisoning Prevention and Control

Part He-P 1601 Purpose and Scope

N.H. Code Admin. R. Ann. He-P 1601.01 Purpose

(a) The lead paint poisoning prevention and control rules are adopted to implement the requirements of the New Hampshire Lead Paint Poisoning Prevention and Control Act, RSA 130-A.

(b) The lead paint poisoning prevention and control rules set forth standards and requirements for lead hazard reduction and inspection, licensing of lead inspectors, risk assessors, lead abatement contractors, and owner-contractors, certification of lead abatement workers and lead abatement supervisors, and for blood lead reporting by laboratories, as required by RSA 130-A, 15 USC 2681-2692, 40 CFR 745.226, and 42 USC 4821-4856.

History

• #1592, eff 7-1-80; ss by #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1601.02 Scope

(a) The lead paint poisoning prevention and control rules shall apply after an investigation by the commissioner identifies lead exposure hazards, or to persons engaged in lead hazard reduction as defined in He-P 1602.01(ay), or to any person subject to the provisions of RSA 130-A.

(b) Pursuant to Part 1, Article 28-a of the Constitution of New Hampshire, political subdivisions shall be exempt from the provisions of RSA 130-A and He-P 1600, except for the licensing and certification of lead educational programs and lead professionals as detailed in He-P 1611 and He-P 1612, unless:

(1) The programs and responsibilities imposed under RSA 130-A and the rules are fully funded by the state; or

(2) The subdivisions voluntarily and at their own expense comply.

History

• #1592, eff 7-1-80; ss by #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1602 Definitions

N.H. Code Admin. R. Ann. He-P 1602.01 Definitions

(a) “Abatement” means measure(s) designed to permanently eliminate lead-based paint hazards as defined in 40 CFR Part 745.223 including:

(1) Activities resulting in the permanent elimination of lead-based paint hazards, including all preparation, cleanup, disposal, and post-abatement clearance testing activities associated with such measures conducted by individuals certified or licensed in accordance with He-P 1612;

(2) Activities resulting in the permanent elimination of lead-based paint hazards that are conducted in response to an investigation, an order of lead hazard reduction or other enforcement action undertaken by the commissioner pursuant to RSA 130-A:5 or RSA 130-A:7, or by a local health department pursuant to RSA-130-A:11, II; or

(3) Any other measures or set of measures conducted in, or to, a residential dwelling, dwelling unit, or child-care facility designed to permanently eliminate lead-based paint hazards.

(b) “Abrasive blasting” means the procedure of removing paint from a surface by using a mechanical force to apply an abrasive material, including sand, grit, or other abrasive material, to a painted surface.

(c) “Administrative inspection warrant” means “inspection warrant” as defined in RSA 595-B:1.

(d) “Bare soil” as used in the definition of “lead exposure hazard” in RSA 130-A:1, XVI, means soil or sand that is accessible to children or pets and is not covered with grass, sod, other vegetation, asphalt, concrete, decking, or other substantive covering, and includes soil or sand in a sandbox or play area.

(e) “Blood lead level” means a blood lead measurement obtained by a diagnostic blood lead test conducted by a laboratory certified pursuant to 42 CFR Part 493 Medicare, Medicaid and Clinical Laboratory Improvement Amendments (CLIA) Program and, if applicable, licensed pursuant to He-P 808.

(f) “Business entity” means a partnership, firm, association, corporation, sole proprietorship, or other business concern.

(g) “Certificate of lead safe” means a certificate issued by a licensed risk assessor following a risk assessment or clearance inspection when no lead exposure hazards are identified or remain at the time of the inspection or assessment.

(h) “Certification” means the process of being certified.

(i) “Certified” means that an individual has a current valid certificate from the commissioner and has complied with all certification requirements set forth in this chapter.

(j) “Chewable” means a horizontal accessible surface that protrudes more than a ½ inch and is located more than 6 inches but less than 4 feet from the ground or floor.

(k) “Child” or “children” means “child” or “children” as defined in RSA 130-A:1, I.

(l) “Child care facility” means “child care facility” as defined in RSA 130-A:1, II.

(m) “Clearance inspection” means a visual assessment and collection and analysis of environmental samples following lead hazard reduction activities to determine that the lead hazard reduction activities are complete and no lead exposure hazards remain in the dwelling, dwelling unit, or child care facility.

(n) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

(o) “Commissioner” means “commissioner” as defined by RSA 130-A:1, III, or their designee.

(p) “Common areas” means a portion of a building that is generally accessed by occupants and users including areas on the interior of the dwelling or exterior of the property such as hallways, stairways, laundry areas, attics, recreational rooms, yards, parking areas, play areas, and the building’s exterior, garages, and boundary fences.

(q) “Component” means specific design or structural elements or fixtures in the interior or on the exterior of the dwelling, dwelling unit, or child care facility that are distinguished from each other by form, function, or location onto which paint, stain, varnish, shellac, or other similar coating has been applied and which have a common substrate.

(r) “Containment” means the physical measures taken to ensure that dust and debris created or released during lead hazard reduction are not spread, blown, or tracked from inside to outside the worksite.

(s) “Damage” means failure of a paint film or the underlying substrate that results in the paint becoming detached or is at risk of becoming detached from the substrate, including:

(1) Peeling, chipping, flaking, or chalking paint;

(2) Plaster which is crumbling;

(3) Paint that can be removed with a fingernail; or

(4) Other paint film or underlying substrate failure.

(t) “Days” means calendar days unless otherwise specified.

(u) “Department” means “department” as defined by RSA 130-A:1, IV.

(v) “Deteriorated” means any condition of reduced structural or surface integrity.

(w) “Dwelling” means “dwelling” as defined in RSA 130-A:1, V.

(x) “Dwelling unit” means “dwelling unit” as defined in RSA 130-A:1, VI.

(y) “Encapsulation” means “encapsulation” as defined in RSA 130-A:1, VII.

(z) “Enclosure” means the use of rigid durable construction materials that are fastened to the substrate in order to act as a barrier between lead-based paint and the living space and does not include encapsulants as defined in (y) above.

(aa) “Environmental inspection” means an on-site inspection, conducted by the department, of the dwelling, dwelling unit, or child care facility for the purpose of determining if lead exposure hazards exist for a child.

(ab) “Environmental investigation” means the collection of documentation and evidence, used to determine potential sources of lead exposure for a child in accordance with RSA 130-A:5.

(ac) “Environmental lead testing laboratory” means a laboratory recognized by the EPA National Lead Laboratory Accreditation Program (NLLAP) to accurately analyze paint chips, dust, or soil samples for lead.

(ad) “Friction surface” means a surface, such as a door, floor, stair, or window, which is subject to abrasion, damage, or deterioration with normal repeated use.

(ae) “Good cause” means any circumstances beyond a person’s control, that prevents that person from complying with an order of lead hazard reduction or taking some required action, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(af) “Hazardous waste” means “hazardous waste” as defined in the New Hampshire Hazardous Waste Management Act, RSA 147-A:2, VII.

(ag) “Health authority” means “health authority” as defined in RSA 130-A:1, VIII.

(ah) “HEPA vacuum” means a vacuum cleaner equipped with a high-efficiency particulate air (HEPA) filter capable of capturing particles of 0.3 microns or greater from a body of air, with 99.97 percent efficiency, and is designed so that all air drawn into the machine is expelled through the HEPA filter.

(ai) “Impact surface” means a point of contact such as a door, floor, stair, or window where the component is subject to repeated impact through normal use, sufficient to cause damage or deterioration of lead-based paint.

(aj) “In-house training” means training offered by the department and certified by the department pursuant to RSA 130-A:2, I(h) for the certification and licensure of lead abatement supervisors, lead inspectors, lead risk assessors, lead clearance testing technicians, and lead abatement workers.

(ak) “In-place management” means “in-place management” as defined in RSA 130-A:1, XII.

(al) “Interim controls” means “interim controls” as defined in RSA 130-A:1, IX.

(am) “Laboratory” means any site that tests blood lead levels on individuals residing in New Hampshire.

(an) “Lead abatement contractor” means “lead abatement contractor” as defined in RSA 130-A:1, XIV.

(ao) “Lead abatement supervisor” means a lead abatement worker that supervises other lead abatement workers and is certified in accordance with He-P 1612 to perform responsibilities as outlined in He-P 1612.01(e).

(ap) “Lead abatement worker” means “lead abatement worker” as defined in RSA 130-A:1, X.

(aq) “Lead-based paint” means paint or other surface coating that contains lead equal to or in excess of 1.0 milligram per square centimeter or 0.5 percent by weight or as established by the United States Environmental Protection Agency, in which case the federal standard shall prevail.

(ar) “Lead-based paint inspection” means a surface by surface investigation to determine the presence of lead-based paint and the provision of a report explaining the results of the investigation.

(as) “Lead-based substance” means “lead-base substance” as defined in RSA 130-A:1, XI.

(at) “Lead-based substance inspection” means a surface by surface investigation to determine the presence of lead-based paint, collection and analysis of environmental samples including dust and soil samples, and the provision of a report explaining the results of the investigation.

(au) “Lead clearance testing technician” means “lead clearance testing technician” as defined in RSA 130-A:1, XVI-c.

(av) “Lead-containing waste material” means any waste, debris, dust, or material intended for disposal, including items such as disposable equipment and clothing that contains lead that was generated by lead hazard reduction work regulated under this chapter.

(aw) “Lead education program” means any persons or entities offering or providing lead educational programs to individuals or entities to be licensed or certified as lead inspectors, lead risk assessors, lead abatement supervisors, lead clearance testing technicians, or lead abatement workers by the state of New Hampshire in accordance with RSA 130-A and He-P 1611.

(ax) “Lead exposure hazard” means “lead exposure hazard” as defined in RSA 130-A:1, XVI.

(ay) “Lead hazard reduction” means measures used to control lead exposure hazards through abatement, interim controls, or a combination of the 2 measures.

(az) “Lead inspection” means an examination to determine the presence of a lead-based substance, which can be used to evaluate an existing or potential lead exposure hazard, or to determine compliance with RSA 130-A or He-P 1600, and includes:

(1) Clearance inspections, both preliminary and final;

(2) Compliance inspections;

(3) Environmental inspections, as part of investigations;

(4) Lead-based paint inspections;

(5) Lead-based substances inspections;

(6) Inspections as part of a risk assessment;

(7) Visual, dust, and soil inspections; and

(8) Any other examination to determine the presence of a lead-based substance, which can be used to evaluate an existing or potential lead exposure hazard, or to determine compliance with RSA 130-A or He-P 1600.

(ba) “Lead inspection survey report” means a report, prepared by the department, documenting an environmental inspection of a dwelling, dwelling unit, or child-care facility where a lead exposure hazard exists for a child.

(bb) “Lead inspector” means “lead inspector” as defined in RSA 130-A:1, XV.

(bc) “Lead investigation” means a request for information on an environmental inspection performed by the department to determine potential sources of lead exposure for a child.

(bd) “Lead professional” means an individual who performs lead-based paint activities for remuneration, including individuals licensed or certified in accordance with He-P 1612 such as a lead abatement worker, a lead abatement supervisor, a lead inspector, a lead clearance testing technician, or a risk assessor.

(be) “Lead risk assessor” means “lead risk assessor” as defined in RSA 130-A:1, XVI-b.

(bf) “Lead safe” means a designation made after a risk assessment or a clearance inspection has been completed and the dwelling, dwelling unit, or child care facility does not have lead exposure hazards at the time of the assessment or inspection.

(bg) “Letter of recommendation” means a letter issued to an owner explaining steps they are recommended to take to identify and eliminate lead exposure hazards.

(bh) “Licensed” means that a person has a currently valid license from the commissioner and has complied with all licensing requirements set forth in this chapter.

(bi) “Licensure” means the process of obtaining a valid license.

(bj) “Mini-containment area” means the construction of a temporary walled area to isolate a specific space requiring lead hazard reduction work in order to ensure that no dust or debris leaves the space while work is being performed.

(bk) “Multi-family dwelling” means a dwelling consisting of 2 or more dwelling units on a single lot including:

(1) Apartment buildings;

(2) Townhouses;

(3) Condominiums;

(4) Shared housing;

(5) Rooming units;

(6) Rooming houses; and

(7) Other dwellings consisting of 2 or more dwelling units on a single lot.

(bl) “Newly-constructed rental units” means “newly-constructed rental units” as defined in RSA-A:5-d, namely “rental units being converted from a use other than residential rental housing”.

(bm) “Occupant” means “occupant” as defined in RSA 130-A:1, XVII.

(bn) “Occupant protection plan” means the measures and management procedures that will be taken during the lead hazard reduction activities to protect the building occupants.

(bo) “Occupied” means a dwelling or dwelling unit where a person resides or a property being used as a child care facility.

(bp) “Order of lead hazard reduction” means an order issued by the commissioner requiring all lead exposure hazards be reduced or eliminated from a given dwelling, dwelling unit, or child care facility.

(bq) “Owner” means “owner” as defined in RSA 130-A:1, XVIII.

(br) “Owner’s agent” means a person who has charge, care, or control of a dwelling or dwelling unit and has authority to fund capital or major property rehabilitation on behalf of the owner. This term includes “owner’s designee”.

(bs) “Owner-contractor” means an individual who:

(1) Owns 7 or fewer dwelling units;

(2) Meets the lead abatement supervisor education and licensing requirements for an initial or renewed license but is not required to have 2 years’ work experience;

(3) Complies with the functions and responsibilities of a licensed lead abatement contractor and lead abatement supervisor; and

(4) Performs lead hazard reduction work only on dwellings and dwelling units owned by the individual.

(bt) “Owner occupied” means a dwelling or dwelling unit that is in use and occupied by the owner as defined in RSA 130-A:1, XVIII.

(bu) “Participating” or “participate” “in the management of a dwelling, dwelling unit, or child care facility” means “participating” or “participate” “in the management of a dwelling, dwelling unit, or child care facility” as defined in RSA 130-A:1, XIX.

(bv) “Permanently” as used in the definition of “lead base substance abatement” in RSA 130-A:1, XIII, means that the duration of the method of abatement can reasonably be depended upon to last for a minimum of 20 years.

(bw) “Person” means “person” as defined in RSA 130-A:1, XX.

(bx) “Play area” means an area of bare soil contact by children as indicated by the following:

(1) The presence of play equipment such as sandboxes, swing sets, and sliding boards;

(2) Toys or other children’s possessions;

(3) Observations of play patterns or wear;

(4) Information provided by parents, residents, care givers, or owners; or

(5) Any other evidence given or observed indicating a child uses the area for play.

(by) “Risk assessment” means an on-site inspection conducted by a New Hampshire licensed risk assessor, to determine the existence, nature, severity, and location of lead exposure hazards, and the provision of a written report explaining the results of the inspection and options for reducing lead exposure hazards.

(bz) “Rooming house” means a dwelling with multiple rooms rented out individually in which tenants share bathroom and kitchen facilities.

(ca) “Rooming unit” means any room or group of rooms forming a single habitable unit intended for living and sleeping, but not for cooking or eating.

(cb) “Substrate” means the material underneath paint and includes materials such as brick, concrete, drywall, metal, plasters, and wood.

(cc) “Window well” means, for a typical double-hung window, the portion of the exterior window sill between the interior window sill or stool and the frame of the storm window, or when there is no storm window, the area that receives both the upper and lower window sashes when they are both lowered. The term includes “window trough”.

(cd) “Work scope” means a written document detailing all lead hazard reduction activities including identification and location of each component as well as abatement or interim control methods planned for use for each component.

(ce) “Work site” means an interior or exterior area where lead hazard reduction activity takes place. There might be more than one work site within a residential dwelling, dwelling unit, child care facility, or within individual rooms. When used, a mini containment system might constitute the work site.

(cf) “X-ray fluorescence analyzers (XRF)” means a handheld non-destructive analytical device used to determine the elemental composition of materials by measuring the fluorescent or secondary X-rays emitted from a sample when excited by a primary X-ray source.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1603 Laboratory Standards and Reporting

N.H. Code Admin. R. Ann. He-P 1603.01 Laboratory Certification

All laboratories performing blood lead testing on adults or children residing in New Hampshire shall comply with 42 CFR Part 493 Laboratory Requirements, and, if applicable, He-P 808.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1609.03)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1603.02 Reporting

(a) In accordance with RSA 141-A, every person or entity operating under a CLIA waiver, that tests a person’s blood lead level, through the use of a point of care instrument, shall notify the department of the use of this instrument.

(b) In accordance with RSA 141-A, every person or entity operating under a CLIA waiver, that tests a person’s blood lead level shall report the information required by (g) below, electronically to the department by an encrypted electronic transmission at leadtest@dhhs.nh.gov or a secure file transfer protocol.

(c) In accordance with RSA 141-A, every laboratory operating under a CLIA license that analyzes a person’s blood lead level shall report the information required by (g) below to the department via a secure electronic transmission using one of the following formats:

(1) American Standard Code for Information Interchange (ASCII) format;

(2) Health Language 7 (HL7) format or similar formats as developed by a national coalition on electronic laboratory reporting;

(3) Command separated values (CSV) or text (TXT) file; or

(4) Other formats which are compatible with those of the department.

(d) Laboratories shall report all blood lead test results in micrograms per deciliter.

(e) Any laboratory receiving a blood sample for lead analysis from a health care provider, referring laboratory, collecting station, or other source shall require that the requisition includes all the information required in (g) below.

(f) Laboratories shall follow up with health care providers, referring laboratories, collecting stations, or other sources to collect required information in (g) below if information is incomplete.

(g) Laboratories shall supply the following information to the department for each blood lead analysis report:

(1) Specimen identification number;

(2) The individual’s name;

(3) The individual’s date of birth;

(4) The individual’s street address, including the town or city of residence, state of residence, and postal code;

(5) The first and last name of the clinical provider ordering the test;

(6) The name and address of the health care institution where the clinical provider works;

(7) The submitting laboratory’s name, address, and telephone number;

(8) The name of the referring laboratory, if applicable;

(9) Whether the specimen is a venous or capillary sample;

(10) The date of the sample collection;

(11) The date of the sample analysis;

(12) The blood lead analysis results;

(13) The individual’s race;

(14) The individual’s ethnicity;

(15) The individual’s gender;

(16) The name of the individual’s parent or guardian if the individual is aged 15 years or younger;

(17) The occupation of individuals aged 16 years or older;

(18) The name of the individual’s employer at the time that the blood lead test is performed when testing is a requirement of the individual’s occupation;

(19) The method of analysis; and

(20) The results of erythrocyte protoporphyrin analysis and zinc protoporphyrin analysis used to identify anemia and elevated blood lead levels, if conducted.

(h) Laboratories shall report blood lead test results to the department and ordering health care provider as follows:

(1) Within one business day of the analysis when the blood lead level is 45 micrograms per deciliter or higher;

(2) Within 3 business days of the analysis when the blood lead level is 10 micrograms per deciliter but less than 45 micrograms per deciliter; and

(3) Within 5 business days of the analysis when the blood lead level is zero micrograms per deciliter but less than 10 micrograms per deciliter.

(i) A positive blood lead specimen report on a child shall include a recommendation to the ordering health care provider that the child receive follow-up testing.

(j) When a laboratory refers a blood lead sample to another laboratory for analysis, the laboratories shall agree, in writing, on which laboratory:

(1) Is responsible for ensuring that the information required by (g) above is collected; and

(2) Will file the report in compliance with this section.

(k) The agreement in (j) above shall not alter the legal responsibility of both laboratories to ensure that a report is made in compliance with (h) above.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1610.20)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1603.03 Effect on Other Reporting Requirements

Nothing in He-P 1603 shall be construed as relieving any laboratory from reporting the results of any blood lead analysis to the health care provider that ordered the test, or to any other entity as required by state, federal, or local statutes, rules, or regulations.

History

• #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1603.04 Election Not to Participate in Blood Lead Level Testing

(a) A child shall be exempt from the participation in blood lead level testing as required by RSA 130-A:5-c, if:

(1) A parent or legal guardian objects to such testing and completes an “Opt Out Form-Elevated Blood Lead Level Testing” (February 2025) certifying the following:

“I understand that by not testing my child’s blood, neither I, nor my physician, will know if my child has an elevated blood lead level. I understand that young children exposed to lead often look and act healthy, demonstrating no outward signs or symptoms to illness. I understand that young children are especially vulnerable to lead exposure due to their normal developmental behaviors (for example, orally ingesting lead paint and dust) and lead can accumulate in their bodies over time. I understand that an elevated blood lead level can negatively affect my child’s neurological and behavioral development, including speech and language development, memory and learning, hearing, self-regulation and control, muscle motor skills, and coordination, and can result in increased impulsivity and aggressions. If high enough, lead exposure could lead to convulsions, coma, and even death.”;

“My physician has reviewed the risks associated with my child having an elevated blood lead level with me.”; and

“I understand that I may reverse my decision at any time and have my child tested for elevated blood lead levels through a simple test.”; or

(2) A physician licensed under RSA 329, or a physician exempted under RSA 329:21, III completes an “Opt Out Form-Elevated Blood Lead Level Testing” (February 2025) certifying the following:

“As the attending physician, I hereby certify that blood lead level testing may be detrimental to this patient’s health. I acknowledge that this exemption shall only exist for the length of time that I believe testing would be detrimental to the child.”

(b) The form in (a)(1) shall be available:

(1) On the medical care providers landing page at https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/lead-poisoning-prevention-program/medical-providers ; or

(2) By contacting the healthy homes and lead poisoning prevention program at (603) 271-4507.

(c) Executed forms shall be held by the physician in the child’s medical record.

(d) Notwithstanding (a)(1) above, parents or guardians may reverse their decision at any time and choose to consent to blood lead level testing for their child(ren).

History

• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1604 Investigative Process

N.H. Code Admin. R. Ann. He-P 1604.01 Purpose

The commissioner shall investigate cases of lead poisoning in children with elevated blood lead levels as defined in RSA 130-A:5.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1604.02 Requests for Information

In accordance with RSA 130-A:5, I(a), the commissioner shall require information and periodic reports for the purposes of medical and environmental case management and for lead investigations including:

(a) From a child’s health care provider:

(1) The child’s full name;

(2) The child’s date of birth;

(3) The child’s race and ethnicity;

(4) The child’s physical addresses;

(5) The names of the child’s parents or guardians;

(6) The child’s blood lead analysis results;

(7) The plans for medical management of the child;

(8) The names of the child’s siblings;

(9) The child’s siblings’ dates of birth;

(10) The results of the child’s siblings’ blood lead analysis;

(11) Any information available about the child’s sources of lead exposure; and

(12) Any other information pertinent to the management of the child’s elevated blood lead level;

(b) From an owner or owner’s agent of a dwelling or dwelling unit:

(1) Dates of occupancy by the child;

(2) Whether the child continues to occupy the dwelling or dwelling unit at the time of the request;

(3) New address of family, if known, when the family has moved or is relocated under RSA 130-A:8-a;

(4) The lead hazard reduction activities that will be used at the dwelling or dwelling unit;

(5) A progress report on what lead hazard reduction activities have been completed;

(6) Measures taken to protect the child from further exposure to lead;

(7) A completed “Tenant Roster Form” (February 2025); and

(8) Any other information pertinent to the lead investigation and environmental inspection;

(c) From an owner or operator of a child care facility:

(1) Dates of attendance by the child;

(2) Number of hours per week that the child attends the facility;

(3) Whether the child is attending the child care facility at the time of the request;

(4) Names and ages of other children attending the facility;

(5) The lead hazard reduction activities that will be used at the child care facility;

(6) A progress report on what lead hazard reduction activities have been completed;

(7) Measures taken to protect the child and other children in the facility from further exposure to lead; and

(8) Any other information pertinent to the lead investigation and environmental inspection; and

(d) From an owner, owner’s agent, or lead abatement contractor involved in lead inspection or hazard reduction activities at a child’s dwelling, dwelling unit, or child care facility:

(1) A completed “Notification of Work Form” (February 2025) pursuant to He-P 1608.06;

(2) An occupant protection plan, written in accordance with He-P 1608.05, outlining measures taken to protect the child and other persons in the dwelling, dwelling unit, or child care facility from further exposure to lead before and during lead hazard reduction activities;

(3) A written work scope detailing all lead hazard reduction activities including identification and location of each component as well as abatement or interim control methods planned for use for each component; and

(4) The results of any lead inspections conducted at a child’s dwelling, dwelling unit, child care facility, or at any other building associated with a lead investigation.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1612.02)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1604.03 Lead Investigations

(a) In accordance with RSA 130-A:5, I, lead investigations shall include environmental inspections of dwellings, dwelling units, or of any child care facility, and testing environmental samples.

(b) Once the commissioner has notified an owner that an environmental inspection is to be conducted, the owner or owner’s agent shall:

(1) Not re-rent any dwelling or dwelling unit included in the notification that is vacant or becomes vacant until such time as:

a. The inspection(s), as detailed in He-P 1604.03(c) through (e) below, have been conducted;

b. The owner receives a written report from the commissioner; and

c. Has satisfied any order(s) issued on the dwelling or dwelling unit;

(2) Not perform any remodeling, renovating, maintenance, lead hazard reduction work, or any other dust-generating activity until such time as:

a. The inspection(s), as detailed in He-P 1604.03(c) through (e) below, have been conducted;

b. The owner receives a written report from the commissioner; and

c. The activity follows any order(s) issued on the dwelling, dwelling unit, or child care facility; and

(3) Complete and submit to the department at least 24 hours prior to the environmental inspection, a “Tenant Roster Form” (February 2025) certifying the following:

“I certify as an owner of the property that all information contained herein is true and correct to the best of my knowledge and belief and I grant HHLPPP permission to access the property for the purpose of conducting compliance inspections. The parties agree that this Tenant Roster Form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Tenant Roster Form on the basis that it was executed electronically.”

(c) In addition to the procedures set forth in RSA 130-A:6, the commissioner shall carry out the following procedures when conducting environmental inspections of dwellings, dwelling units, or a child care facility where children have elevated blood lead levels as defined in RSA 130-A:5:

(1) Contact the child’s parent or guardian to schedule the environmental inspection;

(2) Arrange access for an environmental inspection with the owner or owner’s agent;

(3) Collect the “Tenant Roster Form” (February 2025) from the owner or owner’s agent;

(4) Test representative painted or varnished interior or exterior building surfaces, and collect water, soil, and dust samples, if applicable, corresponding with the dwelling that the child occupies or occupied when they were tested for lead exposure;

(5) Record all test results and note whether each identified lead-based substance constitutes a lead exposure hazard;

(6) Record the presence of chewed woodwork, including toys and furniture;

(7) Take representative photographs, if applicable, of areas where there is visual presence of chipping, peeling, or flaking paint;

(8) Request assistance from a parent or guardian in identifying a child’s potential lead exposure, that shall include, but not be limited to, the following information:

a. A description of the child’s habits that might increase risk of lead exposure;

b. Possible exposure to other sources of lead, such as lead in pottery and parental occupations and hobbies;

c. Previous addresses and length of residence;

d. A description of other dwellings, dwelling units, and child care facilities in which the child spends time;

e. Recent renovations which might have disturbed lead-painted surfaces; and

f. Any other information that might help identify potential sources of a child’s lead exposure; and

(9) Obtain relevant information in accordance with this section.

(d) If a lead exposure hazard is determined to exist during the environmental inspection in (c) above, the commissioner shall conduct inspections of all other dwelling units of the dwelling, as applicable, as part of the lead investigation to include the following:

(1) All dwelling units disclosed on the “Tenant Roster Form” (February 2025) occupied by a child;

(2) All dwelling units disclosed on the “Tenant Roster Form” (February 2025) occupied by a pregnant woman;

(3) All dwelling units for which a “Tenant Roster Form” (February 2025) was not received by the department at least 24 hours prior to the inspection, as required by He-P 1604.03(b)(3), and assumed to be occupied by a child or pregnant woman;

(4) All dwelling units for which the occupancy status is unknown at the time of the inspection and assumed to be occupied by a child or pregnant woman;

(5) All dwelling units where evidence of being occupied by a child or pregnant woman is discovered during the inspection including discussions with tenants, presence of toys, and other visual or audible cues; and

(6) All other dwelling units which the property owner has expressly requested to be inspected.

(e) Environmental inspections conducted, as part of the lead investigation, in accordance with (d) above shall include the following:

(1) Arranging access for environmental inspections with the owner or owner’s agent;

(2) Recording the resident names and contact information;

(3) Testing representative painted or varnished surfaces for the presence of lead-based substances;

(4) Recording all test results and note whether each identified lead-based substance constitutes a lead exposure hazard;

(5) Recording the presence of chewed woodwork, including toys and furniture;

(6) Recording recent renovations, which might have disturbed lead-painted surfaces;

(7) Taking representative photographs, if applicable, of areas where there is visual presence of chipping, peeling, or flaking paint; and

(8) Other activities conducted and documented to determine the presence of a lead-exposure hazard.

(f) The department shall obtain an administrative inspection warrant under RSA 595-B if consent of the property owner or the owner’s agent for an investigation or inspection is denied.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #142340, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1604.04 Lead Investigation Records

(a) The department shall prepare documentation after conducting a lead investigation that contains:

(1) Date(s) of the environmental inspection(s);

(2) The names, ages, and blood lead levels, if applicable, of all children who reside at or are cared for at the dwelling, dwelling unit, or child care facility being investigated, as provided by the child’s parent or guardian;

(3) The names, physical addresses, including dwelling unit designations and mailing addresses, of all adults and children residing in the dwelling or dwelling unit(s) as provided by the owner on the “Tenant Roster Form” (February 2025);

(4) Findings by the department regarding the existence of lead exposure hazards, including:

a. A description of all locations tested or sampled;

b. Which surfaces meet the definition of a lead-based substance; and

c. Which surfaces meet the definition of a lead exposure hazard;

(5) The results of any environmental sampling conducted by the department including water, dust, and soil if applicable;

(6) The manufacturer, model number, serial number, and calibration verification readings of all XRF equipment used to sample building components;

(7) The name, signature, and license number of the individual performing the environmental inspection(s);

(8) The need for additional testing, and recommended steps to minimize potential lead exposure hazards; and

(9) Any other relevant information collected during the lead investigation and environmental inspection.

(b) The commissioner shall:

(1) Maintain these records on file for the period of at least 4 years;

(2) Provide copies of the documents listed below:

a. Lead inspection survey report to all persons designated in RSA 130-A:6, I, II, III, and IV;

b. Order of lead hazard reduction to all persons designated in RSA 130-A:6, I and II; and

c. Letter of recommendation to all persons designated in RSA 130-A:6, III and IV;

(3) Remove all blood lead test results and other confidential information from all documents provided to the owner or owner’s agent of a dwelling, dwelling unit, child care facility, or to the operator of a child care facility;

(4) In accordance with RSA 130-A:5-7, issue an order of lead hazard reduction or other action when a lead exposure hazard determination has been made; and

(5) Record all orders of lead hazard reduction with the registry of deeds for the county in which the property is situated.

History

• #9986, eff 9-1-11 (from He-P 1612.03), EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1604.05 Role of Health Authorities in Investigations

(a) Health authorities may assist in conducting lead investigations under He-P 1600 in accordance with RSA 130-A:5, III, by providing the following types of assistance:

(1) Contacting owners or occupants to schedule an environmental inspection;

(2) Gathering information as described in He-P 1604.02; and

(3) Any other assistance requested by the commissioner to aid in conducting a lead investigation.

(b) In accordance with RSA 130-A:11, III, the commissioner shall approve a health authority to carry out lead investigations upon submission of the following to the department:

(1) A request in writing to the commissioner for approval to conduct lead investigations;

(2) Documentation of the health authority’s attendance and successful completion of one of the following:

a. An educational program for lead inspectors that is certified in accordance with He-P 1611; or

b. An educational program for risk assessors that is certified in accordance with He-P 1611;

(3) Documentation that the health authority meets all of the criteria for field use of a XRF in accordance with He-P 1608.04(d); and

(4) Written assurance that the health authority will:

a. Conduct lead investigations in accordance with RSA 130-A:5 and 6, and this chapter; and

b. Submit copies of all lead investigation related documents, such as environmental inspection results, to the department.

(c) Approval for a health authority to conduct lead investigations and environmental inspections shall be valid for a period of 12 months.

(d) The commissioner shall renew the approval upon submission of the following by the health authority to the department:

(1) A request in writing to the commissioner for renewal of approval to conduct lead investigations;

(2) When applicable, documentation of attendance and successful completion by the health authority of an approved lead inspector or risk assessor refresher training program as described in He-P 1611 and He-P 1612;

(3) Documentation that the health authority meets all of the criteria for field use of a XRF in accordance with He-P 1608.04(d); and

(4) A written assurance that the health authority will conduct lead investigations in accordance with RSA 130-A:5 and 6, and this chapter.

(e) The commissioner shall deny or revoke such approval in accordance with He-P 1606.02.

History

• #9986, eff 9-1-11 (from He-P 1612.05), EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1605 Orders of Lead Hazard Reduction

N.H. Code Admin. R. Ann. He-P 1605.01 Issuance of Orders of Lead Hazard Reduction

(a) In accordance with RSA 130-A:6 and RSA 130-A:7, the commissioner shall issue an order of lead hazard reduction to an owner when an investigation performed in accordance with He-P 1604 determines that:

(1) A lead exposure hazard as defined in RSA 130-A:1, XVI(a), (b), or (c), exists at a dwelling, dwelling unit, or child care facility; or

(2) A lead exposure hazard as defined in RSA 130-A:1, XVI(d), exists in:

a. Bare soil in a child’s play area; or

b. Any areas where the following combination of soil conditions exists:

1. The total surface area of the bare soil, as defined in He-P 1602.01(d), is equal to or greater than one square yard or 9 square feet; and

2. The soil is located in one or more of the following areas:

(i) Drip line or foundation area;

(ii) Bare pathways; or

(iii) Pet areas.

(b) When an investigation performed in accordance with He-P 1604 does not include testing of any or all of the bare soil, an order of lead hazard reduction shall assume that a lead exposure hazard, as defined in RSA 130-A:1, XVI(d), exists unless analysis in accordance with He-P 1608.04(b) proves otherwise.

(c) Orders of lead hazard reduction issued by the commissioner shall:

(1) Include all information as set forth in RSA 130-A:7, II(a)–(e);

(2) Be sent to the owner by USPS mail and email;

(3) Be accompanied by links to the current versions of RSA 130-A and He-P 1600 if sent via email and copies of RSA 130-A and He-P 1600 if sent via USPS mail;

(4) Set forth corrective action; and

(5) Be sent by mail to the occupant(s) of the dwelling, dwelling unit, or child care facility via the United States Postal Services (USPS).

(d) If requested by an occupant of the dwelling or the guardian of a child attending the child care facility, the owner shall provide a copy of any order of lead hazard reduction issued on the property to the occupant or guardian within 10 business days of the request.

(e) The owner shall disclose, in writing, the existence of an order of lead hazard reduction prior to the sale, lease, rental, or transfer of interest in the dwelling, dwelling unit, or child care facility.

(f) In accordance with RSA 130-A:6, I and II, the commissioner shall notify all occupants of the dwelling, dwelling unit, or child care facility of lead exposure hazard findings in common areas.

(g) The owner shall notify the commissioner of any address change and any change of mailing address of the owner.

(h) The owner shall notify the commissioner of any change in ownership.

History

• #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11 (from He-P 1613.02)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1605.02 Extension Requests

(a) Any owner who has received an order of lead hazard reduction pursuant to RSA 130-A:7, II, may request an extension of the time period for lead hazard reduction as stated in the order by completing and submitting to the department at least 5 business days prior to the expiration of the time frame of the order an “Extension Request Form” (February 2025) certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Extension Request may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Extension Request on the basis that it was executed electronically.”

(b) Upon submission and review of the “Extension Request Form” the commissioner shall extend the time period for lead hazard reduction in accordance with RSA 130-A:7, II(c), upon making the determination that the owner or owner’s agent has:

(1) Provided the department with a completed “Extension Request Form” at least 5 business days prior to the expiration of the order;

(2) Good cause, as defined in He-P 1602.01(ae), for not completing lead hazard reduction work within the time frame ordered;

(3) No outstanding administrative fines or court sanctions issued pursuant to RSA 130-A or He-P 1600; and

(4) Provided the department with evidence of forward progress toward bringing the property into compliance such as:

a. A risk assessment conducted by a licensed risk assessor;

b. A work scope and occupant protection plan developed by a licensed risk assessor or lead abatement supervisor;

c. A “Notification of Work Form” (February 2025) indicating abatement work start and end dates; or

d. Proof of enrollment in a HUD grant program with timeline for completion of a risk assessment and abatement.

(c) Extensions of time for lead hazard reduction granted by the commissioner in accordance with this section shall be in writing and set forth the department’s findings and conditions for granting the extension.

(d) If, upon completion of the time period stated in the order, or an extended time period approved by the commissioner, the owner has not complied with the order, the department shall impose an administrative fine in accordance with He-P 1606 or seek injunctive relief in accordance with RSA 130-A:17.

(e) The commissioner shall deny a request for extension or revoke an extension already granted when it is found that:

(1) The owner is in violation of or noncompliant with one or more provisions of RSA 130-A or He-P 1600;

(2) The request for extension does not meet the criteria in (b) above; or

(3) The order for abatement is the result of the owner’s failure to maintain a current certificate of lead safe interim controls in accordance with He-P 1610.06.

(f) If an extension request is denied or revoked by the commissioner, the denial or revocation shall be:

(1) In writing and set forth the department’s reasons for denying or revoking the extension based on this section; and

(2) Be sent to the owner by USPS mail and email.

(g) If, upon completion of the extension of time, the owner or owner’s agent requires additional time to comply with the order, a new request shall be submitted and reviewed in accordance with this section.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9057, INTERIM, eff 1-3-08, EXPIRED: 7-1-08
• #9210, eff 7-19-08; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1613.03)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1605.03 Variance Requests

(a) Any individual licensed in accordance with He-P 1612 or person subject to the requirements of RSA 130-A or He-P 1600, including, but not limited to, property owners, certified or licensed lead abatement professionals and individuals providing education, may request a variance from compliance with one or more provisions of RSA 130-A or He-P 1600 pursuant to RSA 130-A:10, XV.

(b) A request for variance shall be made by completing and submitting to the department at least 5 days prior to initiating the work or activity that requires a variance, a “Request for a Variance Form” (February 2025), certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Request for a Variance Form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request for a Variance Form on the basis that it was executed electronically.”

(c) If applicable, a copy of the occupant protection plan and work scope shall be included with the request for variance.

(d) Prior to submission, the person making the request shall notify all residents and other persons affected by the variance request by:

(1) Providing a copy of the request; and

(2) Notifying them of their right to contact the department with any questions or concerns.

(e) Only a request for a variance from RSA 130-A or He-P 1600 shall be accepted by the department.

(f) The department shall approve a request for a variance when:

(1) The person making the request is not in violation of any of the provisions of RSA 130-A or He-P 1600;

(2) The department finds that approval of the request will not jeopardize the health and safety of others;

(3) The department finds that the variance request, occupant protection plan, and work scope satisfy the intent of the rules as an alternative to complying with the statute or rule(s); and

(4) The person making the request or the owner does not have any outstanding administrative fines or court sanctions issued pursuant to RSA 130-A or He-P 1600.

(g) When approving a request for a variance the department shall specify what, if any, conditions are being placed on the approval of the request.

(h) If a variance request is approved, compliance with the approved variance shall ensure that the objective or intent of the statute and rules from which the variance is sought will be accomplished.

(i) Lead hazard reduction activities that require a variance shall not be conducted until written approval, including any requirements specified by the department, is received from the department.

(j) The department shall deny a request for a variance if the request does not meet the criteria in (f) above.

(k) The department shall revoke a variance when it is found that:

(1) The person who has been granted the variance has violated or is noncompliant with one or more provisions of RSA 130-A or He-P 1600; or

(2) The work is not done in accordance with the occupant protection plan or work scope submitted to the department.

(l) If during a compliance inspection conducted in accordance with He-P 1605.04 the department determines that any of the requirements placed on the variance are not being complied with, the department shall verbally notify the person in charge of the work site during the compliance inspection and the owner to immediately:

(1) Rectify the deficiencies; or

(2) Cease all lead hazard reduction work, if applicable.

(m) If a variance request is denied or revoked by the department, the denial or revocation shall be in writing and set forth the reasons for denying or revoking the variance.

History

• #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-19; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1605.04 Compliance Inspections

(a) The commissioner shall conduct compliance inspections to verify compliance with the requirements of RSA 130-A and He-P 1600.

(b) When conducting compliance inspections, the commissioner shall use the following procedures:

(1) Obtain written permission from the property owner(s) by the submission of the “Tenant Roster Form” (February 2025) or via another written format;

(2) Upon request, present credentials indicating the authority to conduct such inspections;

(3) Inspect the dwelling, dwelling unit, or child care facility to determine compliance with He-P 1600;

(4) Obtain representative samples of surface coatings, fixtures, soils, or other materials when it is necessary to determine the presence of lead-based substances or a lead exposure hazard;

(5) Take photographs, if necessary, to document the inspection or lead hazard reduction work; and

(6) Inspect and, if necessary, obtain a copy of any lead inspection reports, records of employee licensure or certification, or other documents required under RSA 130-A or He-P 1600.

(c) After completing a compliance inspection, the commissioner shall:

(1) Prepare a written report detailing the findings of the inspection that contains the following information:

a. The date of the compliance inspection;

b. The name of the owner, agent, tenant, lead abatement contractor, lead abatement supervisor, lead abatement worker, or person(s) conducting the lead hazard reduction work to whom credentials were presented, lead inspector, lead risk assessor, lead clearance testing technician, educational program manager, or laboratory director;

c. The name of the department staff conducting the compliance inspection;

d. Findings of the compliance inspection;

e. Results of any testing or analysis conducted on collected samples; and

f. Any other pertinent findings related to the inspection;

(2) Maintain the report on file for a period of 4 years;

(3) Provide copies of the report, upon request, to relevant parties including:

a. The owner or owner’s agent;

b. The dwelling manager;

c. The operator of the child care facility;

d. The occupant;

e. The lead risk assessor, lead inspector, or lead clearance testing technician;

f. The lead abatement contractor or supervisor;

g. The laboratory director;

h. The training manager; or

i. Any other relevant party; and

(4) Pursue enforcement action(s), if necessary, as authorized under RSA 130-A and He-P 1600.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1613.05)
• #13052, eff 6-11-19; ss by #14230, eff 4-2-25

Part He-P 1606 Enforcement Actions

N.H. Code Admin. R. Ann. He-P 1606.01 Administrative Fines

(a) The department shall impose an administrative fine upon an owner, applicant, licensee, certificate holder, or an unlicensed or uncertified individual for violations of RSA 130-A, “Lead Paint Poisoning Prevention” or He-P 1600, “Lead Poisoning Prevention and Control Rules.”

(b) When the department imposes an administrative fine, it shall provide written notice, pursuant to RSA 130-A:7 and RSA 130-A:14, as applicable, which:

(1) Identifies the specific statute or rule that has been violated;

(2) Identifies the specific sanction(s) that has been imposed; and

(3) Provides the following information:

a. The right to a hearing in accordance with RSA 541-A and He-C 200; and

b. The reduction of the imposed administrative fine by 25% if fine payment is received by the department within 10 business days of receipt of the notice of the violation, basis and amount of the administrative fine, and the owner, applicant, licensee, certificate holder, or unlicensed or uncertified individual waives the right to appeal the administrative fine.

(c) Payment of any imposed administrative fine to the department shall meet the following requirements:

(1) Payment shall be received by the department within 10 business days of receiving the fine notice if a person does not appeal the imposed fine as described in He-P 1607.01;

(2) Payment shall be made in the form of personal check or money order made payable to “Treasurer, State of New Hampshire”; and

(3) Money order or certified bank check shall be required when any past payment to the department by personal check has been returned for insufficient funds.

(d) A person may appeal the notice of administrative fine within 10 business days as set forth in He-P 1607.01.

(e) A person may waive the right of appeal of the notice of administrative fine and pay the administrative fine within 10 business days of the date of receipt of the notice.

(f) Any hearing held on an appeal under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(g) An administrative fine, which is appealed and upheld, shall be paid in full within 10 business days of the date of the decision of the administrative appeals unit (AAU).

(h) The department shall impose administrative fines as follows:

(1) For failure to provide the commissioner with all requested information as required by He-P 1604.02, the administrative fine shall be $250.00. Each day the requested information is not provided to the department shall be considered a separate offense and subject to an additional $250.00 fine;

(2) For submitting false or fraudulent information on or with any documentation submitted to the department the administrative fine shall be $5,000.00. Each piece of fraudulent information shall be considered a separate offense and subject to an additional $2,000.00 fine;

(3) For failure to comply with an order of lead hazard reduction issued in accordance with He-P 1605.01, the administrative fine shall be $1,000.00. Each day the order remains in noncompliance shall be considered a separate offense subject to an additional $1,000.00 fine;

(4) For failure by an owner or owner’s agent to allow access, or to arrange access, to a dwelling, dwelling unit, child care facility, or units within a multi-family dwelling for purposes of lead investigation and environmental inspection, in violation of He-P 1604.03(c)(2) and (e)(1), the administrative fine shall be $500.00;

(5) For re-renting a residential dwelling, dwelling unit, or child care facility under a written order by the commissioner or health authority for lead hazard reduction, without a valid and current certificate of lead safe-abatement or certificate of lead safe-interim controls, in violation of RSA 130-A:8-a, III and IV, the fine shall be $5,000.00;

(6) For re-renting a residential dwelling, dwelling unit, or child care facility subject to a lead investigation, after being notified of an impending environmental inspection in violation of He-P 1604.03(b)(1), the fine shall be $5,000.00;

(7) For initiating or performing any remodeling, renovating, maintenance, lead hazard reduction work, or any other dust generating activities after being notified that an environmental inspection shall occur, in violation of He-P 1604.03(b)(2), the administrative fine shall be $5,000.00;

(8) For initiating or performing any remodeling, renovating, maintenance, lead hazard reduction work, or any other dust generating activities prior to the receipt of a written report from the commissioner in violation of He-P 1604.03(b) or in violation of any order(s) issued on the dwelling or dwelling unit, the administrative fine shall be $5,000.00;

(9) For failure by an owner or owner’s agent to submit a “Tenant Roster Form” (February 2025) to the department at least 24 hours prior to an environmental inspection as required by He-P 1604.03(b)(3), the administrative fine shall be $250.00;

(10) For certifying that a dwelling or dwelling unit is either owner occupied or off the rental market as required by He-P 1609.04 and He-P 1609.05 when the dwelling or dwelling unit is not, the administrative fine shall be $5,000.00;

(11) For failure of a property owner to submit a copy of the lead safe certificate to the department prior to re-occupancy in accordance with He-P 1608.13(b)(2), the administrative fine shall be $500.00;

(12) For the failure to disclose, in writing, the existence of an order of lead hazard reduction prior to the sale, lease, rental, or transfer of interest of the property in violation of He-P 1605.01(e), the administrative fine shall be $2,000.00;

(13) For conducting lead hazard reduction work that requires a written variance from the department prior to receiving the department’s written decision, in violation of He-P 1605.03(i), the administrative fine shall be $1,000.00;

(14) For failure to maintain at the work site all documentation required by He-P 1608.15(a) while lead hazard reduction work is taking place, the administrative fine shall be $200.00;

(15) For failure to submit a “Notification of Work Form” (February 2025) including copies of the occupant protection plan and work scope for the project as required by He-P 1608.06, the administrative fine shall be $250.00. Each day abatement activities are being performed and the “Notification of Work Form” (February 2025) and attachments are not provided to the department shall be considered a separate offense and subject to an additional $250.00 fine;

(16) For performing the duties of a lead professional without a current license, certificate, or a variance from the department, in violation of He-P 1612, licensure and certification criteria for lead professionals, the administrative fine shall be $5,000.00 per person per instance;

(17) For utilizing or employing uncertified or unlicensed persons to perform lead hazard reduction work without the written permission of the department, in violation of He-P 1605.03, the administrative fine shall be $2,000.00 per uncertified or unlicensed person or owner;

(18) For falsifying a lead professional license or certification, the administrative fine shall be $1,000.00;

(19) For performing lead hazard reduction work without an occupant protection plan written in accordance with He-P 1608.05 the administrative fine shall be $500.00;

(20) For failure to follow the occupant protection plan specific to the dwelling, dwelling unit, or child care facility as approved and submitted to the department in accordance with He-P 1608.05, the administrative fine shall be $1,000.00;

(21) For failure to provide for the safety of the building’s occupants during lead hazard reduction work, in violation of He-P 1608.10(a) and (e), the administrative fine shall be $1,000.00;

(22) For failure of a lead abatement supervisor or owner-contractor to remain on site when lead hazard reduction work is being carried out, in violation of He-P 1609.01(f), the administrative fine shall be $300.00;

(23) For failure of a contractor or owner-contractor to be available to a lead abatement supervisor when lead hazard reduction work is being carried out, in violation of He-P 1609.01(g), the administrative fine shall be $300.00;

(24) For performing lead hazard reduction work utilizing any of the prohibited practices listed in He-P 1609.02(c), the administrative fine shall be $1,000.00;

(25) For failure to comply with worker safety requirements, in violation of He-P 1608.09(b) through (d), the administrative fine shall be $500.00;

(26) For failure to ensure the maintenance of an accurate record of individuals entering and exiting a lead hazard reduction work area, as required by He-P 1608.10(b) and (c), the administrative fine shall be $200.00;

(27) For failure to prepare the work area in a manner that prevents the escape of lead contaminated materials, in violation of He-P 1608.07 and He-P 1608.08, the administrative fine shall be $500.00 per occurrence;

(28) For failure to contain lead-based substances or lead contaminated material in the work area in violation of He-P 1608.09(a), the administrative fine shall be $1,000.00;

(29) For failure to clean up and dispose of waste in accordance with He-P 1608.11(a) through (f), the administrative fine shall be $1,000.00;

(30) For failure to have a preliminary clearance inspection conducted, if required, in accordance with He-P 1608.12(b) and (c), the administrative fine shall be $500.00;

(31) For allowing unlicensed workers on site prior to passing a preliminary clearance inspection as required by He-P 1608.12(c) the administrative fine shall be $250.00;

(32) For failure of a risk assessor to submit a copy of the certificate of lead safe to the property owner and department within 24 hours when tenants have been relocated during lead hazard reduction work as required by He-P 1608.14(b), the administrative fine shall be $250.00;

(33) For issuing a certificate as described in He-P 1608.14 without complying with all of the requirements of a clearance inspection or issuance of a certificate, in violation of He-P 1608.12 or He-P 1608.14 the administrative fine shall be $2,000.00;

(34) For failure of a risk assessor to submit a copy of the complete written clearance inspection report to the department within 30 days of the collection of samples during the final on-site clearance inspection as required by He-P 1608.12(v)(4)c., the administrative fine shall be $250.00;

(35) For failure of the risk assessor to correct and submit the final complete written clearance inspection report as required by He-P 1608.12(w) with the certificate of lead safe-abatement or certificate of lead safe-interim controls within 10 days of receipt of an errors and omissions inquiry from the department, the administrative fine shall be $250.00;

(36) For failure of a lead abatement contractor, lead inspector, or risk assessor to keep all business and personnel records of all lead projects for a minimum of 5 years after the completion of the project, and make said records available to the department upon request in violation of He-P 1608.15(b) and (c), the administrative fine shall be $200.00;

(37) For conducting blood lead analysis without a valid New Hampshire laboratory license, CLIA Certification, or both, whichever is applicable, in violation of He-P 1603.01, the administrative fine shall be $1,000.00;

(38) For the failure of a laboratory to report all the information required by He-P 1603.02(g)(1)-(20) to the department, the administrative fine shall be $250.00 for each missing item and each incorrect item provided from the information in a blood lead analysis;

(39) For failure of any laboratory to report all the information electronically as required in He-P 1603.02(c)(1)-(4) to the department, the administrative fine shall be $250.00 for each submission;

(40) For failure by a laboratory to report results of blood lead analysis within the timelines required in violation of He-P 1603.02(h), the administrative fine shall be $200.00 for each submission;

(41) For teaching classes without authorization by the department, in violation of He-P 1611.01(a), the administrative fine shall be $2,000.00;

(42) For utilizing faculty who do not meet the requirements as described in He-P 1611.01(d) or (e) in a training program, the administrative fine shall be $500.00;

(43) For failure to notify the department within 30 business days of changes in the names and addresses of the responsible corporate department of the licensed educational company, as required by He-P 1611.01(f), the administrative fine shall be $250.00;

(44) For failure to notify the department before the start of an educational program in violation of He-P 1611.01(g), the administrative fine shall be $500.00;

(45) For failure of a program manager to maintain required educational records pursuant to He-P 1611.01(i) for a period of 5 years, the administrative fine shall be $500.00;

(46) For failure to pay an administrative fine within 10 business days, in violation of He-P 1606.01(c)(1), the fine shall be $250.00;

(47) For failure of a property owner to obtain certification of lead safety for newly constructed rental units prior to being used as a residential rental unit in violation of RSA 130-A:5-d, the fine shall be $500.00 per instance per day;

(48) For failure of a newly licensed day care facility to obtain certification of lead safety in buildings erected prior to January 1, 1978, in violation of RSA 130-A:5-d, the fine shall be $500.00 per instance per day; and

(49) For failure of a property owner to perform and maintain documentation of in-place management requirements in accordance with He-P 1608.16, the fine shall be $1,000.00.

(i) If an administrative fine has been issued, and the same violation is subsequently cited or the violation has not been remedied within 30 days, a second administrative fine in the amount of 2 times the amount of the first fine, per violation shall be issued.

(j) For the third and all subsequent repeat violations to those cited in (i) above, or for violations that have not been remedied after 90 days, the administrative fine per violation shall be 3 times the amount of the first fine.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11; ss by #11007, eff 12-23-15; ss by #13052 (formerly He-P 1606.01); ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1606.02 Denial, Suspension, or Revocation of a License or Certificate

(a) The department shall deny a license or certificate of an applicant, a certificate holder, or licensee if they:

(1) Are in violation of any of the provisions of RSA 130-A or He-P 1600;

(2) Fail to submit a completed application that meets the requirements of He-P 1600 within 30 days after being notified of and given an opportunity to supply missing information;

(3) Have failed to meet the requirements set forth in He-P 1611 or He-P 1612 for receiving a license or certificate for which the applicant is applying;

(4) Have submitted false, misleading, or fraudulent information whether by action or omission;

(5) Have failed to comply with a decision of the department, AAU, a settlement or consent agreement, or court issued decision;

(6) Have failed to pay an administrative fine imposed by the department or the courts;

(7) Have had enforcement action taken by another state or the EPA for lead regulation violations resulting in a current license or certificate being revoked or suspended;

(8) Or any of their representatives or employees:

a. Provide false or misleading information to the department;

b. Prevent, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fail to provide requested files or documents to the department; or

(9) Have knowingly committed or participated in fraud or misrepresentation in obtaining, using, or maintaining licensure or certification such as:

a. Performing work requiring licensure or certification at a job site without having current and valid licenses or certificates available at the job site for inspection;

b. Permitting the duplication or use of their license or certificate by another;

c. Performing lead hazard reduction work or inspections before receiving the appropriate license or certificate from the department; or

d. Obtaining a license or certificate through fraud or misrepresentation of educational documents, examination documents, professional registration, or experience requirements.

(b) The department shall suspend a license or certificate of a certificate holder, or licensee if the individual, lead educational program, or business entity:

(1) Is in violation of any of the provisions of RSA 130-A or He-P 1600;

(2) Has failed to pay an administrative fine imposed by the department or the courts;

(3) Has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of money order or certified check within 5 business days of notification; or

(4) Any of their representatives or employees:

a. Provides false or misleading information to the department;

b. Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide requested files or documents to the department.

(c) The department shall revoke a license or certificate of a certificate holder or licensee if the individual, lead educational program, or business entity:

(1) Has failed to or is unable to comply with the conditions set forth in a decision for suspension, in accordance with (b) above;

(2) Has submitted false, misleading, or fraudulent information whether by action or omission;

(3) Has failed to comply with a decision of the department, AAU, a settlement or consent agreement, or court issued decision;

(4) Has issued a lead educational program completion certificate to an individual who did not meet all of the educational requirements for that completion certificate as defined by He-P 1611;

(5) Has had enforcement action taken by another state or the EPA for lead regulation violations resulting in a current license or certificate being revoked or suspended;

(6) Has knowingly committed or participated in fraud or misrepresentation in obtaining, using, or maintaining licensure or certification such as:

a. Performing work requiring licensure or certification at a job site without having current and valid licenses or certificates available at the job site for inspection;

b. Permitting the duplication or use of their license or certificate by another;

c. Performing lead hazard reduction work or inspections before receiving the appropriate license or certificate from the department; and

d. Obtaining a license or certificate through fraud or misrepresentation of educational documents, examination documents, professional registration, or experience requirements; or

(7) Is cited a third time under RSA 130-A or He-P 1600 for the same violation within the prior 18 months.

(d) When the department denies, suspends, or revokes a license or certificate, it shall provide written notice, which:

(1) Identifies the specific statute or rule that has been violated, if applicable;

(2) Identifies the specific sanction(s) that has been imposed, if applicable; and

(3) Contains information on the right to a hearing in accordance with RSA 541-A and He-C 200.

(e) If the department finds that the public health, safety, or welfare requires emergency action and incorporates such a finding in its order, the department shall order an immediate suspension of a license, or certificate pending an adjudicative proceeding to be conducted in accordance with RSA 541-A:30, III and He-C 200.

(f) When a license or certificate is revoked by the department, the individual, business entity, or educational program shall not be eligible to reapply for a license or certificate for 2 years.

(g) The 2 year period referenced in (f) above shall begin on:

(1) The date of the department’s decision to revoke the license, or certificate if an administrative hearing has not been requested; or

(2) The date a decision is issued by the AAU or court if a hearing is requested.

(h) A decision by the department to deny or revoke a license, or certificate shall not preclude any other enforcement action authorized under RSA 130-A, 15 USC 2681-2692, and 42 USC 4821-4856.

(i) If the individual, business entity, or educational program reapplies for a license or certificate after the 2 year period as referenced in (f) above, the individual, business entity, or educational program shall submit, in writing to the department, steps taken to address the violations(s) that led to the revocation.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20 (formerly He-P 1602.03); ss by #14230, eff 4-2-25

Part He-P 1607 Appeals

N.H. Code Admin. R. Ann. He-P 1607.01 Appeals Procedures

(a) Any person who wishes to appeal an enforcement action issued by the department pursuant to RSA 130-A and He-P 1600 shall make a request for a hearing in accordance with the following:

(1) The request for a hearing shall be received by the department within 10 business days of the date of receipt of the following:

a. An order of lead hazard reduction;

b. A notice of administrative fine(s);

c. A decision to deny an initial or renewal license application; or

d. A decision to suspend or revoke a license or certificate; and

(2) The request shall be in writing, signed by the person(s) named in the order, notice or decision, or their legal representative, and shall list specific information as to why the order, notice of fine, or decision was unlawful or unwarranted.

(b) The appeal shall be sent to:

Department of Health and Human Services

Division of Public Health Services

Healthy Homes and Lead Poisoning Prevention Program

29 Hazen Drive

Concord, NH 03301

(c) The department shall be responsible for ensuring that a request for a hearing is delivered to the AAU.

(d) The hearing shall be conducted in accordance with the provisions of RSA 541-A and He-C 200.

(e) The order, notice, or decision issued by the department shall become final if the person(s) named in the order, notice, or decision fails to request a hearing within 10 business days as described in (a) above.

(f) Requesting a hearing relative to the imposition of a fine does not relieve the person(s) named in the order from the responsibility of complying with the order.

History

• #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1615.01)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1608 Lead Hazard Reduction Requirements

N.H. Code Admin. R. Ann. He-P 1608.01 Inspection Requirements

(a) All lead inspection activities shall be performed by persons licensed or certified in accordance with He-P 1612.

(b) No person performing lead inspections, or risk assessments shall:

(1) Perform the lead hazard reduction work on the dwelling, dwelling unit, or child care facility being inspected or assessed;

(2) Be paid, employed, have an interest in, financial or otherwise, direct or indirect, or otherwise be compensated by the lead abatement supervisor, the contractor for which the lead abatement supervisor is affiliated, or owner-contractor, unless the owner is acting as an owner-contractor; or

(3) Be the owner of, an employee of the owner, or have an interest, financial or otherwise, direct or indirect, in the dwelling, dwelling unit, or child care facility.

(c) All persons conducting risk assessment and lead inspection work shall comply with:

(1) Standards and requirements set forth in RSA 130-A and He-P 1600; and

(2) Standards and requirements set forth in the OSHA Lead in Construction Standard, 29 CFR 1926.62.

(d) A licensed risk assessor, lead inspector, or certified lead clearance testing technician, shall develop written inspection procedures containing the following elements and submit the procedures with an initial application for licensure:

(1) A general description of sampling protocols including the selection process of components to be sampled;

(2) Testing methods to be used to inspect for the presence of lead-based substances according to type of surface and substrate;

(3) Procedures to be followed when weather conditions prohibit sampling of soil at the time of inspection;

(4) Procedures as described in (3) above shall include soil sampling within 14 calendar days after soil conditions allow for such testing; and

(5) Quality control procedures for all field measurement and sample collection methods.

(e) A lead inspector, lead clearance testing technician, or risk assessor who is conducting an inspection for lead-based substances shall include the following in the inspection report:

(1) Date of inspection;

(2) Address of dwelling, dwelling unit(s), or child care facility;

(3) Date of construction of dwelling, dwelling unit(s), or child care facility;

(4) Unit number(s), if applicable;

(5) A description of the current use of the dwelling, dwelling unit(s), or child care facility;

(6) Name(s), address(es), and telephone number(s) of all dwelling, dwelling unit(s), or child care facility owners;

(7) Name(s), legal and business address(es), signature(s), and license number(s) of each licensed inspector(s), lead clearance testing technician(s), or risk assessor(s) conducting the inspection;

(8) Name(s), address(es), and telephone number(s) of any company or other person employing the lead inspector(s), lead clearance testing technician(s), or risk assessor(s) in that capacity;

(9) A schematic site plan of the area inspected, showing rooms within the dwelling, dwelling unit, or child care facility and their use, common areas, exterior surfaces and areas, play areas, and any other relevant structures on the property, including the locations or written description of any bare soil and dust collection points;

(10) Specific locations of each painted component tested for the presence of lead-based paint and each soil sample collected including a clear designation of whether or not the soil sample collected was from a child’s play area;

(11) Each testing method and device or sampling procedure employed for paint, soil, and dust analysis, including quality control data and, if used, the manufacturer, model number, and serial number of any XRF device;

(12) If more than one XRF is used to conduct an inspection, the results of each surface and representative area tested to be annotated on the report to indicate the specific XRF used for testing;

(13) The results of the inspection expressed in terms appropriate to the sampling method used and if tested, identification of all components with coating which meets the definition of lead based paint;

(14) The location and condition of any damaged or deteriorated substrate or component that compromises the effectiveness of the lead hazard reduction technique;

(15) All data collected using on-site testing devices including calibration check readings;

(16) Name(s), address(es), and telephone number(s) of all laboratories conducting analysis of collected samples;

(17) All results of laboratory analysis on collected samples including paint, surface coatings, soil, and dust samples;

(18) Recommendations regarding the need for additional testing;

(19) A signed certification stating, “I hereby certify that sampling and analyses have been conducted pursuant to He-P 1608.04 and accurately represents the conditions in the areas tested on this date”;

(20) The written inspection procedures as required in (d) above; and

(21) A statement regarding the owner’s requirement to disclose in accordance with 40 CFR Part 745.107.

(f) If an inspector, lead clearance testing technician, or risk assessor becomes aware that lead hazard reduction work has not been done in accordance with RSA 130-A or He-P 1600, the inspector, lead clearance testing technician, or risk assessor shall provide notice to the department within 24 hours of the discovery via telephone at (603) 271-4507, fax at (603) 271-3991, email at nhleadprogram@dhhs.nh.gov, or in writing.

(g) A notice made to the department in accordance with (f) above, shall include the following information:

(1) The date(s) the violation(s) occurred, if known;

(2) The address(es) where the violation(s) took place;

(3) The nature of the violation(s);

(4) The date(s) the violation(s) was discovered by the person submitting the notice; and

(5) The name(s) of the individual(s) that conducted the work, if known.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.02 Requirements for Lead-Based Paint Inspections

, Lead-Based Substance Inspections, and Visual, Dust, and Soil Inspections.

(a) A lead-based paint inspection shall:

(1) Be conducted by either a lead inspector or risk assessor licensed in accordance with He-P 1612;

(2) Identify all components within a dwelling, dwelling unit, or child-care facility with coating which meets the definition of lead-based paint;

(3) Consist of testing all components for lead-based paint including sampling and analysis methods as listed in He-P 1608.04 on all surfaces of each painted, varnished, or otherwise coated component of the dwelling, dwelling unit, or child care facility.

(b) A lead-based substance inspection shall consist of all the requirements for conducting a lead-based paint inspection in accordance with He-P 1608.02 and the following which may be performed by a certified lead clearance testing technician or a licensed lead inspector or risk assessor:

(1) Collecting soil samples for analysis in accordance with He-P 1608.04 if bare soil is located in any of the following areas:

a. In a child’s play area;

b. Within 5 feet of the foundation area; or

c. Within 100 feet of the foundation when the total surface area of the bare soil is equal to or greater than one square yard or 9 square feet; and

(2) Collecting single surface or composite dust samples and submitting the samples to a certified laboratory for analysis in accordance with procedures set forth in He-P 1608.04(b) and (c) from the following areas:

a. In single family dwellings the samples shall be collected from the floor and a window well, or a windowsill in each living area, hallway, and stairwell where a child is likely to come in contact with dust; or

b. In a multi-family dwelling or child care facility the samples shall be collected from the floor and a window well, or a windowsill, in living and common areas to the dwelling unit or child care facility where a child is likely to come in contact with dust.

(c) A visual, dust, and soil inspection shall:

(1) Be conducted by a lead inspector, risk assessor, or lead clearance testing technician licensed or certified in accordance with He-P 1612;

(2) Include a visual assessment identifying areas of deteriorated, flaking, chipping, peeling, or not-intact paint;

(3) Include collection of soil samples for analysis in accordance with He-P 1608.04 and submitting the samples to a certified laboratory for analysis if bare soil is located in any of the following areas:

a. In a child’s play area;

b. Within 5 feet of the foundation area; or

c. Within 100 feet of the foundation when the total surface area of the bare soil is equal to or greater than one square yard or 9 square feet; and

(4) Include collection of single surface dust samples and submission of the samples to a certified laboratory for analysis in accordance with procedures set forth in He-P 1608.04(b) and (c) from the following areas:

a. In single family dwellings the samples shall be collected from the floor and a window well, or a windowsill in at least four rooms where a child is likely to come in contact with dust; or

b. In a multi-family dwelling or child care facility, in addition to (a) above, samples shall also be collected from the floor and a window well, or a windowsill in common areas to the dwelling unit or child care facility where a child is likely to come in contact with dust.

(d) The licensed or certified individual conducting the lead-based paint, lead-based substance inspection, or visual, dust, and soil inspection, shall issue a report to the owner and department, as applicable that complies with the requirements of He-P 1608.01(e).

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.03 Requirements for a Risk Assessment

(a) Upon receipt of an order of lead hazard reduction, the owner shall have a risk assessment of the dwelling, dwelling unit, or child care facility conducted by a risk assessor licensed in accordance with He-P 1612 to identify all lead-based substances and lead exposure hazards.

(b) A risk assessment shall include:

(1) All requirements of a lead-based substance inspection as set forth in He-P 1608.02(b);

(2) Collection of background information regarding the physical characteristics of the dwelling, dwelling unit(s), or child care facility, and occupant use patterns that might cause lead-based paint exposure;

(3) Conducting a visual inspection to locate the existence of potential lead exposure hazards including paint which is located on chewable, friction, or impact surfaces or is in a damaged or deteriorated condition, and to assess the extent and causes of damages or deteriorated paint or lead exposure hazards; and

(4) Testing each surface identified to be a potential lead exposure hazard by the visual inspection described in (3) above and having a distinct paint history for the presence of lead in accordance with He-P 1608.04.

(c) The risk assessor shall prepare a complete written risk assessment report, which includes the following information:

(1) All information required by He-P 1608.01(e);

(2) Identification of all lead-based substances and lead exposure hazards as defined by RSA 130-A:1, XI and XVI including a description of the location, type, and condition;

(3) Results of the visual inspection;

(4) Any background information collected pursuant to He-P 1608.03(b)(2);

(5) The results of any previous inspections or analyses for the presence of lead-based paint, or other lead exposure hazards to the extent that they are used as part of the lead-based paint hazard determination;

(6) A schematic site plan of the area or a written description of all dust and soil collection points;

(7) Any observed conditions that could potentially create a lead exposure hazard or compromise the effectiveness of the lead hazard reduction technique such as water leaks, moisture, or mold;

(8) Recommendations, if warranted, for a follow-up risk assessment, and as appropriate, any further action;

(9) A description of interim controls or abatement options for each lead exposure hazard identified;

(10) Recommendations for a maintenance and monitoring schedule if the use of an encapsulant or enclosure is recommended; and

(11) Results for all samples collected and analyzed from the environmental laboratory.

(d) Complete risk assessment reports prepared in (c) above on properties under order of lead hazard reduction shall be submitted to the department by the risk assessor within 30 calendar days of the risk assessment.

(e) Any risk assessment report submitted to the department after 30 calendar days from the receipt of all results of any samples analyzed from the environmental laboratory shall be subject to administrative action.

History

• #5920, eff 1-1-95; ss by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.04 Sampling and Analysis Methods

(a) Testing for the presence of lead in paint shall be conducted by one or more of the following methods:

(1) Field measurement by XRF using standards set forth in the U.S. Department of Housing and Urban Development (HUD) “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 Edition), available as noted in Appendix A;

(2) Laboratory analysis of paint chips by atomic absorption spectrometry using standards set forth in Appendix 14.1 of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 Edition), available as noted in Appendix A; or

(3) Any testing method using recognized published procedures or methods developed and validated by the laboratory using assayed materials, inter-lab comparisons, or proficiency test samples.

(b) All collection and analysis of samples from paint chips, dust, soil, or other media shall comply with standards set forth in the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A.

(c) All environmental samples shall be submitted to a laboratory recognized by the EPA National Lead Laboratory Accreditation Program (NLLAP).

(d) The following requirements shall apply if field measurements by XRF are used:

(1) The user shall have a currently valid license or registration for the XRF instrument used, issued by the department’s radiological health section in accordance with He-P 4000, if applicable;

(2) The calibration of each XRF unit shall be checked as follows:

a. The calibration of XRF instruments shall be checked against the manufacturer’s standards for that instrument in accordance with the manufacturer’s specifications for that instrument and the “Performance Characteristic Sheet (PCS)”, a document based on methodology developed jointly by the EPA and HUD set forth in Chapter 7, Addendum 3 of the HUD’s “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing" (2012 Edition), available as noted in Appendix A;

b. At a minimum, the calibration check for each XRF instrument used shall be conducted before the inspection begins and either after the day’s inspection work has been completed, or at least every 4 hours, whichever occurs first and in accordance with manufacturer’s specifications for the instrument if more frequent calibration checks are recommended;

c. If the XRF instrument’s calibration check average of 3 readings is outside the acceptable calibration check tolerance range specified in the instrument’s PCS, and the manufacturer’s instructions to bring the instrument back into control does not yield a successful calibration check the instrument shall be removed from use until such time as the unit is again operating within the acceptable calibration check tolerance range of the instrument’s PCS and the manufacturer’s specified tolerance for each standard; and

d. The results of all calibration checks shall be recorded on the inspection report;

(3) Except as provided in (4) below, XRF measurements shall be adjusted to compensate for substrate interference utilizing substrate correction protocols set forth in the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing" (2012 Edition), available as noted in Appendix A;

(4) Adjustment of XRF measurements to compensate for substrate interference shall not be required when the manufacturer’s PCS indicates that substrate corrections are not necessary; and

(5) Surfaces shall not be considered to contain lead-based paint when the XRF reading is less than 1.0 mg/cm2 and the PCS’s classification of results are factored into the calculation of the reading.

(e) When conducting lead inspections in multifamily housing that has more than one dwelling unit or child care facility in the same building, complex, or development, the lead inspection shall be conducted in accordance with the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.05 Occupant Protection Plan

(a) An occupant protection plan shall describe the measures and management procedures that will be taken during the lead hazard reduction activities to protect the building occupants from exposure to any lead hazards including compliance with requirements of He-P 1608.07 and He-P 1608.08.

(b) An occupant protection plan shall be:

(1) Required before any lead hazard reduction work is performed;

(2) Based on the performance and review of a lead inspection or risk assessment conducted in accordance with He-P 1608.02 and He-P 1608.03;

(3) Unique to each residential dwelling, dwelling unit, or child care facility; and

(4) Developed by a lead risk assessor, lead abatement supervisor, or an owner-contractor licensed or certified in accordance with He-P 1612, or any person who has been granted a variance by the commissioner in accordance with He-P 1605.03.

(c) If an occupant protection plan is developed by a person who has been granted a variance by the commissioner, the occupant protection plan shall be approved by a lead risk assessor, or a lead abatement supervisor, licensed or certified in accordance with He-P 1612, prior to being implemented.

(d) Whenever lead abatement activity is being conducted in a common area of a residential dwelling containing 2 or more dwelling units, the occupant protection plan shall:

(1) Indicate alternative entrances and exits that do not require passing through the common area(s) where lead abatement activity is being conducted; or

(2) Identify the containment that shall be utilized to create a passageway through the common area(s) for use as an entry into uncontaminated residential dwellings, dwelling units, or child-occupied facilities.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.06 Notification

of Work.

(a) The lead abatement contractor or person granted a variance in accordance with He-P 1605.03, shall notify the department in writing using a “Notification of Work Form” (February 2025) of the intended schedule of work at least 5 days before lead abatement work begins.

(b) A complete “Notification of Work Form” (February 2025) shall be submitted to the department and the owner or owner’s agent at least 5 days prior to the abatement project beginning, certifying the following:

(1) “I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I understand a certified lead abatement supervisor shall be on site at all times while abatement activities are in progress and if unlicensed or uncertified individuals will be working on the project I understand they are only allowed on-site once preliminary clearance has been achieved. I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Notification of Work Form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Notification of Work Form on the basis that it was executed electronically.”

(c) The “Notification of Work Form” (February 2025) shall be accompanied by:

(1) A copy of the work scope, detailing actions to be taken to abate or manage by interim controls all lead-based substances; and

(2) A copy of the occupant protection plan prepared in accordance with He-P 1608.05.

(d) Notification of changes to the start or end date(s) documented on the “Notification of Work Form” (February 2025) shall be made by the lead abatement contractor, lead abatement supervisor, or person granted a variance as follows:

(1) By contacting the department by telephone or email at least 48 hours before the new start or end date(s), and resubmitting to the department another “Notification of Work Form” (February 2025) within 48 hours of the telephone notification; or

(2) By resubmitting to the department by facsimile or email another “Notification of Work Form” (February 2025) that meets the requirements set forth in this section at least 48 hours before the new start or end date.

(e) The owner or owner’s agent of a leased or rented dwelling or dwelling unit shall provide written notification to all occupants affected by the lead hazard reduction work at least 5 days in advance of the proposed lead hazard reduction work, which includes:

(1) Scheduled dates and work hours for the lead hazard reduction work;

(2) Identification of work site(s);

(3) Information on the alternative entrance or exit to be used during the work; and

(4) A copy of the occupant protection plan.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.05)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.07 Preparation of Interior Work Areas

(a) Prior to beginning any lead hazard control activity on the interior of any dwelling, dwelling unit, or child care facility, all interior lead hazard reduction work areas shall be prepared in accordance with the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition) available as noted in Appendix A, to ensure that the work area is isolated and no dust or debris leaves the work area while the work is being performed, in addition to the following requirements:

(1) All sheeting used in containment and barrier systems and sealant materials shall:

a. Be polyethylene sheeting at least 6-mil thick or an equivalent material intended to contain leaded dust and debris;

b. Be secured in place with waterproof tape;

c. Be maintained to prevent the release of lead or lead-contaminated materials from the work areas;

d. Remain in place and intact until clean-up for the preliminary inspection when at least one layer shall remain in place;

e. Be removed before the final clearance inspection;

f. Be stored, managed, and disposed of in accordance with He-P 1608.11;

g. Adhere to the details outlined in the occupant protection plan written for the lead hazard reduction project in accordance with He-P 1608.05; and

h. Adhere to the worker protection requirements of He-P 1608.09;

(2) All furniture and related movable and non-movable objects such as refrigerators, stoves, rugs, furniture, window coverings, and food preparation counters in the work area shall be removed from the work area or covered with sheeting used in containment and barrier systems and taped securely at all seams and at all junctures to the floor with waterproof tape;

(3) When heating, ventilation, or air conditioning (HVAC) intake or exhaust vents are located in a lead hazard reduction work area, the HVAC system shall be shut down in the work area and vents sealed with sheeting, used in barrier and containment systems, and waterproof tape;

(4) If a break or tear occurs in any sheeting used in barrier and containment systems to seal the HVAC system:

a. The HVAC system at the site of the break shall be visually inspected by the person conducting the lead hazard reduction work; and

b. Any visible lead contamination shall be cleaned by a cycle of vacuuming with a HEPA vacuum, wet washing with a general all-purpose or lead-specific cleaner, and a repeat HEPA vacuuming;

(5) Floor sheeting shall comply with the following:

a. Sheeting shall be sized to minimize seams;

b. A minimum of 2 layers of 6-mil polyethylene sheeting, or an equivalent material intended to contain leaded dust and debris, and sealant materials shall be maintained to prevent the contamination of flooring with lead or lead-contaminated materials;

c. If a break or tear occurs in the bottom sheet of any sheeting used in a barrier and containment system that is covering carpeting, the carpet shall be cleaned prior to the clearance inspection by:

1. A thorough vacuuming with a HEPA vacuum;

2. Shampoo or steam cleaning using a general all-purpose or lead-specific cleaner; and

3. A second vacuuming with a HEPA vacuum when the carpet is dry; and

d. If abatement is needed on the flooring, work shall be conducted in phases and sheeting shall meet the requirements above and be utilized in such a manner to prevent lead dust contamination from other abatement work on the existing flooring, underlayment, and new flooring;

(6) A mini-containment area may be built by surrounding the work area with temporary walls to allow small areas to be addressed or windows to be replaced;

(7) The area in (6) above shall comply with:

a. The requirements of (1) through (5) above; and

b. The following:

1. The mini-containment area shall be constructed of wood or other rigid framing and 6-mil polyethylene sheeting or an equivalent material in order to define the area with sides, a ceiling and a floor;

2. An air-flap shall be constructed at the entryway to the mini-containment;

3. The mini-containment shall be affixed securely to the wall such that there are no gaps between the mini-containment and the wall;

4. The mini-containment area shall be subject to daily and final cleaning, as well as clearance sampling requirements;

5. Passageways used by workers going to and from the mini-containment area and other areas used for storage of tools or debris shall be covered with 2 layers of 6-mil polyethylene sheeting or an equivalent material;

6. The mini-containment area shall remain in place until final clean up; and

7. Access to the room where any mini-containment area has been constructed shall be restricted in accordance with the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 Edition), available as noted in Appendix A, until clearances have been achieved.

(b) Prior to removing lead-based substances or beginning any other lead hazard reduction work, warning signs shall be posted in accordance with the following:

(1) Signs shall be posted at all entrances and exits of the dwelling, dwelling unit, or child care facility clearly defining the work area and warning occupants and other persons not involved in the abatement activities to remain outside the work area;

(2) All signs shall be at least 8.5 inches by 11 inches, and include the phrase “Lead Hazard, Keep Out,” or similar wording in bold lettering at least 3/4 inches high;

(3) In common areas that are to be abated in dwellings with 2 or more dwelling units or a child care facility, the signs shall be posted at all entrances and exits of the dwelling or child care facility and include the phrase, “Caution Lead Hazard, Do Not Remain in Work Area Unless Authorized,” or similar wording, in bold lettering at least 3/4 inches high;

(4) Signs shall remain in place and be readable until abatement is completed and clearance achieved; and

(5) Signs shall include a 24-hour contact phone number and name of person responsible for the work area.

(c) In addition to all of the requirements under (a) and (b) above, when dust generating activities are utilized on the work site during the lead exposure hazard reduction project, a worker changing area shall be:

(1) Set up adjacent to the abatement work area; and

(2) Constructed in accordance with Chapter 9 of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A.

(d) No person shall exit the abatement work area without removing their abatement work clothes, gloves, boot or shoe covers, and respirator in the designated changing area.

(e) All tools and other items shall be wiped free of dust and debris before leaving the work area.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.10)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.08 Preparation of Exterior Work Areas

(a) Prior to beginning any lead hazard control activity on the exterior of any structure or dwelling, the area shall be prepared in accordance with Chapter 8 of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A, and the following requirements:

(1) All sheeting materials used in containment and barrier systems shall be:

a. Polyethylene sheeting at least 6-mil thick, or an equivalent material intended to contain leaded dust and debris;

b. Secured with a minimum of waterproof tape;

c. Maintained to prevent the release of lead or lead-contaminated materials from the work areas;

d. Used and constructed following the details outlined in the occupant protection plan written for the lead hazard reduction project in accordance with He-P 1608.05; and

e. Used and constructed to follow the worker protection requirements of He-P 1608.09 and OSHA.

(2) Clean drop cloths shall be used to cover grass, shrubbery, and other vegetation that might otherwise be damaged if polyethylene sheeting is used;

(3) All lead substances and lead dust shall be contained in the work area by the following measures:

a. All doors, windows, or other openings on the side of a building as well as any windows and doors within 20 feet of where any wet sanding, component removal, or other dust-generating exterior activity is planned shall be closed and sealed with sheeting on the outside;

b. The ground or floor surface under all work areas shall be covered with sheeting or drop cloths as described in (1) and (2) above as follows:

1. When sheeting or a drop cloth is placed on the ground, it shall be raised at its edges at least 3 inches and shall extend out from the foundation at least 3 feet per story, with a minimum of 5 feet and a maximum of 20 feet to contain all waste;

2. The sheeting or a drop cloth shall be securely fastened to the foundation or exterior wall and sealed with waterproof tape;

3. The sheeting or a drop cloth shall be sealed at all seams with waterproof tape; and

4. When sheeting is placed on an exterior floor, it shall be raised at its edges at least 3 inches to contain all waste and shall cover the entire floor;

c. If the constant wind speed is over 20 miles per hour, exterior abatement producing dry wastes or lead-containing dust shall not be performed unless vertical shrouds are constructed which contain all lead dust within an area where there is no public access; and

d. If the requirements of He-P 1608.08(a)(3)(b)(1) above cannot be met, ground covering shall not be used and vertical containment or equivalent extra precautions in containing the work area are necessary in order to prevent contamination of other buildings or areas; and

(4) All exterior work areas shall be posted with the warning signs required under He-P 1608.07(b).

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.11)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.09 Worker Protection

(a) All work areas where employees perform lead hazard reduction work shall be arranged, equipped, operated, and conducted in a manner which will prevent lead-based substances or lead contaminated materials from escaping from the work areas, in accordance with the requirements set forth in He-P 1608, He-P 1609, He-P 1610, and OSHA 29 CFR 1926.62 Lead in Construction.

(b) No employee shall be permitted to eat, drink, chew gum, use tobacco products, vape, or apply cosmetics in any lead hazard reduction work area.

(c) All individuals and employees who enter into an area where lead hazard reduction work is occurring shall comply with all applicable worker safety and respiratory protection requirements in accordance with 29 CFR 1910.134.

(d) All personal protective equipment required in (c) above shall be provided to the employees by their employer free of charge.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.10 Control of Access

(a) Until a clearance inspection has been completed and the dwelling, dwelling unit, or child care facility has been found to meet the criteria set forth in He-P 1608.12, the lead abatement contractor, owner-contractor, lead abatement supervisor, or any person(s) granted a variance by the commissioner shall:

(1) Make certain that all occupants have been relocated outside the work area in accordance with the occupant protection plan and the United States Department of Housing and Urban Development (HUD) “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition) available as noted in Appendix A; and

(2) Limit access and entry into any lead containment area to the following:

a. The owner of the property where the lead hazard reduction work is occurring, or the owner’s designee;

b. Licensed or certified lead professionals;

c. Any federal, state, or local official with jurisdiction over one or more of the activities within the work area; and

d. Non-licensed or non-certified workers only after a preliminary clearance inspection has been obtained as described in He-P 1608.12(a)–(g).

(b) The lead abatement contractor, owner-contractor, lead abatement supervisor, or any person(s) granted a variance by the commissioner shall maintain an access control log for persons who have entered any lead hazard reduction work area as allowed in (a)(2) above.

(c) All individuals entering and exiting the lead hazard reduction work area shall provide the following information on the access log:

(1) Date of entry;

(2) Printed name(s) and signature(s) of person(s) entering the lead hazard reduction work area;

(3) Employer of person(s) entering the lead hazard reduction work area; and

(4) Time of entry and exit.

(d) The lead abatement contractor, owner-contractor, lead abatement supervisor, or any person(s) granted a variance by the commissioner shall ensure that the lead hazard reduction work does not violate state laws, rules, or local ordinances for health, building and fire safety for access to the dwelling, dwelling unit, or child care facility.

(e) Whenever lead hazard reduction work is being performed in any common or shared area of an occupied dwelling or child care facility, the following shall apply:

(1) The lead abatement contractor, owner-contractor, lead abatement supervisor, or any person(s) granted a variance by the commissioner shall conduct work in phases, or shall ensure that an uncontaminated passage that is in compliance with all state laws, rules, or local ordinances for health, building, and fire safety exists for entry and egress from the dwelling, dwelling unit(s), or child care facility for all occupants to use; or

(2) When it is not possible to preserve an uncontaminated passage for entrance and exit of all occupants from the dwelling in compliance with all state laws, rules, or local ordinances for health, building, and fire safety:

a. Lead hazard reduction work shall only be conducted in any common area when all occupants whose access is affected by the lead hazard reduction work are out of the building during all work periods provided that:

1. The work area shall be cleaned with a HEPA vacuum at the end of each work period;

2. The HEPA vacuuming shall be followed by a wet washing using a general all-purpose or lead-specific cleaner; and

3. After the work area is completely dry, a repeat HEPA vacuuming shall be done until all surfaces are free of visible dust and debris; or

b. The owner shall comply with the provisions of RSA 130-A:8-a regarding the relocation of building occupants whose access is affected by the lead hazard reduction activities for the duration of the work that hinders access.

History

• #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.11 Clean-up Requirements

(a) The lead abatement contractor, owner-contractor, lead abatement supervisor, or the person(s) granted a variance by the commissioner to perform lead hazard reduction work shall be responsible for the following:

(1) All lead debris and lead contaminated materials shall be stored, managed, and disposed of in compliance with this section; and

(2) At the end of each workday, daily clean-up of the work area and all other areas where lead dust or lead contaminated materials are present shall consist of:

a. Removing all waste materials and debris generated by lead hazard reduction activities and securing in a designated storage area that is inaccessible to the public;

b. Cleaning all horizontal surfaces with a HEPA vacuum;

c. Inspecting sheeting used in barrier and containment systems, and patching and repairing the sheeting, if necessary; and

d. Securing the area to ensure that unauthorized persons do not have access.

(b) Daily clean-up of the interior shall not be required when all occupants, furnishings, and belongings have been removed from the dwelling, dwelling unit, or child care facility.

(c) Prior to any preliminary clearance inspection, the lead abatement contractor, owner-contractor, lead abatement supervisor, or the person(s) granted a variance by the commissioner to perform lead hazard reduction work shall be responsible for the work areas being cleaned as follows:

(1) All equipment used in lead hazard reduction work shall be cleaned with a general all-purpose or lead-specific cleaner or vacuumed with a HEPA vacuum prior to removal from the work area;

(2) All sheeting used in barrier and containment systems and coverings shall be wet misted;

(3) With the exception of the bottom layer of sheeting covering the floor, all misted sheeting shall be removed with the sheeting used as a barrier to separate the contaminated area from uncontaminated areas being removed last;

(4) The misted sheeting used in barrier and containment systems shall be folded in upon itself, dirty side inward, to capture the dust, placed in a double 4-mil, single 6-mil, or equivalent plastic bag and removed from the lead hazard reduction work area in compliance with this section;

(5) All lead-containing waste materials including debris, used sealing tape, sheeting used in containment and barrier systems, disposable cleaning materials, air and vacuum filters, and disposable clothing, shall be placed in a double 4-mil, single 6-mil, or equivalent container and disposed of in compliance with this section;

(6) All surfaces and objects including walls, floors, windows, doors, and fixtures in the lead hazard reduction work area, containment area, and within 2 feet of the work area shall be cleaned, from higher to lower, by a cycle of HEPA vacuuming and wet washing with a general all-purpose or lead-specific cleaner and a repeat HEPA vacuuming; and

(7) The sequence of vacuuming, wet cleaning, and vacuuming laid out in (6) above shall be repeated until no visible dust or residue is left in the containment area.

(d) Upon completion of lead hazard reduction work in the interior areas of a dwelling, dwelling unit, or child care facility, the area shall be cleaned as follows:

(1) A final clean-up shall be conducted no sooner than one hour after the completion of lead hazard reduction work or surface preparation for repainting or sealing of lead-based substances;

(2) The final clean-up shall be performed in accordance with (c) above;

(3) All containment sheeting covering the floor shall be completely removed; and

(4) All rugs, carpets, or other fabric surfaces shall be vacuumed with a HEPA vacuum equipped with a beater bar followed by shampooing or steam cleaning.

(e) All wastes generated by lead hazard reduction work, including wastes generated during clean-up and preparation, shall be tested, stored, transported, managed, and disposed of in compliance with federal requirements under the Resource Conservation and Recovery Act (RCRA), 42 U.S.C. 6901 et seq. (1976), RSA 147-A, Env-Hw 400, and Env-Hw 600.

(f) In addition to the requirements of (e) above, each owner-contractor, lead abatement supervisor, or lead abatement contractor engaged in a lead hazard reduction project shall remove all lead-containing waste material from the site not later than 48 hours after completion of the final clean-up required above.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.12)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.12 Clearance Inspections

(a) Preliminary and final clearance inspections shall be conducted by a licensed lead inspector or risk assessor who:

(1) Has not performed the lead hazard reduction work;

(2) Has not been paid, employed, or otherwise compensated by anyone performing or involved in the lead hazard reduction work or the company for which the person is affiliated, unless the owner or their agent is acting as the owner-contractor;

(3) Is not an employee of the owner, or the owner of the dwelling, dwelling unit, or child care facility at which the clearance inspection is being conducted; and

(4) Does not have a financial or other interest, direct or indirect, in the dwelling, dwelling unit, or child care facility at which the clearance inspection is being conducted.

(b) A preliminary clearance inspection shall be conducted on interior work areas:

(1) After removal of all component(s) being replaced has been completed;

(2) After removal of surface coatings is completed, but prior to painting, encapsulation, or otherwise applying a new coating to a component(s);

(3) After all dust-generating activities have been completed;

(4) When preparation of the surface(s) prior to application of encapsulants is completed utilizing dust-generating method(s); and

(5) Before enclosure of component(s), unless the enclosure of the component(s) will generate dust, then the enclosure of such component(s) shall be completed before the preliminary clearance.

(c) A preliminary clearance inspection shall be conducted in accordance with (b) above before non-licensed workers are allowed to perform non-dust generating activities on interior or exterior work areas.

(d) A preliminary clearance inspection shall consist of a documented visual inspection to confirm that:

(1) All components to be replaced have been removed or replaced;

(2) All lead hazard coatings requiring removal have been removed to the bare substrate and surfaces are prepared for repainting or sealing;

(3) At least one layer of sheeting remains on the floor;

(4) Areas within the work area are visibly free of dust and debris;

(5) All dust generating activities have been concluded; and

(6) All surfaces prepared for encapsulation have been documented with passing results of field testing requirements.

(e) To ensure the areas are visibly free of dust and debris, the preliminary clearance inspection shall include a visual aid of wiping an area of at least one surface of a building component that shall not be tested during final clearance, such as a wall, door casing, door jamb, window, baseboard, etc., with a wet disposable cleaning cloth in each room where lead hazard reduction work occurred.

(f) Results of the preliminary clearance inspection shall:

(1) Be documented in writing by the licensed lead inspector or risk assessor and be sent to the lead abatement contractor within 48 hours of completion;

(2) Include the name and license number of the person performing the preliminary clearance inspection;

(3) Include the date of the inspection;

(4) Identify the rooms, areas, or components that were inspected;

(5) Include a statement from the risk assessor verifying all requirements for the passing of a preliminary clearance inspection in (d) above have been met; and

(6) Be sent via email to the department for properties under order of lead hazard reduction from the licensed lead inspector or risk assessor;

(7) Be passing prior to allowing unlicensed workers on-site.

(g) Upon passing a preliminary clearance inspection, non-licensed workers shall be permitted to encapsulate, repaint, perform non-dust generating enclosure of old components, or replace the removed components with new components.

(h) A final clearance inspection shall be conducted after completion of lead hazard reduction work on the interior or exterior of a dwelling, dwelling unit, or child care facility, including:

(1) A visual assessment, described in (i)–(m) below;

(2) Surface dust sample collection and analysis, described in (o), (p), and (s) below; and

(3) If lead hazard reduction work has occurred on lead-contaminated soil, soil inspection and soil sample collection and analysis, described in (r) and (s) below.

(i) When conducting a final clearance inspection, the lead inspector or risk assessor shall:

(1) Visually examine all surfaces within the work site, dwelling, dwelling unit, or child care facility identified as a lead-based substance or a lead exposure hazard in any lead inspection report, or presumed to be a lead-based substance or lead exposure hazard, to determine if:

a. All lead exposure hazards have been abated in accordance with He-P 1608 and He-P 1609 or managed through interim controls in accordance with He-P 1608 and He-P 1610;

b. All surfaces that had been stripped to the bare substrate have been recoated in accordance He-P 1610.02(e)(5)-(7) and (f)(4);

c. There has not been a change in condition or function that would create a lead exposure hazard; and

d. All visible dust and debris have been removed;

(2) Visually examine all other surfaces in the work areas and areas within 5 feet of the designated work area to ensure that no visible dust or debris is present and wipe an area of at least one surface of a building component that will not be tested during final clearance, such as a wall, door casing, door jamb, window, baseboard, or similar surface, with a wet disposable cleaning cloth in each room where lead hazard reduction work occurred as a visual aid of the presence of remaining dust;

(3) Visually examine the grounds around the dwelling, dwelling unit, or child care facility to ensure that all waste and debris have been removed, and that leaded dust or paint chips were not transferred outside; and

(4) Obtain a copy of the results of the “Pull-Off Tape Test for Adhesion” or the “Assessment of Painted Surfaces for Adhesion”, as described in the American Society for Testing and Materials (ASTM) E 1796-03, “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A, and as described in He-P 1609.03(c)–(g), to verify that the proper number of tests were performed and all surfaces encapsulated were tested and passed if an encapsulant product was used.

(j) If dust was not contained to the rooms or common areas in which work is conducted, the clearance area shall cover the entire space including the work site and all the rooms in the dwelling unit and the common areas that are associated with the work area in accordance with Ch. 15 of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 edition), available as noted in Appendix A.

(k) If dust has been contained to the work site, the clearance area shall cover at least the area within the containment, the floor outside the containment area to make sure contamina­tion has not spread, and passageways used by workers walking to and from the work site in accordance with Ch. 15 of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 edition), available as noted in Appendix A.

(l) To determine if the clearance area meets the requirements of (k) above, the lead inspector or risk assessor shall have identified where the containment was located and what passageways were used by workers, otherwise clearance shall follow (j) above.

(m) If the lead inspector or risk assessor determines through the visual assessment required in (i) above that lead exposure hazards, visible dust, or debris remain in the work area or adjacent areas:

(1) The clearance inspection procedure shall halt;

(2) The work site, dwelling, dwelling unit, or child care facility shall fail the clearance inspection;

(3) The lead inspector or lead risk assessor shall immediately notify the lead abatement contractor or supervisor and the owner or owner’s agent verbally or in writing, within 24 hours of the inspection, of the failure and the reasons for the failure; and

(4) After the dwelling, dwelling unit, or child care facility has been re-cleaned, another final clearance inspection, conducted in accordance with (h) above, shall be performed.

(n) If, during a second or subsequent final clearance inspection, the lead inspector or risk assessor determines through the visual assessment required in (i) above, that lead exposure hazards, visible dust, or debris remain in the work area or adjacent areas and finds that a lead exposure hazard still exists the lead inspector or lead risk assessor shall immediately notify the department, the lead abatement contractor or supervisor, and the owner or owner’s agent verbally or in writing within 24 hours of the inspection, of the failure and the reasons for the failure.

(o) If the lead inspector or risk assessor determines through the visual assessment required in (i) above that all lead exposure hazards have been controlled and there is no visible dust or debris remaining in the work area or adjacent areas, the lead inspector, or risk assessor shall:

(1) Allow enough dry time in accordance with manufacturer’s instructions after the completion of repainting or varnishing before collecting surface dust wipe samples; and

(2) Allow at least one hour after final clean-up activities have been completed before collecting surface dust wipe samples.

(p) Dust wipe samples shall be collected by a licensed lead inspector or risk assessor as follows:

(1) When lead hazard reduction work has occurred and there were no designated non-work areas, dust wipe samples shall be collected from at least one windowsill, one window well, and the floor as follows:

a. In at least 4 rooms of the dwelling unit if there are 4 or more rooms; and

b. In all rooms of the dwelling unit if there are less than 4 rooms;

(2) When lead hazard reduction work has occurred where there was designated work and non-work areas, dust wipe samples shall be collected by a licensed lead inspector or risk assessor as follows:

a. From a windowsill, a window well, and a floor, in at least 4 treated rooms where lead hazard reduction work has occurred or in all treated rooms if there are less than 4 treated rooms;

b. One floor sample in the main traffic pathway outside the containment area, but within 10 feet of the airlock, to determine the effectiveness of the containment system for each containment area; and

c. One floor sample along each passageway used by workers walking to and from the work area;

(3) In addition to (1) above, the following samples shall be collected by a licensed lead inspector or risk assessor in the common areas:

a. One dust wipe sample from the floor for every 2,000 square feet;

b. One dust wipe sample from outside the containment area; and

c. Dust wipe samples as requested by the department based on findings of a compliance inspection conducted in accordance with He-P 1605.04;

(4) When lead hazard reduction work has occurred on an exterior surface(s), a dust wipe sample shall be collected by a licensed lead inspector or risk assessor from:

a. An exterior window sill on each floor where exterior work was performed;

b. A window well from a lower floor; and

c. An adjacent horizontal surface in the outdoor living area, such as a porch floor, railing, exterior sill, or stoop; and

(5) When lead hazard reduction work has occurred in a multi-family dwelling with similarly constructed and maintained dwelling units, if random sampling is utilized it shall be conducted in accordance with 40 CFR Part 745.227(e)(9)(i)-(iii) or any subsequent amendments thereto.

(q) When the purpose of the final clearance inspection is to issue a subsequent certificate of lead safe – interim controls for the interior and interior common areas in accordance with He-P 1610.06(a), and when renovation, remodeling, or other dust generating activities have:

(1) Occurred, dust wipe samples shall be collected in accordance with (p) above as well as one dust wipe sample from the floor for every 2,000 square feet in the common areas; or

(2) Not occurred, dust wipe samples shall be collected from a windowsill, window well, and a floor in at least 3 areas where a child would likely spend time.

(r) A final clearance inspection on lead-contaminated soil shall include:

(1) Visual examination of exterior horizontal and accessible surfaces adjacent to the areas in which soil lead hazard reduction activities were conducted to ensure that no visible dust or debris are present; and

(2) Collection of random samples by a licensed lead inspector or risk assessor from the area in accordance with He-P 1608.04(b).

(s) Analysis of all dust wipe and soil samples shall be conducted pursuant to He-P 1608.04(b) and (c).

(t) The results of the dust wipe and soil sample analysis shall meet the following standards:

(1) Clearance lead levels in interior dust for a single dust wipe shall be:

a. Less than 10 micrograms per square foot on floors;

b. Less than 100 micrograms per square foot on interior window sills; and

c. Less than 100 micrograms per square foot on window wells;

(2) Clearance lead levels in interior dust for a composite dust wipe sample shall be calculated by dividing the clearance level as described in (1) above by half of the number of subsamples in the composite sample;

(3) The number calculated in (2) above shall be the clearance standard to be met for the composite sample on the floors, interior window sills, or window wells sampled;

(4) Lead levels in exterior dust shall be less than 40 micrograms per square foot on porch floors and less than 200 micrograms per square foot in all other samples; and

(5) Lead levels in replacement soil shall be tested and shall be confirmed to be less than 200 parts per million (ppm) pursuant to He-P 1609.02(e).

(u) When any residual dust level exceeds the clearance standards set forth in (t) above:

(1) The lead inspector or lead risk assessor shall immediately notify the lead abatement contractor or supervisor and the owner or owner’s agent verbally or in writing, within 24 hours of the receipt of sample results;

(2) The lead inspector or risk assessor shall require that all the components represented by the failed sample that were not previously sampled or that failed the dust test shall be cleaned again as described in He-P 1608.11(c)(6) and (7);

(3) After completing the cleaning described in (2) above, the lead inspector or risk assessor shall collect dust wipe samples from:

a. All components which failed the previous dust test; and

b. At least one component not previously tested for each component type that failed, except in the case of a floor where the sample shall be taken from a previously un-sampled floor area;

(4) The lead inspector or risk assessor shall have dust wipe and soil samples analyzed in accordance with He-P 1608.04(b) and (c); and

(5) If, during a second and subsequent final clearance inspection, the lead inspector or risk assessor determines through the analysis of the dust wipe samples that the level exceeds the clearance limits in (t) above, the lead abatement contractor or the person performing the lead hazard reduction work shall reimburse the owner for the cost of all future clearance inspections and sample testing.

(v) When a lead inspector or risk assessor conducts a final clearance inspection and finds that no lead exposure hazards remain and that all dust wipe and soil sample results are below the clearance levels set forth in (t) above, they shall:

(1) Notify the lead abatement contractor or supervisor and the owner of such findings in writing and send laboratory analysis reports within 24 hours of the receipt of all dust wipe and soil sample results;

(2) Notify the department, in writing, for properties under order of lead hazard reduction, within 24 hours of the receipt of all dust wipe and soil sample results that a final clearance inspection has been completed and an inspection has found that no lead exposure hazards remain at the property;

(3) Document a written clearance inspection report detailing the results of the inspection within 30 days of collection of samples during the final on-site clearance inspection; and

(4) Submit a copy of the complete written clearance inspection report to the following, within 30 days of collection of samples during the final on-site clearance inspection:

a. The owner of the dwelling, dwelling unit, or child care facility;

b. The lead abatement contractor or supervisor; and

c. The department for any dwelling, dwelling unit, or child care facility under an order of lead hazard reduction or other enforcement action pursuant to RSA 130-A or He-P 1600 or when the abatement work was completed utilizing a lead hazard remediation loan.

(w) All errors and omissions in the written clearance inspection report shall be corrected within 10 days of notification by the department.

(x) The written clearance inspection report in (v)(3) and (4) above shall include the following:

(1) The date of the clearance inspection;

(2) A copy of the certificate issued in accordance with He-P 1608.14;

(3) The printed name(s) and license number(s) of the person(s) that performed the final clearance inspection(s);

(4) Name(s), address(es), and telephone number(s) of any company or other person(s) employing the inspector or risk assessor in that capacity;

(5) Name, certification number(s), and address(es) of all lead abatement contractors who worked at the dwelling, dwelling unit, or child care facility;

(6) A schematic site plan of the area inspected, showing rooms within the dwelling, dwelling unit, or child care facility and their use, common areas, exterior surfaces, and exterior areas including the locations of soil collection points;

(7) A schematic site plan of the area or a written description of the locations of dust sampling collection points;

(8) If not previously submitted to the department, a copy of the original risk assessment report and the date that the lead inspector or risk assessor verified that each surface or component requiring lead hazard reduction has been addressed;

(9) The specific testing device(s) used in the initial inspection or clearance inspection, their serial number, and sampling procedures employed;

(10) Name(s), address(es), and telephone number(s) of all laboratories conducting analysis of collected samples;

(11) Copies of the results of all laboratory analyses and testing of all samples taken during the inspection;

(12) A description of all in-place management measures necessary to ensure the continued control of potential lead exposure hazards in the inspected dwelling pursuant to He-P 1608.16; and

(13) A copy of the work scope detailing the specific lead hazard control method employed for each component for each lead hazard identified on the risk assessment report.

(y) The owner shall provide a copy of the written clearance inspection report required by (v)(4) above to occupants affected by the lead hazard reduction work within 5 days of receipt of the report by:

(1) Posting the report in a common area or entry for at least 5 days; or

(2) Hand delivering of a copy of the report to an adult occupant of each occupied dwelling unit in the dwelling.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.07)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.13 Standards for Re-occupancy

(a) When lead hazard reduction work has been performed and the dwelling, dwelling unit, or child-care facility is vacant or occupants have been relocated for the duration of the work, the dwelling, dwelling unit, or child care facility shall not be re-occupied by existing or new occupants until:

(1) A clearance inspection conducted pursuant to He-P 1608.12 determines that no lead exposure hazards remain in the dwelling unit of a multi-family home or the interior of a dwelling of a single family home or child-care facility;

(2) A certificate described in He-P 1608.14(a) has been issued by a licensed risk assessor for the interior, as well as, at a minimum, safe passage of at least one means of egress associated with dwelling, dwelling unit, or child care facility;

(3) The owner has provided the prospective or existing residents with proper disclosure including any known information concerning the existence of lead-based substances and any known lead exposure hazards and available records per 40 CFR 745, Lead-Based Paint Poisoning Prevention in Certain Residential Structures; and

(4) The owner has notified the occupants, in writing, of any known remaining hazards and future planned lead hazard reduction work and has an occupant protection plan in place including continued safe passage in and out of the dwelling, dwelling unit, or child care facility for the duration of the remaining lead hazard reduction work on other areas of the dwelling including common areas, exteriors, and soils.

(b) When an order of lead hazard reduction has been issued, in addition to the requirements of He-P 1608.13(a) above the owner shall:

(1) Obtain a certificate of lead safe-abatement from a licensed risk assessor prior to re-occupancy for the interior of the dwelling, dwelling unit, or child care facility;

(2) Send the department a copy of the certificate of lead safe-abatement prior to re-occupancy;

(3) Provide the tenants with a copy of the risk assessment, work scope, and certificate of lead safe-abatement for the interior of their dwelling unit prior to re-occupancy;

(4) Provide notice to the tenants in writing that if lead hazard reduction work is not entirely complete in the dwelling to continue to follow the occupant protection plan until a certificate of lead safe-abatement has been issued for the entire dwelling including the exterior and all common areas; and

(5) Have all remaining lead hazard reduction work completed and obtain a certificate of lead safe-abatement on the remaining areas including interior common areas and exteriors indicated in the order of lead hazard reduction under the existing work scope and occupant protection plan for the project within the time frame determined by the commissioner.

History

• #9986, eff 9-1-11, EXPIRED 9-1-19 (from He-P 1605.16)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.14 Certificates

(a) After a risk assessment or clearance inspection has been completed and it has been determined that no lead-based paint hazards or lead exposure hazards, including but not limited to paint, dust, and soil as applicable are present, the licensed risk assessor shall issue a certificate of lead safe.

(b) When a property is under order of lead hazard reduction and occupants have been relocated during lead hazard reduction work, certificates of lead safe shall be sent by the licensed risk assessor via email to the property owner and department within 24 hours of determination that no lead-based paint hazards or lead exposure hazards, including but not limited to paint, dust, and soil as applicable are present.

(c) After a lead-based paint or lead-based substances inspection has been completed and it has been determined that no lead-based paint or substances exist in the dwelling, dwelling unit, or child care facility, the licensed risk assessor or lead inspector shall issue one of the following:

(1) Certificate of no lead-based substances detected, if no lead including paint, dust, and soil is identified; or

(2) Certificate of no lead-based paint detected, if no lead-based paint is identified.

(d) Any certificate issued pursuant to (a) and (c) above shall contain:

(1) The dwelling, dwelling unit, or child care facility address, including unit number, if applicable;

(2) The order number, if applicable;

(3) The risk assessor’s printed name and license number;

(4) The risk assessor’s signature;

(5) The date the certificate was issued;

(6) Specific identification of the scope of the certificate, including the dwelling, dwelling unit, child care facility, common area(s), exteriors, or component(s) the certificate is being issued for including the date(s) that each area met the clearance criteria described in He-P1608.12(i)-(t);

(7) Specific identification of the lead hazard reduction methods employed, if any, including a designation of whether abatement, interim controls, or a combination of the two were utilized to achieve the certificate; and

(8) One of the following certification statements:

a. When no lead exposure hazards are observed at the time of the inspection or remain following lead abatement:

“I hereby certify that sampling and analyses was performed in accordance with He-P 1608.04 and He-P 1608.12 and accurately represents the conditions in the areas tested on this date. I further certify that no lead exposure hazards were detected during the inspection, and dust wipe and soil sample analyses complied with He-P 1608.12(t). This certificate of lead safe for this dwelling, dwelling unit, or child care facility shall remain in effect as long as there continues to be no lead exposure hazards present, all encapsulants or enclosures remain in place and undamaged, and all required records regarding in place management practices are completed and maintained.”;

b. For a certificate of lead safe-interim controls:

“I hereby certify that sampling and analyses was performed in accordance with He-P 1608.04 and He-P 1608.12 and accurately represents the conditions in the areas tested on this date. I further certify that no lead exposure hazards were detected during the inspection, and dust wipe and soil sample analyses complied with He-P 1608.12(t). This certificate of lead safe for this dwelling, dwelling unit, or child care facility shall remain in effect for one year or as long as there continues to be no lead exposure hazards present, all encapsulants or enclosures remain in place and undamaged, and all required records regarding in place management practices are completed and maintained.”;

c. For a certificate of no lead-based substances detected:

“I hereby certify that sampling and analyses was performed in accordance with He-P 1608.04 and He-P 1608.12 and accurately represent the conditions in the areas tested on this date. I further certify that no lead-based substances were detected during the inspection, and dust wipe and soil sample analyses complied with He-P 1608.12(t). This certificate of no lead detected for this dwelling, dwelling unit, or child care facility shall remain in effect as long as there continues to be no lead present.”

d. For a certificate of no lead-based paint detected:

“I hereby certify that sampling and analyses was performed in accordance with He-P 1608.04 and He-P 1608.12 and accurately represent the conditions in the areas tested on this date. I further certify that no lead-based paint was detected during the inspection. Soil and dust sampling was not conducted during the inspection and the owner and residents should presume that any bare soil and settled dust may potentially contain lead. This certificate of no lead-based paint detected for this dwelling, dwelling unit, or child care facility shall remain in effect as long as there continues to be no lead-based paint present.”

(e) After a visual, dust, and soil inspection has been completed a lead inspector, risk assessor, or lead clearance testing technician shall issue a certificate of visual, dust, and soil results.

(f) Any certificate issued pursuant to (e) above shall contain:

(1) The dwelling, dwelling unit, or child care facility address, including unit number, if applicable;

(2) The year the dwelling, dwelling, unit, or child care facility was built;

(3) The risk assessor’s, lead inspector’s, or lead clearance testing technician’s, printed name and license or certification number;

(4) The risk assessor’s, lead inspector’s, or lead clearance technician’s signature;

(5) The date the certificate was issued;

(6) A passing visual paint inspection result if all paint including paint located in the dwelling, dwelling unit, child care facility, common area(s), exteriors, or component(s) on the same lot is intact;

(7) A failing visual paint inspection result if any paint located in the dwelling, dwelling unit, child care facility, common area(s), exteriors, or component(s) on the same lot is not intact;

(8) A passing dust and soil result if the result of all samples collected do not meet the definition of a lead-based substance as defined by RSA 130-A:1(XI);

(9) A failing dust and soil result if the result of any samples collected meet the definition of a lead-based substance as defined by RSA 130-A:1(XI); and

(10) The following certification statement:

“I hereby certify that sampling and analyses was performed in accordance with He-P 1608.04(b)(c) and accurately represents the conditions in the areas tested on this date. I further certify that paint was only visually observed to determine whether it was intact or not. No testing of the paint or hazard identification was performed on this date to determine whether it meets the definition of lead-based paint or a lead exposure hazard. Lead-based paint that is not intact or located on friction, impact, or chewable surfaces is extremely hazardous. Further testing in the form of a lead paint inspection or risk assessment by a licensed lead inspector or risk assessor is recommended.”

(g) A certificate of lead safe for the interior of a multi-family dwelling shall not be issued until all interior work areas associated with the dwelling units where lead hazard reduction activities have occurred, has passed a clearance inspection, including, when applicable, interior common areas associated with the dwelling units.

(h) Certificates issued in accordance with (g) above shall:

(1) Clearly exclude any dwelling unit(s), including unit designations and common areas in the multi-family dwelling, where no lead hazard reduction work has taken place; and

(2) Recommend further testing and lead hazard reduction work in any excluded dwelling unit(s) prior to re-renting.

(i) A certificate of lead safe for the exterior shall not be issued until the exterior, exterior common areas, and bare soil for the dwelling or child care facility have passed a clearance inspection.

(j) When the commissioner finds, through a compliance inspection or review of in-place management documentation, that the interior, common areas, exterior, or soils of a dwelling, dwelling unit, or child care facility fails to meet the standards for maintenance of the certificate of lead safe, the commissioner shall invalidate the certificate of lead safe and enforce the order of lead hazard reduction.

(k) A licensed risk assessor shall issue a certificate of lead safe to the owner of a dwelling, dwelling unit, or child care facility, when a risk assessment is performed in accordance with Chapter 5 “Risk Assessment and Re-evaluation” and Chapter 7 “Lead-Based Paint Inspection” of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A, and it has been determined that all lead-based substances are being controlled and are in a condition and location that do not pose a lead exposure hazard.

(l) A licensed risk assessor or lead inspector shall issue a certificate of no lead detected or no lead-based paint detected to the owner of a dwelling, dwelling unit, or child care facility when lead-based paints or similar coatings, lead contaminated dust, or lead contaminated soils are not found as a result of:

(1) A lead inspection performed in accordance with Chapter 5 (Risk Assessment and Re-evaluation) and Chapter 7 (Lead-Based Paint Inspection) of the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A;

(2) Dust sampling performed in accordance with the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A; and

(3) Soil sampling performed in accordance with the HUD “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1608.08)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.15 Record-Keeping Requirements

(a) The following shall be maintained by the lead abatement supervisor at the project site for the duration of the lead hazard reduction project:

(1) A current copy of He-P 1600 and RSA 130-A;

(2) A copy of the work scope and occupant protection plan, developed specifically for the lead reduction work of the project;

(3) Copies of currently valid certificates and licenses for the lead abatement contractor and all individuals engaged in the lead hazard reduction work;

(4) Documentation of all substrate assessments and encapsulant application such as the “Pull-Off Tape Test for Adhesion” or the “Assessment of Painted Surfaces for Adhesion” as described in the ASTM E 1796-03 “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A, showing satisfactory results, if encapsulants are utilized;

(5) Copies of any letters from the department relative to the use of encapsulant products, interim controls, or variance requests;

(6) A 24-hour contact number for the person in charge of conducting the lead hazard reduction work, which shall be posted at all entrances to the work site at all times;

(7) A written description of procedures to be followed during medical emergencies, including the name, phone number, and location of the nearest hospital or emergency medical service unit;

(8) Copies of any written respiratory programs, if subject to 29 CFR 1926.62;

(9) An access control log for persons who have entered any lead hazard reduction work area in accordance with He-P 1608.10; and

(10) Documentation of the results of the passing of a preliminary clearance inspection from a licensed lead inspector or risk assessor prior to unlicensed individuals working on-site.

(b) The following shall be maintained by a licensed lead inspector or risk assessor and provided via email to the department upon request:

(1) Reports prepared by a licensed lead inspector or risk assessor in accordance with He-P 1608.02, He-P 1608.03, and He-P 1608.12;

(2) The issuance of any certificates in accordance with He-P 1608.14;

(3) A copy of the work scope and occupant protection plan for the abatement project; and

(4) Documentation of the passing of a preliminary clearance inspection in accordance with He-P 1608.12(f).

(c) Written records as described in (a) and (b) above shall be maintained by the lead abatement contractor or supervisor, licensed lead inspector, or lead risk assessor for each lead hazard reduction project and shall be retained for a minimum of 5 years after the completion of the project.

(d) When an order has been issued in accordance with He-P 1605.01, the owner of the dwelling, dwelling unit, or child care facility shall retain written documentation for the duration of ownership and all documentation shall be given at the time of sale, lease, rental, or transfer of interest in the dwelling, dwelling unit, or child care facility to the subsequent owners.

(e) Written records required by (d) above shall, at a minimum, include the following:

(1) A risk assessment report prepared by a licensed lead risk assessor in accordance with He-P 1608.03(c);

(2) A copy of the written work scope and occupant protection plan prepared for the project in accordance with He-P 1608.05;

(3) A copy of the written final clearance report as detailed in He-P 1608.12(x);

(4) Copies of all variances, permission to use interim controls, or other communications with the department; and

(5) Copies of any orders of lead hazard reduction, notices of violation or administrative fines, or consent agreements issued in regard to the lead hazard reduction project.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.07)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.16 In-Place Management Standards

(a) In-place management shall be implemented when:

(1) Lead hazard reduction work has been completed and a certificate has been issued in accordance with He-P 1608.14; and

(2) Lead-based substances remain in the dwelling, dwelling unit, or child care facility.

(b) In-place management may be used by an owner or owner’s agent as a means of preventing lead-based substances from becoming lead exposure hazards.

(c) When practicing in-place management of lead-based substances, an owner or owner’s agent shall:

(1) Provide a written notice to the tenants of the dwelling, dwelling unit, or child care facility requesting them to notify the owner or agent of any damaged or deteriorating painted surface;

(2) Respond to the notification of deteriorating or damaged paint in writing with a plan as to how and when the issues will be rectified within 10 business days;

(3) Conduct visual inspections of each dwelling, dwelling unit, or child care facility to detect any change in condition of components, surfaces, or areas which may result in the creation of a lead exposure hazard:

a. At least once every 6 months;

b. Prior to re-occupancy after unit is vacated by previous occupant;

c. Upon request of an occupant of a dwelling, dwelling unit, or child care facility; and

d. In accordance with He-P 1609.03(i) if encapsulation products are used;

(4) Document in writing the findings of the visual inspection with the following information:

a. The date of the visual inspection;

b. A written description of all observations made pursuant to (3) above; and

c. The signature of the owner or person conducting the visual inspection;

(5) Maintain the written documentation of the visual inspection for a period of 5 years;

(6) Provide a copy of the written documentation of the visual inspection to the commissioner upon request;

(7) Clean all horizontal surfaces in common areas that are accessible to children by a cycle of vacuuming with HEPA vacuum, wet washing with a general all-purpose or lead-specific cleaner, and a repeat HEPA vacuuming; and

(8) Conduct cleaning prior to re-occupancy after unit is vacated by previous occupant.

(d) When in-place management practices are implemented and an annual clearance inspection is conducted as required by He-P 1610.06 for the renewal of a certificate of lead safe – interim controls, that inspection may count as one of the inspections required by (c)(3)a. above.

(e) When renovations or repairs are needed and the EPA’s Renovation, Repair, and Paint rule 40 CFR 745, Subpart E does not apply, they shall be considered in-place management, and shall be remedied with interim controls in accordance with He-P 1610.02 through He-P 1610.05.

(f) When conducting renovations or repairs described in (e) above, the owner or owner’s agent shall not engage in any lead-based substance abatement as prohibited under RSA 130-A:9,VI. Any abatement activities shall follow standards set forth in He-P 1609.

(g) When renovations or repairs are needed and involve more than 6 square feet of surface area, the owner or owner’s agent shall:

(1) Address the needed renovations and repairs in accordance with either He-P 1609 or He-P 1610, utilizing persons licensed and certified in accordance with EPA’s Renovation, Repair, and Painting Rule 40 CFR 745, Subpart E; and

(2) Maintain documentation of the repair work and make the documentation available to the department upon request.

(h) When lead exposure hazards are found to exist, they shall be addressed by following the requirements of He-P 1600, and utilizing persons licensed and certified in accordance with He-P 1612.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1607.01)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1608.17 Review and Validation of Certificates

(a) The department shall:

(1) Conduct a document review to validate that all certificates of lead safe have been submitted to the department;

(2) Conduct compliance inspections to validate the issuance of any certificate of lead safe; and

(3) Such compliance inspections shall:

a. Be conducted whenever the validity of the certificate of lead safe is unclear through the document review conducted in (1) above;

b. Be conducted, at least once annually, for each licensed risk assessor submitting certificates of lead safe to the department;

c. Be conducted within 30 days of receipt of the certificate by the department; and

d. Be arranged with the property owner to grant access to the dwelling, dwelling unit, or child-care facility.

(b) Any person may request the department to review and validate any certificate issued pursuant to He-P 1608.14, in accordance with RSA 130-A:10, III, by filing a written request with the department including:

(1) The name and address of the requester;

(2) The address and location of the dwelling, dwelling unit, or child care facility that is the subject of the request;

(3) The name and address of the owner, if known; and

(4) The name and address of the licensed lead inspector or licensed risk assessor who performed the inspection, if known.

(c) Within 60 days after receiving a request for review of a certificate, the department shall contact the requester, the owner, and the risk assessor who prepared the certificate and conduct a site visit and inspection, as necessary, to determine the existence of any lead exposure hazard, in accordance with the procedures set forth in He-P 1605.04.

(d) If a lead exposure hazard is discovered during a compliance inspection, the commissioner shall:

(1) Contact the owner or owner’s agent, lead risk assessor, lead abatement contractor, lead abatement supervisor, or person granted a variance by the department to address the hazards; and

(2) Invalidate the certificate of lead safe and enforce the order of lead hazard reduction if after 10 business days the lead exposure hazard still exists.

(e) The department shall not conduct a review and validation for the following:

(1) Buildings which do not meet the definition of a dwelling, dwelling unit, or child care facility; or

(2) Dwellings, dwelling units, or child care facilities built after 1978.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1608.09)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1609 Standards for Lead Abatement

N.H. Code Admin. R. Ann. He-P 1609.01 Abatement Requirements

(a) Abatement activities shall not include:

(1) Activities that fall under the EPA’s Renovation, Repair, and Painting Rule 40 CFR 745, Subpart E, including renovation, remodeling, landscaping, or other activities, when such activities are not designed to permanently eliminate lead-based paint hazards, but are designed to repair, restore, or remodel a given structure or dwelling, even though these activities might incidentally result in a reduction or elimination of lead-based paint hazards; or

(2) Interim controls done in accordance with He-P 1610, operations and maintenance activities, or other measure and activities designed to temporarily, but not permanently, reduce human exposure or likely exposure to lead-based paint hazards.

(b) All abatement activities shall be conducted in accordance with RSA 130-A and He-P 1600.

(c) Abatement activities shall only be performed by persons licensed or certified in accordance with He-P 1612.

(d) Activities conducted at an active abatement work site that do not disturb lead-based paint or generate dust may be performed by any person provided:

(1) A licensed lead abatement supervisor is present at all times in accordance with He-P 1609.01(f);

(2) The work scope is reviewed and approved by a NH licensed lead abatement supervisor in accordance with RSA 130-A:9,VI;

(3) The individual does not engage directly in lead based substance abatement in accordance with RSA 130-A:9, VI;

(4) All other requirements of He-P 1600 are followed;

(5) The work is being conducted in an area free of dust and debris where all dust generating activities have been completed; and

(6) The passing of a preliminary clearance as described in He-P 1608.12(d) and (f) has been achieved.

(e) Examples of activities allowed to be performed by any person in accordance with (d) above include:

(1) Installation of exterior siding;

(2) Installation of interior carpeting or other floor covering where paint is not disturbed;

(3) Enclosure of bare soil using asphalt or concrete;

(4) Removal of a door from hinge pins;

(5) Non-dust generating preparation to surfaces that are intact prior to the application of encapsulants per He-P 1609.03;

(6) Application of encapsulants per He-P 1609.03; and

(7) Other activities that do not disturb lead-based paint or cause dust generation with prior department approval following the submission of a “Request for a Variance” (February 2025).

(f) Abatement activities, including those activities conducted under He-P 1609.01(d), shall only be performed when either a certified lead abatement supervisor or certified owner-contractor is present at the site.

(g) During any abatement activity where there is a lead abatement supervisor present on the site, a person representing the certified lead abatement contractor or certified owner-contractor shall be available to the supervisor, at a minimum, by telephone.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.03)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1609.02 Abatement Methods

(a) One or more of the following lead hazard reduction techniques shall be used on lead-based substances to meet abatement standards:

(1) Removal of lead-based substances by:

a. Removal and replacement of any component with a component that is free of lead-based substances; or

b. Removal of the surface coating down to the substrate by:

1. Wet sanding;

2. Utilizing non-flammable chemical strippers, which do not contain methylene chloride;

3. Removing the lead containing component for off-site stripping and then reinstalling;

4. Scraping with the aid of a chemical stripper not containing methylene chloride;

5. Misting the surface with water and wet scraping;

6. Controlled low-level heating element, which produces a temperature no greater than 700 degrees Fahrenheit;

7. Machine sanding, planning, or abrasive blasting using a tool equipped with a HEPA local vacuum exhaust sized to match the tool so that no visible dust or release of air occurs outside the shroud or containment system;

8. Dry scraping within 6 inches of an area that would present an electrical hazard if other methods were used; or

9. Any other method approved by the department through a variance in accordance with He-P 1605.03;

(2) Application of an encapsulant product that is:

a. Approved in accordance with He-P 1609.03(a);

b. Used only on those surfaces specified by the manufacturer; and

c. Applied in accordance with the manufacturer’s instructions;

(3) Enclosure of the surface to ensure that no lead containing surface remains by:

a. First labeling the surface to be enclosed with a warning, “Danger: Lead-Based Paint” written in permanent ink with lettering no less than one inch high horizontally and vertically approximately every 16 square feet on large components, such as walls and floors, and every 4 linear feet on smaller components, such as baseboards;

b. Securely fastening and affixing all junctions of floors, walls, ceilings, and other joined surfaces by fastening with nails, screws, or an adhesive recommended by the manufacturer for the covering so that the covering remains in place and the physical integrity of the covering remains intact to prevent removal, and then caulking and sealing all seams;

c. Covering floor surfaces with ceramic tile, wood, stone, or similar durable material intended for use as flooring;

d. Covering floor surfaces with a rigid, durable material intended for use as an underlayment prior to the installation of wall to wall carpeting or similar material intended for use as flooring;

e. Covering all other interior surfaces with wood, vinyl, aluminum, plastic, or similar durable materials, except that wallpaper and plastic sheeting shall not be allowed;

f. Covering walls or ceiling surfaces with gypsum board, fiberglass mats, vinyl wall coverings, formica, tile, paneling, or other material that does not tear, chip, or peel;

g. Enclosing exterior surfaces with aluminum, vinyl siding, wood, concrete, or similar durable material after covering with breathable building wrap; and

h. Enclosing exterior trim with aluminum or vinyl coil stock; and

(4) Permanent fastening of window sashes to eliminate friction surfaces if not otherwise prohibited by any state laws, rules, or local ordinances for health, building, and fire safety.

(b) The materials used in (a)(3) above shall:

(1) Comply with all state laws, rules, or local ordinances for health, building, and fire safety; and

(2) Only be used in places that the manufacturer intended them to be used.

(c) The following methods shall be prohibited when performing lead-based substance abatement:

(1) Dry scraping or sanding except as allowed by He-P 1609.02(a)(1)(b)(8). above;

(2) Dry sweeping of lead contaminated areas or surfaces;

(3) Dry abrasive blasting using sand, grit, or any other particulate without a HEPA local vacuum exhaust tool;

(4) Utilizing mechanical sanding, planning, grinding, or other removal equipment without a HEPA local vacuum exhaust tool;

(5) Torch or open-flame burning;

(6) Propane-fueled heat grids;

(7) Heating elements operating above 700 degrees Fahrenheit;

(8) Uncontained hydroblasting or high-pressure wash;

(9) Use of methylene chloride or solutions containing methylene chloride in interior work areas; and

(10) Encapsulants that have not been approved under He-P 1609.03(a).

(d) The following precautions shall be used when conducting lead-based substance removal on properties listed in or determined eligible for the National Register of Historic Places and the New Hampshire State Register of Historic Places found at www.nh.gov/nhdhr/programs/state_register.html:

(1) When an orbital sander with a HEPA local vacuum exhaust sized to match the tool is used, such device shall be used only as a finishing or smoothing tool;

(2) When a belt sander with a HEPA local vacuum exhaust sized to match the tool is used, such device shall be used only on flat surfaces; and

(3) When abrasive blasting with a HEPA local vacuum exhaust sized to match the tool is performed, such method shall only be used on cast and wrought iron, steel, or concrete substrates under the supervision of a professionally qualified art or architectural conservator.

(e) Soil abatement shall occur as follows:

(1) For children’s play areas, the contaminated soil shall be completely excavated to a depth of at least 6 inches and replaced with soil containing less than 200 ppm lead, or completely enclosed with asphalt or concrete;

(2) For areas of contaminated bare soil other than children’s play areas lead soil abatement shall occur as follows:

a. The contaminated soil shall be completely excavated to a depth of at least 6 inches and replaced with 6 inches of soil containing less than 200 ppm lead;

b. When the soil below 2 inches from the surface has been found to contain lead below 1,200 ppm, the contaminated soil shall be excavated to a depth of at least 2 inches, and the excavated soil replaced with 2 inches of soil containing less than 200 ppm lead;

c. When the soil below 4 inches from the surface has been found to contain lead below 1,200 ppm, the contaminated soil shall be excavated to a depth of at least 4 inches, and the excavated soil replaced with 4 inches of soil containing less than 200 ppm lead; or

d. The contaminated soil shall be completely enclosed with asphalt or concrete;

(3) As an alternative to replacement soil, the excavated soils may be replaced at the same depth with crushed stone, gravel, or similar material intended for landscaping uses.

(f) During soil abatement:

(1) Surface run-off and the windblown spread of lead-contaminated soil shall be prevented by either:

a. Keeping bare soil wet during the entire period of abatement; or

b. Temporarily covering exposed sites with sheeting used in barrier and containment systems and secured in place at all edges and seams;

(2) Soil removal activities shall not be conducted when:

a. The constant wind speed exceeds 20 miles per hour; or

b. It is raining in such a manner as to create surface run-off of contaminated soil; and

(3) All contaminated soil shall be disposed of in accordance with He-P 1608.11(e) and (f).

(g) When soil lead levels are equal to or greater than 5,000 ppm, interim controls shall not be used and abatement shall occur following (e) and (f) above.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.08)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1609.03 Encapsulant Products and Their Use

(a) Encapsulant products shall be approved in accordance with RSA 130-A:1, VII, or (q) and (r) below prior to their use.

(b) Except for a licensed lead abatement supervisor, lead abatement worker, or owner-contractor, any person who wishes to use an encapsulant product shall request permission from the department by completing and submitting to the department a “Request for Use of Encapsulant Paint”, form (February 2025) prior to initiating the work or activity certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I agree to follow all rules in He-P 1600 regarding encapsulant products and their use as well as any manufacturer recommendations. I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Request for Use of Encapsulant Paint form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request for Use of Encapsulant Paint form on the basis that it was executed electronically.”; and

“I understand that any violation of the law will result in this approval being revoked and could result in administrative fines.”

(c) The following shall be submitted with the “Request for Use of Encapsulant Paint” (February 2025) form:

(1) A copy of the work scope describing the components on which encapsulant products are requested to be used on; and

(2) A copy of the occupant protection plan.

(d) Encapsulant products shall be applied:

(1) After passing substrate assessment testing using the “Pull-Off Tape Test for Adhesion” or the “Assessment of Painted Surfaces for Adhesion” as described in the ASTM E 1796-03 “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A, for each architectural system, element, or building component where an encapsulant paint product is to be used;

(2) Only after surface preparation, and all other dust generating phases of lead hazard reduction work including component removal is complete;

(3) In accordance with the manufacturer’s criteria;

(4) In accordance with ASTM International’s (ASTM E 1796-03) “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A when encapsulation paint is used; and

(5) After passing one patch test in each room where encapsulant paint product is to be used.

(e) Encapsulant paint products shall not be used on any surface(s) that:

(1) Fails the substrate assessment test such as the “Pull-Off Tape Test for Adhesion” or the “Assessment of Painted Surfaces for Adhesion” as described in the ASTM E 1796-03 “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A; or

(2) Is not recommended for encapsulation or restricted by the product manufacturer.

(f) Surface preparation as described in (d)(2) above shall include:

(1) Cleaning and deglossing with a strong detergent or similar deglossing agent or by wet sanding, if necessary;

(2) Making minor repairs such as filling holes with plaster or spackling; and

(3) Paint stabilization of the interior, exterior, or both, as described in He-P 1610.02, as required.

(g) All encapsulant debris generated through the application process and any unused encapsulant not suitable for application shall be disposed of in accordance with the encapsulant manufacturer’s instructions.

(h) When encapsulant paint products have been used and the dwelling, dwelling unit, or child care facility has no documentation of passing the substrate assessment or the substrate assessment test has failed for any architectural system, element, or building component, the risk assessor shall not issue a certificate of lead safe – abatement.

(i) The owner shall perform a visual inspection of the encapsulated surfaces as recommended by the manufacturer and as follows:

(1) Thirty days after application;

(2) Every 6 months thereafter; and

(3) Whenever there is a change in tenant occupancy.

(j) The visual inspection required by (i) above shall determine whether the encapsulant has maintained its integrity and is not:

(1) Cracked;

(2) Peeling;

(3) Sagging;

(4) Bubbling;

(5) Water damaged or evidencing other moisture related problems;

(6) Blistering;

(7) Open to the environment in a manner that could damage the encapsulated area; or

(8) Otherwise altered in a manner which jeopardizes its protective qualities.

(k) If signs of wear or deterioration, as described in (j) above, are found during the visual inspection, the owner shall visually inspect the encapsulated surfaces at least every 3 months for the next 6 months, then annually thereafter.

(l) If the encapsulation fails to maintain its integrity or if repairs are needed and the affected area involves less than 6 square feet of surface, the repair shall be considered in-place management and shall be remedied in accordance with the encapsulant manufacturer’s recommendations, He-P 1608, He-P 1609.03, and He-P 1610.02 through He-P 1610.05.

(m) When repairing a surface as described in (k) above, the owner or owner’s agent shall not engage in any practice prohibited under He-P 1609.02(c).

(n) When a repair of the affected area involves more than 6 square feet of surface area, the owner or owner’s agent shall remedy the affected area in accordance with lead hazard reductions pursuant to He-P 1608 and as it applies to abatement pursuant to He-P 1609 or interim controls pursuant to He-P 1610, including the requirement for a clearance inspection with dust wipes for the area where work occurred.

(o) In addition to the record keeping requirements of He-P 1608.15, the owner shall maintain the following records for the life of the encapsulant product:

(1) Documentation of:

a. The name of the encapsulant product applied;

b. The results of the “Pull-Off Tape Test for Adhesion” or the “Assessment of Painted Surfaces for Adhesion” test as described in the ASTM E 1796-03 “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition), available as noted in Appendix A, for encapsulation paint;

c. The location of the encapsulant application; and

d. The date of encapsulant application; and

(2) Written documentation of the visual inspections required by (i) through (k) above.

(p) The owner shall make all records required by (o) above available to:

(1) The commissioner upon request; and

(2) An owner or entity upon the sale, lease, rental, or transfer of interest in the dwelling, dwelling unit, or child care facility.

(q) The commissioner shall approve encapsulant paint products for lead hazard reduction work that have been tested and meet or exceed:

(1) ASTM International’s ASTM E 1795-17, “Standard Specification for Non-Reinforced Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition) available as noted in Appendix A; or

(2) ASTM International’s ASTM E 1797-12, “Standard Specification for Reinforced Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2017 edition), available as noted in Appendix A.

(r) Requestors shall submit the following documentation to the commissioner prior to the encapsulation paint product being approved:

(1) Documentation in the form of a performance testing report showing:

a. Compliance with the applicable ASTM standard;

b. That all testing was conducted by an independent and National Voluntary Laboratory Accreditation Program (NVLAP) certified testing laboratory; and

c. The minimum dry film thickness at which the lead encapsulant paint product meets or exceeds the requirements of the applicable ASTM standard in (q) above for interior or exterior use; and

(2) Documentation showing that the encapsulation product:

a. Is warrantied by the product manufacturer to perform for at least 20 years as a durable barrier between the lead-based paint and the environment in locations or conditions similar to those of the planned application; and

b. Is formulated with an FDA-approved anti-ingestant ingredient which deters oral contact with the cured film and which discourages ingestion of delaminated coatings.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.09)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1609.04 Abatement Alternatives

(a) When an order of lead hazard reduction has been issued pursuant to He-P 1605.01, the owner(s) or owner’s agent may request to use abatement alternatives by completing and submitting to the department a “Request for Use of Abatement Alternatives” (February 2025) certifying the following:

“As defined by RSA 130-A:1, XVIII and in accordance with He-P 1609.04, I, do hereby certify that I am the owner of the property identified below.;

“I further certify that the dwelling identified above is currently:

Vacant and will remain vacant until the Order(s) has been satisfied;

Converted to non-residential use (explain and provide documentation); or

Destroyed (explain and provide documentation to indicate abatement of soils, any other outbuildings, or other structures under Order).”;

“I hereby certify as:

Owner(s); or

Owner’s Agent

That the information is true and accurate, on this day.”; and

“I further certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). The parties agree that this Request for Use of Abatement Alternatives may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request for Use of Abatement Alternatives form on the basis that it was executed electronically.”

(b) The following abatement alternatives shall be allowed:

(1) Certifying that the dwelling is vacant and will remain vacant until the order(s) has been satisfied;

(2) The use of interim controls in accordance with He-P 1610;

(3) Destruction of the dwelling or child care facility;

(4) The property no longer houses a child care facility and remains off the residential rental market; or

(5) Other abatement alternatives approved by the commissioner in accordance with (d) below.

(c) When the dwelling or child care facility has been completely destroyed, in accordance with (b)(3) above, the owner shall submit to the department:

(1) A signed statement from a representative of the city or town certifying that the property has been completely destroyed; and

(2) A certificate of lead safe– abatement for the soils and any remaining structures which remain under the order of lead hazard reduction, such as an outbuilding.

(d) If the owner wishes to use alternative abatement methods not provided by He-P 1600, the owner shall:

(1) Submit a written variance request to the commissioner in accordance with He-P 1605.03 describing in detail what alternative methods they would like to use and describe how the proposed procedures will provide the same level of protection as that which is provided by abatement or interim controls; and

(2) Receive written approval from the commissioner prior to using alternative abatement methods.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1605.02)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1609.05 Request to Remove the Dwelling or Dwelling Unit(s) from the Rental Market.

(a) When an order of lead hazard reduction has been issued pursuant to He-P 1605.01, the owner(s) or owner’s agent may request to remove the dwelling or dwelling unit(s) from the rental market, pursuant to RSA 130-A:8-a, III.

(b) To certify that the dwelling or dwelling unit(s) are removed from the residential rental market, or that the dwelling or the dwelling unit is owner-occupied, the owner shall complete and submit to the department an “Request to Remove from the Residential Rental Market” (February 2025) certifying the following:

“I hereby certify as owner(s) or owner’s agent that the dwelling and dwelling unit(s) indicated above have been removed from the residential rental market and the information provided on this form is true and accurate to the best of my knowledge. The parties agree that this Request to Remove from the Residential Rental Market form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request to Remove from the Residential Rental Market form on the basis that it was executed electronically. I further certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A) and acknowledge that any dwelling or dwelling unit(s) under an Order of Lead Hazard Reduction cannot be returned to the residential rental market until such time as the Order of Lead Hazard Reduction has been satisfied.”

(c) The department shall approve a request to remove a dwelling or dwelling unit(s) under order of lead hazard reduction from the residential rental market when the following criteria are met:

(1) If there are multiple dwelling units at the dwelling, all lead exposure hazards associated with the components located in the interior common areas, exterior, bare soils, and components on the exterior of buildings on the same lot shall be reduced;

(2) The owner(s) are not in violation of the provisions of RSA 130-A or He-P 1600 on any property they own together or individually that is under an order of lead hazard reduction; and

(3) The owner(s) making the request do not have any outstanding administrative fines or court sanctions on any property they own together or individually that is under an order of lead hazard reduction.

(d) Provided the property owner is in compliance with (a) through (c) above, the department shall notify the property owner in writing if a request to remove the property from the residential rental market is approved.

(e) If the property owner is not in compliance with (a) through (c) above, the department shall deny the request to remove the property from the residential rental market.

(f) The department shall revoke a removal from the residential rental market when it is found that there are any violations of the provisions of RSA 130-A or He-P 1600.

(g) If a request to remove from the residential rental market is denied or revoked by the department, the denial or revocation shall be:

(1) In writing setting forth the reasons for denying or revoking the request to remove from the residential rental market; and

(2) Sent by a form of delivery that provides confirmation that the denial or revocation was delivered.

History

• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1610 Standards for Interim Controls

N.H. Code Admin. R. Ann. He-P 1610.01 Interim Control Standards

(a) He-P 1610 shall apply to any persons engaged in lead hazard reduction as defined in He-P 1602.01(ay) and who has chosen to utilize interim controls as a means of temporarily reducing lead exposure hazards on a dwelling, dwelling unit, or child care facility.

(b) All interim control activities shall be conducted in accordance with RSA 130-A and He-P 1600.

(c) When a property is under an order of lead hazard reduction, the owner shall request permission in writing from the commissioner to use interim controls as an alternative to abatement by completing and submitting a to the department, at least 5 business days prior to the anticipated start date of the lead hazard reduction work, a “Request for Interim Control Use Form” (February 2025) certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Request for Interim Control Use Form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request for Interim Control Use Form on the basis that it was executed electronically.”

(d) In addition to the “Request for Interim Control Use Form” (February 2025), the owner shall submit:

(1) A copy of the work scope as described in He-P 1602.01(cd); and

(2) A copy of the occupant protection plan as described in He-P 1608.05.

(e) Interim control work shall not be conducted on properties under an order of lead hazard reduction until written approval is received from the department.

(f) The period of time that a property owner is allowed to use interim controls on properties under an order of lead hazard reduction shall not exceed 5 years from the date of approval. After 5 years the property shall be abated and have a valid certificate of lead safe-abatement issued by a licensed risk assessor.

(g) The commissioner shall deny a request to use interim controls when it is found that:

(1) The person making the request is in violation of one or more provisions of RSA 130-A and He-P 1600;

(2) The person making the request has outstanding administrative fines; or

(3) The requested plan does not satisfy the intent of the rules as an alternative to complying with the rules.

(h) The commissioner shall revoke permission for the use of interim controls and order the owner to abate all lead exposure hazards when it is found that:

(1) The owner has failed to maintain a current certificate of lead safe – interim controls; or

(2) When a compliance inspection conducted in accordance with He-P 1605.04 reveals that the property with a certificate of lead hazard control – interim controls no longer meets the requirements of He-P 1600.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.02)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1610.02 Lead-Based Paint Stabilization

(a) Lead-based paint stabilization or work being performed pre-stabilization where those activities disturb lead based paint, shall be conducted in accordance with He-P 1608.07 through He-P 1608.11 and only when the substrates of the surfaces to be treated are dry, clean, and in good repair, prior to the application of new paint or other coating.

(b) The following substrate defects shall be repaired prior to lead-based paint stabilization:

(1) Dry, rotted, or rusty structural, siding, window, door, or railing components;

(2) Moist or moldy components including, but not limited to, structural, siding, window, door, or railing components;

(3) Wall and ceiling plaster that is unkeyed from the underlying lath;

(4) Loose siding or trim; and

(5) Any other substrate condition that would compromise the effectiveness of the interim control measures.

(c) Prior to lead-based paint stabilization the following interior conditions that might jeopardize the effectiveness of the lead-based paint stabilization shall be repaired in rooms undergoing lead-based paint stabilization as well as those above or adjacent to rooms undergoing lead-based paint stabilization:

(1) Visual leaks in waste lines, traps, supply lines, or fixtures;

(2) Undirected or clogged condensate drip lines for air conditioners;

(3) Water heaters, dishwashers, and washing machines without drip pans or an overflow mechanism;

(4) Inadequately ventilated attic spaces, bathrooms, kitchens, or laundry areas as defined by either:

a. The International Building Code pursuant to RSA 155-A;

b. The International Residential Code pursuant to RSA 155-A; or

c. A local building code adopted by a municipality under RSA 48-A;

(5) Clogged plumbing fixtures or drains;

(6) Interior windows that are loose or do not close completely;

(7) Missing or broken window panes;

(8) Absent, incomplete, or deteriorated caulking around sinks and tubs in the bathroom or kitchen; and

(9) Any other deterioration or damage to interior components that would compromise the effectiveness of the interim control measures.

(d) Prior to lead-based paint stabilization, the following exterior conditions that might jeopardize the effectiveness of the lead-based paint stabilization on the interior or exterior of the dwelling or dwelling unit shall be repaired:

(1) Damaged or missing flashing on a door, window, roof, or other visual roof leaks;

(2) Siding in contact with soil;

(3) Water-damaged siding or clapboards;

(4) Missing or deteriorated trim on a door or window opening;

(5) Missing or broken window panes;

(6) Missing, damaged, or deteriorated window caulking or glazing; and

(7) Any other deterioration or damage to building components that would compromise the effectiveness of the interim control measures.

(e) Lead-based paint stabilization of interior surfaces shall be conducted in the following manner and in accordance with He-P 1608.07, He-P 1608.11, and 40 CFR 745, if applicable:

(1) Loose and flaking paint shall be scraped away from surfaces after misting the surfaces with water;

(2) After drying, all surfaces shall be vacuumed with a HEPA vacuum until no visible dust or debris remains;

(3) All surfaces shall be cleaned using a general all-purpose or lead-specific cleaner and water solution and rinsed with clean water;

(4) After drying, all surfaces shall be HEPA vacuumed again;

(5) All surfaces shall be primed with primer;

(6) Except as allowed by (7) below, all surfaces shall be covered with at least 2 coats of paint or other coating; and

(7) When the surface is a wall, a single layer of vinyl wallpaper may be used in place of the 2 coats of paint or other coating.

(f) Lead-based paint stabilization of exterior surfaces shall be conducted in the following manner and in accordance with He-P 1608.08, He-P 1608.11, and 40 CFR 745, if applicable:

(1) Loose and flaking paint shall only be removed by:

a. Scraping after first misting the surface with water; or

b. Dry scraping within 6 inches in an area that would present an electrical hazard if other methods were used;

(2) All surfaces shall be cleaned using a general all-purpose or lead-specific cleaner and water solution and rinsed with clean water;

(3) All adjacent horizontal surfaces shall be vacuumed with a HEPA vacuum, cleaned with a general all-purpose or lead-specific cleaner and water solution, and rinsed with clean water; and

(4) Recoating of surfaces shall be done by:

a. Priming all surfaces with primer; and

b. Covering all surfaces with at least 2 coats of paint or other coating.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.03)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1610.03 Abrasion, Friction, and Impact Surfaces

(a) When interim controls are implemented on the friction and impact surfaces of windows, the following measures shall occur:

(1) The window stop holding the lower sash in place shall either:

a. Be misted with water and removed; or

b. Have aluminum, vinyl, or polyvinyl chloride window channel or slides installed;

(2) The lower window sash, and when necessary, the upper window sash and parting bead, shall be misted with water and removed to access other surfaces requiring paint stabilization;

(3) Repairs shall be made to bring all window components into compliance with He-P 1610.02(b) through (f);

(4) The window well shall be capped with vinyl, aluminum coil stock, sheet metal flashing, or other impervious material securely affixed to the well with edges sealed and caulked; and

(5) The original window sash(es), window stop, and parting bead shall be installed.

(b) As an alternative to (a) above, friction and impact surfaces may be eliminated by permanently fastening window sashes shut, when not otherwise prohibited by any other state laws, rules, or local health, building, or fire safety ordinances.

(c) When interim controls are implemented for doors, the following measures shall take place in the order listed:

(1) Doorstops shall:

a. Be misted with water, removed, and replaced with new doorstops;

b. Be wrapped with vinyl or aluminum coil stock securely affixed to the door frame; or

c. Have unpainted rubber bumpers securely affixed on the surface of the doorstop to protect the door and doorstop from impacting against one another;

(2) The door shall be corrected to reduce rubbing against the doorjamb by:

a. Removing the door from its hinges or replacing it;

b. Planing the edges of the door to eliminate any friction points by either using a HEPA local vacuum exhaust sized to match the tool used or hand planing a wetted surface;

c. Conducting lead-based paint stabilization in accordance with He-P 1610.02; and

d. One of the following:

1. Rehanging and checking the door to verify that all friction points have been eliminated; or

2. Making the surface intact in accordance with He-P 1610.02 when no friction or impact points exist;

(3) Lead-based paint stabilization shall be conducted on all door components in accordance with He-P 1610.02; and

(4) When applicable, a stop shall be installed to prevent a door from striking a wall or baseboard.

(d) When interim controls are implemented for stair systems, which shall include the treads, risers, balusters, newel posts, handrails, baseboards, and stringers, the following measures shall take place in the order listed:

(1) Lead-based paint stabilization shall be conducted on all surfaces of the stair system in accordance with He-P 1610.02; and

(2) After first labeling in accordance with He-P 1609.02(a)(3)a., the entire width of the stair tread between the stair baseboard and balusters, including any chewable edges of the stair tread, shall be covered by securely affixing a carpet or a hard, durable, and cleanable covering such as rubber tread guards on treads.

(e) When interim controls are implemented for baseboards, the following measures shall take place:

(1) Lead-based paint stabilization shall be conducted for all surfaces in accordance with He-P 1610.02;

(2) A rubber bumper shall be installed to prevent impact from nearby doors; and

(3) Any shoe or quarter round moldings found or assumed to contain lead shall be misted with water, removed, and replaced.

(f) When interim controls are implemented for outside wall corners, wooden, or plastic corner bead shall be installed.

(g) When interim controls are implemented for drawers and cabinets, the following measures shall take place:

(1) Impact points of doors and drawer covers shall be:

a. Wet planed or planed with a HEPA local vacuum exhaust tool; or

b. Fitted with unpainted rubber bumpers installed to reduce impact; and

(2) Lead-based paint stabilization shall be conducted on all surfaces in accordance with He-P 1610.02.

(h) When interim controls are implemented for any floor, including the floors of a porch or deck, lead-based paint stabilization shall be conducted, in accordance with He-P 1610.02, for all surfaces, using a paint or coating that is intended for use on flooring.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.04)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1610.04 Chewable Surfaces

(a) When implementing interim controls for lead exposure hazards, an owner shall implement procedures for lead-based paint stabilization in accordance with He-P 1610.02.

(b) When interim controls are implemented for baseboards that meet the definition of a lead exposure hazard, quarter round or similar molding shall be applied to the top to remove the chewable edge.

(c) When interim controls are implemented for interior and exterior windowsills, plastic wallpaper corner guards, or a similar material, shall be securely affixed to the top and bottom of the edge to prevent a child from mouthing the sill.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-11 (from He-P 1606.05)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1610.05 Contaminated Bare Soil

(a) Interim control measures may be utilized as an alternative to abatement of lead-contaminated bare soil if the lead level of the soil is found to be less than 5,000 ppm.

(b) For bare soil found to be equal to or greater than 400 ppm in children’s play areas or 1,200 ppm average in the rest of the yard, one or more of the following methods shall be utilized:

(1) Coverage of the contaminated soil with one of the following:

a. Soil that contains less than 200 ppm of lead to a depth of at least 6 inches, covered by grass or sod;

b. Stone, crushed rock, or gravel to a depth of at least 6 inches;

c. Artificial turf;

d. Thorny or dense shrubbery, sufficient to deter access to the soil by children; or

e. Bark mulch or wooden nuggets to a depth of at least 6 inches; or

(2) Implementation of land use controls, which may include one or more of the following:

a. Fencing;

b. Decks; or

c. Other forms of land use controls against access to bare soil.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.06)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1610.06 Maintaining a Certificate of Lead Safe - Interim Controls

(a) When interim controls have been implemented on a dwelling, dwelling unit, or child care facility in response to an order of lead hazard reduction, the owner shall maintain a current certificate of lead safe – interim controls until:

(1) All lead hazards have been abated from the dwelling, dwelling unit, or child-care facility;

(2) The dwelling, dwelling unit, or child-care facility has been completely destroyed and any remaining lead exposure hazards have been abated;

(3) The entire dwelling or dwelling unit is removed from the rental market and all lead hazards within the common areas, exterior, outbuildings, and soils have been abated;

(4) The dwelling or dwelling unit is not used for residential purposes; or

(5) The property no longer houses a child care facility and is not used for residential purposes.

(b) A certificate of lead safe – interim controls issued in accordance with He-P 1608.14 shall expire one year from the date of its issuance.

(c) The owner shall have the certificate of lead safe – interim controls renewed annually as follows:

(1) A licensed risk assessor or lead inspector shall conduct a clearance inspection in accordance with He-P 1608.12(h) and (i); and

(2) A licensed risk assessor shall issue a new certificate of lead safe – interim controls when it is determined that no lead exposure hazards exist and dust samples meet the standards in He-P 1608.12(t).

(d) The owner shall submit the new certificate of lead safe – interim controls to the commissioner prior to the expiration of the current certificate.

(e) Failure to submit a new certificate of lead safe – interim controls prior to the expiration of the current certificate shall result in the commissioner revoking approval for the use of interim controls and ordering the owner to abate all lead exposure hazards.

(f) When a compliance inspection conducted in accordance with He-P 1605.04 reveals that a property with a certificate of lead safe – interim controls no longer meets the requirements of He-P 1600, the commissioner shall revoke the certificate of lead safe – interim controls and order the owner to abate all lead exposure hazards.

(g) If an owner is ordered to abate all lead exposure hazards pursuant to (e) or (f) above, the owner shall have 90 days to submit a certificate of lead safe – abatement to the commissioner.

(h) An owner shall be granted permission to utilize interim controls on a property under order of lead hazard reduction only for a period not to exceed 5 years from approval by the department.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1606.08)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1611 Lead Educational Programs and Standards

N.H. Code Admin. R. Ann. He-P 1611.01 Lead Educational Programs

(a) Lead educational programs for licensure or certification of lead professionals under He-P 1612 shall be certified and approved by the department in accordance with this part and RSA 130-A:12.

(b) Lead education programs and training may be offered by the department when:

(1) There are no lead educational programs certified or approved in accordance with He-P 1611 to teach each discipline;

(2) A lead educational program for a particular discipline has not been held in the last 3 months; or

(3) Those seeking licensure have not been able to gain access to a course being offered by a certified lead educational program in the last 3 months.

(c) Lead education programs shall have, at a minimum, the following program staff:

(1) A program manager;

(2) A principal instructor; and

(3) Guest instructor(s), as applicable.

(d) The program manager shall:

(1) Have the following education and experience requirements:

a. One of the following:

1. A minimum of a bachelor’s degree in building construction technology, engineering, industrial hygiene, occupational safety, public health, education, business administration, or program management;

2. A minimum of 2 years of experience, education or training, in teaching workers or adults; or

3. A minimum of 2 years of experience in managing a program specializing in environmental hazards; and

b. Demonstrated experience, education, or training in the construction industry including, but not limited to, lead or asbestos abatement, painting, carpentry, renovation, or remodeling;

(2) Have a minimum of 24 hours of classroom experience teaching adults;

(3) Implement and monitor the program’s compliance with all of the requirements of He-P 1611;

(4) Ensure that individuals serving as principal and guest instructors have met the requirements set forth in He-P 1611.01(d)(6)(a) and He-P 1611.01(e);

(5) Provide facilities for hands-on skill development that demonstrate current work practices and actual field conditions;

(6) Appoint guest instructors to provide information specific to the lecture, hands-on skill development, or work practice components of a program, provided that:

a. Guest instructors have at least one year of experience in the specific aspects of the subject matter being presented; and

b. Guest instructors shall not provide more than 30 percent of a program’s total hours;

(7) Develop a final written examination and hands-on skills assessment that meet the requirements of this section and which assesses knowledge of all required content areas; and

(8) Develop and implement a quality control program for each type of program offered, in order to maximize quality by preventing or correcting identified problems, which contains, at a minimum, the procedures for:

a. Annual review of principal and guest instructor(s)’ competency;

b. Annual review and revision, as needed, of all course materials, course written examinations, and hands-on skill assessments to reflect innovations in the field and meet the requirements of He-P 1611.03 and He-P 1611.04; and

c. Ensuring that the facilities and equipment used meet the needs of the students and cover all required hands-on skills.

(e) The principal instructor(s) shall:

(1) Have at least 2 years of demonstrated experience, education, or training in the construction industry including, but not limited to, lead or asbestos abatement, painting, carpentry, renovation, or remodeling, including one year as a licensed or certified lead abatement supervisor, lead inspector, or lead risk assessor in an EPA authorized state or Tribal Nation, or as issued by the EPA;

(2) Have a current license or certification in an EPA authorized state or Tribal Nation, or as issued by the EPA as:

a. A lead inspector, risk assessor, or lead clearance testing technician to teach a lead clearance testing technician program;

b. A lead abatement supervisor to teach a lead abatement worker or lead abatement supervisor program;

c. A lead inspector or lead risk assessor to teach a lead inspector program; or

d. A risk assessor to teach a lead inspector or lead risk assessor program;

(3) Have at least 12 hours of demonstrated classroom experience teaching workers or adults during the previous 6 months;

(4) Maintain professional competency by attending at least 12 hours of continuing education each licensing year in subject areas including, but not limited to, worker safety, hands-on skills, or related lead paint subject matter; and

(5) Organize and teach the program.

(f) The program manager shall notify the department in writing at least 30 days prior to making any changes in staff, course content, hands-on skill equipment, or classroom facilities, including documentation of the new instructor’s qualifications and a description of any other program changes, as applicable.

(g) At least 10 days prior to the start of an educational program, the program manager shall provide the department with the following information:

(1) Date, time, and location of the scheduled program; and

(2) Name(s) of the program manager and all principal and guest instructors.

(h) A representative of the department shall be allowed to monitor and audit each program not offered by the department and to take the written examination without cost to the department.

(i) The program manager shall maintain records for a minimum of 5 years and make them available to the department upon request including:

(1) The title of each educational program presented;

(2) The dates when the program was presented;

(3) The name, address, and date of birth of each student who successfully completed the program; and

(4) The unique certificate number for each student who successfully completed the program.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1611.02 Certification of Lead Educational Programs

(a) Any person or entity offering or providing lead educational programs for individuals to be licensed or certified by the state of New Hampshire as lead clearance testing technicians, lead abatement workers, lead abatement supervisors, lead inspectors, or lead risk assessors shall be certified by the department in accordance with this section.

(b) The department may offer or provide lead educational programs for individuals to be licensed or certified by the state of New Hampshire as lead clearance testing technicians, lead abatement workers, lead abatement supervisors, lead inspectors, or lead risk assessors in accordance with He-P 1611.01(b).

(c) The department shall certify the following programs:

(1) Lead clearance testing technician – initial or refresher;

(2) Lead abatement worker – initial or refresher;

(3) Lead abatement supervisor – initial or refresher;

(4) Lead inspector – initial or refresher;

(5) Lead risk assessor – initial or refresher; and

(6) State of New Hampshire rules course which shall focus on the specific New Hampshire requirements of RSA 130-A and He-P 1600 for those seeking licensure, certification, and reciprocity.

(d) No provider shall be certified to offer a refresher program without being certified to offer an initial program in the same discipline.

(e) Fees shall be as follows:

(1) For initial applicants for certification of a lead educational program the application fee shall be $300; and

(2) For renewal applicants for certification of a lead educational program the application fee shall be $300.

(f) The fees in (e) above shall not apply to educational programs for certification and licensure offered by the department.

(g) Any added disciplines or revision of course materials beyond those required by He-P 1611.01(d)(8)(b) shall be considered an initial application and follow the fee structure in (1) above.

(h) Any lead educational program whose certificate has expired by more than 30 days shall complete an initial application and follow the fee structure in (1) above.

(i) All fees shall be non-transferable and non-refundable.

(j) The department shall process all applications under this section in accordance with RSA 541-A:29.

(k) Each applicant for certification as a lead educational program provider shall submit the following to the department at least 120 days prior to the anticipated start date of the program:

(1) A completed “Request for Training Program Certification” application (February 2025) indicating the program(s) for which certification is being requested certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Request for Training Program Certification form may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Request for Training Program Certification form on the basis that it was executed electronically.”;

(2) The applicable certification fee(s) pursuant to (e) above, paid by check or money order, in the exact amount made payable to the “Treasurer, State of New Hampshire”; and

(3) The following for each program for which the provider is requesting certification:

a. A copy of the course agenda, which includes all content required by He-P 1611.03;

b. A copy of all student manuals, handouts, and instructor curriculum;

c. A list of all audiovisual aids;

d. All other course materials not listed above;

e. For each program manager, principal instructor(s), guest instructor(s), or hands-on skills(s) instructor used by the program:

1. Photocopies of applicable lead licenses, certificates, or any other documents which have been issued by another state, jurisdiction, Tribal Nation, or the EPA;

2. Photocopies of official academic transcripts issued by the relevant educational institution;

3. Résumés, qualifications, or records of work experience that show that the individual meets the requirements of He-P 1611.01(d) and (e); and

4. A listing of what content areas and or hands-on skills practice that each individual will be involved with;

f. For each program using a qualified, independent translator, a signed statement that they had compared the course to the English language version and found the translation to be accurate;

g. Each independent translator shall submit to the department resume detailing their qualifications, or records of work experience that demonstrate the individual is qualified to provide services as a translator;

h. A description of the hands-on training that shall be provided, including the outline for instruction, the number of students to be accommodated, and the number of instructors;

i. A detailed description of the facilities and equipment available for both lecture and hands-on skills practice and assessment;

j. A copy of the quality control plan as required in He-P 1611.01(d)(8);

k. A description of the format for all course examinations, which shall include:

1. The proportion of written exam questions devoted to each major course topic; and

2. A detailed description of the procedures to be used in the evaluation of hands-on skills for all skills required under He-P 1611.04(d);

l. An example of the numbered course completion certificates, as described in He-P 1611.04(e)-(f), to be issued to students who successfully complete the course; and

m. A list of all state and federal agencies that have certified, accredited, or given other forms of approval to the applicant to provide lead training, including the name, address, and telephone number of the person, department, or agency giving such approval, and copies of all such written approvals.

(l) In addition to He-P 1611.02(k) above, a request for certification for a state of New Hampshire rules course program shall include documentation that the educational provider is currently certified or is currently requesting certification for at least one initial lead educational program.

(m) The following conditions shall apply to all certifications issued under this section:

(1) The certification(s) shall expire one year from the date of issuance, unless it has been suspended or revoked by the department pursuant to He-P 1606.02;

(2) The certified program shall be required to comply with all standards set forth in He-P 1611; and

(3) The program manager shall provide any of the above documentation upon request by the department.

(n) In order to renew a program certification, each certificate holder shall submit to the department the following within at least 120 days prior to the expiration date of the current certificate:

(1) A completed “Request for Training Program Certification” application (February 2025) indicating the program(s) for which certification is being requested, which has been legibly completed and signed by the applicant;

(2) The applicable certification fee(s) pursuant to He-P 1611.02(e) above, paid by check or money order, in the exact amount made payable to the “Treasurer, State of New Hampshire”; and

(3) Any new information required by He-P 1611.02 (k)(3) above that has not been submitted to the department in accordance with He-P 1611.01(f).

(o) The denial, suspension, or revocation of a certification issued under this part shall be in accordance with He-P 1606.02.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19 (from He-P 1611.08)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1611.03 Program Content and Hands-On Skill Development

(a) All lead educational programs shall:

(1) Include all required course content for the discipline of lead professional for which certificates are being offered;

(2) Present all information through a combination of lectures, demonstrations, and hands-on skill development;

(3) Include a discussion of New Hampshire requirements per RSA 130-A and He-P 1600;

(4) Provide instruction in hands-on skill development which meets the following requirements:

a. All students shall be required to perform those hands-on skills being taught; and

b. There shall be a student-to-instructor ratio of not greater than 10 to 1;

(5) Be conducted as follows:

a. Offered by the training provider when at least 5 clients are scheduled for a course;

b. No program shall last longer than 3 weeks;

c. Students shall not be required to attend more than 8 hours of classes in a single 24-hour period;

d. Evening classes shall not exceed 4 hours in any single session; and

e. At the discretion of the program manager, previous education, including completion or partial completion of a lead educational program, may be recognized towards the requirements of another discipline of lead professional if the education occurred within the past 12 months; and

(6) Have written procedures for testing students and assessing hands-on skills, as set forth in He-P 1611.04.

(b) All lead educational programs may be offered by the department in accordance with He-P 1611.01(b).

(c) The lead clearance testing technician program shall:

(1) Contain a minimum of 8 hours of class time including a minimum of 2 hours of hands-on skills development; and

(2) Include the following content areas:

a. History of lead paint use and the history and recognition of sources of environmental lead contamination including paint, surface dust, soil, water, air, food, and occupational exposure;

b. An explanation of lead inspection and lead hazard reduction activities contained in all relevant local, state, and federal laws, rules, and ordinances including, but not limited to:

1. Federal and OSHA worker safety requirements under state law and the OSHA Lead in Construction Standard, 29 CFR 1926.62;

2. HUD “Guidelines for the Evaluation and Control of Lead Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A and

3. State requirements as set forth in RSA 130-A and He-P 1600;

c. Roles and responsibilities of a lead clearance testing technician;

d. Lead-paint inspection methods and requirements, including selection of rooms and components for sampling or testing;

e. Formulating a sampling plan, including techniques for:

1. Computing sample location and size;

2. Selecting the components in each unit to be sampled; and

3. Classification of components;

f. Conducting visual assessments of potential sources of lead hazards and correctly identifying visible dust, debris, and deteriorated paint;

g. Alternative inspection technologies and methods, including paint chip, soil, and dust wipe sample collection for laboratory analysis;

h. Preparing for and collecting dust wipe samples following state and federal lead sampling requirements;

i. Selecting an accredited lab and submitting samples;

j. Interpreting the sampling results;

k. Preparing an accurate and understandable report of sampling results;

l. Record keeping requirements under He-P 1608.15; and

m. Preparation of reports of test results in accordance with He-P 1608.01(e) and issuance of a certificate of results in accordance with He-P 1608.14.

(d) The lead abatement worker program shall:

(1) Contain a minimum of 24 hours of class time including a minimum of 8 hours of hands-on skills development; and

(2) Include the following content areas:

a. History of lead paint use, and the history and recognition of sources of environmental lead contamination including paint, surface dust, and soil, water, air, food, and occupational exposure;

b. An explanation of lead inspection and lead hazard reduction activities contained in all relevant local, state, and federal laws, rules, and ordinances including, but not limited to:

1. Federal and OSHA worker safety requirements under state law and the OSHA Lead in Construction Standard, 29 CFR 1926.62;

2. HUD “Guidelines for the Evaluation and Control of Lead Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A; and

3. State requirements as set forth in RSA 130-A and He-P 1600;

c. Roles and responsibilities of a lead abatement worker;

d. Lead exposure hazard recognition and control;

e. How lead enters the body and the health effects of lead exposure;

f. Medical surveillance of worker lead exposure;

g. Occupational health and safety;

h. Respiratory protection in accordance with 29 CFR 1926.103, including the proper use of respiratory protection devices;

i. The proper use of personal protective equipment;

j. Hygiene practices;

k. Engineering and work practices;

l. Interpreting and responding to lead exposure measurements in the workplace;

m. Prohibited and permissible lead hazard reduction methods, including the reduction of lead hazards associated with dust and soil;

n. Requirements for controlling lead contamination and maintaining containment systems at work sites; and

o. Interior and exterior clean-up methods, and preliminary clearance and final clearance standards.

(e) The lead abatement supervisor program shall:

(1) Contain a minimum of 32 hours of class time, including a minimum of 8 hours of hands-on skills development; and

(2) Include the following content areas:

a. A review of all content listed in (d)(2) above; and

b. Roles and responsibilities of a lead abatement supervisor including:

1. Those listed in He-P 1612.01(e);

2. Conducting and interpreting workplace lead exposure measurements and medical monitoring;

3. Developing and implementing a worker safety and health plan including, but not limited to, medical surveillance of workers’ lead exposure;

4. Implementing programs for employee information and training;

5. Development and implementation of an occupant protection plan and work scope;

6. Risk assessment and inspection report interpretation;

7. Waste management and disposal requirements;

8. Clearance standards and testing;

9. Record keeping requirements under He-P 1608.15;

10. Project management;

11. Cost estimation; and

12. Liability and insurance issues related to lead hazard reduction.

(f) The lead inspector program shall:

(1) Contain a minimum of 24 hours of class time with a minimum of 8 hours of hands-on skills development; and

(2) Contain the following content areas:

a. The history and recognition of sources of environmental lead contamination including paint, surface dust, and soil, water, air, food, and occupational exposure;

b. An explanation of lead inspection and lead hazard reduction activities contained in all relevant local, state, and federal laws, rules, and ordinances including, but not limited to:

1. Federal and OSHA worker safety requirements under state law and the OSHA Lead in Construction Standard, 29 CFR 1926.62;

2. HUD “Guidelines for the Evaluation and Control of Lead Based Paint Hazards in Housing”, (2012 Edition), available as noted in Appendix A ; and

3. State requirements as set forth in RSA 130-A and He-P 1600;

c. Role and responsibilities of the lead inspector including those listed in He-P 1612.01(g);

d. How lead enters the body and the health effects of lead exposure;

e. Symptoms of childhood lead poisoning and blood lead levels that indicate lead poisoning;

f. Lead-based paint testing operations;

g. Treatment and control of lead exposure hazards;

h. Lead-based paint inspection methods and requirements including selection of rooms and components for sampling or testing;

i. Clearance standards and testing, including random sampling;

j. Formulating a sampling plan, including techniques for:

1. Computing sample location and size;

2. Selecting the components in each unit to be sampled; and

3. Classification of components;

k. Conducting visual assessments of potential sources of lead hazards and correctly identifying visible dust, debris, and deteriorated paint;

l. The licensing and registration, operation and maintenance of the XRF, including:

1. Federal and New Hampshire state laws, rules, and regulations;

2. Correcting for substrate interference;

3. Radiation safety;

4. Similarities and differences between the direct and spectrum;

5. Interpretation of the XRF sampling data; and

6. Transportation of XRF analyzers;

m. Alternative inspection technologies and methods, including paint chip, soil, and dust wipe sample collection for laboratory analysis;

n. Preparing for and collecting dust wipe samples following state and federal lead sampling requirements;

o. Selecting an accredited lab and submitting samples;

p. Interpreting the sampling results;

q. Preparing an accurate and understandable report of sampling results;

r. Record keeping requirements under He-P 1608.15; and

s. Preparation of a clearance inspection report including test results in accordance with He-P 1608.01(e) and He-P 1608.12(x).

(g) The lead risk assessor program shall:

(1) Be a minimum of 40 hours with a minimum of 12 hours of hands-on skills development; and

(2) Contain the following content areas:

a. All information taught in the lead inspector course as listed in (f)(2) above;

b. Roles and responsibilities of a risk assessor including those listed in He-P 1612.01(h);

c. Collection of background information as required by He-P 1608.03 to perform a risk assessment;

d. Determining inspection criteria and locations to collect samples in accordance with the requirements of He-P 1608.01 through He-P 1608.04;

e. Interpretation and preparation of inspection reports;

f. Development and implementation of sampling and analysis guidelines;

g. Dust wipe and soil sample collection in accordance with the requirements of He-P 1608.04(b) including the following:

1. Sources of lead dust exposure;

2. Sources of soil lead exposure;

3. Number and location of dust wipe and soil samples;

4. Dust wipe and soil sample collection techniques; and

5. Interpretation of test results;

h. Interpretation of lead-based paint and other lead sampling results, including all applicable federal and state laws, rules, and guidance pertaining to lead-based paint hazards;

i. Lead hazard reduction activities, abatement, and interim control methods;

j. Development of an occupant protection plan and work scope in accordance with He-P 1608.05, including the development of recommendations to abate or reduce lead-based paint hazards and instruction on when interim controls are appropriate;

k. Interpretation of results and preparation of preliminary and final clearance inspections or risk assessment reports, in accordance with the requirements of He-P 1608.01 through He-P 1608.04, He-P 1608.12, and He-P 1608.14;

l. Record keeping requirements under He-P 1608.15;

m. Clean-up and clearance testing requirements under He-P 1608.11 and He-P 1608.12;

n. Waste disposal requirements;

o. Operations and maintenance planning;

p. Construction techniques; and

q. Cost estimation.

(h) The refresher programs for lead clearance testing technicians shall contain a minimum of 2 hours of class time, the refresher programs for lead abatement workers, lead abatement supervisors, lead inspectors, and lead risk assessors shall contain a minimum of 8 hours of class time, and include the following:

(1) A review of all the curriculum topics from the full-length course, as appropriate;

(2) An overview of the current worker safety and lead safety practices and requirements;

(3) An update on federal and state laws and regulations and rules with regard to lead-based substance activities and occupational safety; and

(4) An update on current technologies related to lead-based paint work.

(i) The NH rules course program shall:

(1) Accept students who are seeking reciprocity and hold a current license or certificate as a lead clearance testing technician, lead abatement worker, lead abatement supervisor, lead abatement contractor, lead inspector, or risk assessor from an approved EPA state or Tribal Nation;

(2) Contain a minimum of 4 hours of class time; and

(3) Include the following content areas from RSA 130-A and He-P 1600:

a. Duties of the respective discipline of lead professional;

b. The role of the department in conducting investigations and issuing orders;

c. Lead Inspections;

d. Standard inspection protocols;

e. Custom inspection analysis and plans;

f. Occupant protection plans and work scopes;

g. Provisions for historic properties;

h. Prohibitions contained in RSA 130-A;

i. Prohibited lead hazard reduction activities;

j. Permitted lead hazard reduction activities;

k. Interim control methods and requirements;

l. Reporting requirements;

m. Record keeping requirements;

n. The issuance of certificates;

o. The role of the department in conducting compliance inspections; and

p. Requirements for maintaining licensure and certification.

(j) Electronic learning and other alternative course delivery methods shall be permitted for the classroom portion of the lead risk assessor, lead inspector, lead abatement supervisor, lead clearance testing technician, lead abatement worker, as well as state of New Hampshire rules course for those seeking reciprocity but not the hands-on portion of these courses, or for final course tests or proficiency tests described in He-P 1611.04 (a) through (d) below.

(k) Electronic learning courses shall comply with the following requirements:

(1) A unique identifier shall be assigned to each student for them to use to launch and re-launch the course;

(2) The training provider shall track each student’s course log-ins, launches, progress, and completion and maintain these records in addition to and in accordance with He-P 1611.01(i); and

(3) The course shall include periodic knowledge checks totaling at least 16 over the entire course. The knowledge checks shall be successfully completed before the student can proceed to the next module.

(l) Lead clearance testing technicians, lead abatement workers, lead abatement supervisors, lead abatement contractors, lead inspectors, or risk assessors who hold a current license or certificate from an approved EPA state or Tribal Nation shall be issued certifications and licenses in the state of New Hampshire if they pass an examination offered by the department on RSA 130-A and He-P 1611.

(m) Lead professionals from an approved EPA state or Tribal Nation shall not be required to take a course on RSA 130-A or He-P 1611 prior to taking the examination.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1611.04 Examinations, Assessments, and Course Completion Certificates

(a) At the conclusion of each program, each student shall complete an examination that tests the student’s knowledge of all required content areas.

(b) Successful completion of the written examination shall be demonstrated by receiving a score of at least 70%.

(c) The number of questions on the examinations shall be as follows:

(1) For lead clearance testing technicians and individuals seeking certification via reciprocity as lead clearance testing technicians, there shall be at least 25 questions;

(2) For lead abatement workers, and individuals seeking certification via reciprocity as lead abatement workers, there shall be at least 50 questions;

(3) For lead abatement supervisors, lead inspectors, and lead risk assessors, and individuals seeking licensure or certification via reciprocity as lead abatement supervisors, lead inspectors, or lead risk assessors, there shall be at least 100 questions;

(4) For individuals completing a refresher program for lead clearance testing technicians or lead abatement workers, there shall be at least 25 questions; and

(5) For individuals completing a refresher program for lead abatement supervisors, lead inspectors, or lead risk assessors, there shall be at least 50 questions.

(d) At the conclusion of each program, excluding refresher programs and reciprocity programs, each student shall successfully complete a hands-on skills assessment which:

(1) Incorporates actual field conditions and current work practices;

(2) Evaluates the ability of the student to correctly perform all work practices and procedures that were covered in the hands-on skills portion of the course; and

(3) Shall be graded on a pass/fail basis and in accordance with the hands-on skills assessment developed by the program manager.

(e) Each student who successfully completes the course, including class attendance and passage of the written examination and hands-on skills assessment, shall receive a course completion certificate.

(f) The certificate shall include:

(1) The name, address, telephone number, and certification number of the provider of the program;

(2) The discipline of lead professional for which the completed educational program is certified;

(3) If it was taught electronically or in-person;

(4) The language in which the course was taught, if other than English;

(5) The number of course hours in person versus e-learning;

(6) The dates of the course;

(7) The name of the student; and

(8) A unique certificate number.

(g) Course completion certificates shall be valid for one year.

(h) If the third-party testing process is not completed within 6 months of successfully completing the applicable lead educational program, the applicant shall restart the process including retaking and successfully completing the applicable lead educational program.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; amd by #7393, INTERIM, eff 10-28-00, EXPIRED: 4-26-01; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-11
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Part He-P 1612 Licensure and Certification Criteria for Lead Professionals

N.H. Code Admin. R. Ann. He-P 1612.01 Functions of Certified and Licensed Persons

and Business Entities.

(a) All persons and business entities licensed or certified under this part shall comply with all applicable sections of RSA 130-A and He-P 1600.

(b) No licensed or certified lead risk assessor, lead inspector, lead abatement supervisor, lead clearance testing technician, or lead abatement worker shall perform inspection or lead hazard reduction activities unless working under an entity licensed as a lead abatement contractor in accordance with He-P 1612.

(c) A certified lead clearance testing technician shall:

(1) Conduct visual assessments of all painted surfaces located in the dwelling, dwelling unit, common areas, exterior, and surfaces of structures on the same lot;

(2) Collect dust wipe and soil samples following state and federal lead sampling requirements;

(3) Provide dust wipe and soil sampling results; and

(4) Prepare a report and certificate of test results in accordance with He-P 1608.01 and He-P 1608.14.

(d) No certified lead abatement worker shall perform lead hazard reduction activities unless under the supervision of a lead abatement supervisor or owner-contractor.

(e) A certified lead abatement supervisor shall:

(1) Verify that all lead abatement workers are certified in accordance with this section;

(2) Supervise all lead abatement workers;

(3) Perform or direct workers, as applicable, to perform all lead hazard reduction activities, in accordance with He-P 1600;

(4) Be physically present at the work site at all times when lead hazard reduction activities are being performed;

(5) Ensure compliance with He-P 1600 at all lead hazard reduction projects to which they are assigned;

(6) Prepare and ensure adherence to written occupant protection plans and work scopes for lead hazard reduction projects as set forth in He-P 1608.05; and

(7) Maintain records in accordance with He-P 1608.15.

(f) A licensed lead abatement contractor shall be responsible for:

(1) Assigning a lead abatement supervisor to perform the activities listed in (e) above;

(2) Utilizing only appropriately certified and licensed lead abatement workers and lead abatement supervisors to conduct lead-based paint activities;

(3) Ensuring that the business and its employees follow all applicable federal and state work practice standards for conducting lead-based paint activities; and

(4) Maintaining records in accordance with He-P 1608.15.

(g) A licensed lead inspector shall:

(1) Conduct inspections for lead-based substances and complete written inspection reports and standard written protocols in accordance with He-P 1608.01, He-P 1608.02, and He-P 1608.04;

(2) Conduct clearance inspections in accordance with He-P 1608.12;

(3) Issue inspection reports pursuant to He-P 1608.01(e); and

(4) Issue certificates in accordance with He-P 1608.14.

(h) A licensed risk assessor shall:

(1) Be responsible for the same functions set forth in (g) above for lead inspector and He-P 1608.03;

(2) Be responsible for the work of all lead inspectors who are working under their supervision;

(3) Interpret the results of lead inspections and make recommendations on hazard control options;

(4) Prepare written occupant protection plans and work scopes for lead hazard reduction projects as set forth in He-P 1608.05; and

(5) Issue certificates in accordance with He-P 1608.14.

History

• #5920, eff 1-1-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-11
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.02 Licensing or Certification Requirements

(a) All individuals and business entities performing lead hazard reduction activities shall be licensed or certified, as applicable, in accordance with RSA 130-A and this part.

(b) The following categories of lead professionals and business entities shall be licensed by the department:

(1) Lead risk assessor;

(2) Lead inspector; and

(3) Lead abatement contractor.

(c) The following categories of lead professionals shall be certified by the department:

(1) Lead abatement supervisor;

(2) Lead abatement worker; and

(3) Lead clearance testing technician.

(d) Pursuant to RSA 130-A, an owner-contractor shall not be required to be licensed, but they shall comply with all applicable licensing requirements, including the successful completion of a lead abatement supervisor educational program, successful completion of the required proficiency examinations, and submission of an application to the department.

(e) To be licensed as a lead risk assessor, an individual shall be 18 years of age or older and meet the following requirements:

(1) Successfully complete a lead risk assessor educational program certified in accordance with He-P 1611, another state, Tribal Nation, or by the EPA with prior approval from the department;

(2) Successfully complete the proficiency examinations described in He-P 1612.04;

(3) The individual shall be a NH licensed lead inspector for a minimum of one year and shall have one of the following combinations of work and education requirements:

a. A bachelor’s degree in any discipline and one year of experience by the individual in a related field of lead, asbestos, environmental remediation work, or construction; or

b. An associate’s degree in any discipline and a minimum of 2 years of experience by the individual in a related field of lead, asbestos, environmental remediation work, or construction;

c. A high school diploma or equivalent and a minimum of 3 years of experience by the individual in a related field of lead, asbestos, environmental remediation work, or construction; or

d. Certification or licensure, as an industrial hygienist, civil, environmental, or structural engineer, architect, or environmental health practitioner; and

(4) Successful completion of a 6 month probation period during which time:

a. The individual will be issued a provisional license;

b. The individual shall perform all aspects of at least 5 risk assessments on 5 separate dwellings;

c. The risk assessments required in b. above shall:

1. Be conducted after the issuance of a provisional license;

2. Be conducted in accordance with He-P 1608.03;

3. Be documented in accordance with He-P 1608.03(c); and

4. Be sent to the department for review, either with or without redaction of the information requested in He-P 1608.01(e)(2) and He-P 1608.01(e)(6), within 15 days of completion of each risk assessment; and

d. The department shall:

1. Complete a review of the risk assessments required in b. above;

2. Determine whether or not each risk assessment submitted meets the requirements of c. above; and

3. Approve or deny the individual’s application for licensure.

(f) To be licensed as a lead inspector, an individual shall be 18 years of age or older and meet the following requirements:

(1) Successfully complete a lead inspector educational program certified in accordance with He-P 1611, another state, Tribal Nation, or by the EPA with prior approval from the department;

(2) Successfully complete the proficiency examinations described in He-P 1612.04;

(3) The individual’s license shall be marked as in training until the individual has performed all aspects of:

a. Five lead-based paint inspections performed in accordance with He-P 1608.02(a) on 5 separate dwellings; and

b. Five lead-based substance inspections performed in accordance with He-P 1608.02(b) on 5 separate dwellings; and

(4) The inspections required in (3) above shall:

a. Be conducted after the successful completion of the lead inspector lead educational program;

b. Be conducted in accordance with He-P 1608.02;

c. Be documented in accordance with He-P 1608 and sent to the department, either with or without redaction of the information requested in He- P 1608.01(e)(2) and He-P 1608.01(e)(6) for review within 15 days of completion of each inspection; and

d. Be prepared for a minimum of 5 separate dwellings or dwelling units collectively.

(g) To be licensed as a lead abatement contractor or to renew an existing lead abatement contractor license, an individual or business entity shall submit to the department a completed “Lead Abatement Contractor Application” (February 2025) and certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I understand I shall employ only individuals, to include subcontractors, certified or licensed in accordance with He-P 1612, including lead-certified or licensed employees or lead-certified or licensed subcontractor personnel to conduct lead-based paint activities, and all employees and lead-certified subcontractors shall follow the work practice standards of He-P 1600. I understand that the lead abatement contractor license carries no permissions to actively engage in lead-based paint or lead hazard reduction activities. I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Lead Abatement Contractor Application may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Lead Abatement Contractor Application on the basis that it was executed electronically.”

(h) Along with the “Lead Abatement Contractor Application” (February 2025), the applicant shall demonstrate that they meet all applicable standards and requirements, including the following:

(1) Evidence that the business entity:

a. Directly employs or employs as a subcontractor, a New Hampshire lead abatement supervisor, lead clearance testing technician, lead inspector, or risk assessor certified in accordance with He-P 1612; and

b. If applicable, has an up-to-date written worker protection program that conforms with the following OSHA standards:

1. The standard for Respiratory Protection, 29 CFR 1910.134; and

2. The standard for Lead in Construction, 29 CFR 1926.62;

(2) A list of all lead associated citations and notices of violation received in the United States including the name of the issuing agency or department and the final disposition of such citation or notice;

(3) A list of states in which the applicant holds a license, certification, accreditation, or any other approval for lead abatement activity and description of the licensed activity;

(4) A list of the names of the applicant’s principals or officers, and any persons with a controlling interest in the business;

(5) A list of all other entities that perform lead abatement activities of which the applicant or its principals or officers, or persons with a controlling interest, is a principal or officer, or person with a controlling interest;

(6) A list of all names and acronyms by which the applicant’s business entity is known or under which it does or has done business;

(7) A statement certifying that all of the information provided in support of the application is true and complete;

(8) A list of all individuals in the contractor’s employ that perform lead abatement activities including first and last names and license numbers;

(9) A statement attesting that the contractor shall employ only individuals certified or licensed in accordance with He-P 1612, including lead-certified or licensed employees or lead-certified or licensed subcontractor personnel to conduct lead-based paint activities, and that the business entity and its employees and lead-certified subcontractors shall follow the work practice standards of He-P 1600; and

(10) Provide evidence, in the form of the business entity’s business identification number, of being registered to do business in the state of New Hampshire, as required by the Secretary of State.

(i) To be certified as an owner-contractor, an individual shall be 18 years of age or older and meet the following requirements:

(1) Successful completion of a lead abatement supervisor educational program certified in accordance with He-P 1611, another state, Tribal Nation, or by the EPA with prior approval from the department;;

(2) Successful completion of the proficiency examinations described in He-P 1612.04; and

(3) Have at least 2 years of work experience in asbestos, lead, environmental remediation, or in the building trades.

(j) To be certified as lead abatement supervisor, an individual shall be 18 years of age or older and meet the following requirements:

(1) Successful completion of a lead abatement supervisor educational program certified in accordance with He-P 1611, another state, Tribal Nation, or by the EPA with prior approval from the department;;

(2) Successful completion of the proficiency examinations described in He-P 1612.04; and

(3) The individual shall have the following experience requirements:

a. At least 12 months of work experience as a certified lead abatement worker; or

b. Have at least 2 years of work experience in asbestos, lead, environmental remediation, or in the building trades.

(k) To be certified as a lead abatement worker, an individual shall be 18 years of age or older and successfully complete a lead abatement worker educational program certified in accordance with He-P 1611.

(l) To be certified as a lead clearance testing technician, an individual shall be 18 years of age or older and meet the following requirements:

(1) Successful completion of a lead clearance testing technician education program certified in accordance with He-P 1611; and

(2) Successful completion of the proficiency examination described in He-P 1612.04(a)(1).

(m) Any individual who has a current New Hampshire license as a lead inspector or risk assessor on the effective date of these rules and who continuously maintains that license shall not be required to meet the requirements in (e)(4)and (f)(3)-(4) above.

(n) A refresher lead educational program, certified in accordance with He-P 1611 and specific to the discipline of lead professional being applied for, shall be successfully completed annually.

(o) All individuals licensed or certified under this part shall notify the department, in writing, within 30 days of any changes to any of the information contained on the most current application submitted to the department.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.03 Reciprocity

(a) Any lead professional required to be licensed or certified who is currently licensed or certified as such in another state, Tribal Nation, or by the EPA shall apply for reciprocity in order to perform lead hazard reduction activities in New Hampshire.

(b) An individual applying for reciprocity shall submit to the department the following:

(1) A completed application, pursuant to He-P 1612.05, except that:

a. The information described in He-P 1612.05(a)(4), relative to academic transcripts, and (a)(7), relative to work experience references, shall only be submitted to the department upon request;

b. The information described in He-P 1612.05(a)(5), relative to course completion certificates, shall not be required; and

c. The information described in He-P 1612.05(a)(6), relative to proficiency examinations, shall be submitted to the department in accordance with (4) below;

(2) A copy of the current license or certificate issued by another state, Tribal Nation, or the EPA;

(3) A refresher course completion certificate in the applicable lead professional discipline, issued by another state; and

(4) Documentation that the applicant has passed the following proficiency examinations within required timeframes:

a. The EPA proficiency examination described in He-P 1612.04(a)(2); and

b. One of the following:

1. The New Hampshire proficiency examination described in He-P 1612.04(a)(1); or

2. The NH rules reciprocity educational program examination described in He-P 1611.03(i).

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9057, INTERIM, eff 1-3-08, EXPIRED: 7-1-08
• #9210, eff 7-19-08; ss by #9986, eff 9-1-11; EXPIRED: 9-1-19 (from He-P 1611.06)
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.04 Proficiency Examinations

(a) With the exception of lead abatement workers, all lead professionals seeking licensure or certification under this part shall successfully complete the following proficiency examinations specific to the discipline of lead professional being applied for:

(1) A New Hampshire proficiency examination that covers the requirements of RSA 130-A and He-P 1600, which shall meet the following requirements:

a. The examination shall include a minimum of 25 multiple choice questions; and

b. The examination shall be administered by the department; and

(2) With the exception of lead clearance testing technicians, an EPA examination that covers the requirements of 40 CFR 745 and the standards set forth in Appendix 14 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing, (2012 Edition) available as noted in Appendix A, which shall meet the following requirements:

a. The examination shall include a minimum of 100 multiple choice questions; and

b. The examination shall be administered by the department or another state.

(b) If the examinations in (a) above are not completed successfully within 6 months of successfully completing the applicable lead educational program, the applicant shall retake and successfully complete the applicable lead educational program.

(c) An individual shall receive a score of at least 70% on each examination in order to have successfully completed the examinations.

(d) Failure to attain a score of at least 70% shall result in the following:

(1) After each examination(s) failure, the applicant shall take a different version of the examination(s);

(2) After the third failure of the EPA examination in (a)(2) above, the applicant shall be required to:

a. Retake and successfully complete the entire initial educational program; and

b. Successfully complete the failed examination; and

(3) After the third failure of the New Hampshire examination in (a)(1) above, the applicant shall be required to successfully complete the NH rules course described in He-P 1611.03(i).

(e) Neither of the examinations listed in (a) above shall be taken more than 3 times within a 6-month period.

(f) If an applicant provides proof of attaining a score of 70% or greater on an examination approved by the EPA, from an EPA authorized state or Tribal Nation, covering the content listed in (a)(2) above, the commissioner shall not require that the examination listed in (a)(2) be retaken.

History

• #5920, eff 1-1-95; amd by #6096, eff 9-22-95; ss by #7181, eff 12-24-99; ss by #7495, eff 5-23-01; ss by #8039, eff 2-13-04; ss by #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.05 Initial License or Certificate Application Requirements

(a) Each applicant for a license or certificate as a lead professional shall comply with the requirements of RSA 130-A, and submit the following to the department:

(1) A completed “Lead License or Certification Application” (February 2025) provided by the department for the discipline of lead professional being applied for, certifying the following:

“I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief. The parties agree that this Lead License or Certification Application may be executed electronically with electronic signatures, and the electronic signatures shall be valid and binding on both parties. Neither party will contest the enforceability of this Lead License or Certification Application on the basis that it was executed electronically.”;

(2) The applicable licensing or certification fee(s) pursuant to He-P 1612.08(a), for the discipline of lead professional being applied for, paid by check or money order, in the exact amount of the fee(s) and made payable to the “Treasurer, State of New Hampshire”;

(3) An original, current, clear photograph of the applicant, such as a passport photograph;

(4) Photocopies of official academic transcripts or diplomas issued by the relevant educational institution or a GED, as required by He-P 1612.02;

(5) A copy of the course completion certificate for the lead educational program completed in accordance with He-P 1611 for the discipline of lead professional being applied for;

(6) With the exception of a lead abatement worker, documentation that the applicant has passed the proficiency examinations required by He-P 1612.04;

(7) Documentation, including the name, address, telephone number, and email, if available, of a contact person(s) who can verify all work experience required by He-P 1612.02;

(8) A list of all names, trade names, acronyms, and other identifiers used currently or in the past when performing lead hazard reduction activities, lead inspections, or risk assessments; and

(9) A list of any pending or completed federal, state, or local enforcement actions against the applicant which resulted from lead hazard reduction activities, lead inspections, or risk assessments for the 10 years preceding submission of the application, including:

a. Notices of warnings, violations, or administrative fines;

b. Administrative orders or consent decrees;

c. Notices of license or certification denial, suspension, or revocation; and

d. Pending or completed civil or criminal actions involving the applicant.

(b) The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Division of Public Health Services

Healthy Homes and Lead Poisoning Prevention Program

29 Hazen Drive

Concord, NH 03301

History

• #8932, eff 7-6-07; ss by #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.06 Processing of Applications and Issuance of Licenses or Certificates

(a) An application for an initial license or certificate shall be complete when the department determines that all items required by He-P 1612.05(a) have been received.

(b) The department shall process all applications for licensure or certification in accordance with RSA 541-A, and as follows:

(1) If an application does not contain all of the items required by He-P 1612.05(a), the department shall notify the applicant in writing or by telephone of the items required before the application can be processed; and

(2) Any fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(c) Licensing or certification fees shall not be transferable to any other application(s).

(d) A license or certificate shall be issued if the department determines that an applicant requesting an initial license or certificate is in full compliance with RSA 130-A and He-P 1600.

(e) Any licensee or certificate holder who has failed to pay an outstanding administrative fine that has been imposed by the department shall submit full payment as a condition of initial licensure or certification.

(f) The department shall deny a licensing or certification request in accordance with He-P 1606.02.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.07 License and Certificate Expirations and Procedures for Renewals

(a) All licenses and certificates shall expire one year from the date of issuance, unless the license or certificate has been suspended or revoked by the department pursuant to He-P 1606.02.

(b) In order to renew a license or certificate, each licensee or certificate holder shall complete and submit to the department a “Lead License or Certification Application” (February 2025) pursuant to He-P 1612.05(a)(1) no later than 60 days before the expiration date of the current license or certificate.

(c) The applicant shall submit with the renewal application:

(1) The current license or certificate number;

(2) The applicable fee(s) pursuant to He-P 1612.08(a);

(3) The material required in He-P 1612.05(a)(8) and (a)(9) if any of this information has changed;

(4) A list of all lead professionals in the applicant’s employ at the time that the application is submitted;

(5) A request for renewal of any existing variances previously granted by the department, in accordance with He-P 1606.02, if applicable;

(6) Documentation of meeting the annual education requirement pursuant to He-P 1612.02; and

(7) Proof of passing the proficiency examinations required in He-P 1612.04.

(d) A license or certificate shall be renewed if the department determines that the licensee or certificate holder:

(1) Submitted an application containing all the items required by (b) and (c) above, as applicable, no later than 60 days before the expiration of the current license or certificate; and

(2) Has paid all outstanding administrative fines that have been imposed by the department.

(e) The department shall deny a licensing or certification renewal request in accordance with He-P 1606.02.

(f) Any licensee or certificate holder who has failed to pay an outstanding administrative fine that has been imposed by the department shall submit full payment as a condition of licensure or certification renewal.

(g) If an individual’s New Hampshire license or certificate lapses, the individual shall not engage in lead hazard reduction activities.

(h) If an individual’s New Hampshire license or certificate lapses, the individual may apply for a new license or certificate, in accordance with He-P 1612.05 without successfully completing the initial educational program if the individual’s:

(1) Proficiency examination results are at least 70% and less than 3 years old for the examination described in He-P 1612.04(a)(2);

(2) Annual ongoing education requirements listed in He-P 1612.02 are current; and

(3) The renewal application is received by the department within 6 months after the expiration of the current license or certificate.

(i) Duplicate licenses shall be obtained by submitting a written request to the department with a current, clear photograph of the licensee and corresponding fee as listed in He-P 1612.08(a)(7).

(j) Duplicate licenses shall not be issued if the approved license or certificate has expired.

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

N.H. Code Admin. R. Ann. He-P 1612.08 License, Training, and Certificate Fees

(a) Fees for initial and renewal licenses or certificates shall be as follows:

(1) For a lead clearance testing technician, $75.00

(2) For a lead abatement worker, $75.00;

(3) For a lead abatement supervisor, $125.00;

(4) For a lead abatement contractor or owner-contractor with 7 or more dwelling units, $300.00;

(5) For an owner-contractor with 4 to 6 dwelling units, $150.00;

(6) For a lead inspector, $100.00;

(7) For a risk assessor, $250.00;

(8) For a duplicate license, $15.00;

(9) There shall be no fee for an owner-contractor with less than 4 dwelling units; and

(10) Individuals applying for multiple disciplines shall pay the highest discipline fee plus $25 per additional discipline.

(b) Fees for training courses offered by the department shall be $250.00 per student per 8 hour training day.

(c) Application fees received by the department are non-transferable and non-refundable.

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-P 1608.04(a)(1), (a)(2), (b), (d)(2) and (3), and (e); He-P 1608.07(a), (a)(7)b.7., (c)(2); He-P 1608.08(a); He-P 1608.10(a)(1); He-P 1608.12(j) and (k); He-P 1608.14(k) and (l); He-P 1611.03(c)(2)b.2., (d)(2)b.2., and (f)(2)b. 2.; and He-P 1612.04(a)(2)

U.S. Department of Housing and Urban Development’s “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing” (2012 Edition)

Publisher: U.S. Department of Housing and Urban Development

Cost: Free to the Public

The incorporated document is available at:

https://www.hud.gov/program_offices/healthy_homes/lbp/hudguidelines

He-P 1608.12(i)(4), He-P 1608.15(a)(4), and He-P 1609.03(d)(1), (d)(4), (e)(1), (o)(1)b.,

ASTM E 1796-03, “Standard Guide for Selection and Use of Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition)

Publisher: ASTM International

Cost: $83.00

The incorporated document is available at:

https://www.astm.org/Standards/E1796.htm

He-P 1609.03(q)(1)

ASTM E 1795-17, “Standard Specifications for Non-Reinforced Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition)

Publisher: ASTM International

Cost: $48.00

The incorporated document is available at:

http://www.astm.org/cgi-bin/resolver.cgi?E1795

He-P 1609.03(q)(1)

ASTM E 1795-17, “Standard Specifications for Non-Reinforced Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2016 edition)

Publisher: ASTM International

Cost: $83.00

The incorporated document is available at:

http://www.astm.org/cgi-bin/resolver.cgi?E1795

He-P 1609.03(q)(2)

ASTM E 1797-12, “Standard Specification for Reinforced Liquid Coating Encapsulation Products for Leaded Paint in Buildings” (2017 edition)

Publisher: ASTM International

Cost: $83.00

The incorporated document is available at:

https://www.astm.org/Standards/E1797.htm

APPENDIX B

Rule

Specific State Statute which the Rule is Intended to Implement

He-P 1601

RSA 130-A:2, I(d); RSA 130-A:11; RSA 130-A:11, I ; 15 USC 2681-2692; 42 USC 4821-4856

He-P 1602

RSA 130-A:2, I(d); RSA 130-A:11, I

He-P 1602.02

RSA 130-A:2, I(i); RSA 130-A: 7; RSA 130-A:10; RSA 130-A:11, I; RSA 130-A:14; 40 CFR 745.327

He-P 1603

RSA 130-A:2, I(j); RSA 130-A:3; RSA 130-A:10, XII

He-P 1604

RSA 130-A:2, I(i); RSA 130-A:5; RSA 130-A:6; RSA 130-A:10, V; RSA 130-A:11, III

He-P 1605

RSA 130-A:2, I(i); RSA 130-A:6; RSA 130-A:7; RSA 130-A:10, III; RSA 130-A:10, VI; RSA 130-A:10, VIII; RSA 130-A 10, XV; RSA 130-A:17

He-P 1606

RSA 130-A:2, I(a)-(b); RSA 130-A:7, I and III; RSA 130-A:10, VII; RSA 130-A:10, IX and X; RSA 130-A:14; RSA 130-A:16

He-P 1607

RSA 130-A:10, X; RSA 130-A:14

He-P 1608

RSA 130-A:9, I-IV; RSA 130-A:9, VI; RSA 130-A:10, III and VIII; 15 USC 2682; 42 USC 4852c

He-P 1609

RSA 130-A:9, I; RSA 130-A:9, IV; RSA 130-A:9, VI; RSA 130-A:10, VIII and XIV; 15 USC 2682

He-P 1610

RSA 130-A:7, V; RSA 130-A:9, I; RSA 130-A:10, III; RSA 130-A:10, VII and VIII; 15 USC 2682; 42 USC 4852c

He-P 1611

RSA 130-A:2, I(h); RSA 130-A:9, VII; RSA 130-A:10, XI; RSA 130-A:12, III; 15 USC 2682

He-P 1612

RSA 130-A:2, I(a)-(c); RSA 130-A:9, V and VI; RSA 130-A:10, I, II and IV; RSA 130-A:12; 15 USC 2682

History

• #9986, eff 9-1-11, EXPIRED: 9-1-19
• #13052, eff 6-11-20; ss by #14230, eff 4-2-25

Chapter He-P 1900 Indoor Smoking Rules

Part He-P 1901 Definitions

N.H. Code Admin. R. Ann. He-P 1901.01 Purpose

The purpose of this chapter is to protect the health of the public by identifying the conditions and procedures for the enforcement of the New Hampshire Indoor Smoking Act, RSA 155:64-78.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1901.02 Definitions

(a) “Act” means RSA 155:64 to RSA 155:78, the Indoor Smoking Act, and includes the rules adopted pursuant to the Act.

(b) “Acute care facility” means the following:

(1) A hospital as defined in (i) below;

(2) Infirmaries;

(3) Ambulatory surgical centers;

(4) Outpatient clinics;

(5) Prenatal clinics;

(6) Well-baby clinics;

(7) Well-child clinics;

(8) Free-standing kidney dialysis units;

(9) Free-standing radiological therapy units;

(10) Free-standing birthing centers;

(11) Mobile and free-standing x-ray units;

(12) Mobile and free-standing laboratory units;

(13) Mobile and free-standing emergency medical services units; and

(14) Mobile medical units.

(c) “Cocktail lounge” means “cocktail lounge” as defined in RSA 155:65, I.

(d) “Commissioner” means “commissioner” as defined in RSA 155:65, III.

(e) “Department” means “department” as defined in RSA 155:65, IV.

(f) “Determining preference” means ascertaining whether an individual prefers to reside in or to work in a no-smoking designated area of a facility or a smoking-permitted designated area of a facility that is effectively segregated.

(g) “Effectively segregated” means “effectively segregated” as defined in RSA 155:65, V.

(h) “Health care facility” means “health care facility” as defined in RSA 155:65, VII, and includes hospitals licensed under RSA 151 which provide psychiatric, substance abuse, and physical rehabilitation care on an outpatient or inpatient basis.

(i) “Hospital” means a health care facility where the ill or injured can receive medical, surgical, or psychiatric treatment and nursing care on an inpatient or outpatient basis.

(j) “Multi-resident building” means a building containing multiple separate and distinct domiciles such as rooms, suites of rooms, or apartments.

(k) “Person in charge” means “person in charge” as defined in 155:65, IX.

(l) “Public housing” means dwelling units, which are funded through public funds.

(m) “Resident room” means the place in which a person resides and has sleeping accommodations within a multi-resident building.

(n) “Restaurant” means “restaurant” as defined in RSA 155:65, XIV.

(o) “Smoking” means “smoking” as defined in RSA 155:65, XV.

(p) “Subsidized housing” means dwellings which are rented with the renter receiving monetary support to pay the rent, in whole or in part from public funds.

(q) “Unreasonably intrude” means a condition whereby smoke from a smoking-permitted area enters a no-smoking area such that ambient air quality standards for fine particulate matter exceed United States Environmental Protection Agency (USEPA) standards per 40 CFR part 50.

(r) “Written policies” means “written policies” pursuant to RSA 155:68, I and II.

(s) “Written procedures” means “written procedures” as specified in RSA 155:69 and also means written procedures for effectively segregating all smoking-permitted designated areas from no-smoking designated areas.

History

• #12677, eff 11-20-18 (formerly He-P 1901.01); amd by #12996, eff 2-26-20

Part He-P 1902 Smoking Prohibited and Smoking Permitted in Effectively Segregated Areas

N.H. Code Admin. R. Ann. He-P 1902.01 Smoking Prohibited

Pursuant to RSA 155:66, I, smoking shall be prohibited in:

(a) Public educational facilities at any time, and in child care agencies licensed under RSA 170-E during the hours of operation, except foster family homes and foster family group homes;

(b) Hospitals and other acute care facilities;

(c) Grocery stores by customers;

(d) Elevators, tramways, gondolas, and other such public conveyances;

(e) Public conveyances;

(f) Restaurants;

(g) Cocktail lounges; and

(h) Enclosed places owned and operated by social, fraternal, or religious organizations when open to the general public. Purposes for which such places may be open to the general public may include, but shall not be limited to, public meetings, voting, suppers, bingo games, theatrical events, fairs, and bazaars.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1902.02 Smoking Permitted in Effectively Segregated Areas

Pursuant to RSA 155:66, II:

(a) Smoking may be permitted in enclosed places of public access and publicly owned buildings and offices, including workplaces, other than those listed in He-P 1902.01, in effectively segregated smoking-permitted areas designated by the person in charge;

(b) Smoking shall be totally prohibited in any such enclosed place, if smoking cannot be effectively segregated; and

(c) The person in charge may declare any location non-smoking in its entirety.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-2915-12
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1903 Inquiries and Complaints

N.H. Code Admin. R. Ann. He-P 1903.01 Inquiries

Inquiries regarding the Act, He-P 1900, and registering complaints shall be made to the Tobacco Prevention and Cessation Program at 1-800-852-3345, ext. 8949, or electronically at: https://www.dhhs.nh.gov/dphs/tobacco/indoor.htm.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1903.02 Registering Complaints

(a) Pursuant to RSA 155:73, a complainant shall register with the department a complaint regarding non-compliance with the Act once the following requirements have been met:

(1) The complainant has registered the complaint with the person in charge; and

(2) The complaint has not been resolved within one calendar month of registering the complaint in (a)(1).

(b) The complainant shall register a complaint by completing and submitting an “Indoor Smoking Act Complaint Form” (October 2018 Edition) to the department via email to TPCP@dhhs.nh.gov, via facsimile to (603) 271-5318, or by mailing to:

Department of Health and Human Services

Division of Public Health Services

Tobacco Prevention and Cessation Program

29 Hazen Drive

Concord, NH 03301

(c) In addition to the requirement in (b) above, a complaint shall include a copy of the policy and procedure regarding smoking in the facility if the complainant knows of such policy and procedure.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99; EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1903.03 Complainant Confidentiality

Confidentiality of the complainant shall be protected pursuant to RSA 155:74, II, as follows:

(a) In accordance with RSA 91-A, all information contained in a complaint shall be furnished to the public upon request, except the complainant’s name, which shall not be supplied without express written approval of the complainant;

(b) All physical copies of complaints shall be stored in a receptacle secured from public or unrestricted access, such as a locked file cabinet, when not in use; and

(c) Electronic information regarding complaints that include the complainant’s name shall be stored on a computer hard drive(s) or disk(s) and be secured from unauthorized access, as follows:

(1) Removable disks which contain such data shall be secured in the same manner as physical copies, as detailed in He-P 1903.03(b); and

(2) Non-removable disks or computer hard drives which contain such data shall be secured by using password protection of those computer files.

History

• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1904 Complaint Investigation and Location Inspection Procedures

N.H. Code Admin. R. Ann. He-P 1904.01 Complaint Investigation Procedures

(a) Upon receipt of a letter from the department informing the person in charge of the registered complaint, the person in charge shall respond to the department by completing and submitting an “Indoor Smoking Act Complaint Response Form” (October 2018 Edition) to the department via email to TPCP@dhhs.nh.gov, via facsimile to (603) 271-5318, or by mailing to:

Department of Health and Human Services

Division of Public Health Services

Tobacco Prevention and Cessation Program

29 Hazen Drive

Concord, NH 03301

(b) In addition to the requirements in (a) above, the person in charge shall include a copy of the facility’s or location’s written policies and procedures regarding smoking in the facility, if applicable.

(c) The person in charge shall submit the “Indoor Smoking Act Complaint Response Form” referenced in (a) above to the department within 10 business days of the date on the department’s letter. This deadline date shall be included in the department’s letter.

(d) If the response of the person in charge is not received by the department by the date specified in the department’s letter, the location in question shall be subject to an on-site inspection per He-P 1904.02.

(e) If the materials submitted by the person in charge, pursuant to He-P 1904.01(a), are incomplete, the person in charge shall be required to provide such additional information as is needed to complete the submission.

(f) If the department cannot make a determination of compliance or non-compliance based solely on the submitted materials, then the location in question shall be subject to an on-site inspection per He-P 1904.02.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1904.02 On-Site Inspection Procedures

(a) In order to determine compliance with the Act, pursuant to He-P 1904.01(c) and (e), the location shall be subject to an on-site inspection.

(b) If the location subject to an on-site inspection is a location where smoking is permitted in effectively segregated areas, pursuant to He-P 1902.02 and RSA 155:66, II, the department shall determine if the smoking-permitted area(s) has been effectively segregated, as follows:

(1) Determine if procedures for accurately and fairly determining preference as defined in He-P 1901.01(f) have been followed; and

(2) Conduct ambient air quality testing for fine particulate matter using USEPA recommended monitoring equipment and USEPA methods and standards, per 40 CFR part 50, in order to:

a. Determine if the design, designation, or juxtaposition of no-smoking and smoking-permitted areas are such that smoke does not cause harm or unreasonably intrude into areas occupied by persons who are not smoking; and

b. Determine if the smoking-permitted area(s) is in proximity to exhaust fans, if possible, and areas designated as no-smoking areas have ambient air quality standards for fine particulate matter that do not exceed USEPA standards, per 40 CFR part 50.

(c) If the location subject to an on-site inspection is a facility where smoking is prohibited in its entirety, pursuant to He-P 1902.01 and RSA 155:66, I, the department shall determine if smoking is or has been permitted or if smoking is occurring or has occurred by conducting ambient air quality testing for fine particulate matter using USEPA recommended monitoring equipment and USEPA methods and standards, per 40 CFR part 50.

(d) As part of an on-site inspection, the department shall also determine if the location has:

(1) Written smoking policies per RSA 155:68;

(2) Written smoking procedures per RSA 155:69; and

(3) Sign requirements per RSA 155:71 and He-P 1908.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99; EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1905 Notification of Investigation Findings

N.H. Code Admin. R. Ann. He-P 1905.01 Notification of a Finding of Compliance

If the department determines that the person in charge is in compliance with the Act, both the complainant and the person in charge shall be notified in writing of that determination.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07; ss by #9351, eff 1-1-09, EXPIRED: 1-1-17
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1905.02 Notification of a Finding of Non-Compliance

If the department determines that a person in charge is not in compliance with the Act, the following procedures shall be followed:

(a) The person in charge shall be issued a factual summary of the investigation, along with a statement of the department’s finding of non-compliance;

(b) The notification in (a) shall include:

(1) Specific directives as to the necessary steps to be taken to come into compliance with the Act, including one or more of the following:

a. When smoking continues to occur in a location where smoking is prohibited pursuant to He-P 1902.01 and RSA 155:66, I, the location shall be designated no-smoking in its entirety;

b. When the location has no written policies or the location’s written policies do not comply with the Act, that the location’s written policies shall be written or revised to meet specifications set forth in RSA 155:68 and He-P 1900;

c. When the location has no written procedures or the location’s written procedures do not comply with the Act, that the location’s written procedures shall be written or revised to meet specifications set forth in RSA 155:69 and He-P 1900;

d. When written policies and procedures exist but are not enforced, that the written policies and procedures shall be fully implemented pursuant to the Act; or

e. When a smoking-permitted area is not effectively segregated, that the location shall be designated no-smoking in its entirety;

(2) The deadline by which the person in charge shall comply with the directives in the notification and the Act;

(3) A statement that the location in question shall be subject to on-site inspection(s) to determine compliance with the directives and the Act; and

(4) A description of the possible consequences for not complying with the directives, including a description of the penalty scale to be used in assessing the fine, as described in He-P 1906.01;

(c) The deadline in (b)(2) shall be 30 days from the date of the notification of finding of non-compliance;

(d) The person in charge may request an extension of the deadline for compliance as stated in (c) above by requesting a waiver pursuant to the process outlined in He-P 1909;

(e) The location shall be subject to an on-site inspection by the department to determine if the person in charge has come into compliance with the directives in the notification and the Act by the deadline established in the notification or by an extension granted in (d); and

(f) The complainant shall be notified in writing of the determination of a finding of non-compliance and of the directives issued by the department to the person in charge, to be carried out in order to achieve compliance with the Act.

History

• #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07; ss by #9351, eff 1-1-09, EXPIRED: 1-1-17
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1906 Administrative Fines

N.H. Code Admin. R. Ann. He-P 1906.01 Administrative Fines

(a) If the department determines that the person in charge has not complied with the Act by the deadline established in He-P 1905.02(c) or (d), the department shall, pursuant to RSA 155:78, impose upon the person in charge an administrative fine of $100 per day for the first offense and $200 per day for each subsequent offense.

(b) The penalties prescribed in (a) above shall be imposed for each day that the person in charge is not in compliance with the Act, beginning with the date that the notification under He-P 1905.02 is issued and continuing for each day of non-compliance, or until the date of compliance.

(c) The department shall provide written notice to the person in charge:

(1) Identifying each finding of non-compliance;

(2) Informing the person in charge of the amount of the assessed fine under (a) and (b) above;

(3) Informing the person in charge of the right to appeal the department’s decision to assess a fine, pursuant to RSA 541-A and He-C 200, by submitting a written request for a hearing to the commissioner no later than 10 calendar days from the date of receipt of the notice;

(4) Informing the person in charge of the opportunity to waive the right to a hearing by paying the fine within 10 days of the receipt of the department notice of assessed administrative fine; and

(5) Informing the person in charge that if he or she does not request an appeal as specified in (3) above, the department’s decision to assess a fine shall become final after the 10 day period specified in (4) above and the fine shall be paid to the department no later than 10 days from that date.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07; ss by #9351, eff 1-1-09, EXPIRED: 1-1-17
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1907 Criteria for Smoking-Permitted Areas

N.H. Code Admin. R. Ann. He-P 1907.01 Designation of Smoking-Permitted Areas

(a) The criteria established in He-P 1907 shall apply to the following facilities, referred to in RSA 155:67 V, VI, VII, and X:

(1) Dormitories;

(2) Public housing facilities;

(3) Nursing homes;

(4) Sheltered care facilities;

(5) Residential treatment facilities;

(6) Prisons and detention facilities;

(7) Rehabilitation facilities;

(8) Health care facilities, except for acute care facilities; and

(9) All other facilities listed in RSA 155:67.

(b) The criteria as set forth in this part shall apply to all staff, administrators, volunteers, residents, visitors, consultants, contractors, and other vendors and surveyors of services in the facilities referenced in (a) above.

(c) The following designation criteria for smoking-permitted areas, specific for each location, shall be followed for each of the facilities referenced in (a) above:

(1) Where smoking is permitted in resident dormitories operated by postsecondary educational institutions, the following shall apply:

a. Preference for smoking or non-smoking resident room assignments shall be determined for each resident by the person in charge;

b. Determining preference for smoking or non-smoking resident room assignments shall be completed prior to the beginning of each school year or semester by the person in charge;

c. Housing application forms which student residents fill out prior to assignment of housing shall include a section to indicate preference for smoking or non-smoking room assignment, or a separate form shall be developed for this purpose;

d. Either smoking or non-smoking designated rooms may be assigned to those individuals who do not indicate a preference relative to smoking when making application for room assignments;

e. The number of such smoking-designated rooms or areas shall be commensurate with the number of residents indicating a preference to smoke;

f. No student resident who prefers non-smoking accommodations shall be housed with a smoker nor shall any student resident who prefers non-smoking accommodations have a room assigned in the smoking-permitted areas; and

g. All non-smoking designated rooms and accommodations shall meet the USEPA standard for ambient air quality;

(2) Where smoking is permitted in any public housing location, the following shall apply:

a. Preference for smoking or non-smoking dwelling unit assignments shall be determined for each resident by the person in charge;

b. Determining preference for smoking or non-smoking dwelling unit assignments shall be completed prior to the assignment of a dwelling unit by the person in charge;

c. Public housing application forms which residents fill out prior to assignment of housing shall include a section to indicate preference for smoking or non-smoking, or a separate form shall be developed for this purpose;

d. Either smoking or non-smoking designated dwelling units may be assigned to those individuals who do not indicate a preference relative to smoking when making application for public housing;

e. The number of such smoking-designated dwelling units shall be commensurate with the number of residents indicating a preference to smoke;

f. No resident who prefers non-smoking accommodations shall have a dwelling unit assigned in the smoking-permitted areas; and

g. All non-smoking designated dwelling units shall meet the USEPA standard for ambient air quality;

(3) Where smoking is permitted in resident rooms in nursing homes, residential care facilities, supported residential care facilities, residential treatment facilities, and rehabilitation facilities, the following shall apply:

a. Preference for smoking or non-smoking resident room assignments shall be determined for each resident;

b. Determining preference for smoking or non-smoking resident room assignments shall be completed prior to the assignment of resident rooms by the person in charge;

c. Resident room application or admission forms which residents fill out prior to assignment of resident rooms shall include a section to indicate preference for smoking or non-smoking, or a separate form shall be developed for this purpose;

d. Either smoking or non-smoking designated resident rooms may be assigned to those individuals who do not indicate a preference relative to smoking when making application for room assignments or admission;

e. The number of such smoking-designated resident rooms shall be commensurate with the number of residents indicating a preference to smoke;

f. No resident who prefers non-smoking accommodations shall have a resident room assigned in the smoking-permitted areas; and

g. All non-smoking designated resident rooms shall meet the USEPA standard for ambient air quality;

(4) Where smoking is permitted in the resident rooms of health care facilities, such as drug and alcohol treatment facilities and mental health facilities, exclusive of hospitals or other acute care facilities as listed in He-P 1901.02(b) and He-P 1901.02 (j), the following shall apply:

a. Preference for smoking or non-smoking assignments shall be determined for each patient by the person in charge;

b. Determining preference for smoking or non-smoking patient room assignments shall be completed prior to admission to the facility by the person in charge;

c. Patient admission forms shall include a section to indicate preference for smoking or non-smoking, or a separate form shall be developed for this purpose;

d. Either smoking or non-smoking designated patient rooms may be assigned to those individuals who do not indicate a preference relative to smoking when filling out admission forms;

e. The number of such smoking-designated patient rooms shall be commensurate with the number of patients indicating a preference to smoke;

f. No patient who prefers non-smoking accommodations shall be housed with a smoker nor shall any patient who prefers non-smoking accommodations have a patient room assigned in the smoking-permitted areas; and

g. All non-smoking designated patient rooms shall meet the USEPA standard for ambient air quality;

(5) If a hospital has, as part of its facility, a wing or unit which is not free-standing and which is used on an in-patient basis for the care and treatment of patients suffering from mental illness, drug and alcohol withdrawal, or for the delivery of physical rehabilitation services, the resident rooms of the wing or unit shall be subject to He-P 1907.01(a)(8), (b), and (c)(4)a.-g.;

(6) Where smoking is permitted in private sector facilities providing out-patient care, including doctors’ offices and dental offices, and exclusive of acute care facilities as defined in He-P 1901.01(b) and He-P 1901.01(i):

a. Examination rooms, diagnostic testing rooms, and treatment rooms shall be designated as no smoking; and

b. If smoking-permitted areas are to be designated for the use of staff for such facilities then RSA 155:66, II shall apply;

(7) Where smoking is permitted in resident rooms or cells of prisons and detention facilities, the following shall apply:

a. Preference for smoking or non-smoking inmate room or cell assignments shall be determined for each inmate by the person in charge;

b. Determining preference for smoking or non-smoking inmate room assignments shall be completed prior to the assignment of an inmate room or cell by the person in charge;

c. Incarceration forms shall include a section to indicate preference regarding smoking or non-smoking, or a separate form shall be developed for this purpose;

d. Either smoking or nonsmoking designated inmate rooms or cells may be assigned to those individuals who do not indicate a preference relative to smoking when incarcerated;

e. The number of such smoking-designated inmate rooms or cells shall be commensurate with the number of inmates indicating a preference to smoke;

f. If security and space permit, no inmate who prefers non-smoking accommodations shall have an inmate room or cell assigned in the smoking-permitted areas; and

g. All non-smoking designated inmate rooms or cells shall meet the USEPA standard for ambient air quality; and

(8) If smoking-permitted areas are to be designated for the use of staff of the facilities referenced in (a) above, they shall be subject to the provisions of RSA 155:66, II.

(d) If the facilities referenced in (a) above have rooms or areas wherein residents receive medical or dental services, the designation of no smoking shall prevail in these rooms or areas for staff, patients, and visitors, pursuant to RSA 155:66, I (b).

(e) The areas referred to in (d) above shall include:

(1) Examining rooms;

(2) Diagnostic testing rooms;

(3) Treatment rooms;

(4) Infirmaries; and

(5) Dental examination and treatment rooms.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1908 Signs Restricting or Prohibiting Smoking

N.H. Code Admin. R. Ann. He-P 1908.01 Exterior Signs

(a) Signs for notification relative to smoking restrictions or prohibitions shall be placed on the exterior of buildings, facilities, or other enclosed places as defined in RSA 155:65, VI, proximate to all major entrances.

(b) All exterior signs shall be of a permanent nature.

(c) Where smoking is prohibited, signs shall state that “smoking is prohibited in this building or facility”, or words to that effect, or the international symbol for no-smoking, as depicted in Figure 1900.1, may be substituted for or used in conjunction with the prohibition statement.

Figure 1900.1 The International Symbol for No-Smoking

(d) Where smoking is restricted to effectively segregated smoking-permitted areas, signs shall state that “smoking is prohibited in this building or facility except in designated smoking-permitted areas”, or words to that effect, or the international symbol for no-smoking, as depicted in Figure 1900.1, may be used in conjunction with the restriction statement.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1908.02 Interior Signs

(a) Signs for notification relative to smoking restrictions or prohibition, in buildings or facilities which permit smoking in designated areas only, shall be placed inside those buildings, facilities, or other enclosed places as defined in RSA 155:65, VI in the following areas, including:

(1) Offices;

(2) Waiting rooms;

(3) Entrances areas;

(4) Elevators;

(5) Rest rooms;

(6) Cafeterias;

(7) Break rooms;

(8) Meeting rooms;

(9) Hallways;

(10) Stairwells; and

(11) Other common-use areas.

(b) Interior signs shall be of a permanent nature, except as allowed by (f)-(h) below.

(c) Interior signs shall be affixed to a permanent structure such as a wall, door, permanent room divider, or partition, except as allowed by (f)-(h) below.

(d) Where smoking is prohibited, signs shall state that “smoking is prohibited in this room or area of the facility or building”, or words to that effect, or the international symbol for no-smoking, as depicted in Figure 1900.1, may be substituted for or used in conjunction with the prohibition statement.

(e) Where smoking is prohibited in every room and area of a given building and He-P 1908.01 is abided by, then interior signs shall not be required.

(f) Where smoking is permitted in an effectively segregated smoking-permitted room or area of a given facility, pursuant to RSA 155:66, II and RSA 155:67, III, V, VI, VII, and X, interior signs may be affixed to interior structures or placed on table tops or surfaces in those rooms or areas, stating that “smoking is permitted in this room or area of the facility”, or words to that effect, or the international symbol for smoking-permitted, as depicted in Figure 1900.2, may be substituted for or used in conjunction with the smoking-permitted statement.

Figure 1900.2 The International Symbol for Smoking-Permitted

(g) Where smoking is permitted, pursuant to RSA 155:67, II and IV, interior signs may be temporarily affixed to interior structures or placed temporarily on table tops or surfaces in those rooms or areas, stating that “smoking is permitted in this room or area of the facility”, or words to that effect, or the international symbol for smoking-permitted, as depicted in Figure 1900.2, may be substituted for or used in conjunction with the smoking-permitted statement.

(h) Table top signs may be used in conjunction with other interior signs.

(i) In a facility containing 2 or more rooms or areas comparable in size and which are used for the same activity, the person in charge may place smoking-permitted signs in one entire room or area provided that the other comparable-in-size room or area is posted as a no-smoking area and is effectively segregated from the smoking-permitted area.

(j) Signs demarcating smoking-permitted areas shall not be placed in areas more than proportionate in size to the number of users who show preferences for this designation.

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1908.03 Size of Signs

Signs shall meet the following size requirements as specified in Table 1900.1.

Table 1900.1 Size of Signs

Farthest Distance

from which Sign Is

to Be Read

Height of

Lettering

Diameter of Outer Circle

for International Symbol

for Smoking or No-Smoking

25 feet

1/2 inch

3 inches

50 feet

1 inch

4 inches

150 feet

2 inches

6 inches

350 feet

4 inches

8 inches

500 feet

6 inches

12 inches

History

• #5759, eff 12-20-93; ss by #7172, eff 12-21-99, EXPIRED: 12-21-07
• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Part He-P 1909 Waivers

N.H. Code Admin. R. Ann. He-P 1909.01 Request for Waiver

(a) Pursuant to RSA 155:75, a person in charge shall request a waiver for the purpose of seeking a period of time to comply with the Act by submitting a written waiver request to the commissioner.

(b) A waiver request shall be made for one or more of the following:

(1) For complying with RSA 155:68, relative to the development of written policies;

(2) For complying with RSA 155:69, relative to the development of written procedures;

(3) For complying with RSA 155:70 and He-P 1908, relative to the placement of signs that restrict, prohibit, or permit smoking; or

(4) For creating an effectively segregated smoking-permitted area pursuant to He-P 1902.02(a) and in compliance with RSA 155:65, V.

(c) The person in charge requesting a waiver shall do so by completing and submitting to the department an “Indoor Smoking Act Waiver Request Form” (October 2018 Edition).

(d) In addition to the requirement in (c) above, a waiver request shall include the following, as applicable:

(1) If the facility or location requesting the waiver currently has written policies or written procedures relative to smoking in place, then a copy of those policies or procedures shall be attached to the waiver request;

(2) If the facility or location is requesting a waiver in order to develop or to amend written policies or written procedures relative to smoking, then a copy of the draft of the proposed written policies or procedures shall be attached to the waiver request, if available; and

(3) If the facility or a location is requesting a waiver because the requirement the facility or location wishes to be waived causes undue hardship pursuant to RSA 155:75, II, the waiver request shall include documentation for the claim of undue hardship, such as, but not limited to, a construction estimate with financial records that show the person in charge is unable to pay, or proof that the requirement in question would interfere with other requirements imposed by policies of the facility, such as but not limited to, a copy of those policies.

History

• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1909.02 Determining Eligibility and Approval for a Waiver

(a) Pursuant to RSA 155:75, III, the commissioner shall determine eligibility for a waiver.

(b) A person in charge shall be determined to be eligible for a waiver if the following criteria are met:

(1) The waiver request requirements described in He-P 1909.01 are met;

(2) The waiver request is not in response to a finding of a violation of the Act;

(3) The waiver request is not contrary to fire, safety, or sanitation requirements or other state or federal statutes; and

(4) The waiver, if granted, would not create a condition whereby smoke causes harm or unreasonably intrudes into any areas designated as no-smoking or any areas occupied by persons who do not smoke.

History

• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1909.03 Time Period for Approved Waivers

The time period for which an approved waiver shall extend shall be as follows:

(a) A waiver request for complying with RSA 155:68, relative to the development of written policies, shall be granted for 30 calendar days;

(b) A waiver request for complying with RSA 155:69, relative to the development of written procedures, shall be granted for 30 calendar days;

(c) A waiver request for complying with RSA 155:70 and He-P 1907, relative to the placement of signs that restrict, prohibit, or permit smoking, shall be granted for 60 calendar days;

(d) A waiver request for complying with an effectively segregated smoking-permitted area pursuant to He-P 1902.02(a) and in compliance with RSA 155:65, V, shall be granted as follows for the following time frames:

(1) If exterior construction is being proposed in the waiver request, such as building an addition to the existing facility or location, then a waiver shall be granted for one year; and

(2) If interior construction or modification of the facility or location is being proposed in the waiver request, such as building partitions or moving walls, then a waiver shall be granted for 6 months;

(e) Waivers shall not be approved for any period of time exceeding one year, for any purpose; and

(f) Extensions for waivers shall not be granted.

History

• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

N.H. Code Admin. R. Ann. He-P 1909.04 Notification of Waiver Decision

(a) The person in charge shall be notified in writing of the department’s decision to grant a waiver, including the specific provisions of the waiver and the time period for which the waiver has been granted.

(b) The facility or location for which a waiver has been approved shall be subject to an on-site inspection by the department to determine if the waiver requirements have been met.

(c) The person in charge shall be notified in writing of the department’s decision to deny the waiver request, including:

(1) The reasons for the denial; and

(2) A directive to come into compliance with the Act within 30 days from receipt of the written waiver denial.

Appendix

Rule

Specific State or Federal Statutes the Rule Implements

He-P 1901

RSA 155:64; RSA 155:65

He-P 1901.02 (o)-(s)

RSA 155:64; RSA 155:65

He-P 1902

RSA 155:66

He-P 1903

RSA 155:71, III, V; RSA 155:73; RSA 155:74, II

He-P 1904

RSA 155:74, I

He-P 1905

RSA 155:71, III

He-P 1906

RSA 155:78

He-P 1907

RSA 155:67, V, VI, VII, & X; RSA 155:71, I

He-P 1908

RSA 155:70; RSA 155:71, II

He-P 1909

RSA 155:71, IV; RSA 155:75, I, II, & III

History

• #9054, eff 12-29-07, EXPIRED: 12-29-15
• #12534, INTERIM, eff 5-24-18, EXPIRES: 11-20-18; ss by #12677, eff 11-20-18

Chapter He-P 2100 Beverages and Bottled Water

Part He-P 2101 Definitions

N.H. Code Admin. R. Ann. He-P 2101.01 Definitions

(a) “Adequate” means that which is needed to accomplish the intended purpose.

(b) “Approved source” means the source(s) of the water and the water therefrom, which has been approved by the New Hampshire department of environmental services (DES) in accordance with RSA 143:16 or RSA 485:3.

(c) “Artesian water” means “artesian water” as defined in 21 CFR 165.110 (a)(2)(i), namely “water from a well tapping a confined aquifer in which the water level stands at some height above the top of the aquifer.”

(d) “Beverages” means “beverage” as defined in RSA 143:9, namely “all still and carbonated drinks, fruit juices and all beverages compounded therefrom; all bottled waters, whether for medicinal or table use; and all packaged liquids intended for use in the manner of drink. Milk and unmixed products thereof, and fruit juices and waters retailed exclusively by the producer or manufacturer direct, are not included.”

(e) “Bottled water” means “bottled water” as defined in 21 CFR 165.110(a)(1).

(f) “Bottler” means any person, firm, or corporation engaging in the business of bottling beverages and/or water for sale or distribution.

(g) “Bulk water” means a source of water, not bottled by its owner, but which is transported via tanker truck or an equivalent means from one area to another for the purpose of treatment, packaging and human consumption.

(h) “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

(i) “Compliant facility” means a facility that achieves a score of 90 or greater on an inspection, in accordance with He-P 2108.01.

(j) “Corrosion resistant material” means those materials that maintain their original surface characteristics when exposed to the conditions encountered during intended use including expected contact with product and cleaning, sanitizing or sterilization compounds or solutions.

(k) “Deionized water” means “deionized water” as defined in 21 CFR 165.110(a)(2)(iv), namely water that “has been processed by deionization.”

(l) “Demineralized water” means “demineralized water” as defined in 21 CFR 165.110(a)(2)(iv), namely “water that has been produced by distillation, deionization or reverse osmosis, or other suitable processes and that meets the definition of ‘purified water’ in the United States Pharmacopeia, 23rd Revision, January 1, 1995.”

(m) “Department” means the New Hampshire department of health and human services.

(n) “Distilled water” means “distilled water” as defined in 21 CFR 165.110(a)(2)(iv), namely water that “has been produced by distillation.”

(o) “Imminent health hazard” means a significant threat or danger to health that is considered to exist when there is evidence sufficient to show that a product, practice, circumstance, or event creates a situation that requires immediate correction or cessation of operation to prevent injury, based on the number of potential injuries and the nature, severity, and duration of the anticipated injury.

(p) “Maximum contaminant level (MCL)” means “maximum contaminant level” as defined in RSA 485:1-a,VII.

(q) “Mineral water” means “mineral water” as defined in 21 CFR 165.110(a)(2)(iii), namely “water containing not less than 250 parts per million (ppm) total dissolved solids (TDS) coming from a source tapped at one or more bore holes or springs, originating from a geologically and physically protected underground water source.”

(r) “Multiservice containers” means containers intended for use more than one time.

(s) “Natural water” means ground water that is not modified in its mineral content by addition or subtraction except the modification that might occur through minimal treatment such as filtration, aeration, ozonation, ultraviolet light, or equivalent disinfection processes intended to remove undesirable elements.

(t) “Non-compliant facility” means a facility that scores less than 90 on an inspection, in accordance with He-P 2108.01.

(u) “Nontoxic materials” means materials for product contact surfaces utilized in the transporting, processing, storing, and packaging of bottled beverages or drinking water, which are free of substances which could render the water injurious to health or which could adversely affect the flavor, color, odor or bacteriological quality of the beverage or water.

(v) “Operations water” means water which is delivered under pressure to a plant for container washing, hand washing, plant, and equipment cleanup and for other sanitary purposes.

(w) “Person” means an individual or firm, partnership, company, corporation, trustee, association, or any public or private entity.

(x) “Primary container” means the immediate container in which product water is packaged.

(y) “Processing authority” means “processing authority” as defined in 9 CFR 318.300 (q), namely “the person(s) or organization(s) having expert knowledge of thermal processing requirements for foods in hermetically sealed containers, having access to facilities for making such determinations, and designated by the establishment to perform certain functions as indicated in this subpart.”

(z) “Product water” means water that is processed by a plant for bottled drinking water or for the manufacture of beverages.

(aa) “Purified water” means “purified water” as defined in 21 CFR 165.110 (a)(2)(iv), namely “water that has been produced by distillation, deionization, reverse osmosis, or other suitable processes, and which meets the definition of ‘purified water’ in the United States Pharmacopeia, 23rd Revision, January 1, 1995.”

(ab) “Sanitize” means the application of cumulative heat, chemicals or equivalent processes on cleaned product contact surfaces that, when evaluated for efficacy, is sufficient to yield a reduction of 5 logs, which is equal to 99.999% reduction of representative disease microorganisms of public health importance.

(ac) “Single-service container” means a container intended for one time usage only.

(ad) “Sparkling bottled water” means “sparkling bottled water” as defined in 21 CFR 165:110 (a)(2)(v), namely “water that after treatment and possible replacement with carbon dioxide, contains the same amount of carbon dioxide from the source that it had at emergence from the source.”

(ae) “Spring water” means “spring water” as defined in 21 CFR 165.110 (a)(2)(vi), namely “water derived from an underground formation from which water flows naturally to the surface of the earth.”

(af) “Sterile water” means “sterile water” as defined in 21 CFR 165.110 (a)(2)(vii), namely “water that meets the requirements under ‘Sterility Tests’ in the United States Pharmacopeia, 23rd Revision, January 1, 1995.”

(ag) “Unit package” means a standard commercial package of a beverage or bottled drinking water.

(ah) “Vended water” means water that is dispensed by a water vending machine that is not placed by a bottler in sealed containers.

(ai) “Wash” means cleaning with a solution that contains soap, detergent, acid cleaner, alkaline cleaner, or other cleaning agents according to the cleaning agents manufacturing label instructions.

(aj) “Well water” means “well water” as defined in 21 CFR 165.110 (a)(2)(viii), namely “water from a hole bored, drilled, or otherwise constructed in the ground which taps the water of an aquifer.”

History

• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #6737, Interim, eff 4-25-98, EXPIRED: 8-23-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18; ss by #13283, eff 10-23-21

Part He-P 2102 Bottled, Bulk and Vended Water

N.H. Code Admin. R. Ann. He-P 2102.01 Approval of Sources for Bottled, Bulk and Vended Water

(a) All in-state sources of water intended for use as bottled water, bulk water or vended water, including mineral water, shall be approved by the Department of Environmental Services (DES) in accordance with RSA 143:16 and Env-Dw 303 or Env-Dw 305 or Env-Dw 302 if applicable.

(b) All in-state sources of water which have been approved in accordance with Env-Dw 305 or Env-Dw 302 shall obtain written approval from DES stating that the source can be used for bottled water in addition to its previously approved use.

(c) All out-of-state and foreign water sources shall be licensed or approved by the government agency having jurisdiction.

(d) All bottled water sources shall be of safe and sanitary quality and be in conformance at all times with the applicable laws and regulations of the government agency or agencies having jurisdiction.

(e) Bottlers shall not utilize any source for bottled water until written source approval, as required in (a), (b) or (c) above, is obtained from DES or the government agency having jurisdiction if the source is located in another state or country.

(f) All sources of water approved by the department that have not maintained an annual beverage license with the department shall be required to follow He-P 2102.01(a).

History

• #1930, eff 1-26-82; ss by #2599(E), eff 1-23-84, exp. 5-23-84
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #6737, Interim, eff 4-25-98, EXPIRED: 8-23-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2102.02 Standards of Quality for Bottled Water

(a) All sources of water for bottled, bulk, or vended water, under the regulatory authority of DES shall meet the quality standards required by DES in accordance with RSA 485:3.

(b) All finished bottled water products, regardless of state or country of origin, shall meet the FDA standards of quality for bottled water in 21 CFR 165.110(b) and the maximum contaminant level (MCL) requirements of Env-Dw 702 through 705.

(c) For standards that are included in both 21 CFR 165.110 and in Env-Dw 702-705, the level set in 21 CFR 165.110 (b) shall be used.

History

• #1930, eff 1-26-82; ss by #2599(E), eff 1-23-84, exp. 5-23-84
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #6737, Interim, eff 4-25-98, EXPIRED: 8-23-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18; ss by #13283, eff 10-23-21

N.H. Code Admin. R. Ann. He-P 2102.03 Spring Water

Spring water shall meet all requirements set forth in 21 CFR 165.110(a)(2)(vi), as follows:

(a) Spring water, as defined in He-P 2101.01(ad), shall be collected only at the spring or through a bore hole tapping the underground formation feeding the spring;

(b) There shall be a natural force causing the water to flow to the surface through a natural orifice;

(c) The location of the spring shall be identified;

(d) Spring water collected with the use of an external force shall:

(1) Be from the same underground stratum as the spring, as shown by a measurable hydraulic connection using a hydrogeologically valid method between the borehole and the natural spring; and

(2) Have all the physical properties, before treatment, and be of the same composition and quality, as the water that flows naturally to the surface of the earth;

(e) If spring water is collected with the use of an external force, water shall continue to flow naturally to the surface of the earth through the spring’s natural orifice; and

(f) Plants shall demonstrate on request, to appropriate regulatory officials, using hydrogeologically valid methods, that a hydraulic connection exists between the natural orifice of the spring and the borehole.

History

• #1930, eff 1-26-82; ss by #2599(E), eff 1-23-84, exp. 5-23-84
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #6737, Interim, eff 4-25-98, EXPIRED: 8-23-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2102.04 Artesian Water

Artesian water, as defined in He-P 2101.01(c), may be collected with the assistance of external force to enhance the natural underground pressure.

History

• #1930, eff 1-26-82; ss by #2599(E), eff 1-23-84, exp. 5-23-84
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #6737, Interim, eff 4-25-98, EXPIRED: 8-23-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2102.05 Bottled Water Sample Requirements

(a) All samples of bottled water sources or finished product, located within the continental United States, shall be analyzed by a laboratory which has been accredited according to Env-C 300.

(b) All samples of bottled water sources or finished product, located outside the continental United States, shall be analyzed by a laboratory which has been accredited according to Env-C 300 or has been certified according to the International Organization for Standardization’s (ISO) “ISO/IEC 17025:2017 General Requirements for the Competence of Testing and Calibration Laboratories” (2017 edition), as noted in Appendix A.

(c) To assure that the plant’s production of bottled water is in compliance with the quality standards set forth in He-P 2102.02, the plant ownership shall collect samples of finished product for analysis as follows:

(1) For microbiological standards, analyze, at least once each week, a sample from a batch or segment of the continuous production for each type of finished bottled water produced by the plant; and

(2) For chemical, physical, and radiological standards, analyze, at least once each calendar year, a sample from a batch or segment of a continuous product run for each type of finished bottled water produced by the plant.

(d) The samples required by (1) and (2) above shall be derived from primary containers or unit packages of the product.

History

• #12680, eff 11-27-18; ss by #13283, eff 10-23-21

N.H. Code Admin. R. Ann. He-P 2102.06 Source Water

To assure that the source used by a plant for bottled water is in compliance with the quality standards set forth in He-P 2102.02, the plant or bulk source ownership shall collect or direct the collection of samples of source water for analysis, in accordance with 21 CFR 129.35, as follows:

(a) For chemical and physical standards, samples of source water shall be collected and analyzed at least once each calendar year;

(b) For radiological standards, samples of source water shall be collected and analyzed at least once every 4 years; and

(c) For microbiological standards, samples of source water shall be collected and analyzed at least once each calendar year if the source is a public water supply, or once each week if the source is not a public water supply.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2102.07 Analysis Results

(a) Sample analysis results shall be maintained at the plant for at least 2 years.

(b) The plant ownership shall make all analysis results available for review by the commissioner or an agent of the commissioner.

(c) Whenever any sampling result indicates that a water sample contains contaminants above the quality standards set forth in He-P 2102.02 or a bottler has reason to believe that a substance might be present in a water source or finished product that might cause a product to be a reportable food, as defined in 21 USC 350f.417(a)(2), the person responsible for the bottling plant shall:

(1) File an oral report with the department within 24 hours; and

(2) File a written report to the department within 3 days that explains the contamination levels and what action was taken by the ownership because of the contaminant level.

(d) When a water sample result does not meet the quality standard as set forth in He-P 2102.02, bottling plant personnel shall conduct additional testing as follows:

(1) For microbiological samples test results which show coliform bacteria in the water, samples shall be tested at least 2 times each week on non-consecutive days for one month following the original sample and after any corrective actions have been taken;

(2) For chemical, physical and radiological contaminants, samples shall be tested at least once each month for 3 months following the original sample and after any corrective actions have been taken; and

(3) The plant or bulk source ownership shall submit results of all follow-up tests to the department.

History

• #12680, eff 11-27-18

Part He-P 2103 Beverage and Bottled Water Facilities, Equipment and Operations

N.H. Code Admin. R. Ann. He-P 2103.01 Construction and Design of Building and Facilities

(a) Floors, walls and ceilings shall be tight, impervious, easily cleanable, and maintained in good repair.

(b) Floors in the bottling area shall be graded to drain.

(c) All drains shall be properly trapped to prevent access of odors and sewer gases into the plant.

(d) All doors into the bottling area shall be solid, tight, and self-closing.

(e) All outer openings into the plant operation and storage areas shall be tight to prevent access by insects and rodents.

(f) All outer doors into the facility shall be solid, tight, and self-closing.

(g) Ventilation shall be provided to minimize odors and condensation in processing rooms, bottling areas, and in container washing and sanitizing areas.

(h) The intake of all pressure ventilation systems shall be properly filtered to remove particulate contamination.

(i) There shall be no cross-connections between beverages or product water and any non-potable water supplies.

(j) If the product is bottled water, there shall be no cross-connections between the operations water and the product water.

(k) The washing and sanitizing operation shall be positioned so as to minimize any possible post-sanitizing contamination of the containers before they are filled.

(l) Rooms in which beverages or water are handled, processed, or held, or in which containers, utensils, or equipment are washed or held, shall not open directly into any living quarters.

(m) When employee locker and lunch rooms are provided, they shall be kept clean and be separated from plant operations and storage areas with self-closing doors.

(n) Hand wash stations shall be provided in locations convenient to the processing room, locker rooms, and lunch rooms, and be equipped with soap, paper towels or electric hand dryers, and hot and cold or warm running water.

(o) Restrooms shall be maintained in a clean and sanitary manner, and in good repair.

(p) Restrooms shall be equipped as follows:

(1) Hand washing facilities with hot and cold running water, soap and paper towels or air dryers shall be provided;

(2) Doors shall be solid and self-closing;

(3) Adequate ventilation shall be provided to minimize odors and condensation;

(4) Ventilation ducts shall vent to the outside; and

(5) All windows shall be effectively screened against entry by insects when open.

(q) Signs shall be posted in all rest rooms, locker rooms, and lunch rooms reminding employees to wash hands before starting or returning to work.

(r) Disposal of sewage and other wastes shall be in a public sewage system or in a manner in compliance with state and local regulations.

(s) All plumbing shall be sized, installed, and maintained according to the provisions of the State of New Hampshire building code as authorized by RSA 155-A.

(t) Each facility shall be equipped with a minimum of a 2-compartment sink of adequate size to wash, rinse, and sanitize manually washed equipment and be installed and plumbed according to the State of New Hampshire building code as authorized by RSA 155-A.

(u) The premises shall be maintained free of insects, rodents, and other pests. The presence of insects, rodents and other pests shall be controlled to eliminate their presence.

(v) Each facility shall provide adequate lighting and proper shielding to prevent product contamination.

(w) Private water supply wells shall be properly constructed and maintained in accordance with NH water well board rules We 100-1000.

(x) The beverage facility shall be maintained in clean and good repair.

History

• #1682, eff 12-21-80; ss by #1930, eff 1-26-82; ss by #3069, eff 7-23-85; ss by #4658, eff 7-31-89; ss by #5383, eff 4-22-92, EXPIRED: 4-22-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.02 Equipment

(a) All plant equipment and utensils shall be suitable for their intended use and in sound condition.

(b) Self contained units for washing, sanitizing, and filling multiservice containers shall be located in a properly designed and constructed facility, in accordance with He-P 2103.01.

(c) All product contact surfaces, including containers and closures, shall be constructed of nontoxic, nonabsorbent and corrosion resistant materials.

(d) Storage tanks shall be of the type that can be closed to exclude all foreign matter, and have properly protected vents.

History

• #1682, eff 12-21-80; ss by #1930, eff 1-26-82; ss by #3069, eff 7-23-85, EXPIRED: 7-23-91
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.03 Cleaning and Sanitizing

(a) The product contact surfaces of all multiservice containers, utensils, pipes, fillers, and equipment used in the transportation, processing, handling, and storage of beverages or water shall be:

(1) Washed and rinsed after each use and shall be sanitized just prior to being used;

(2) Inspected as often as necessary by plant personnel to maintain the sanitary condition of such surfaces and to assure they are kept free of scale, oxidation, and other residue or foreign matter; and

(3) Cleaned immediately if the inspection shows the presence of any unsanitary condition, scale, residue, or oxidation.

(b) After cleaning, all multiservice containers, utensils, and disassembled piping and equipment shall be transported and stored in a self draining position.

(c) Mechanical washers shall be inspected as often as is necessary to assure adequate performance.

(d) Filling equipment used for bottled beverages shall not be used for any non-beverage foods.

(e) When filling equipment used for bottled water is also utilized for other beverages, such equipment shall be thoroughly washed, rinsed, and sanitized before being used for water.

(f) Fillers, storage tanks, piping, and any other processing equipment used for non-food products shall not be used for beverages or bottled water.

(g) Any methods prescribed in 21 CFR 129.80(d) or any subsequent amendments thereto, shall be considered the minimum levels to effect proper sanitization.

(h) All chemical sanitizers shall be approved by the EPA, registered, and used according to the label.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.04 Product and Operations Water

(a) All product water that is used for bottled water shall be from an approved source as required in He-P 2102.01.

(b) All product and operations water shall be:

(1) From a source which is properly located, protected, and operated to avoid contamination;

(2) Of adequate quantity; and

(3) Analyzed at least annually for bacteria, nitrates, and nitrite to assure the water is of a safe, sanitary quality.

(c) All treatment of product water by distillation, ion-exchange, filtration, ultraviolet treatment, ozonation, reverse osmosis, carbonation, mineral addition, or any other process shall be done in a manner so as to be effective in accomplishing its intended purpose and in accordance with section 409 of the Federal Food, Drug, and Cosmetic Act.

(d) All such treatment processes shall be performed in and by equipment designed for the purpose and with substances which will not adulterate the product water.

(e) Product water samples shall be taken after processing and prior to bottling by the plant and analyzed as often as necessary to assure uniformity and effectiveness of the treatment processes.

(f) Water that has been treated with ozone for purposes of disinfection shall not exceed 0.4 mg/l of residual ozone in the bottled water.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.05 Filling and Capping

(a) Filling, capping, and sealing of all beverage and bottled water containers shall be done in a sanitary manner.

(b) The performance of the filler, capper, or sealer shall be monitored and the filled containers visually or electronically inspected.

(c) Single-service or multiservice containers which are damaged or defective shall not be used.

(d) Whenever air under pressure is directed at the beverage or product water or a product contact surface:

(1) It shall be from a filtered source and be free of oil, dust, rust, moisture, and extraneous materials;

(2) It shall not affect the bacteriological or chemical quality of the beverage or water; and

(3) It shall not adversely affect the flavor, color or odor of the beverage or water.

(e) Single-service containers and caps or seals shall be stored in an enclosed container in an area that is clean and dry.

(f) Packaging or wrapping material or other processing supplies shall not be stored in locker or lunch rooms.

(g) The facility shall have controls in place to ensure containers and closures are free from contamination prior to being used for filling.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.06 Record Keeping

(a) The plant shall maintain the following records:

(1) Analysis results of all required testing of the water, along with sampling date, type of product sampled, and production code;

(2) Sanitization records including the date of sanitization, intensity of the sanitizing agent, and the duration of time the agent was in contact with the item or surfaces being sanitized;

(3) Kind of product, volume produced, date produced, production code used, the source(s) used, if the plant bottles water from more than one source, and the distribution of the finished product to wholesale or retail outlets; and

(4) Plants which treat water with methods prescribed in 21 CFR 129.80(d) shall keep a record of the type and date of physical inspections of the treatment equipment, the conditions found and the performance and effectiveness of the treatment equipment.

(b) All records above shall be kept on file at the plant for at least 2 years.

(c) The bottling facility shall make records available to the department upon request.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.07 Product Coding

(a) Each unit package from a batch or segment of a continuous production run of a beverage or bottled drinking water shall be identified by a production code.

(b) The production code shall identify a particular batch or segment of a continuous production run and the day produced.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2103.08)

N.H. Code Admin. R. Ann. He-P 2103.08 Recall Procedure

(a) Each bottler shall develop and maintain on file a written procedure for the recall of their product.

(b) The recall procedure shall include procedures for the notification of the department and consumers, and removal of the product from commerce.

(c) Production records as required in He-P 2103.06(a)(3) shall be used to enable location of products if a recall is initiated.

(d) A bottler shall recall any product which the bottler or the department knows or has reason to believe might adversely affect the health and safety of the public.

(e) If the department determines that the circumstances present an imminent health hazard and that consumer notification or product recall can significantly minimize the threat to health and safety of the public, the department shall direct the bottler to initiate a product recall.

(f) The bottler shall be responsible for disseminating notification of the recall to all wholesale and retail outlets in a manner that allows quick response in an effort to protect the public health.

(g) If directed by the department, the bottler shall issue notification to consumers who might be affected by the problem using such methods, including the media, as will assure timely notification to the consumers.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2103.09)

N.H. Code Admin. R. Ann. He-P 2103.09 Storage and Transportation of Bulk Water for Bottling

(a) Bulk water shall be stored, loaded, transported, and unloaded in a manner that prevents contamination.

(b) Facilities for the storage and transfer of bulk water for bottling shall be constructed and maintained as follows:

(1) Walls and ceilings shall be tight, smooth, easily cleanable, and maintained in good repair;

(2) Floors shall be smooth, impervious, graded to drain, and maintained in good repair;

(3) All drains shall be properly trapped to prevent access of odors and sewer gases;

(4) All outer openings shall be tight to prevent access by insects and rodents;

(5) Doors shall be self-closing;

(6) Ventilation shall be provided to minimize odors and condensation;

(7) The intake of all pressure ventilation systems shall be properly filtered;

(8) The transfer facility shall not open directly into any room which is not used as part of the water operations;

(9) Hand wash stations equipped with soap, paper towels, and hot and cold or warm running water or hand sanitize stations shall be located conveniently to the transfer facility; and

(10) Restrooms shall not open directly into the transfer facility.

(c) Facilities for the transfer of bulk water for bottling shall be equipped and operated as follows:

(1) All equipment, including storage tanks, piping, pumps, and transport tankers shall be suitable for their intended use;

(2) All product water contact surfaces shall be made of nontoxic, nonabsorbent, and corrosion resistant materials and maintained in good repair;

(3) All equipment shall be cleaned, sanitized, and inspected on a routine basis;

(4) Storage tanks and transport tankers shall be of the type that can be closed to exclude all foreign matter;

(5) All connections, hoses, and pumps used for loading and unloading bulk water shall be stored to prevent contamination;

(6) Vents on storage tanks and transport tankers shall be properly protected during filling and emptying;

(7) Manhole covers on transport tankers shall be closed while filling and emptying;

(8) Transport tankers used for bulk water shall not be used or have previously been used for any non-food products;

(9) If the transport tanker is used for any food product containing fat or protein it shall be cleaned and sanitized immediately after such use and before it is used for bulk water;

(10) Product contact surfaces of all transport tankers, storage tanks, and related equipment shall be cleaned, sanitized, and inspected as frequently as necessary to maintain the sanitary condition of such surfaces and to assure they are kept free of scale, oxidation and other residue or foreign matter; and

(11) A record of all cleaning and sanitizing showing the date, time, place, and signature of person doing the work shall be maintained with the vehicle or at the bulk storage and transfer facility for a minimum of 2 years.

(d) Each shipment of bulk water shall be accompanied by a shipping statement that provides at least the following information:

(1) Name and address of the owner of the source water;

(2) Site of the water source;

(3) Date of loading;

(4) Name of facility the water is delivered to;

(5) Gallons of water delivered;

(6) Date and time delivered to facility; and

(7) Any treatment, such as ozonation, provided at the bulk water source.

(e) The shipping statement shall be retained by the plant receiving the bulk water for at least 2 years.

(f) Upon filling, all access points to the tanker shall be sealed using a tamper evident seal printed with a unique identifier.

(g) Seals shall only be removed by the receiving plant.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2103.10)

N.H. Code Admin. R. Ann. He-P 2103.10 Special Requirements for Juices and Non-Carbonated Beverages

(a) Manufacturers of juices shall comply with all applicable requirements for Hazard Analysis and Critical Control Point Systems in 21 CFR Part 120.

(b) Beverage manufacturers of non-carbonated beverages which are not subjected to heat treatment or other steps intended to consistently produce, at a minimum, a 5 log or 99.999% reduction of viable microorganisms for at least as long as the shelf life of the product, shall have a process review conducted by a processing authority on each product prior to its being produced.

(c) If the processing authority declares in writing that there are no biological concerns with the beverage after conducting the process review, the beverage shall be allowed to be produced.

(d) All products manufactured in which a process review was conducted shall be required to follow all aspects of the process review and document any required information.

(e) Manufacturers shall keep all process review information on file and retained on site for as long as the product is being manufactured. All process review information shall be available for review by the department upon request.

(f) A list of processing authorities described in (b) above, or a website link to the same, shall be available on the department’s website at http://www.dhhs.nh.gov/dphs/fp/beverage/index.htm. More extensive lists of processing authorities may be found through web search or via industry specific manufacturers’ associations.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2103.11)

N.H. Code Admin. R. Ann. He-P 2103.11 Alcohol Content Review

(a) Any product that can produce alcohol shall not exceed 0.5% alcohol by volume and shall be maintained at 0.5% or below for the entirety of the listed shelf life.

(b) Testing for alcohol shall be performed on the product, at minimum, at the end of the product’s shelf life.

(c) Testing of products shall be the responsibility of the licensee and shall be tested at an accredited laboratory.

History

• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.12 Personnel

(a) All employees shall be adequately trained and monitored by responsible supervisory personnel with regards to proper food handling procedures and the danger of poor personal hygiene and unsanitary practices.

(b) Any person who, by medical examination or supervisory observation, is shown to have, or appears to have, an illness, open lesion, including boils, sores or infected wounds, or any other abnormal source of microbial contamination by which there is a reasonable possibility of the beverage, product water, product contact surfaces, or containers or closures becoming contaminated, shall be excluded from any operations which might be expected to result in such contamination until the condition is corrected.

(c) Personnel shall report any such health conditions, described in (b) above, to their supervisors.

(d) Employees shall maintain good personal hygiene to prevent contamination.

(e) Employees shall thoroughly wash their hands and the exposed portions of their arms in an adequate hand washing facility before starting work, after each absence from the work station, and at any other time when the hands might have become soiled or contaminated.

(f) Employees shall refrain from eating food, chewing gum, drinking beverages, or using tobacco in areas where beverages or water are processed, packaged, or stored.

(g) Employees shall wear clean outer clothing.

(h) Employees shall wear, in an effective manner, hair nets, caps, beard covers, or other effective hair restraints.

(i) Employees shall remove all unsecured jewelry or other objects that might fall into equipment, or containers.

(j) Gloves, if used, shall:

(1) Be impermeable;

(2) Be maintained in an intact, clean, and sanitary condition; and

(3) Not be a substitute for handwashing.

(k) Employees shall store all clothing or other personal belongings in areas other than where the beverages or water are processed, bottled, and stored.

(l) Employees shall take all precautions necessary to avoid the contamination of the beverages product water, product contact surfaces, containers, and closures with microorganisms or foreign substances that include perspiration, hair, tobacco, chemicals, medicines applied to the skin, and any other microorganisms and foreign substances.

History

• #10116, eff 4-19-12 (from He-P 2103.11); ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2103.13 Labeling of Beverages and Bottled Water

(a) All labeling shall be in compliance with the applicable requirements of the federal food labeling regulations, 21 CFR Part 101, and federal bottled water regulations 21 CFR Part 165.110.

(b) The label shall state the name of the product in accordance with 21 CFR 165.110 and He-P 2103.14.

(c) When bottled water comes from a community or municipal water system, except when it has been treated by deionization, distillation, or reverse osmosis, or meets the definitions of purified or sterile water, and is labeled as such, the water shall be labeled as follows:

(1) The statement “from a community water system” or, alternatively, “from a municipal source”, as appropriate, shall be on the label’s principal display panel; and

(2) This statement shall immediately and conspicuously precede or follow the name of the water without intervening written, printed, or graphic matter, in type size at least one-half the size of the statement of identity but in no case less than one-sixteenth of an inch.

(d) Water labeled as sodium free, low sodium, or very low sodium shall be in compliance with labeling requirements for sodium in 21 CFR 101.61.

(e) Spring water, as defined in He-P 2101.01(ad), shall be labeled as follows:

(1) The term “spring”, “springs”, or “spring water” shall not be used as a product name or a brand name on a label unless the water source meets the definition of spring water in He-P 2101.01(ad); and

(2) If the word “spring” appears in the company name and the water source does not meet the definition of spring water, the word(s) designating the type of water source shall be no smaller than one-half the size of the word “spring” in the company name.

(f) Mineral water, as defined in He-P 2101.01(p), shall be labeled as follows:

(1) The label for mineral water which contains total dissolved solids of less than 500 ppm shall include the statement “low mineral content”;

(2) The label for mineral water which contains total dissolved solids of 1,500 ppm or higher shall include the statement “high mineral content”; and

(3) Statements of low or high mineral content shall appear on the label’s principal display panel, following the statement of identity, in type size at least one-half the size of the statement of identity but in no case less than one-sixteenth of an inch.

(g) If the word “natural” appears in the company name on the label and the finished product has been subject to treatment such that it does not meet the definition of natural water in He-P 2101.01(r), the word(s) designating the type of water, such as distilled, deionized, demineralized, or drinking water, shall be no smaller than one-half the size of the word “natural” in the company name.

(h) The words in the product name on the label shall be in letters of the same style, size, and color on a background of contrasting color.

(i) Supplemental printed information and graphics on the label concerning recognized uses of the water when appearing on the label shall not infer properties of the product or preparation methods which are not factual.

(j) When the label or labeling of a bottled water product states or implies through label statements or vignettes that the bottled water is for use in feeding infants, and the product does not meet the definition of “sterile water” in He-P 2101.01(ae), the product label shall bear the statement “not sterile” conspicuously and on the principal display panel.

(k) Bottled water which has on its principal display panel, or primary label, a statement of identity such as spring water, purified water, or drinking water and contains added ingredients, including minerals, caffeine, flavorings, or any other additional ingredients, shall be clearly labeled as containing additional ingredients.

History

• #12680, eff 11-27-18 (formerly He-P 2104.01)

N.H. Code Admin. R. Ann. He-P 2103.14 Name of Product

(a) The term “natural” may be used on the label with mineral, spring, artesian, or well water provided that the particular product also meets the definition of natural water in He-P 2101.01(r).

(b) All bottled water labeling shall comply with the standard of identity of the water source as defined in 21 CFR 165.110, He-P 2101, and as follows:

(1) Artesian water as defined in He-P 2101.01(c) shall be labeled “artesian water” or “artesian well water”;

(2) Deionized water as defined in He-P 2101.01(k) shall be labeled as “deionized water” or “deionized drinking water”;

(3) Demineralized water as defined in He-P 2101.01(l) shall be labeled as “demineralized water” or “demineralized drinking water”;

(4) Distilled water as defined in He-P 2101.01(n) shall be labeled as “distilled water” or “distilled drinking water”;

(5) Mineral water as defined in He-P 2101.01(p) shall be labeled “mineral water”;

(6) Purified water as defined in He-P 2101.01(z) shall be labeled “purified water” or “purified drinking water”;

(7) Spring water as defined in He-P 2101.01(ad) shall be labeled “spring water”;

(8) Sterile water as defined in He-P 2101.01(ae) shall be labeled as “sterile water” or “sterile drinking water”; and

(9) Well water as defined in He-P 2101.01(ai) shall be labeled as “well water”.

History

• #12680, eff 11-27-18 (formerly He-P 2104.03)

Part He-P 2104 Application and Licensing of in-State Beverage and Bottled Water Facilities

N.H. Code Admin. R. Ann. He-P 2104.01 Initial License Application Requirements

(a) All applicants for licensure under RSA 143:10 shall complete and submit to the department, Form ISB APP “Application for Beverage and Bottled Water License” (November2018 Edition), obtained from the department at https://www.dhhs.nh.gov/dphs/fp/beverage/license.htm, affirming and certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with response to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates to the information provided.”

(b) The applicant shall include the following in the application submittal:

(1) Copies of all types of labels to be used in New Hampshire;

(2) Copies of any FDA approval issued relative to labels making claims of medicinal or health giving properties;

(3) Laboratory results of the water analysis required by He-P2102, with the exception of He-P 2102.05 (b) (1) for both the source and the finished product, if the product is bottled water, or source water analysis if the product is a beverage; and

(4) Cash, check, money order, or on-line payment for the applicable fees, in accordance with He-P 2104.04.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12, ss by #12680, eff 11-27-18 (formerly He-P 2106.01)

N.H. Code Admin. R. Ann. He-P 2104.02 Processing of Initial Applications and Issuance of Licenses

(a) An application shall be processed in accordance with RSA 541-A:29.

(b) An application for an initial license shall be complete when the department determines that all items required by He-P 2104.01 have been received.

(c) If an application does not contain all of the items required by He-P 2104.01, the department shall:

(1) Not process that application; and

(2) Notify the applicant in writing of which items are required to be submitted before the application can be processed.

(d) Any licensing fee submitted to the department in the form of a cash, check, money order, or online payment and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(e) Licensing fees shall not be transferable to any other application(s).

(f) Following an inspection, conducted pursuant to RSA 143:11 and in accordance with He-P 2105, a provisional license shall be issued if the department determines that an applicant is in compliance with RSA 143,and these rules.

(g) Pursuant to RSA 143:11:

(1) A provisional license shall expire 90 days after the date of issuance; and

(2) If a license is not issued following the expiration of a provisional license, the beverage or bottled water facility shall cease operation the day after the provisional license expires and not operate until a license is obtained.

(h) All licenses and provisional licenses issued in accordance with RSA 143-A shall be issued for a specific license classification under He-P 2104.04.

(i) License holders shall operate in accordance with the class of license issued.

(j) Laboratory analysis of the source water, as required in He-P 2102.06, shall show the source water to be in compliance with the standards set forth in He-P 2102.02, provided the plant is bottling water.

(k) The labels shall be in compliance with He-P 2103.

(l) An inspection of the facility while in operation shall be conducted by the department within the 90 days that the provisional license is in effect.

(m) If the operational inspection and the analysis results of the finished product determine that the facility is in compliance with He-P 2100, a full annual license shall be issued.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2106.02)

N.H. Code Admin. R. Ann. He-P 2104.03 License Expirations and Procedures for License Renewal.

(a) Licenses issued following a provisional license shall expire on the first day of January of the year following issuance unless revoked prior to that date.

(b) Each licensee shall apply to renew his or her license at least 30 days prior to the expiration of the current license.

(c) The licensee shall submit all requirements listed in 2104.01 (b) and any changes to information provided to the department in the initial application.

(d) A license shall be renewed if the department determines that the licensee:

(1) Submitted the renewal information containing all the items required by (c) above, as applicable, at least 30 days prior to the expiration of the current license;

(2) Has submitted a compliance agreement that has been accepted by the department and implemented by the licensee if the deficiencies were cited at the last licensing inspection; and

(3) Is found to be in compliance with RSA 143 and He-P 2100.

(e) If a license holder fails to submit all required information and documentation required for the renewal process as required under (b) and (c) above, the facility shall cease operation the day after the license expires , and shall not operate until a license is obtained.

(f) License renewal applications shall be processed and issued or denied in accordance with He-P 2104.02 and 2106.04.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.04 Beverage License Classes and In State Beverage Fees

(a) Licensure fees shall be non-refundable and graduated by class in accordance with the following schedule:

(1) “Class 1” means bottlers of 5,000 gallons or more per day, averaged over a period of one years. Bottlers in class 1 shall pay a licensure fee of $300;

(2) “Class 2” means bottlers of 500 gallons or more but less than 5000 gallons per day, averaged over a period of one year. Bottlers in class 2 shall pay a licensure fee of $175; and

(3) “Class 3” means bottlers of less than 500 gallons per day, averaged over a one year period. Bottlers in class 3 shall pay a licensure fee of $75;

(b) Fees shall be due and payable prior to the issuance of a license.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.05 Change in Ownership of a Beverage or Bottled Water Facility

(a) When there is a change of ownership of a bottled water or beverage facility, the new owner shall submit the items required for initial license applicants under He-P 2104.01 to the department at least 30 days prior to the change of ownership.

(b) Upon receipt and processing of the items required by (a) above, and after an inspection conducted in accordance with He-P 2105.01 which shall also determine compliance with the beverage rules He-P 2100, the department shall issue a provisional license reflecting the change in ownership.

(c) The issuance of a provisional license due to a change in ownership shall void the license of the previous owner on the date the change of ownership occurs.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.06 Change in Name of a Beverage or Bottled Water Facility

(a) When a license holder intends to change the name of a bottled water or beverage facility, that license holder shall submit a written request to the department for a new license at least 30 days prior to the intended date of change in name.

(b) The written request shall include:

(1) The reason for requesting a new license;

(2) The name of the bottled water or beverage facility as it appears on the existing license;

(3) The name of the bottled water or beverage facility as the license holder requests it to appear on the new license; and

(4) The date upon which the change in name is intended to occur.

(c) Following receipt of the items required by (b) above, the commissioner shall issue a revised license reflecting the change in name. The establishment number and expiration date shall remain the same as it was on the immediately preceding license.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.07 Change in Location of a Bottled Water or Beverage Facility

(a) When there is a change of location of a bottled water or beverage facility, the license holder shall submit the items required for initial license applicants under He-P 2104.01 to the department at least 30 days prior to the change of location.

(b) Upon receipt and processing of the items required under (a) above, and after an inspection conducted in accordance with He-P 2105.01 , the department shall issue a provisional license reflecting the change of location.

(c) The issuance of a provisional license due to a change in location shall void the previous license on the date the change of location occurs.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.08 Change in License Class

(a) A license holder wishing to request an upgrade to a higher-level class of license listed in He-P 2104.04 shall:

(1) Be treated as an applicant for a new license; and

(2) Apply for a new license in accordance with He-P 2104.01.

(b) The issuance of a provisional license due to an upgrade in license class shall void the previous license on the date the upgrade occurs.

(c) A license holder wishing to request a downgrade to a lower level class of license listed in He-P 2104.04 shall submit a written request for downgrade to the department.

(d) The written request in (c) above shall include:

(1) The reason for requesting a downgrade; and

(2) The date upon which the downgrade is intended to occur.

(e) Following receipt of the request under (c) above, the licensee shall be issued a revised license reflecting the downgrade in class of license. The establishment number and expiration date shall remain the same as it was on the immediately preceding license.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.09 Submission of Plans and Specifications for New or Remodeled Beverage Facilities

(a) A new applicant or a current license holder undergoing remodeling of a beverage facility shall complete and submit to the department Form BBFPAPP “Plan Review Application”(October 2018 Edition).

(b) In addition to submitting a completed application in (a) above, an applicant or license holder shall provide with the application a copy of the plans and specifications for the beverage facility that include:

(1) Location of all equipment which clearly identifies the piece of equipment;

(2) Location of all refrigeration;

(3) Location of all sinks; and

(4) Location of all restrooms, employee locker, and lunch rooms.

(c) The application and attachments in (a) and (b) above shall be submitted at least 45 days prior to:

(1) Constructing a new beverage facility;

(2) Remodeling an existing structure for use as a beverage facility;

(3) Remodeling a beverage facility; or

(4) Relocating a beverage facility when the relocation also involves (1), (2), or (3) above.

(d) An applicant or licensee shall pay a fee of $75, in the form of cash, check, money order or online payment, submitted with the application, for each plan review application submitted.

(e) The department shall review plans for construction, remodeling or structural alterations of a beverage facility for compliance with all applicable sections of RSA 143 and He-P 2100 and notify the applicant or licensee as to whether the plan complies with the requirements set forth therein.

History

• #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2104.10 Variances

(a) Applicants or license holders seeking variances from specific rules shall contact the department by telephone at (603) 271-4589 or by mail, to obtain a VR Form “Beverage and Bottled Water License Variance Request Form” (October 2018 Edition).

(b) Applicants or license holders shall complete and submit VR Form “Beverage and Bottled Water License Variance Request Form” (October 2018 Edition) to the department by mailing to:

Department of Health and Human Services

Division of Public Health Services

Food Protection Section

29 Hazen Dr.

Concord, NH 03301

(c) The commissioner shall approve a request for variance if:

(1) The commissioner concludes that authorizing deviation from strict compliance with the rule item from which a variance is sought does not contradict the intent of the rule; and

(2) The alternative proposed by the applicant or license holder ensures that the objective or intent of the rule item from which a variance is sought will be accomplished.

(d) If a variance is approved, the license holder’s subsequent compliance with the alternatives approved in the variance shall be considered equivalent to complying with the rule item from which a variance was sought.

(e) A variance shall be approved until the expiration of the current license or as specified by the department.

(f) No request for a variance concerning the rules of other state agencies which are referred to in this chapter shall be approved.

History

• #12680, eff 11-27-18

Part He-P 2105 Inspections and Compliance

N.H. Code Admin. R. Ann. He-P 2105.01 Inspection of Beverage Facilities

(a) Inspections shall be conducted:

(1) Prior to issuance of a license;

(2) At least once annually; or

(3) Whenever the department has reason to believe a condition exists that places the bottling facility in non-compliance with RSA 143 and He-P 2100.

(b) Inspections shall be scored by a point system with the following points being assigned to each item:

(1) Floors, walls, ceilings, 2 points;

(2) Outer openings and doors, 2 points;

(3) Lighting and ventilation, 2 points;

(4) Plumbing, constructed and installed, 4 points;

(5) Plumbing in good repair, 2 points;

(6) Sewage disposal, 4 points;

(7) Handwash stations, 2 points;

(8) Restrooms, 2 points;

(9) Separate rooms, 2 points;

(10) Plant cleanliness, 2 points

(11) Evidence of insects or rodents, 2 points;

(12) Well head maintenance and construction, 2 points;

(13) Equipment properly, designed and stored, 2 points;

(14) Proper tank ventilation, 2 points;

(15) Contact surfaces cleaned, 4 points;

(16) Contact surfaces sanitized, 4 points;

(17) Preventing contamination, 2 points;

(18) Facilities for storage, 2 points;

(19) Facilities for transfer, 2 points;

(20) Shipping statements, 2 points

(21) Filling access points and seals, 2 points;

(22) Process review on site, 2 points;

(23) Process review followed, 4 points;

(24) Records maintained and properly retained, 2 points

(25) Approved treatment, 4 points;

(26) Container integrity, 2 points;

(27) Performance of filler, capper and sealer monitored, 2 points;

(28) Air under pressure cleaned and filled, 2 points;

(29) Operation conducted to preclude the contamination of product, 2 points;

(30) Container and cap storage, 2 points;

(31) Product properly labeled, 2 points;

(32) Date coding, 2 points;

(33) Source water testing, 4 points;

(34) Finished product testing, 4 points;

(35) Recall procedure developed, 4 points;

(36) Sanitizing log, 2 points;

(37) Records maintained and properly retained, 2 points;

(38) Health and reporting, 4 points;

(39) Personal cleanliness, 2 points; and

(40) Proper handwashing, 4 points.

(c) The license holder shall be notified in writing of violations and the compliance status of the facility.

(d) Follow-up inspections shall be conducted on noncompliant facilities.

(e) If a second follow-up inspection determines the facility is still non-compliant, the licensee shall enter into a compliance agreement in accordance with He-P 2105.02

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2105.02 Compliance Agreements

(a) Compliance agreements shall be completed at the conclusion of an inspection or at a mutually agreed upon time and place between the license and inspector, with in a time period not to exceed one week.

(b) The following shall be provided in the compliance agreement:

(1) The date of the agreement;

(2) The name of the establishment;

(3) The license number of the establishment;

(4) The name of the person in charge of the establishment;

(5) Attestation to the agreement to make repairs, corrections or changes that are necessary to bring the establishment into compliance with He-P 2100;

(6) A list of each repair, correction, or change to be made including the date of intended completion;

(7) The signature of the person in charge;

(8) The title of the signee; and

(9) The signature of the inspector or department representative making the agreement.

(c) Failure on the part of the license holder to comply with the signed compliance agreement shall result in action against the license as specified in He-P 2105.01(e) and He-P 2106.02.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

Part He-P 2106 Enforcement Actions

N.H. Code Admin. R. Ann. He-P 2106.01 Enforcement Actions and Notice of Right to Appeal

(a) The department shall impose enforcement actions for violations of RSA 143, or He-P 2100, including the following:

(1) Imposing fines upon an applicant, licensee, or unlicensed individual;

(2) Denying a license application;

(3) Revoking a license; or

(4) Immediately closing the beverage facility.

(b) When imposing a fine, denying a license application, or revoking a license, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The action to be taken by the department;

(2) The reasons for the action, including the identification of each deficiency as applicable; and

(3) The right of the applicant or licensee to request a hearing in accordance with RSA 541-A, He-C 200, and He-P 2106 prior to the enforcement action becoming final.

(c) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 143, RSA 541-A:30, III, or He-P 2100.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2106.02 Schedule of Administrative Fines

The department shall impose administrative fines not to exceed the specified amounts for the following violations:

(a) For willful submission of fraudulent or materially false information on or with an application, in violation of He-P 2104.01 or He-P 2107.01, the fine shall be $1,000;

(b) For failure to cooperate during an inspection of a beverage or water bottling facility, the fine shall be $2,000;

(c) For operating a beverage or water bottling facility in the state without first obtaining a license, as required in RSA 143:10, the fine shall be $1,000. Each day that an individual or business continues to operate without obtaining a license shall be considered a separate offense subject to an additional $500 fine;

(d) For failure to cease operation upon notification by the department to do so, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(e) For failure to cease operation after a license has expired when an application has been denied or when a license has been revoked, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(f) For failure to notify the department within 24 hours of receiving an analysis result indicating that a quality standard as set forth in He-P 2102.02 has been exceeded or identifying other circumstances that might adversely affect the safety of the bottled product as required in He-P 2103.08 (e) and He-P 2102.07 the fine shall be $100;

(g) For failure to obtain a registration before offering for sale within the state any beverage or bottled water which is bottled outside New Hampshire, the fine shall be $500. Each day the beverage or bottled water is offered for sale in New Hampshire shall be considered a separate offense subject to an additional $250 fine;

(h) For failure to remove a product from commerce in New Hampshire when a registration has been revoked, the fine shall be $1,000. Each day the beverage or bottled water is offered for sale after revocation shall be considered a separate offense subject to an additional $500 fine;

(i) For failure to submit a timely license renewal application in accordance with He-P 2104.03 (c), the fine shall be $75;

(j) For failure to submit a timely registration renewal application in accordance with He-P 2104.03, the fine shall be $75;

(k) For failure to notify the department by telephone within 24 hours of any fire or other disaster that jeopardizes the safety or sanitation of bottled product in a bottled beverage establishment establishments, in violation of He-P 2106.06(a), the fine shall be $250;

(l) For failure to notify the department pursuant to He-P 2104.05(a) at least 30 days prior to a beverage facility ownership change, the fine shall be $500;

(m) For failure to notify the department pursuant to He-P 2104.07(a) at least 30 days prior to the change of location of a beverage facility, the fine shall be $500;

(n) For failure to submit a plan for review as required in He-P 2104.09(a) and (b), the fine shall be $300;

(o) For failure to cease operation upon notification by the department to do so, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(p) For failure to cease operation after a license has expired, when an application has been denied, or when a license has been revoked, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(q) For failure to pay an administrative fine within 30 days of its imposition, or within 30 days of the decision to uphold the imposition of a fine that was appealed, the fine shall be $500. Each day until the expiration of the current license, that a license holder fails to pay such a fine shall be considered a separate offense subject to an additional $500 fine;

(r) For a failure to comply with any compliance agreement that has been accepted by the department, the fine shall be $500;

(s) For violating a variance approved in accordance with He-P 2104.10, the fine shall be $500; and

(t) For failure to enter into a compliance agreement, when required by He-P 2105.02, the fine shall be $500.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2106.03 Form of Payment of Fees and Administrative Fines

Whenever an applicant or license or registration holder makes a payment to the department in satisfaction of a fee or administrative fine, the following shall apply:

(a) Payment shall be made in the form of cash, check or money order for the exact amount due;

(b) Cash, money order or certified check shall be required when an applicant or license or registration holder has issued payment to the department by check, and such check was returned for insufficient funds;

(c) Any instrument described in (a) or (b) above shall be made payable to the “Treasurer–State of New Hampshire”; and

(d) Any payment made to the department by check which is returned for insufficient funds, and which an applicant or license or registration holder has not made good by submitting cash, money order or certified check within 2 business days of notification by the department, including any penalty assessment required by RSA 6:11-a, shall result in denial of the application or revocation of the license or registration after notice and opportunity for a hearing.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2106.04 Denial or Revocation of License

(a) The department shall deny an application or revoke a license if:

(1) Inspection of the facility indicates that conditions or operations are such that contamination of the beverages or water is occurring or might occur which might cause a threat to the public health and safety and steps are not taken immediately to bring the conditions or operations into compliance;

(2) An applicant or licensee has failed to pay any applicable fee in accordance with He-P 2104.04 or any administrative fine imposed under He-P 2106.02 or any other court authorized sanction or fee;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee and additional charges in the form of money order or certified check within 2 business days of notification by the department;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 2104.01(b);

(5) An applicant, licensee or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide, upon request, information or documents to the department;

(6) There is a deficiency identified in the inspection report and the applicant or licensee does not either correct it or complete a compliance agreement in accordance with He-P 2105.02;

(7) The licensee fails to implement or continue to implement a compliance agreement that has been accepted by the department in accordance with He-P 2105.02;

(8) The licensee fails, without prior notification to the department, to attend a compliance meeting; or

(9) The licensee is bottling water and analysis of the source or finished product water indicates one or more parameters of public health significance exceed the quality standards set forth in He-P 2102.02 and immediate steps are not taken to remove the contaminants.

(b) The department shall revoke a license in accordance with RSA 143:14 and RSA 541-A:30, II.

(c) Hearings and appeals of decisions of the department resulting from an adjudicative proceeding shall be in accordance with He-C 200.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2106.05 Effect of Denial of Application or Revocation

(a) Any applicant who has been denied a license or renewal license shall not operate or shall cease operation of the beverage facility for which the license or renewal license was denied within 10 calendar days after receipt of the denial notice, unless a timely appeal is submitted.

(b) If a license is revoked by the department, the beverage facility shall cease operation of the beverage production within 10 calendar days after receipt of the revocation notice, unless a timely appeal is submitted.

(c) If a beverage facility is subject to immediate closure as defined in RSA 143:13, the beverage facility shall immediately cease operation pending reinspection and pursuant to the adjudicative proceedings provisions of RSA 541-A.

(d) If a license expires without a timely application for renewal having been made, the beverage facility shall immediately cease operation of the beverage production.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2107.06)

N.H. Code Admin. R. Ann. He-P 2106.06 Closures

(a) A licensee shall immediately discontinue operations and notify the department at 603-271-4589, or if at night or during weekends at 603-271-5300, if an imminent health hazard might exist because of an emergency such as:

(1) A failed sewer system or a sewage backup into the beverage or bottled water facility;

(2) A fire affecting a beverage or bottled water facility;

(3) Flooding in a beverage or bottled water facility;

(4) Chemical exposure in a beverage or bottled water facility;

(5) Any other natural disaster or catastrophic event that could result in contamination of the beverage or bottled water; and

(6) Any other severe unsanitary conditions that threaten to contaminate the beverage or bottled water or its ingredient supply.

(b) A licensee shall not be required to discontinue operations in an area of the beverage or bottled water facility that is unaffected by the imminent health hazard.

(c) If operations are discontinued as specified in (a) above, the licensee shall obtain approval from the department before resuming operations.

(d) The department shall approve the resumption of operations if the imminent health hazard no longer exists or the licensee has offered a plan to mitigate all threats to health or safety.

(e) The failure to include other violations, practices, circumstances, or events in this section shall not be construed as a determination that other violations, practices, circumstances, or events are not or shall not be considered an imminent health hazard.

(f) The commissioner’s order of an immediate closure of a beverage or bottled water facility shall be in accordance with the provisions of RSA 143:13.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18 (formerly He-P 2155.06)

Part He-P 2107 Registration of Out-of-State Beverages and Bottled Water

N.H. Code Admin. R. Ann. He-P 2107.01 Submission of Initial Registration Applications

(a) All applicants registering their products in accordance with RSA 143:12 shall complete and submit to the department Form OSB APP “Application for Beverage and Bottled Water Registration” (October 2021 Edition), obtained from the department or available at https://www.dhhs.nh.gov/dphs/fp/beverage/license.htm, affirming and certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I certify that any bottled water that I am registering meets the standards of quality in He-P 2102.02(b). I understand that it is my responsibility to immediately notify the Food Protection Section regarding to any changes, corrections or updates to the information provided.”

(b) The applicant shall include the following information in the application submittal:

(1) A copy of a sanitary inspection conducted within the previous 12 months by the regulatory authority with jurisdiction or a recognized national third party audit organization, a letter from the regulatory authority confirming compliance with local regulations or a health certificate for the bottling facility issued within the previous 12 months;

(2) If the product is bottled water, a copy of the approval of the source for bottled water, including the approval for the designation “spring water”, if the product is labeled as such, issued by the federal, state, local, provincial, or other government agency with the authority to approve sources for bottled water; and

(3) If the product is bottled water, a copy of laboratory analysis for Methyl tertiary-butyl ether (MtBE) based on the specified Maximum Contaminant Level (MCL) in Env-Dw 705.01 and Per- and Polyfluoroalkyl Substances (PFAS) Contaminants based on the specified MCLs in Env-Dw 705.06 in accordance with He-P 2102.05, of the finished product.

(c) The analyses required by (b)(3) above shall be conducted not more than 12 months prior to the date of the application by an approved laboratory in accordance with He-P 2102.05(a).

(d) Cash, check, money order, or online payment for the application fee of $400, in accordance with RSA 143:12 shall be submitted with the registration application.

(e) Upon receipt of an application for registration and appropriate registration fee, the commissioner shall approve or deny the application in accordance with He-P 2107.04.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #9589, eff 11-5-09; amd by #10956, eff 10-22-15, paras (a), (b), (d), and (e) EXPIRED: 11-5-17; ss by #12680, eff 11-27-18; ss by #13283, eff 10-23-21

N.H. Code Admin. R. Ann. He-P 2107.02 Processing of Out of State Registration Applications

(a) An application shall be processed in accordance with RSA 541-A:29.

(b) If the application does not contain all of the items required by He-P 2107.01, the department shall:

(1) Not process that application; and

(2) Notify the applicant in writing that all required items must be submitted within 30 days in order for the application to be processed.

(c) If all the items required by He-P 2107.01 are received, the application shall be deemed to be complete.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2107.03 Registration Issuance and Duration

(a) A registration shall be issued if the following are met:

(1) The application meets the requirements of He-P 2107.01; and

(2) The inspection report or health certificate submitted with the application indicates that the bottling facility meets the equivalent requirements of He-P 2100.

(b) All registrations shall remain in effect until the first day of January of the year following issuance unless revoked prior to that date.

(c) Registrations shall not be transferable with respect to persons or locations.

(d) Information required with the registration application, including water sources, product labels or FDA labeling approvals, which changes before the registration expires shall be submitted to the department for review at the time the change is made.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2107.04 Denial of Registration Applications

The department shall deny a registration application when:

(a) The application submitted is incomplete and the information requested in accordance with He-P 2107.01 is not provided; or

(b) The inspection of the facility submitted with the application shows noncompliance with He-P 2100.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2107.05 Revocation of Registrations

(a) The department shall revoke a registration if the department has reason to believe that the beverage or bottled water being sold in the State of New Hampshire represents a threat to the public health and safety and there is no effort to correct the situation on behalf of the regulatory authority with control over the bottling facility.

(b) The department shall revoke a registration in accordance with the procedures set forth in RSA 143:14 and RSA 541-A:30, II.

(c) Hearings and appeals of decisions of the department, resulting from an adjudicative proceeding shall be in accordance with He-C 200.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2107.06 Effect of Denial of Application or Revocation

(a) Any applicant who has been denied a registration shall not sell beverages or bottled water in the State of New Hampshire.

(b) If a registration has been revoked, the registrant shall immediately remove all product from commerce in the State of New Hampshire.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2107.07 Renewal of Registrations

(a) A request to renew the registration shall be made to the department at least 30 days prior to the expiration of the registration.

(b) To renew, an applicant shall supply the requirements with supporting documentation required in He-P 2107.01, any changes to information provided to the department on the initial application, and payment as specified in He-P 2701.01(c), except the description of the source shall not need to be resubmitted unless the source has changed.

(c) Registration renewals shall be processed and issued or denied in accordance with He-P 2107.02, He-P 2107.03, and He-P 2107.04.

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; ss by #10956, eff 10-22-15; ss by #12680, eff 11-27-18

Part He-P 2108 Administrative Fines – Reserved

N.H. Code Admin. R. Ann. He-P 2108.01 Procedure for Administrative Fines

Reserved

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; rpld by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2108.02 Schedule of Administrative Fines

Reserved

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #9589, eff 11-05-09; ss by #10116, eff 4-19-12; ss by #10956, eff 10-22-15; rpld by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2108.03 Form of Payment of Fees and Administrative Fines

Reserved

PARTS He-P 2109 through He-P 2149 - RESERVED

History

• #1685, eff 12-21-80; 1930, eff 1-26-82; 2638(E), eff 3-2-84; #3000, eff 4-2-85; #3069, eff 7-23-85; ss by #4658, eff 7-31-89, EXPIRED: 7-31-95
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; rpld by #12680, eff 11-27-18

Part He-P 2150 New Hampshire Shellfish Sanitation Rules: Declaration of Purpose

N.H. Code Admin. R. Ann. He-P 2150.01 Declaration of Purpose

Statutory Authority: RSA 143:20-28

REVISION NOTE:

Document #10704, effective 10-23-14, readopted with amendments the former rules He-P 2150, titled “New Hampshire Shellfish Sanitation Rules”, and renumbered them as Part He-P 2150 through Part He-P 2159. Document #10704 made extensive changes to the wording, numbering, and format of rules in the former He-P 2150.

Document #10704 replaces all prior filings for rules in the former He-P 2150. The filings affecting the former He-P 2150 include the following documents:

#3069, eff 7-23-85, EXPIRED: 7-23-91

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

#6587, eff 9-26-97

#7653, eff 2-21-02

#8899, eff 6-9-07

#9589, eff 11-5-09

The Part numbers for former Part He-P 2151 through former Part He-P 2159 had been reserved prior to the filing of Document # 10704 because the rules filed in those Parts had expired. The filings affecting the former He-P 2151 through He-P 2159 had included the following documents:

He-P 2151 Titled: “Sanitation of Shellfish Growing Areas – Laboratory Procedures

#3069, eff 7-23-85

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

He-P 2152 Titled “Sanitation of Shellfish Growing Areas – Growing Area Survey and Classification

#3069, eff 7-23-85

#4128, eff 9-10-86;

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

He-P 2153 Titled: Sanitation of Shellfish Growing Areas – Preparation of Shellfish for Marketing

#3069, eff 7-23-85

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

He-P 2154 RESERVED

#3069, eff 7-23-85

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

He-P 2155 Titled: “Sanitation of Shellfish Growing Areas – Bacteriological Criteria for Shucked Oysters at the Wholesale Market Level

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

He-P 2156 through 2159 RESERVED

#3069, eff 7-23-85

#4229, eff 2-23-87

#4658, eff 7-31-89, EXPIRED: 7-31-95

RSA 143:20-28 requires the New Hampshire department of health and human services to ensure the safety of shellfish being sold for food within the state of New Hampshire.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2151 New Hampshire Shellfish Sanitation Rules: Definitions

N.H. Code Admin. R. Ann. He-P 2151.01 Definitions

(a) “Adequately iced” means that the amount and application of the ice is sufficient to ensure that immediate cooling begins and continues for all shellfish. If ice slurry is used and the shellfish are submerged, the presence of ice in the slurry indicates adequate ice.

(b) “Approved” means a classification used as an identifier for a growing area where harvest for direct marketing is allowed.

(c) “Aquaculture” means cultivating shellfish in controlled conditions for human consumption.

(d) “Authority” means the state or local shellfish control authority or authorities or their designated agents, which are responsible for the enforcement of the National Shellfish Sanitation Program (NSSP) Guide for the Control of Molluscan Shellfish, as incorporated by reference in He-P 2152.01.

(e) “Certificate” means the document issued by the authority to a person to harvest or transport shellstock for commercial sale.

(f) “Certification” means the issuance of a numbered certificate to a person for a particular activity or group of activities that indicates:

(1) Permission from the department to conduct the activity; and

(2) Compliance with the provisions of RSA 143:22 and the requirements of these rules including the NSSP Guide for the Control of Molluscan Shellfish, as incorporated by reference in He-P 2152.01.

(g) “Certification number” means the unique identification number issued by the authority to each dealer for each location, which consists of a one to 5 digit Arabic number preceded by the 2 letter state abbreviation and followed by a 2 letter abbreviation for the type of activity or activities the dealer is qualified to perform in accordance with these rules and the NSSP Guide for the Control of Molluscan Shellfish, as incorporated by reference n He-P 2152.01.

(h) “Commingling” means the act of combining different lots of shellfish.

(i) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or the commissioner’s designee.

(j) “Compliance schedule” means a written comply-by-date that is specified on the inspection report that provides a correction time period to eliminate key and other deficiencies.

(k) “Conditional area management plan” means a plan developed by the NH department of environmental services (DES) which establishes a strict set of criteria to be met for the growing area to remain in the open status.

(l) “Conditionally approved” means a classification used to identify a growing area that meets the criteria for the approved classification except under certain conditions described in a conditional area management plan.

(m) “Conditionally restricted” means a classification used to identify a growing area that meets the criteria for the restricted classification except under certain conditions described in a conditional area management plan.

(n) “Conveyance” means any type of container used to transport shellfish.

(o) “Critical control point (CCP)” means a point, step, or procedure in a food process at which control may be applied, and a food safety hazard may as a result be prevented, eliminated, or reduced to acceptable levels.

(p) “Critical deficiency” means a condition or practice which:

(1) Results in the production of a product that is unwholesome; or

(2) Presents a threat to the health or safety of the consumer.

(q) “Critical limit” means the minimum or maximum value at which a physical, biological, or chemical parameter must be controlled at a critical control point to prevent, eliminate, or reduce to an acceptable level the occurrence of the identified food safety hazard.

(r) “Dealer” means a person to whom certification is issued for the activities of shellstock shipper, reshipper, shucker-packer, repacker, or depuration processor.

(s) “Department” means the New Hampshire department of health and human services.

(t) “Depuration” means the process of reducing the pathogenic organisms that may be present in shellstock by using a controlled aquatic environment as the treatment process.

(u) “Depuration processor (DP)” means a person who harvests or receives shellstock from growing areas in the approved classification or conditionally approved classification, restricted classification, or conditionally restricted classification in the open status and submits such shellstock to an approved depuration process.

(v) “Direct marketing” means the sale for human consumption of shellfish which:

(1) Does not require depuration or relaying prior to sale; or

(2) Has been subjected to depuration or relaying activities.

(w) “Facility” means an establishment, equipment, and premises designed, built, or installed to perform a specific function.

(x) “Growing area” means any site which supports or could support the propagation of shellstock by natural or artificial means.

(y) “Harvest” means the act of removing shellstock from growing areas and its placement on or in a manmade conveyance or other means of transport.

(z) “Harvest area” means an area that contains commercial quantities of shellstock and may include aquaculture sites and facilities.

(aa) “Harvester” means a person who takes shellstock by any means from a growing area.

(ab) “Hazard analysis critical control point (HACCP)” means a systematic, science-based approach used in food production as a means to ensure food safety which is based upon the 7 principles identified by the National Advisory Committee on Microbiological Criteria for Foods.

(ac) “Hazard analysis critical control point (HACCP) plan” means a written document that delineates the formal procedures that a dealer follows to implement the HACCP requirements set forth in 21 CFR 123.6 as adopted by the Interstate Shellfish Sanitation Conference.

(ad) “In-shell product” means non-living, processed shellfish with one or both shells present.

(ae) “In-shell product packing” means the process of placing in-shell product into containers for introduction into commerce.

(af) “Interstate Certified Shellfish Shippers List (ICSSL)” means a United States Food and Drug Administration (FDA) publication of shellfish dealers, domestic and foreign, who have been certified by a state or foreign authority as meeting the public health control measures specified in the NSSP Guide for the Control of Molluscan Shellfish, as incorporated by reference in He-P 2152.01.

(ag) “Interstate Shellfish Sanitation Conference (ISSC)” means the organization which consists of agencies from shellfish producing and receiving states, the FDA, the shellfish industry, the National Oceanic and Atmospheric Administration (NOAA), the US Department of Commerce, and the US Environmental Protection Agency (EPA). The ISSC provides the formal structure wherein state regulatory authorities, with FDA concurrence, can establish updated guidelines and procedures for sanitary control of the shellfish industry.

(ah) “Key deficiency” means a condition or practice that might result in adulterated, decomposed, misbranded, or unwholesome product.

(ai) “Label” means any written, printed, or graphic matter affixed to or appearing upon any package containing shellfish.

(aj) “Lot of shellstock” means a single type of bulk shellstock or containers of shellstock of no more than one day’s harvest from a single defined growing area gathered by one or more harvesters.

(ak) “National Shellfish Sanitation Program (NSSP)” means the cooperative program between the states, the FDA, and the shellfish industry for the sanitary control of shellfish that is adequate to ensure that the shellfish produced in accordance with the NSSP Guide for the Control of Molluscan Shellfish, as incorporated by reference in He-P 2152.01, will be safe and sanitary.

(al) “Other deficiency” means a condition or practice that is not defined as a critical or key deficiency and is not in accordance with the requirements of NSSP Guide for the Control of Molluscan Shellfish, as incorporated by reference in He-P 2152.01.

(am) “Performance based inspection” means when a dealer who has demonstrated a history of no critical deficiencies, no more than one key deficiency, and no more than 2 other deficiencies in any one inspection for a 3-year period, and therefore requires no more than one inspection per certification period.

(an) “Person” means any individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind, and any partnership, association, corporation, or other entity. Person includes the federal government, the state, and any other public or private entity.

(ao) “Post-harvest processing” means any process that has been validated using NSSP validation procedures which reduces the levels of pathogenic hazards to below the appropriate FDA action level or, in the absence of such a level, below the appropriate level as determined by the ISSC.

(ap) “Primary dealer” means those certified dealers who receive, purchase, or pack shellfish directly from harvesters.

(aq) “Processing” means any activity associated with the handling, shucking, freezing, packing, labeling, or storing of shellfish in preparation for distribution. This term includes the activities of a shellstock shipper, shucker-packer, repacker, reshipper, or depuration processor.

(ar) “Raw” means shellfish that have not been thermally processed to an internal temperature of 145º Fahrenheit or greater for 15 seconds, or the equivalent.

(as) “Relay” means to transfer shellstock from a growing area classified as restricted or conditionally restricted to a growing area classified as approved or conditionally approved for the purpose of reducing pathogens as measured by the coliform indicator group or poisonous or deleterious substances that may be present in the shellstock by using the ambient environment as the treatment process.

(at) “Repacker (RP)” means a person other than the original certified shucker-packer who repackages shucked shellfish into other containers.

(au) “Reshipper (RS)” means a person who purchases shellfish from dealers and sells the product without repacking or relabeling to other dealers, wholesalers, or retailers.

(av) “Restricted” means a classification used to identify a growing area where harvesting shall be by special certificate and the shellstock, following harvest, is subjected to a suitable and effective treatment process through relaying or depuration.

(aw) “Sanitation control record” means records that document the monitoring of sanitation practices and conditions during processing.

(ax) “Seed” means shellstock that is less than market size.

(ay) “Shellfish” means all fresh or frozen edible species of oysters, clams, or mussels, either shucked or in the shell, or scallops in any form, except when the final product form is the adductor muscle only.

(az) “Shellstock” means live molluscan shellfish in the shell.

(ba) “Shellstock shipper (SS)” means a dealer who grows, harvests, buys, or repacks and sells shellstock, who is not authorized to shuck shellfish nor to repack shucked shellfish, and who is permitted to buy, repack, and sell in-shell product as well as ship shucked shellfish.

(bb) “Shucker-packer (SP)” means a person who shucks and packs shellfish. A shucker-packer may act as a shellstock shipper or reshipper or may repack shellfish originating from other certified dealers.

(bc) “State shellfish standardization officer” means a person that has successfully completed the FDA standardization training course and the field evaluation phase of shellfish plant inspection with an FDA standardization officer.

(bd) “Temperature control” means the mechanical refrigeration or other conveyance pre-chilled and maintained at 45º F (7.22º C) or below and capable of reducing the internal temperature of shellstock to 50 ⁰F (10 ⁰C) or below within 4 hours.

(be) “Time of harvest” means the time when the first shellstock harvested is no longer submerged.

(bf) “Vehicle” means a machine or conveyance, including watercraft and aircraft, used to move or transport shellfish.

(bg) “Vibrio parahaemolyticus (V.p.)” means a bacterium that lives in brackish saltwater and causes gastrointestinal illness in humans.

(bh) “Wet storage” means the storage, by a dealer, of shellstock from growing areas in the approved classification or in the open status of the conditionally approved classification in containers or floats in natural bodies of water or in tanks containing natural or synthetic seawater at any permitted land-based activity or facility.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2152 New Hampshire Shellfish Sanitation Rules: Incorporation of the National Shellfish Sanitation Program Guide for the Control of Molluscan Shellfish

N.H. Code Admin. R. Ann. He-P 2152.01 Incorporation of the NSSP Guide for the Control of Molluscan Shellfish, 2019 Revision

(a) All certificate holders shall comply with the United States Department of Health and Human Services, Public Health Services, Food and Drug Administration, National Shellfish Sanitation Program (NSSP) “Guide for the Control of Molluscan Shellfish”, (2019 Revision), henceforth referred to as the “NSSP Guide,” available as noted in Appendix A.

(b) The NSSP Guide may be viewed or downloaded from the FDA website at http://www.fda.gov/media/143238/download or the ISSC website at https://www.issc.org/nssp-guide.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2152.02 Special Requirements for (Aquaculture) Harvesters of Oysters and Hard Clams for the Control of Vibrio Parahaemolyticus

(a) A shellfish dealer who commercially harvests oysters and hard clams during the timeframe from May 1 through September 30 shall:

(1) Provide adequate shading to protect oysters and hard clams from direct exposure to sunlight during harvest and where harvested oysters or hard clams are stored;

(2) If an ice slurry is used for rapid cooling, ensure that the temperature of the slurry is less than or equal to 50º F;

(3) Ensure that all oysters and hard clams are adequately iced or placed under temperature control within 4 hours from the time of harvest;

(4) Complete a log that contains the following:

a. Time of harvest; and

b. Time to temperature control information as per (3) above;

(5) Ensure that the internal temperature of the oysters and hard clams has reached 50⁰ F or 10⁰ C or below within 4 hours of being placed under temperature control;

(6) Document the internal temperature and time information as specified in (5) above;

(7) Sell only oysters or hard clams that have reached an internal temperature of 50 ⁰F (10 ⁰C) or below; and

(8) Complete a hazard analysis and critical control point (HACCP) plan that indicates pathogen growth of naturally occurring Vibrio parahaemolyticus as a significant hazard that includes the following:

a. A critical limit indicating all oysters and hard clams shall be harvested in accordance with the time temperature requirements of (3) above; and

b. A critical limit indicting that the internal temperature of oysters and hard clams has reached 50 ⁰F (10 ⁰C) or below prior to sale as required in (7) above.

History

• #13569, eff 2-25-23

Part He-P 2153 New Hampshire Shellfish Sanitation Rules: Application and Certificate Procedure

N.H. Code Admin. R. Ann. He-P 2153.01 Initial Certificate Application Requirements

(a) Each applicant for a certificate shall submit the following to the department:

(1) A completed application form entitled “Application for New Shellfish Certification” (SSAPP February 2023), signed and dated by the applicant or the person who represents the applicant and certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates to the information provided.”;

(2) A check, money order, or online payment by credit card at https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/food-protection/shellfish-harvesters-and-dealers for the applicable fees, in accordance with He-P 2153.05(a);

(3) Water system documentation, which meets the requirements outlined in He-P 2153.06;

(4) Wastewater system documentation, which meets the requirements outlined in He-P 2153.07, except that dealers applying to be certified as a reshipper shall not be required to submit such documentation; and

(5) A HACCP plan as required in He-P 2153.12.

(b) The applicant shall apply online at https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/food-protection/shellfish-harvesters-and-dealers, by mail, or by hand delivering the documents to:

Department of Health and Human Services

Bureau of Finance/Receipts Unit – Food Protection

129 Pleasant Street

Concord, NH 03301

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.02 Processing of Initial Applications and Issuance of Certificates

(a) Applications shall be processed in accordance with RSA 541-A:29.

(b) An application for an initial certificate shall be complete when the department determines that all items required by He-P 2153.01(a) have been received.

(c) If an application does not contain all of the items required by He-P 2153.01(a), the department shall notify the applicant in writing within 10 business days specifying any information or supporting documentation required to be submitted before the application can be processed.

(d) If after written notice in (c) above the applicant fails to provide the missing information or supporting documentation, including payment of the required fee, within 30 days of such notice:

(1) The application shall be considered incomplete and shall not be processed; and

(2) The applicant may reapply by submitting a new initial application in accordance with He-P 2153.01(a).

(e) Application fees shall not be transferable to any other application(s).

(f) Application fees shall be nonrefundable.

(g) Following an application and inspection, conducted pursuant to RSA 143:4 and in accordance with He-P 2154, an initial certification shall be issued if the department determines that an applicant is in compliance with RSA 143:20–28 and these rules.

(h) All certificates issued in accordance with RSA 143:22 shall be issued for a specific certificate classification under He-P 2153.04.

(i) All certificates shall be non-transferable by person or location.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.03 Certificate Expirations and Procedures for Renewals

(a) All certificates issued shall expire pursuant to RSA 143:22.

(b) Each dealer shall apply for recertification at least 30 days prior to the expiration of the current certificate.

(c) The certificate holder shall submit a renewal application, provided by the department that contains the following:

(1) A request for renewal of any existing variances previously granted by the department, in accordance with He-P 2153.13, if applicable;

(2) Any changes to information provided to the department in the initial application; and

(3) Applicable permit fees, in accordance with He-P 2153.05(a).

(d) A certificate shall be renewed if the department determines that the certificate holder:

(1) Has submitted a completed application containing all the items required by (c) above, as applicable, prior to the expiration of the current certificate;

(2) Meets the requirements for certification as outlined in the NSSP Guide;

(3) Has a compliance schedule in place to address any new key or other deficiencies not corrected during the inspection;

(4) Is found to be in compliance with RSA 143, RSA 143:20–28, and He-P 2150–2159 at a renewal inspection, as applicable;

(5) Has paid all outstanding fees and fines in full; and

(6) Has, every other year, met the training requirement in He-P 2153.14.

(e) If a certificate holder fails to submit a complete application for renewal as required under (b) and (c) above, the dealer shall cease operation the day after the certificate expires, and shall not operate until a certificate is obtained.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.04 Designations and Permits

(a) When the department certifies a person to become a dealer, the department shall notify the FDA for the purposes of having the dealer listed in the Interstate Certified Shellfish Shippers List (ICSSL). The department shall include any permit designation to be included in the ICSSL.

(b) Certification classifications and permit designations shall be as follows:

(1) Certification classifications:

a. RS – Reshipper;

b. SS – Shellstock shipper;

c. RP – Repacker;

d. SP – Shucker-packer; and

e. DP – Depuration processor; and

(2) Permit designations:

a. PHP – Post-harvest processing;

b. AQ – Aquaculture; and

c. WS – Wet storage.

(c) The department shall issue only one certification number to an individual dealer for a particular location.

(d) The department shall issue more than one certification number to an individual dealer provided that each business is maintained as a separate entity and does not operate at the same location, each of which shall require separate applications and separate fees.

(e) The department shall allow separately certified dealers to share a facility at a single location.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.05 Fees

(a) For each classification of certification, the applicant shall pay the following annual fees:

(1) Reshipper, $175;

(2) Shellstock shipper, $350;

(3) Repacker, $875;

(4) Shucker-packer, $1,100, and

(5) Depuration processor, $1,750.

(b) For each permit, the applicant shall pay the following fees:

(1) Shellstock relaying permit, $50; and

(2) Wet storage permit, $50.

(c) All fees shall be non-transferable and non-refundable.

(d) Payment of any fee to the department shall meet the following requirements:

(1) Payment shall be made in the form of credit card payment, check, or money order made payable to the “Treasurer, State of New Hampshire” in the exact amount due;

(2) Money order or certified check shall be required when an applicant or certificate holder has issued payment to the department by check, and such check was returned for insufficient funds; and

(3) Any payment made to the department by check which is returned for insufficient funds, and which an individual, applicant, or certificate holder has not made good by submitting a money order or certified check within 2 business days of notification by the department, including any penalty assessment allowed by RSA 6:11-a, shall be grounds for denial or revocation of the certificate.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.06 Water System Requirements

(a) Certificate holders who purchase their water from public water systems, as defined by RSA 485:1-a, XV, shall provide proof of their water source along with the application.

(b) Certificate holders which do not fall under (a) above, and are instead served by a water source other than a public water system, shall submit with the initial applications the written results of a laboratory analysis of the water intended for use, which tests the level of the following:

(1) Bacteria;

(2) Nitrates; and

(3) Nitrites.

(c) The analyses required by (b) above shall be conducted not more than 6 months prior to the date of the application by a laboratory accredited by DES to perform such tests in accordance with Env-C 300.

(d) For an application to be approved, the results of the water analysis shall be as follows:

(1) The bacteria test required under (b) above shall not exceed the maximum contaminant level (MCL) for drinking water prescribed by Env-Dw 702; and

(2) The nitrate and nitrite tests required under (b) above shall not exceed the MCL for drinking water prescribed by Env-Dw 704for those 2 contaminants.

(e) Certificate holders which discharge their wastewater to either public or private wastewater systems which hold either a state surface water discharge permit or a groundwater discharge permit issued by the New Hampshire department of environmental services (DES), shall indicate this by selecting “yes” under the town wastewater category on question 10 on the initial application.

(f) Certificate holders which do not discharge their wastewater as described in (a) above shall submit as part of their application a copy of the construction approval and the operation approval for the sewage or waste disposal system that indicates that the system is sufficient in capacity to serve the subject establishment issued by DES in accordance with RSA 485-A:29 and Env-Wq 1000.

(g) If there is no increase in the loading of the waste disposal system serving the certificate holder in (b) above, and the applicant is unable to produce the documentation required, and has obtained approval of the waste disposal system from DES, the department shall waive the requirement in (b) with written approval from DES.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.07 Wastewater System Requirements

(a) Certificate holders which discharge their wastewater to either public or private wastewater systems which hold either a state surface water discharge permit or a groundwater discharge permit issued by the New Hampshire department of environmental services (DES), shall indicate this by selecting “yes” under the town wastewater category on question 10 on the initial application.

(b) Certificate holders which do not discharge their wastewater as described in (a) above shall submit as part of their application a copy of the construction approval and the operation approval for the sewage or waste disposal system that indicates that the system is sufficient in capacity to serve the subject establishment issued by DES in accordance with RSA 485-A:29 and Env-Wq 1000.

(c) If there is no increase in the loading of the waste disposal system serving the certificate holder in (b) above, and the applicant is unable to produce the documentation required, and has obtained approval of the waste disposal system from DES, the department shall waive the requirement in (b) with written approval from DES.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.08 Change in Ownership

(a) When there is a change in ownership, the new owner shall submit the items required for initial applicants under He-P 2153.01 to the department at least 30 days prior to the change in ownership.

(b) Upon receipt and processing of the items required by (a) above, and after an inspection conducted in accordance with He-P 2154, which determines compliance with the NSSP Guide, as incorporated by reference in He-P 2152.01, the department shall issue an initial certification reflecting the change in ownership.

(c) The issuance of an initial certification due to a change in ownership shall void the certificate of the previous owner on the date the change of ownership occurs.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.09 Change in Name

(a) When a certificate holder intends to change the name of its business, the certificate holder shall submit a written request to the department for a new certificate at least 30 days prior to the intended date of name change.

(b) The written request shall include:

(1) The reason for requesting a new certificate;

(2) The name of the business as it appears on the existing certificate;

(3) The name of the business as the certificate holder requests it to appear on the new certificate; and

(4) The date upon which the change in name is intended to occur.

(c) Following receipt of the items required by (b) above, the department shall issue a revised certificate reflecting the change in name. The certificate number and expiration date shall remain the same as it was on the immediately preceding certificate.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.10 Change in Location

(a) When there is a change in location, for land based activities, the certificate holder shall submit the items required for initial certification under He-P 2153.01 to the department at least 30 days prior to the change in location.

(b) Upon receipt and processing of the items required under (a) above, and after an inspection conducted in accordance with He-P 2154, the department shall issue an initial certification reflecting the change of location.

(c) The issuance of an initial certification due to a change in location shall void the previous certificate on the date the change of location occurs.

(d) This section shall not apply to vehicles used to sell wholesale or retail shellfish.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.11 Change in Certificate Classification

(a) A certificate holder wishing to request a change to their certificate classification or permit designation as listed in He-P 2153.04 shall:

(1) Be treated as an applicant for a new certificate; and

(2) Apply for a new certificate in accordance with He-P 2153.01.

(b) The issuance of an initial certification due to a change in certificate classification or permit designation shall void the previous certificate on the date the change occurs.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.12 Hazard Analysis and Critical Control Point (HACCP) Plan and Sanitation Standard Operating Procedure (SSOP) Requirements

(a) Every dealer shall establish and implement a written hazard analysis critical control point (HACCP) plan which is specific to:

(1) Each location where shellfish products are processed by that dealer; and

(2) Each kind of shellfish product processed by the dealer.

(b) At a minimum, the HACCP plan shall include:

(1) A list of the food safety hazards that are reasonably likely to occur as determined by the individual completing the HACCP plan, for each kind of shellfish product processed by that dealer and identification of preventative measures that shall be applied to control those hazards; and

(2) A statement of standard operating procedures for the plan under consideration clearly identifying:

a. Each critical control point;

b. The critical limits for each critical control point;

c. The method and frequency for monitoring and controlling each critical control point by an individual who has successfully completed training in the application of HACCP principles to shellfish processing or who is otherwise qualified through job experience to perform these functions;

d. The method and frequency to routinely verify that the dealer is following standard operating procedures and monitoring critical control points;

e. Action to be taken by the dealer if the critical limits for each critical control point are not met; and

f. Records to be maintained by the dealer to demonstrate that the HACCP plan is properly operated and managed.

(c) The department shall review HACCP plans for compliance with all applicable sections of RSA 143:20-28 and He-P 2150–2159 and notify the applicant or certificate holder as to whether the plan complies with these requirements.

(d) The dealer shall maintain possession of the HACCP plan at all times.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.13 Variances

(a) Applicants or certificate holders seeking variances from specific rules, or from items in the NSSP Guide, as incorporated by reference in He-P 2152.01, shall complete and submit a “Variance Request Form” (SSVARFORM February 2023) to the:

NH Department of Health and Human Services

Division of Public Health Services

Food Protection Section

29 Hazen Drive

Concord, NH 03301

(603) 271-4589

(b) The commissioner shall approve a request for variance if:

(1) The commissioner concludes that authorizing deviation from strict compliance with the rule or the item in the NSSP Guide, as incorporated by reference in He-P 2152.01, from which a variance is sought does not contradict the intent of the rule or the item in the NSSP Guide; and

(2) The alternative proposed by the applicant or certificate holder ensures that the objective or intent of the rule or item in the NSSP Guide, as incorporated by reference in He-P 2152.01, from which a variance is sought will be accomplished.

(c) The commissioner shall deny a request for a variance if:

(1) The request does not meet the requirements of (a) above; or

(2) The request does not meet the criteria for approval in accordance with (b) above.

(d) If a variance is approved, the certificate holder’s subsequent compliance with the alternatives approved in the variance shall be considered equivalent to complying with the rule or the NSSP Guide, as incorporated by reference in He-P 2152.01.

(e) A variance shall be approved for one year or until the expiration of the current certificate, unless otherwise specified by the department.

(f) No request for a variance concerning any statutory provision or the rules of other state agencies referred to in this chapter shall be approved.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2153.14 Training

(a) All dealers shall have for review by inspection staff:

(1) Documentation that the individual responsible for monitoring and controlling each critical control point has successfully completed at the time of certification, a one-time department approved training in the application of HACCP principles to shellfish processing; and

(2) Training documentation for all individuals who have access to the facility where shellfish is processed, packed, stored, and handled, that includes training in proper food handling and personal hygienic practices as it relates to their assigned duties. This is a one-time training and shall be completed within 30 days of initial hiring.

(b) Harvesters shall:

(1) Complete department approved training every 2 years. The training shall include required processing, handling, and transportation practices as determined by the department;

(2) Complete the required training in (b)(1) above within 90 days of initial certification; and

(3) At a minimum, have one individual involved in the harvester’s shellfish operations obtain the required training in (b)(1) above.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2154 New Hampshire Shellfish Sanitation Rules: Inspections and Compliance

N.H. Code Admin. R. Ann. He-P 2154.01 Inspections

(a) For the purpose of determining compliance with RSA 143:20-28 and He-P 2150–2159, as authorized by RSA 143:4 and RSA 143:22, the applicant or certificate holder shall admit and allow any department representative at any time to enter and inspect all facilities, activities, equipment, vehicles, and records pertaining to shellfish processing, holding, or transportation.

(b) Inspections shall be conducted:

(1) Prior to issuance of a certificate;

(2) At a frequency not less than as specified in Section II, Chapter I @.02 F.(1) in the NSSP Guide; and

(3) Whenever the department has reason to believe a condition exists that places the dealer in non-compliance with RSA 143:20-28 and He-P 2150–2159.

(c) The dealer shall agree to a compliance schedule to address any new deficiencies not corrected by the dealer during the inspection.

(d) After the dealer is certified, the department shall make unannounced inspections of the dealer’s facilities during periods of activity, and at the following minimum frequencies:

(1) Within 30 days of beginning production if the dealer was certified on the basis of a pre-operational inspection;

(2) At least monthly for dealer facilities certified as depuration processors;

(3) At least quarterly for production activities certified as shucker-packer or repacker; and

(4) At least semiannually for other dealer activities.

(e) To be eligible for the department’s performance based inspection program (PIP), the dealer shall have demonstrated a history of satisfactory compliance for the previous 3-year period, including, but not limited to, the following:

(1) Full compliance with the minimum inspection frequency listed in (d) above;

(2) Annual recertification of the dealer by the department, with no lapses in certification;

(3) Verification that no critical deficiencies, no more than one key deficiency, and no more than 2 other deficiencies have occurred in any one inspection;

(4) Correction of all identified deficiencies in accordance with the compliance schedule approved by the department; and

(5) No repeat deficiencies.

(f) The minimum frequency of inspection under a PIP shall be no less than one inspection per certification period. The recertification inspection shall qualify as the required minimum inspection frequency.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2154.02 Correction of Deficiencies

(a) When any inspection identifies a critical deficiency:

(1) The deficiency shall be corrected during that inspection; or

(2) The certificate holder shall cease production of the activity(ies) affected by the deficiency.

(b) When a key or other deficiency identified in the inspection report cannot be corrected both immediately and permanently in the presence of the inspector a compliance schedule shall be issued.

(c) The department shall verify the elimination of any key or other deficiencies as specified in the compliance schedule referenced in (b) above, as follows:

(1) The department shall review any materials submitted to the department by the certificate holder and determine whether the materials demonstrate implementation of and compliance with the requirements of the compliance schedule; and

(2) If materials in (1) above are not submitted to the department by the certificate holder, or if the department determines that the materials submitted in (1) above do not demonstrate implementation of and compliance with the requirements of the compliance schedule, the department shall conduct an inspection to determine compliance.

(d) If the department finds the certificate holder to be out of compliance with the compliance schedule, the department shall do one or more of the following, as applicable:

(1) Revise the compliance schedule if the department determines that the certificate holder has mitigated any immediate public health risk and produced evidence of substantial hardship preventing compliance to original compliance schedule for failure to comply with the compliance schedule;

(2) Impose applicable fines, in accordance with He-P 2155.02(a)(14);

(3) Revoke the certificate in accordance with He-P 2155.03(a)(6); or

(4) Deny the application for a renewal of a certificate in accordance with He-P 2153.03(d).

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2155 New Hampshire Shellfish Sanitation Rules: Enforcement Actions

N.H. Code Admin. R. Ann. He-P 2155.01 Enforcement Actions and Notice of Right to Appeal

(a) The department shall impose enforcement actions for violations of RSA 143:20-28, He-P 2150–2159, or the NSSP Guide, as incorporated by reference in He-P 2152.01, as applicable, including the following:

(1) Imposing administrative fines upon an applicant, certificate holder, or any decertified dealer in accordance with He-P 2155.02;

(2) Denying a certificate application in accordance with He-P 2155.03;

(3) Revoking a certificate in accordance with He-P 2155.03;

(4) Ordering embargo of contaminated or adulterated products, including condemning and seizing products, in accordance with RSA 146:20 and (d) below;

(5) Ordering the certificate holder to cease and desist all operations in the event of a threat to the public health and safety in accordance with RSA 143:5-a, RSA 541-A:30, III, or both; and

(6) Ordering a person or entity to cease and desist all operations in the event that the person or entity is operating without a valid certificate.

(b) When the certificate holder fails to comply with He-P 2154.02 (a) above, the department shall immediately begin actions to revoke the certificate holder’s certification.

(c) Product affected by a critical deficiency shall be controlled to prevent contaminated or adulterated product from reaching consumers. When necessary the department shall:

(1) Detain or seize any undistributed lots of shellfish that might have been adulterated;

(2) Initiate a recall of any distributed shellfish; and

(3) Immediately notify FDA’s enforcement officials and any other relevant authorities.

(d) When denying a certificate application, imposing a fine, or revoking a certificate, the department shall send to the applicant or certificate holder a written notice that sets forth:

(1) The action to be taken by the department;

(2) The reasons for the action, including the identification of each deficiency; and

(3) The right of the applicant, certificate holder, or other person or entity to request a hearing in accordance with RSA 541-A, He-C 200, and He-P 2155.04.

(e) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 143, RSA 541-A:30, III, or He-P 2150–2159.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2155.02 Administrative Fines

(a) The department shall impose fines as follows:

(1) For providing false or misleading information on or with an application, in violation of He-P 2153.01(a), the fine shall be $1,000;

(2) For failure to operate only in the manner in which certified to do so, in violation of He-P 2153.02(h), the fine shall be $1,000;

(3) For failure to cooperate during an inspection of a shellfish plant, including but not limited to failing to allow department representatives or inspectors to inspect the premises, vehicles, and records at all times, in violation of He-P 2154.01, the fine shall be $2,000;

(4) For failure to notify the department by telephone within 24 hours of any fire or other incident that jeopardizes the safety or sanitation of shellfish, in violation of He-P 2155.06(a), the fine shall be $250;

(5) For failure to notify the department pursuant to He-P 2153.08(a) at least 30 days prior to a change in ownership, the fine shall be $500;

(6) For failure to notify the department pursuant to He-P 2153.10(a) at least 30 days prior to the change of location, the fine shall be $500;

(7) For failure to discard shellfish as required by RSA 146:20 and in the manner instructed to do so by the department, the fine shall be $1,000;

(8) For failure to cease operation upon notification by the department to do so, the fine shall be $1,000;

(9) For failure to cease operation after a certificate has expired, when an application has been denied, or when a certificate has been revoked, the fine shall be $1,000;

(10) For failure to maintain records in accordance with RSA 143:22, the fine shall be $1,000;

(11) For a violation of the same critical deficiency 2 times within any 12-month period, the fine shall be $1,000;

(12) For a violation of the same key deficiency 3 times within any 12-month period, the fine shall be $500;

(13) For failure to pay an administrative fine within 30 days of its imposition, or within 30 days of the decision to uphold the imposition of a fine that was appealed, the fine shall be $500;

(14) For failure to comply with any compliance schedule that has been accepted by the department, the fine shall be $500;

(15) For operation of a dealer without obtaining a certificate, as required by RSA 143:22, the fine shall be $1,000. Each day operating without a certificate shall be considered a separate offense subject to an additional $500 fine;

(16) For failure to submit a HACCP plan for review, in accordance with He-P 2153.12, the fine shall be $500;

(17) For failure to comply with a variance approved in accordance with He-P 2153.13, the fine shall be $500; and

(18) For failure to submit a timely renewal application, in violation of He-P 2153.03(b), the fine shall be $75.

(b) Except for violations of (a)(18) above, each day that a certificate holder continues to be in violation of the provisions of RSA 143:20-28 or He-P 2150–2159 shall constitute a separate violation and shall be fined in accordance with this section.

(c) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of credit card, check, or money order payable to the “Treasurer, State of New Hampshire” in the exact amount due;

(2) Money order or certified check shall be required when an applicant or certificate holder has issued payment to the department by check, and such check was returned for insufficient funds; and

(3) Any payment made to the department by check which is returned for insufficient funds, and which an applicant or certificate holder has not made good by submitting money order or certified check within 2 business days of notification by the department, including any penalty assessment by RSA 6:11-a, shall be grounds for revocation or denial of the certificate.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2155.03 Denial or Revocation of a Certificate

(a) The department shall deny an application or revoke a certificate if:

(1) An applicant or certificate holder has failed to pay any applicable fee in accordance with He-P 2153.05 or any administrative fine imposed under He-P 2155.02 or any payment ordered by a court to be paid to the department;

(2) An applicant or certificate holder has had a check returned to the department for insufficient funds, and has not re-submitted the outstanding fee and additional charges in the form of money order or certified check within 2 business days of notification by the department;

(3) After being notified of and given an opportunity to supply missing information, an applicant or certificate holder fails to submit an application that meets the requirements of He-2153.01(a);

(4) An applicant, certificate holder or any representative or employee of the applicant or certificate holder:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide, upon request, information or documents to the department;

(5) There is a deficiency identified in the inspection report and the applicant or certificate holder does not either correct it or complete a compliance schedule in accordance with He-P 2154.02;

(6) The certificate holder fails to implement or continue to implement a compliance schedule that has been accepted by the department in accordance with He-P 2154.02;

(7) The certificate holder is cited 2 or more times under RSA 143, or He-P 2150–2159 for the same critical deficiency within the last 12 months or the last 5 inspections;

(8) A certificate holder has had a certificate revoked and submits an application during the one-year prohibition period specified in (b) below;

(9) A certificate holder fails to implement an approved HACCP plan in accordance with He-P 2153.12; or

(10) The certificate holder fails to submit proof of required training as required in He-P 2153.14.

(b) When a certificate has been denied or revoked, the applicant or certificate holder shall be prohibited from reapplying for a certificate for one year at a different location, if the enforcement action pertained to their role in the business.

(c) The one-year period referenced in (b) above shall begin on:

(1) The date of the department’s decision to revoke or deny the certificate, if no request for an administrative hearing is requested or if the request is withdrawn; or

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

(d) Notwithstanding (b) and (c) above, the department shall consider an application submitted after a decision to revoke or deny becomes final, if the applicant provides proof that circumstances have changed and that the applicant has obtained the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 143 and He-P 2150–2159.

(e) Application for a certificate after revocation shall require submission of a written application for a certificate to the department, completed in accordance with He-P 2153.01.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2155.04 Request for an Administrative Hearing

(a) An applicant or certificate holder shall have 10 calendar days after receipt of the notice of an enforcement action to submit a written request for a hearing.

(b) If a request for a hearing is not received pursuant to (a) above, the applicant or certificate holder shall have waived his right to a hearing and the action of the department shall become final.

(c) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(d) For administrative fines, full payment shall be submitted to the department no later than 30 days from receipt of the notice or within 30 days from the date of the decision of the department’s administrative appeals unit, if a hearing has been requested.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2155.05 Effect of Denial of Application, Revocation or Expiration of Certificate

(a) Any applicant who has been denied a certificate or renewal certificate shall not operate or shall cease operation within 10 calendar days after receipt of the denial notice, unless a timely appeal is submitted.

(b) If a certificate is revoked by the department, the certificate holder shall cease operation within 10 calendar days after receipt of the revocation notice, unless a timely appeal is submitted.

(c) If a certificate holder is subject to immediate closure as defined in RSA 143:5-a, the certificate holder shall immediately cease operation pending reinspection and pursuant to the appeals provisions of RSA 541-A.

(d) If a certificate expires without the timely submission of an application for renewal, the certificate holder shall immediately cease operation.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2155.06 Closure

A certificate holder shall immediately discontinue operations and notify the department at 603-271-4589, or if at night or during weekends at 603-271-5300, if an imminent health hazard might exist because of an emergency such as, but not limited to:

(a) Interruption of water services that lasts for 2 or more hours;

(b) Whenever a drinking water sample is found to have E.coli bacteria or exceed the MCL for nitrates or nitrites described in He-P 2153.06(d);

(c) A failed sewer system or a sewage backup into the vehicle or facility;

(d) Interruption of electrical service for 2 or more hours;

(e) A fire affecting the vehicle or facility;

(f) Flooding in the vehicle or facility;

(g) Chemical exposure in the vehicle or facility;

(h) Any other natural disaster or catastrophic event that may result in contamination of the shellfish;

(i) An employee has been found to be infected with a communicable disease as described in the “NSSP Guide” Section II, Chapters XI-XV.02.(G.), as incorporated by reference in He-P 2152.01;or

(j) Any other unsafe or unsanitary conditions that threaten to contaminate the vehicle or facility.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2156 New Hampshire Shellfish Sanitation Rules: Shellfish Related Recalls

N.H. Code Admin. R. Ann. He-P 2156.01 Recall Procedures

(a) The dealer shall develop and maintain on file a written procedure for the recall of shellfish products, including procedures for the notification of the department and consumers of the removal of the product from commerce, which complies with the Recall Enforcement Policy, Title 21 Code of Federal Regulations (CFR) Part 7.

(b) Production and distribution records shall be used to enable location of products if a recall is initiated.

(c) The dealer shall recall any product which the dealer or the department knows or has reason to believe might adversely affect the health and safety of the public, or is adulterated or misbranded.

(d) A dealer who knows or should know that the standard or quality of the product has been violated or has reason to believe that circumstances exist which might adversely affect the safety of the product shall notify the department within 24 hours of learning of the violation or circumstances.

(e) Circumstances in (d) requiring notification shall include, but are not limited to, source contamination, spills, accidents, natural disasters, or breakdowns in treatment processes.

(f) If the department determines that the circumstances present an imminent health hazard and the consumer notification or shellfish product recall can significantly minimize the threat to health and safety of the public, the department shall order the dealer to initiate a product recall.

(g) In cases of a shellfish product recall, the dealer shall disseminate notification within 24 hours of the recall to all wholesale and retail outlets to which the shellfish product was distributed.

(h) If directed by the department, the dealer shall issue notification to consumers who may be affected by the recall by using such methods, including the media, as will ensure timely notification to consumers.

(i) RSA 146:20 shall apply to shellfish products.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2157 New Hampshire Shellfish Sanitation Rules: Shellstock Relaying

N.H. Code Admin. R. Ann. He-P 2157.01 Shellstock

Relaying.

(a) Any dealer who would like to conduct relaying activities shall apply for a shellstock relaying permit.

(b) Permit applications shall be submitted no later than 30 days prior to the requested date of relay.

(c) Any dealer who conducts relaying activities shall comply with the NSSP Guide, as incorporated by reference in He-P 2152.01.

(d) All relaying activities shall be conducted in the presence of the state shellfish standardization officer or state shellfish standardization inspector or their representative.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2157.02 Initial Shellstock Relaying Permit Application Requirements

(a) Each applicant for a shellstock relaying permit shall submit the following:

(1) A completed application form entitled “Application for Shellfish Relay” (SSRAPP February 2023), signed and dated by the applicant or the person who represents the applicant and certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates to the information provided.”; and

(2) A check or money order for the applicable fee, in accordance with He-P 2153.05(b).

(b) The applicant shall mail or hand deliver the documents to:

Department of Health and Human Services,

Bureau of Finance/Receipts Unit – Food Protection Section

129 Pleasant Street

Concord, NH 03301-6503

Telephone: (603) 271-4589; fax (603) 271-4859

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2157.03 Processing of Initial Shellstock Relaying Applications and Issuance of Permits

(a) Applications shall be processed in accordance with RSA 541-A:29.

(b) An application for an initial permit shall be complete when the department determines that a completed application required by He-P 2157.02 has been received.

(c) If an application is incomplete, the department shall notify the applicant in writing as to which items are required to be submitted before the application will be processed.

(d) A permit shall be issued if the department determines that an applicant is in compliance with these rules.

(e) All permits shall be non-transferable by person or location.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2157.04 Permit Expirations

All permits issued are valid only for the dates specified on the application.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2158 New Hampshire Shellfish Sanitation Rules: Wet Storage Application and Permit Procedure

N.H. Code Admin. R. Ann. He-P 2158.01 Wet Storage Application and Permit Procedure

(a) Any dealer who would like to conduct wet storage activities shall apply for a wet storage permit.

(b) Permit applications shall be submitted no later than 60 days prior to the requested date of activity.

(c) Any dealer who conducts wet storage activities shall comply with the NSSP Guide .

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2158.02 Initial Wet Storage Permit Application Requirements

(a) Only a certified shellstock shipper, shucker-packer, or depuration processor may apply for a wet storage permit.

(b) Each applicant for a wet storage permit shall submit the following to the department:

(1) A completed application form entitled “Wet Storage Permit Application” (SSWSAPP February 2023), signed and dated by the applicant or the person who represents the applicant and certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates to the information provided.”;

(2) A check or money order for the applicable fee, in accordance with He-P 2153.05(b);

(3) If a land-based facility, then an operational plan as required by the NSSP Guide, Chapter 7, Section @.01 B (2) and Section .04 A (1)-(3);

(4) Water system documentation which meets the requirements in He-P 2153.06 for wet storage in artificial bodies of water (land-based);

(5) Water treatment system description and maintenance plan for wet storage in artificial bodies of water (land-based);

(6) A flow chart identifying each step in the wet storage process for natural bodies of water (offshore), and in artificial bodies of water (land-based); and

(7) A description of cleaning procedures and a cleaning schedule.

(c) The applicant shall mail or hand deliver the documents to:

Department of Health and Human Services

Bureau of Finance/Receipts Unit – Food Protection Section

129 Pleasant Street

Concord, NH 03301-6503

Telephone: (603) 271-4589; fax (603) 271-4859

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2158.03 Processing of Initial Wet Storage Applications and Issuance of Permits

(a) Applications shall be processed in accordance with RSA 541-A:29.

(b) An application for an initial permit shall be complete when the department determines that all items required by He-P 2158.02(b) have been received.

(c) If an application does not contain all the items required by He-P 2158.02(b), the department shall notify the applicant in writing as to which items are required to be submitted before the application will be processed.

(d) A permit shall be issued if the department determines that the applicant is in compliance with these rules.

(e) All permits shall be non-transferable by person or location.

(f) Permits shall be available for inspection during normal business hours.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2158.04 Permit Expirations and Procedures for Renewals

(a) All permits issued shall expire in accordance with RSA 143:22.

(b) Each dealer shall apply for a wet storage permit via an application form pursuant to He-P 2158.02 at least 30 days prior to the expiration of the current permit.

(c) The permit holder shall submit with the renewal application:

(1) The materials required by He-P 2158.02(b)(1)-(2);

(2) The materials required by He-P 2158.02(b)(3)-(7) if any of these have been altered or changed within the most recent permit period; and

(3) A request for renewal of any existing variances previously granted by the department, in accordance with He-P 2153.13, if applicable.

(d) A permit shall be renewed if the department determines that the permit holder has submitted an application containing all the items required by (c) above, as applicable, prior to the expiration of the current certificate.

(e) If a permit holder fails to submit a complete application for renewal as required under (b) and (c) above, the dealer shall cease operation the day after the permit expires, and shall not operate until a permit is obtained.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2159 New Hampshire Shellfish Sanitation Rules: Commingling

N.H. Code Admin. R. Ann. He-P 2159.01 Commingling Requirements

(a) Any dealer who conducts commingling activities shall comply with the NSSP Guide.

(b) The practice of commingling shall be limited to certified primary dealers who purchase shellstock directly from New Hampshire harvesters.

(c) When a primary dealer chooses to commingle shellstock, they shall possess a written commingling plan approved by the department, which describes the procedures the primary dealer use to commingle product in a way to ensure that each lot of shellstock is identified in a way to prevent misidentification and provide traceability.

(d) The commingling plan in (c) above shall include provisions that minimize commingling but meet the minimum of:

(1) Multiple harvest areas from the same harvest date; or

(2) Multiple harvest times from the same harvest area on the same day.

(e) All shellfish tags and records shall indicate which areas and/or which dates from the same harvest area have been commingled, for example, Quahog Bay/White's Cove, Brunswick commingled, or Quahog Bay, Brunswick 11/12 & 11/13 commingled.

(f) Shucked product may be commingled if it is in one container and from only one day processing. The areas commingled shall be documented in the days shucking log and also in the sales records.

(g) Tags of commingled shellstock that has been held in wet storage shall include the statement: “This Product was in Wet Storage at (Facility Certification Number) from (Date) to (Date).”

(h) When an entire cargo consists only of molluscan shellfish products, for example oysters, hard or soft shell clams, or mussels, the various lots shall be separated so as to avoid unintentional cross-contamination and/or commingling. When a lot of shellfish is part of a mixed cargo, for example, with other seafood or non-seafood products, it shall be protected from contamination and/or commingling through partitioning, horizontal separation, or other isolation methods.

(i) No cargo shall be placed on or above the shellfish unless all cargo is packed in sealed, crush-resistant, waterproof containers.

(j) All handling and recordkeeping practices shall ensure that any container of shellfish can be traced-back to a specific harvest date and harvest area.

(k) Shellstock or shucked product from different lots shall not be commingled during repacking.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

N.H. Code Admin. R. Ann. He-P 2159.02 Depuration Process Commingling Requirements

(a) Unless the dealer has an accepted commingling management plan, different harvest lots of shellfish shall not be commingled during washing, culling, or packing.

(b) If more than one harvest lot of shellfish is being processed at the same time, the identity of each harvest lot shall be maintained throughout the depuration process and final packing.

(c) If shellfish in different tanks are at different stages of depuration, each tank shall be labeled to show when depuration began.

(d) Non-purified shellfish shall not be removed from a depuration plant except under direct supervision by the department.

History

• (See Revision Note at part heading for He-P 2150) #10704, eff 10-23-14; ss by #13569, eff 2-25-23

Part He-P 2170 Beverage Fees - RESERVED

N.H. Code Admin. R. Ann. He-P 2170.01 Classes of Bottlers

Reserved

History

• #3009, eff 4-29-85, EXPIRED: 4-29-92
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #7979, eff 10-22-03; ss by #10012, INTERIM, eff 10-22-11, EXPIRES: 4-19-12; ss by #10116, eff 4-19-12; rpld by #12680, eff 11-27-18

N.H. Code Admin. R. Ann. He-P 2170.02 In-State Beverage Fees

Reserved

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-P 2102.05(b)

International Organization for Standardization’s “ICO/IEC 17025:2017 General Requirements for the Competence of Testing and Calibration Laboratories” (2017 edition)

Publisher: International Organization for Standardization (ISO)

Cost: $138.00 for PDF and eBook. Additional options available.

The incorporated document is available for purchase at:

https://www.iso.org/standard/66912.html

He-P 2152.01(a)

U.S. Food and Drug Administration-National Shellfish Sanitation Program’s (NSSP), “Guide for the Control of Molluscan Shellfish” (2019 Revision)

Publisher: U.S. Food and Drug Administration-National Shellfish Sanitation Program (NSSP)

Cost: Free to the Public

The incorporated document is available at:

https://www.fda.gov/media/143238/download or

https://www.issc.org/2019-nssp-guide

APPENDIX B

Rule

Specific State or Federal Statute the Rule Implements

He-P 2101.01

RSA 143:9; RSA 143:16; 9 CFR 318.30 & 21 CFR 165.110

He-P 2102.02

RSA 143:16; RSA 485:3; 21 CFR 165.110

He-P 2102.01 - He-P 2102.02

RSA 143:16; RSA 485:3; 21 CFR 165.110

He-P 2102.03 - He-P 2102.04

RSA 143:16; RSA 155-A & 21 CFR 165.110

He-P 2102.05

RSA 143:16

He-P 2102.05

RSA 143:16

He-P 2102.06

RSA 143:16 & 21 CFR 129.35

He-P 2102.07

RSA 143:16 & 21 USC 350.f417(a)(2)

He-P 2103.01

RSA 143:11; 21 CFR 129.20 & 21 CFR 129.80 (d)

He-P 2103.02 - He-P 2103.08

RSA 143:11 & 21 CFR 129.40

He-P 2103.09

RSA 143:11

He-P 2103.10

RSA 143:11 & 21 CFR 120

He-P 2103.11- He-P 2103.12

RSA 143:11

He-P 2103.13

21 CFR Part 101 & 21 CFR 165.110

He-P 2103.14

21 CFR Part 101 & 21 CFR 165.110

He-P 2104.01-He-P 2104.10

RSA 143:11

He-P 2105.01- He-P 2105.02

RSA 143:11

He-P 2105.01- He-P 2105.02

RSA 143:11

He-P 2106.01 - He-P 2106.05

RSA 143:7-a; RSA 143:11; RSA 143:14; RSA 541:A

He-P 2107.01

RSA 143:12

He-P 2107.02

RSA 541:A

He-P 2107.03 - He-P 2107.04

RSA 143:12

He-P 2107.05

RSA 143:14; RSA 541:A

He-P 2107.06

RSA 143:15

He-P 2107.07

RSA 143:12

He-P 2150 – He-P 2159

RSA 143:26; 21 CFR Part 123

He-P 2152.01

21 CFR 1, B, section 123.6

He-P 2152.02

RSA 143:26; 21 CFR 1, B, section 123.6

He-P 2153.01

RSA 143:22; RSA 143:22-a; RSA 143:26

He-P 2153.02

RSA 541-A:29; RSA 143:22; RSA 143:4; RSA 143:22-a; RSA 143: 21-26

He-P 2153.03

RSA 143:25; 143:22; RSA 143:26; RSA 143:22-a

He-P 2153.04

RSA 143:22; RSA 143:26; RSA 143:21-a

He-P 2153.05

RSA 143:22-a; RSA 143:22; RSA 6:11-a

He-P 2153.06

RSA 485:1-a,XV; RSA 143:26; RSA 143:21-a

He-P 2153.07

RSA 143:21; RSA 485-A; RSA 485-A:13

He-P 2153.08

RSA 143:22; RSA 143:20-28

He-P 2153.09

RSA 143:22; RSA 143:20-28

He-P 2153.10

RSA 143:4; RSA 143:20-28

He-P 2153.11

RSA 143:21-a; RSA 143:22; RSA 143:26

He-P 2153.12

RSA 143:20-28; 21 CFR 1, B, section 123

He-P 2153.13

RSA 143:20-28

He-P 2153.14

RSA 143:6; RSA 143:22; RSA 143:26

He-P 2154.01

RSA 143:4; RSA 143:22; RSA 143:20-28

He-P 2154.02

RSA 143:4; RSA 143:6; RSA 143:20-28

He-P 2155.01

RSA 143:6; RSA 143; RSA 541-A:30; RSA 541-A:30, III

He-P 2155.02

RSA 143:22; RSA 143:6; RSA 143:7; RSA 143:7-a; RSA 6:11-a

He-P 2155.03

RSA 143; RSA 143:20-28; RSA 143:6, II(d); RSA 143:5-a

He-P 2155.04

RSA 541-A; RSA 541-A:31-36; RSA 143:5-a, IV

He-P 2155.05

RSA 143:1-4; RSA 143:5-a; RSA 143:4; RSA 143:23; RSA 143:24

He-P 2155.06

RSA 143:26; RSA 143:6

He-P 2156.01

RSA 146.20; 21 CFR 7, C sections 7.40-7.59; RSA 143:2; RSA 143:21-a; RSA 143:23; RSA 143:26

He-P 2157.01

RSA 143; RSA 143:22; RSA 143:22-a; RSA 143:26

He-P 2157.02

RSA 143; RSA 143:22; RSA 143:22-a; RSA 143:26

He-P 2157.03

RSA 541-A:29; RSA 143:22; RSA 143:26

He-P 2157.04

RSA 143:22

He-P 2158.01

RSA 143:20-28

He-P 2158.02

RSA 143:20-28

He-P 2158.03

RSA 541-A:29

He-P 2158.04

RSA 143:22

He-P 2159.01

RSA 143:22

He-P 2159.02

RSA 143:22

History

• #3009, eff 4-29-85, EXPIRED: 4-29-92
• #5383, eff 4-22-92, EXPIRED: 4-22-98
• #7979, eff 10-22-03; ss by #9589, eff 11-5-09; ss by #12405, INTERIM, eff 10-24-17, EXPIRES: 4-22-18; rpld by #12680

Chapter He-P 2200 Public Health Laboratories

Part He-P 2205 Laboratory Fee Schedule

N.H. Code Admin. R. Ann. He-P 2205.01 Clinical Specimens, Chemistry

The following fees shall be charged for those clinical specimens set forth in Table He-P 2205.01 Chemistry below:

Table He-P 2205.01 Chemistry

TEST

FEE

Arsenic (total), urine

50.00

Barium

25.00

Beryllium

25.00

Cadmium

25.00

Cadmium, blood

25.00

Creatinine, (spot), urine

15.00

Cyanide, blood

80.00

Lead, blood

25.00

Mercury, blood

25.00

Mercury urine

50.00

Metals panel, blood

75.00

Metals panel, urine

100.00

Miscellaneous analysis

50.00/hr

Speciated arsenic, urine

125.00

Thallium

25.00

Volatile Organic Compounds, serum

80.00

History

• #2461, eff 9-5-83; ss by #4000, eff 2-26-86; ss by #4233, eff 2-23-87; ss by #4480, eff 8-31-88; ss by #5029, eff 12-20-90; ss by #5761; eff 1-3-94; ss by #7171, INTERIM, eff 1-4-00, EXPIRED: 5-4-00; ss by #7256, eff 5-3-00; ss by #8529, eff 12-23-05; ss by #8891, eff 5-25-07; ss by #10935, INTERIM, eff 9-22-15, EXPIRED: 3-20-16
• #11064, eff 4-1-16

N.H. Code Admin. R. Ann. He-P 2205.02 Clinical Specimens, Microbiology

The following fees shall be charged for those clinical specimens set forth in Table He-P 2205.02 Microbiology below:

Table He-P 2205.02 Microbiology/Virology

TEST

FEE

Adenovirus – culture

50.00

Adenovirus – immunofluorescent, each antisera

20.00

Bacterial culture, blood, aerobic

28.00

Bacterial culture, urine

28.00

Bacterial culture, other, aerobic

28.00

Bacterial culture, other, anaerobic

28.00

Bacteria, identification, per isolate, aerobic

21.00

Bacteria, identification, per isolate, anaerobic

21.00

Bacterial identification – 16S rRNA Sequencing

159.00

Bordetella pertussis, PCR

150.00

Bordetella pertussis positive confirmation, PCR

84.00

Bordetella pertussis diluted repeats, PCR

64.00

Chikungunya virus RT-PCR

50.00

Chlamydia culture

50.00

Chlamydia immunofluorescent, each antisera

20.00

Chlamydia trachomatis, amplified method

25.00

Cryptosporidium/Giardia , DFA

35.00

Cryptococcus latex agglutination

25.00

Diphtheria culture

35.00

Direct smear, simple stain

21.00

Eastern Equine Encephalitis (EEE) Virus Antibodies, IgM

35.00

Enteric pathogen culture, stool (single organism)

21.00

Enteric pathogen culture, stool (Salmonella and Shigella)

21.00

Enteric pathogen culture (comprehensive – includes SLT test)

50.00

Enteric isolate for identification, per aerobic isolate

21.00

Enteric isolate for identification, per anaerobic isolate

21.00

Enterovirus culture

50.00

Enterovirus immunofluorescent, each antisera

20.00

Enterovirus RT-PCR

50.00

Enzyme immunoassay, per specimen

18.00

Fluorescent Antibody Tests, Direct

15.00

Gonorrhea culture

21.00

Hepatitis A antibody – total

30.00

Hepatitis A IgM antibody

30.00

Hepatitis B surface antigen

30.00

Hepatitis B surface antibody

30.00

Hepatitis B core antibody – total

30.00

Hepatitis B core antibody IgM

30.00

Hepatitis B - other marker

50.00

Hepatitis C antibody

30.00

Hepatitis C RNA Quantitative

125.00

Hepatitis C Virus Genotyping, Sequencing Method

159.00

Herpes simplex culture

50.00

Herpes simplex immunofluorescent, each antisera

20.00

Herpes simplex DFA, type 1

20.00

Herpes simplex DFA, type 2

20.00

Herpes simplex, type 1 antibody

30.00

Herpes simplex, type 2 antibody

30.00

Human Immunodeficiency Virus –1 and 2 antibody, single assay

40.00

Human Immunodeficiency Virus – 1 and 2 antibody, P24 antigen

40.00

Human Immunodeficiency Virus – 1 and 2 antibody differentiation

50.00

Infectious agent screen – other

35.00

Influenza culture

75.00

Influenza immunofluorescent, each antisera

20.00

Influenza A/B, PCR

100.00

Influenza Subtyping, PCR

200.00

Legionella culture

40.00

Legionella DFA

10.00

Legionella referred isolate

40.00

Measles (Rubeola) IgG antibody (Immune Status)

25.00

Measles (Rubeola) IgM antibody

30.00

Measles virus RNA

50.00

MERS CoV RT-PCR

50.00

Mumps culture

50.00

Mumps immunofluorescent, each antisera

20.00

Mumps IgG antibody

25.00

Mumps IgM antibody

25.00

Mumps virus RNA

50.00

Mycobacteria isolate identification

85.00

Mycobacteria (AFB) smear

10.00

Mycobacteria (AFB) culture

35.00

Mycobacterium tuberculosis direct probe

150.00

Mycobacterium tuberculosis susceptibility – first line drugs, each drug

25.00

Mycology culture, blood

35.00

Mycology culture, skin, hair or nails

35.00

Mycology culture, other

35.00

Mycology yeast identification, per isolate

50.00

Mycology non-yeast identification, per isolate

50.00

Mycology contaminated isolates (charged in addition to identification fee)

20.00

Neisseria gonorrhea , amplified method

25.00

Norovirus, PCR

100.00

Parainfluenza culture

50.00

Parainfluenza virus immunofluorescent, each antisera

20.00

Parasitology, blood/tissue parasites

43.00

Parasitology, stool for ova & parasite

89.00

Parasitology, worm identification

13.00

Parasitology, modified acid fast stain for Cyclospora, Isospora and Sarcocystis

43.00

Parasitology, Microsporidium, modified trichrome blue stain

70.00

Pertussis culture

40.00

Phlebotomy-Capillary

10.00

Phlebotomy-Venipuncture

10.00

Pneumocystis jiroveci (carinii) DFA

35.00

Pulsed field gel electrophoresis (PFGE), per isolate

125.00

Rabies (no public health risk)

175.00

Respiratory virus panel, amplified method

300.00

Respiratory synctial virus (RSV) culture

50.00

Respiratory synctial virus (RSV) immunofluorescent, each antisera

20.00

Respiratory synctial virus (RSV) DFA

20.00

Rubella antibody, IgG

25.00

Rubella antibody, IgM

30.00

Serogrouping, Shigella species

45.00

Serotyping, Salmonella species

50.00

Serotyping, Neisseria meningitidis

66.00

Serotyping, Haemophilus influenzae

66.00

Serotyping, Vibrio cholera serotyping

45.00

Serotyping, Enterohemorrhagic Escherichia coli

66.00

Shiga-like Toxin screen

40.00

Shiga Toxin (STEC), PCR

91.00

Specimen to Reference Lab/CDC

Cost of test shipping.

St. Louis Encephalitis virus antibodies, IgM

35.00

Susceptibility testing - Kirby Bauer (up to 12 disks)

25.00

Susceptibility testing – E-test, per drug

10.00

Susceptibility testing, fungal, per drug

59.00

Syphilis, qualitative

15.00

Syphilis, quantitative

25.00

Syphilis, confirmatory

30.00

Toxin assay

40.00

Varicella zoster virus culture

50.00

Varicella zoster virus immunofluorescent, each antisera

20.00

Varicella zoster virus DFA

20.00

Varicella zoster antibody

35.00

Virus culture - other

50.00

Virus culture immunofluorescent

20.00

Western Blot, other than HIV

60.00

West Nile Virus (WNV), IgM

35.00

MDX - DNA or RNA isolation

6.00

MDX - DNA or RNA purification

15.00

MDX – restriction enzyme digestion, per reaction

6.00

MDX – gel electrophoresis, per lane (reaction)

6.00

MDX – nucleic acid probe, each

6.00

MDX – single PCR amplification

16.00

MDX – duplex PCR amplification

32.00

MDX – multiplex PCR amplification, each additional after duplex

16.00

MDX – reverse transcription

14.00

MDX – cell lysis prior to isolation or purification

12.00

MDX – interpretation and reporting

20.00

MDX - miscellaneous

75.00/hr

History

• #2461, eff 9-5-83; ss by #4000, eff 2-26-86; ss by #4233, eff 2-23-87; ss by #4480, eff 8-31-88; ss by #5029, eff 12-20-90; ss by #5761, eff 1-3-94; eff 1-3-94; ss by #7171, INTERIM, eff 1-4-00, EXPIRED: 5-4-00; ss by #7256, eff 5-3-00; ss by #8891, eff 5-25-07; ss by #10935, INTERIM, eff 9-22-15, EXPIRED: 3-20-16
• #11064, eff 4-1-16

N.H. Code Admin. R. Ann. He-P 2205.03 Occupational and Environmental Health Samples

The following fees shall be charged for those occupational and environmental health samples set forth in Table He-P 2205.03 Occupational and Environmental below:

Table He-P 2205.03 Occupational and Environmental

TEST

FEE

Lead, maple syrup

40.00

History

• #2641, eff 9-5-83; ss by #4000, eff 2-26-86; ss by #4201, eff 1-8-87; ss by #4480, eff 8-31-88; ss by #5029, eff 12-20-90; ss by #5761, eff 1-3-94; eff 1-3-94; ss by #7171, INTERIM, eff 1-4-00, EXPIRED: 5-4-00; ss by #7256, eff 5-3-00; ss by #8891, eff 5-25-07; ss by #10935, INTERIM, eff 9-22-15, EXPIRED: 3-20-16
• #11064, eff 4-1-16

N.H. Code Admin. R. Ann. He-P 2205.04 Consumer Protection Samples

The following fees shall be charged for those consumer protection samples set forth in Table He-P 2205.04 Consumer Protection below:

Table He-P 2205.04 Consumer Protection

TEST

FEE

Food - Complete bacterial analysis

100.00

Food - Coliform count, total and fecal, Most Probable Number (MPN)

60.00

Food - Pathogen screen, per organism

40.00

Food - Foreign object

25.00

Food - pH

7.50

Food - Standard plate count

35.00

Food - Complete bacterial analysis, quality only

50.00

Food – Staphylococcus Culture

35.00

Food - Water activity

7.50

Milk or Cream - Complete analysis

25.00

Milk or Cream - Antibiotics, per group

10.00

Milk or Cream - Butterfat content

11.00

Milk or Cream - Coliform count

10.00

Milk or Cream - Direct Microscopic Somatic Cell Count (DMSCC)

18.00

Milk or Cream - Pathogen screen, per organism

40.00

Milk or Cream - Standard plate count

10.00

Milk or Cream - Total solids

8.00

Milk or Cream - Dairy waters

21.00

Milk or Cream - Phosphatase

8.00

Milk or Cream - Vitamin A or D

50.00

Milk or Cream - Added water

10.00

Milk or cream – Container analysis

15.00

Miscellaneous analysis

50.00/hr

Shellfish - Complete bacterial analysis

70.00

Shellfish - Fecal coliform count, (MPN )

60.00

Shellfish - Standard plate count

50.00

Shellfish - Microorganism identification

40.00

Shellfish Toxin Assay (e.g. PSP)

200.00

Shellfish – Vibrio Analysis (PCR-MPN)

150.00

Toxin assay, misc.

75.00

History

• #2461, eff 9-5-83; ss by #4000, eff 2-26-86; ss by 4201, eff 1-8-87; ss by #4233, eff 2-23-87; ss by #4480, eff 8-31-88; ss by #5029, eff 12-20-90; ss by #5761, eff 1-3-94; eff 1-3-94; ss by #7171, INTERIM, eff 1-4-00, EXPIRED: 5-4-00; ss by #7256, eff 5-3-00; ss by #8891, eff 5-25-07; ss by #10935, INTERIM, eff 9-22-15, EXPIRED: 3-20-16
• #11064, eff 4-1-16

N.H. Code Admin. R. Ann. He-P 2205.05 Addition of Tests to Fee Schedule

Pursuant to RSA 141-C:19 laboratory tests shall be added to the fee schedule if any one or more of the following occurs:

(a) The test is required by law;

(b) The test is required to support the work of the division and other state agencies; and

(c) The test is required to protect the public health of New Hampshire, and is not readily available to other locations within the state.

History

• #2461, eff 9-5-83; ss by #4000, eff 2-26-86; ss by 4201, eff 1-8-87; ss by #4233, eff 2-23-87; ss by #4480; eff 8-31-88; ss by #5029, eff 12-20-90; ss by #5761, eff 1-3-94; eff 1-3-94; ss by #7171, INTERIM, eff 1-4-00, EXPIRED: 5-4-00; ss by #7256, eff 5-3-00; ss by #8891, eff 5-25-07; ss by #10935, INTERIM, eff 9-22-15, EXPIRED: 3-20-16
• #11064, eff 4-1-16

Part He-P 2206 Preliminary Breath Test Devices

N.H. Code Admin. R. Ann. He-P 2206.01 Public Health Laboratories

Statutory Authority: RSA 265:92-a, III

REVISION NOTE:

Pursuant to 2003, 319:80, II, effective 1-1-04, rules He-P 2206 entitled “Preliminary Breath Test Devices”, last filed by the Department of Health and Human Services under Document #7781, effective 10-23-02, were transferred to the Department of Safety. See rules Saf-C 6800 of the Department of Safety.

– He-P 2206.06

History

• #2476, eff 9-14-83; ss by #3068, eff 7-23-85; ss by #4044, eff 4-25-86, EXPIRED: 4-25-92
• #7781, eff 10-23-02 (See Revision Note at part heading for He-P 2206)

N.H. Code Admin. R. Ann. He-P 2206.07 Public Health Laboratories

– He-P 2206.08

History

• #2309, eff 1-1-83; rpld by #2340, eff 4-1-83; original rpld by #2476, eff 9-14-83; ss by #4044, eff 4-25-86, EXPIRED: 4-25-92
• #7781, eff 10-23-02 (See Revision Note at part heading for He-P 2206)

Chapter He-P 2300 Sanitary Production and Distribution of Food

Part He-P 2301 Definitions

N.H. Code Admin. R. Ann. He-P 2301.01 Definitions

(a) “Acid foods” means “acid foods” as defined by 21 CFR 114.3(a), namely, “foods that have a natural pH of 4.6 or below.”

(b) “Acidified foods” means “acidified foods” as defined by 21 CFR 114.3(b), namely, “low-acid foods to which acid(s) or acid food(s) are added; these foods include, but are not limited to, beans, cucumbers, cabbage, artichokes, cauliflower, puddings, peppers, tropical fruits, and fish, singly or in any combination. They have a water activity (aw) greater than 0.85 and have a finished equilibrium pH of 4.6 or below. These foods may be called, or may purport to be, ‘pickles’ or ‘pickled’. Carbonated beverages, jams, jellies, preserves, acid foods (including such foods as standardized and non standardized food dressings and condiment sauces) that contain small amounts of low-acid food(s) and have a resultant finished equilibrium pH that does not significantly differ from that of the predominant acid or acid food, and foods that are stored, distributed, and retailed under refrigeration are excluded from the coverage of this part.”

(c) “Applicant” means the owner of a food establishment or an officer of the legal ownership who applies for a license under these rules.

(d) “Bed and breakfast” means a type of food service establishment that is a transient lodging facility, which is the owner’s or innkeeper’s personal residence, is occupied by the owner or innkeeper at the time of rental to an in-house guest, and in which breakfast is the only meal served to in-house guests, with the exception for service of a snack.

(e) “Beverage” means “beverage” as defined in RSA 143:9.

(f) “Caterer” means a person or entity which provides meals or food at private functions at off-site locations.

(g) “Certified food protection manager” means the person in charge who has shown proficiency of required information through passing a test that is part of an accredited program or as stated in 2-102.12(A) of the Food Code.

(h) “Change of ownership” means any time a controlling interest in a sole proprietorship, joint venture, partnership, corporation, limited liability company, or any other kind of entity is transferred to another sole proprietor, joint venture, partnership, corporation, limited liability company, or any other kind of entity.

(i) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or the commissioner’s designee.

(j) “Continental breakfast” means a light breakfast that includes items such as coffee, tea, juices, toasts, breakfast cereals, assorted pastries, and uncut fruit.

(k) “Corrective action plan (CAP)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified deficiencies.

(l) “Critical control point” means a point or procedure in a specific food system where loss of control might result in an unacceptable health risk.

(m) “Critical limit” means the maximum or minimum value to which a physical, biological, or chemical parameter must be controlled at a critical control point to minimize the risk that the identified food safety hazard might occur.

(n) “Department” means the New Hampshire department of health and human services.

(o) “Exempt homestead food operation” means a homestead food operation whose homestead food products are only for sale directly to the consumer from the homestead residence, the owner’s farm stand, at farmers’ markets, or at a retail food store. An exempt homestead food operation is not a type of food service establishment.

(p) “Farm store” means a retail food store with no food preparation areas and no running water that offers locally grown or produced foods only.

(q) “Food” means “food” as defined in RSA 143-A:3, III.

(r) “Food Code” means the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administration, Food Code, 2017 edition.

(s) “Food establishment” means when both a food service establishment and retail food store are referenced together.

(t) “Food processing plant” means “food processing plant” as defined in RSA 143-A:3, IV-a, namely “a type of food service establishment that is a commercial operation that processes food for human consumption and provides processed food for sale and distribution to other business entities, such as other food establishments. The term does not include an operation that processes food under the oversight of the New Hampshire department of agriculture in accordance with RSA 426, RSA 427, RSA 428, RSA 429, and RSA 434.” This term includes “cold storage” or “refrigerating warehouse”.

(u) “Food service establishment” means “food service establishment” as defined in RSA 143-A:3, IV.

(v) “Foodborne disease outbreak” means the occurrence of 2 or more cases of a similar illness resulting from the ingestion of a common food.

(w) “Harvester” means a person who forages for and harvests wild mushrooms for sale to a distributor, food establishment, or to the public.

(x) “Homestead food operation” means “homestead food operation” as defined in RSA 143-A:12, I(a).

(y) “Homestead food products” means foods which are not potentially hazardous food, as defined in (am) below, that are made at a homestead food operation, and are limited to the following:

(1) Baked items, including, breads, rolls, muffins, cookies, brownies, and cakes;

(2) Double-crusted fruit pies;

(3) Candy and fudge;

(4) Packaged dry products, which include spices and herbs;

(5) Acid foods, including, vinegars and mustards; and

(6) Jams and jellies.

(z) “Identifier” means “identifier” as defined in RSA 143-A:21, VI, namely, “a person who identifies wild mushrooms collected by a harvester on behalf of a distributor or a food establishment.”

(aa) “Immediately endangers public health or safety” means that a condition exists that is an imminent health hazard.

(ab) “Imminent health hazard” means “imminent health hazard” as defined in RSA 143-A:3, IV-b, namely, “a significant threat or danger to health that is considered to exist when there is evidence sufficient to show that a product, practice, circumstance, or event creates a situation that requires immediate correction or cessation of operation to prevent injury or illness.”

(ac) “License” means the document issued by the department or other regulatory agency, which authorizes a license holder to operate a food establishment.

(ad) “License holder” means the entity legally responsible for the operation of a licensed food establishment, including, the owner, the owner’s agent, or other person.

(ae) “Low-acid foods” means “low-acid foods” as defined by 21 CFR 114.3(d), namely, “any foods, other than alcoholic beverages, with a finished equilibrium pH greater than 4.6 and a water activity (aw) greater than 0.85. Tomatoes and tomato products having a finished equilibrium pH less than 4.7 are not classed as low-acid foods.”

(af) “Major food allergen” is a food that contains proteins that may cause the immune system of certain individuals to react in a manner which is harmful to health. The foods that account for most reactions are those containing milk, egg, various fish to include bass, flounder, cod, or various crustacean shellfish to include crab, lobster, or shrimp, tree nuts to include almonds, pecans, or walnuts, wheat, peanuts, sesame, and soybeans, or a food ingredient that contains protein derived from the aforementioned foods.

(ag) “Mobile food unit” means a food service establishment mounted on wheels or otherwise designed to be immediately moveable. This term does not include a food service establishment which is required to meet the wastewater requirements in He-P 2304.07.

(ah) “Mushroom” means “mushroom” as defined in RSA 143-A:21, III, namely, “the fleshy, spore-bearing, fruiting body of a fungus.”

(ai) “Mushroom distributor” means a person who purchases wild mushrooms from a harvester and sells to food establishments or direct to the public. Mushroom distributor does not include food establishments.

(aj) “Non-exempt homestead food operation” means a homestead food operation who wishes to sell homestead food products, as defined in (x) above, to restaurants or other retail food establishments, over the Internet, by mail order, or to wholesalers, brokers, or other food distributors for resale. A non-exempt homestead food operation is a type of food service establishment.

(ak) “Package” means a quantity or an amount of food that is bottled, canned, cartoned, securely bagged, or securely wrapped.

(al) “Person in charge” means the individual present at a food establishment who is responsible for the operation of the establishment at the time of inspection, including the duties described in section 2-103.11 of the Food Code, and who can demonstrate the knowledge required by section 2-102.11 of the Food Code which are pertinent to the risks inherent to that specific food establishment.

(am) “Potentially hazardous food” means “potentially hazardous food” as defined in RSA 143-A:12, I(b), namely, “foods requiring temperature control for safety because they are capable of supporting the rapid growth of pathogenic or toxigenic microorganisms, and the growth of toxin production of clostridium botulinum. Potentially hazardous foods also include processed acidified and low acid canned foods.” This term includes “time/temperature control for safety (TCS) food.”

(an) “Poultry” means “poultry” as defined in RSA 143-A:14, III.

(ao) “Poultry producer” means “poultry producer” as defined in RSA 143-A:14, IV.

(ap) “Priority item” means a provision of the Food Code, marked with a superscript P,P, whose application contributes directly to the elimination, prevention, or reduction to an acceptable level, hazards associated with foodborne illness or injury and there is no other provision that more directly controls the hazard.

(aq) “Public water system” means “public water system” as defined in RSA 485:1-a, XV.

(ar) “Pushcart” means a type of food service establishment that is a non-self propelled vehicle limited to serving non-time/temperature control for safety foods, packaged time/temperature control for safety foods maintained at proper temperatures, or limited to the preparation and serving of frankfurters.

(as) “Rabbit” means “rabbit” as defined in RSA 143-A:14, VI.

(at) “Rabbit producer” means “rabbit producer” as defined in RSA 143-A:14, VII.

(au) “Regulatory authority” means the local, state, or federal enforcement body having jurisdiction over the food establishment.

(av) “Remodeled” means having undertaken construction, which includes, but is not limited to, adding new seats or a food preparation area, or any construction affecting the kitchen or any other part of a food establishment that requires a plumbing modification.

(aw) “Retail food store” means “retail food store” as defined in RSA 143-A:3, VII.

(ax) “Sanitization” means the cumulative heat or chemicals on cleaned food contact surfaces that, when evaluated for efficacy, is sufficient to yield a reduction of 5 logs, which is equal to a 99.999% reduction, of representative disease microorganisms of public health importance.

(ay) “Servicing area” means an operating base location to which a mobile food unit or transportation vehicle returns regularly for such things as vehicle and equipment cleaning, discharging liquid or solid wastes, refilling water tanks and ice bins, and boarding food.

(az) “Sewage” means “sewage” as defined in RSA 485-A:2, X, namely, “the water-carried waste products from buildings, public or private, together with such groundwater infiltration and surface water as may be present.”

(ba) “Soup kitchen” means a food service establishment that prepares or distributes food to the public without charge.

(bb) “Snack” means a small portion of food served in between meals limited to non-potentially hazardous foods, such as baked goods that may be prepared on site or food prepared by handling ready to eat food or by reheating commercially made food.

(bc) “Tier 1 mushroom” means “tier 1 mushroom” as defined in RSA 143-A:21, VIII, namely “a wild mushroom which is easily identified, that has no toxic look-alikes, and which is unlikely to cause illness in humans.”

(bd) “Tier 2 mushroom” means “tier 2 mushroom” as defined in RSA 143-A:21, IX, namely “a wild mushroom which is difficult to identify, may have toxic look-alikes, or may cause illness in some humans.”

(be) “Time/temperature control for safety (TCS) food” means a food that requires time/temperature control for safety to limit pathogenic microorganism growth or toxin formation. This term includes “potentially hazardous food.”

(bf) “Unattended market” means an operation that provides packaged foods or whole fruit using an automated payment system, and has controlled entry not accessible by the general public.

(bg) “Uninspected bison, elk, or red deer” means “uninspected bison, elk, or red deer” as defined in RSA 143-A:18.

History

• #2802, eff 8-8-84-EXPIRED 8-8-90
• #6503, INTERIM, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; amd by #8368, eff 6-4-05; amd by #8863, eff 4-13-07; ss by #9857-A, eff 2-1-11; amd by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; amd by #10956, eff 10-22-15; ss by #12852, eff 8-20-19; ss by #13428, eff 8-5-22; ss by #13883, eff 2-22-24

Part He-P 2302 License Required

N.H. Code Admin. R. Ann. He-P 2302.01 License Required

Unless exempted under RSA 143-A:5, RSA 143-A:5-a, or He-P 2302.02, no person shall operate a food establishment in New Hampshire without obtaining a license from the department.

History

• #2802, eff 8-8-84-EXPIRED 8-8-90
• #6503, INTERIM, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2302.02 Soup Kitchens Exempt from Licensure

In accordance with RSA 143-A:5-a, soup kitchens shall be exempt from licensure by the department provided:

(a) They do not charge for meals; and

(b) They submit to the department a written notice which:

(1) Identifies the name and address of the person operating the soup kitchen;

(2) Identifies the clientele served by the soup kitchen;

(3) Lists the hours the soup kitchen will operate; and

(4) Provides a description of the food to be served.

History

• #2802, eff 8-8-84-EXPIRED 8-8-90
• #6503, INTERIM, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2303 Incorporation of the 2017 Food Code and Other Requirements for Food Establishments

N.H. Code Admin. R. Ann. He-P 2303.01 Incorporation of the 2017 Food Code

(a) All licensees shall comply with the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Food Code, 2017 edition, available as set forth in Appendix A, and free to the public in a PDF format on the web at https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/UCM595140.pdf henceforth known as the Food Code, as amended in (b) below, unless exempted in (c) or (d) below.

(b) The following amendments shall apply to the document incorporated:

(1) Amend section 3-201.11(A) so that (A) reads as follows: “Food shall be obtained from sources that comply with law” except that the exemption under the Poultry Products Inspection Act at 21 USC 464(c)(4) shall not apply in the state of New Hampshire”;

(2) Delete Chapter 8;

(3) Poultry from poultry producers that comply with He-P 2313 shall be considered to be from an approved source under section 3-201.11(A);

(4) Rabbit from rabbit producers that comply with He-P 2313 shall be considered to be from an approved source under section 3-201.11(A); and

(5) Uninspected bison, elk, or red deer meat from producers that comply with RSA 427:2-a, IV shall be considered to be from an approved source under section 3-201.11(A).

(c) Those food establishments applying for licensure or which are licensed as a bed and breakfast shall comply with the Food Code. However, the exceptions to the Food Code listed in He-P 2308.02 shall apply to a bed and breakfast.

(d) Those food establishments applying for licensure or which are licensed as food processing plants or non-exempt homestead food operations shall be exempt from the requirements of the Food Code, and shall comply with the requirements in He-P 2309 and He-P 2311, respectively.

History

• #2802, eff 8-8-84; amd by #4234, eff 2-23-87; ss by #5051, eff 1-22-91; amd by #5631, eff 5-26-93; amd by #6503, INTERIM, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; amd by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; ss by #12852, eff 8-20-19; ss by #13883, eff 2-22-24

N.H. Code Admin. R. Ann. He-P 2303.02 Requirements for Food Protection Manager Certification

(a) The following categories as listed in He-P 2304.04 shall be exempt from the requirement for a certified food protection manager as defined in He-P 2301.01(g):

(1) Category A-1, food processing plants which commercially process 100,000 packages of food or more, per year;

(2) Category C-5, food processing plants which commercially process less than 100,000 packages of TCS food per year;

(3) Category C-6, cold storage or refrigerating warehouse;

(4) Category D-4, retail food stores that allow self-service of food, including coffee, hot dogs, or soft drinks;

(5) Category D-6, servicing areas;

(6) Category E-1, bed and breakfasts;

(7) Category E-3, lodging facilities serving continental breakfasts;

(8) Category F-1, home delivery services of packaged frozen food;

(9) Category F-2, pushcarts and other mobile food units, including, those serving packaged food and non-TCS unwrapped foods only;

(10) Category F-3, retail food stores with no food preparation areas;

(11) Category F-4, wholesalers/distributors of TCS food;

(12) Category F-5, on-site vending machines or unattended markets, which serve TCS food;

(13) Category F-6, bakeries which do not serve TCS food and have no seats;

(14) Category F-7, farm store;

(15) Category G-1, bars/lounges without a food preparation area;

(16) Category G-2, arena/theater concessions serving non-TCS food;

(17) Category G-3, retail food stores serving pre-packaged ice cream;

(18) Category G-7, sellers of pre-packaged frozen meat or poultry that is processed in a USDA-inspected plant; or

(19) Category G-8, food processing plants that manufacturer or package non-TCS food.

(b) A food establishment that is in process of initial licensing shall have a certified food protection manager within first 45 days of the initial licensing inspection.

(c) If a food establishment’s certified food protection manager ceases his/her employment and renders the food establishment out of compliance with food manager certification requirements, the establishment shall have 90 days to come into compliance.

(d) Food establishments that have at least one certified food protection manager on staff shall not be required to have the certified food protection manager present during hours of operation when no food preparation is taking place.

(e) Food establishments having at least one certified food protection manager on staff shall not be required to have the certified food protection manager present when food preparation is limited to reheating commercially prepared food or ready to eat food.

(f) Food establishments having 5 food employees or less on duty are required to have only one certified food protection manager on staff who is available, although not required to be present, during all hours of operation.

(g) A food establishment shall have available the exam certificate of each certified food protection manager for review by inspection staff.

History

• #12852, eff 8-20-19; ss by #13428, eff 8-5-22

N.H. Code Admin. R. Ann. He-P 2303.03 Requirements for Food Allergy Awareness

(a) A food service establishment that offers unpackaged foods intended for immediate consumption by the consumer shall post a notice to customers of the customer’s obligation to inform the server of his or her food allergies.

(b) This notice shall be displayed by brochures, deli case or menu advisories, label statements, table tents, place cards, or other effective written means and state “Before placing your order, please inform your server if a person in your party has a food allergy”.

History

• #13428, eff 8-5-22

Part He-P 2304 Application and Licensing Procedure

N.H. Code Admin. R. Ann. He-P 2304.01 Initial License Application Requirements

(a) Each applicant for a license shall complete and submit to the department an application form entitled “Application for New, Change of Ownership, Change in License Class Food Service License” (FSAPP February 2024), “Application for Annual Food Processing Plant License” (FPAPP August 2019), “Application for New Homestead Food Operation License” (HAPP February 2024), or “Application for Annual Mobile Food Unit License” (MFAPP August 2019), as applicable, signed and dated by the applicant or the person who represents the applicant certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections, or updates to the information provided.”

(b) In addition to submitting the completed application, in (a) above, an applicant shall also submit the following:

(1) A check, money order, or on-line payment by credit card at https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/food-protection for the applicable fee submitted with the application in (1) above, in accordance with He-P 2304.05(a) and (c);

(2) Water system documentation, in accordance with He-P 2304.06, except that food establishments applying to be licensed as a farm store, home delivery services, pushcart and other mobile units, on-site vending machines, retail food stores serving pre-packaged ice cream, and sellers of pre-packaged frozen meat or poultry that is processed in a United States Department of Agriculture (USDA) plant shall not be required to submit such documentation;

(3) Wastewater system documentation, in accordance with He-P 2304.07, except that food establishments in the following categories shall not be required to submit such documentation:

a. Category D-3-mobile cook unit;

b. Category E-1, bed and breakfasts;

c. Category F-1, home delivery services of packaged frozen food;

d. Category F-2, pushcarts and other mobile food units, including, those serving packaged food and non-TCS unwrapped foods only;

e. Category F-3, retail food stores with no food preparation areas;

f. Category F-5, on-site vending machines, which serve TCS food;

g. Category F-7, farm store;

h. Category G-3, retail food stores serving pre-packaged ice cream;

i. Category G-4, institutions including state, county, and municipal institutions;

j. Category G-5, schools, private schools, and schools whose food service is operated by a caterer;

k. Category G-6, senior meal sites;

l. Category G-7, sellers of pre-packaged frozen meat or poultry that is processed in a USDA-inspected plant;

m. Category G-8, food processing plants that manufacturer or package non-TCS food;

n. Class H, Category H-1, non-exempt homestead food operations; and

o. Class O, Category O-1, municipality-run school cafeteria;

(4) A completed “Food Establishment Floor Plan Review Application” (PRAPP February 2024) signed and dated by the applicant, or the person who represents the applicant, if required by He-P 2304.12(a) and if not already submitted to the department for review, and which meets the requirements of the Food Code, unless the applicant is exempt from this requirement as set forth in He-P 2304.12(d);

(5) If the application is for a mobile food unit which uses a servicing area, one of the following:

a. A copy of the food establishment license, from the appropriate regulatory authority, of the facility being used as a servicing area; or

b. A separate license application for the facility to be used as a servicing area;

(6) A hazard analysis and critical control point (HACCP) plan if required by He-P 2304.13; and

(7) A proposed menu or list of food and beverages to be offered.

(c) The applicant shall apply online at https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/food-protection, by mail, or hand deliver the fee, as required in (b)(1) above, and all documents to:

Department of Health and Human Services

Bureau of Finance/Receipts Unit. Food Protection

Food Protection Section

129 Pleasant Street

Concord, NH 03301

(603) 271-4589

(d) Applicants seeking a change in license class, a new license, or a new license due to a change of ownership, shall contact the department’s food protection section to arrange for an inspection of the establishment no later than 30 days from the date of mailing or delivering the fee and application.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; amd by #9857-A, eff 2-1-11, (paras (a)(2)-(7) & (b)); amd by #9857-B, eff 2-1-11, ((a) intro and (a)(1)); amd by #10199-A, eff 10-12-12 ((a) intro and (a)(1)); ss by #10867, eff 6-25-15; amd by #10956, eff 10-22-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19; ss by #13428, eff 8-5-22; ss by #13883, eff 2-22-24

N.H. Code Admin. R. Ann. He-P 2304.02 Processing of Initial Applications and Issuance of Licenses

(a) Applications shall be processed in accordance with RSA 541-A:29.

(b) An application for an initial license shall be complete when the department determines that all items required by He-P 2304.01(a) and (b) have been received.

(c) If an application does not contain all the items required by He-P 2304.01(a) and (b), the department shall:

(1) Not process that application; and

(2) Notify the applicant in writing of which items are required to be submitted before the application can be processed.

(d) Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

(e) Licensing fees shall not be transferable to any other application(s).

(f) Following an inspection, conducted pursuant to RSA 143:4 and in accordance with He-P 2305, a provisional license shall be issued if the department determines that an applicant is in compliance with RSA 143, RSA 143-A, and these rules.

(g) Pursuant to RSA 143-A:6, I:

(1) A provisional license shall expire 90 days after the date of issuance; and

(2) If a license is not issued following the expiration of a provisional license, the food establishment shall cease operation the day after the provisional license expires and not operate until a license is obtained.

(h) If, within 45 days of issuance of a provisional license the department conducts an inspection in accordance with He-P 2305 and determines that an applicant is in compliance with RSA 143, RSA 143-A, and these rules, the department shall issue to the applicant a license valid for a time period of one year following the date of issuance of the provisional license.

(i) All licenses and provisional licenses issued in accordance with RSA 143-A shall be issued for a specific license classification and category under He-P 2304.04.

(j) License holders shall operate in accordance with the class and category of license issued.

(k) All licenses and provisional licenses issued in accordance with RSA 143-A shall be non-transferable by person or location.

(l) Licenses shall be posted at all times in an area of the food establishment that is conspicuous to patrons.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.03 License Expirations and Procedures for Renewals

(a) All licenses issued shall be valid for one year following the date of issuance, or one year following the first day of the month after the date of issuance of an initial license, as applicable.

(b) Each licensee shall apply to renew his or her license\at least 30 days prior to the expiration of the current license.

(c) The licensee shall submit a renewal application that includes the following:

(1) The materials required by He-P 2304.01(b)(1) and(2); and

(2) Any changes to information provided to the department in the initial application.

(d) A license shall be renewed if the department determines that the licensee:

(1) Submitted an application containing all the items required by (c) above, as applicable, at least 30 days prior to the expiration of the current license;

(2) Has submitted a CAP that has been accepted by the department and implemented by the licensee if deficiencies were cited at the last licensing inspection;

(3) Is found to be in compliance with RSA 143, RSA 143-A, and He-P 2300 at a renewal inspection, as applicable; and

(4) Has paid any outstanding fees or fines in full.

(e) If a license holder fails to submit a complete application for renewal as required under (b) and (c) above, the food establishment shall cease operation the day after the license expires, and shall not operate until a license is obtained pursuant to RSA 143-A.

(f) Any food establishment wishing to submit an application for a renewal license whose previous license has been expired in excess of 90 days shall apply in accordance with the requirements of an initial license in He-P 2304.01.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.04 License Classes

(a) For the purpose of licensure, food establishments shall be divided into the following classes:

(1) Class A which shall include:

a. Category A-1, food processing plants which commercially process 100,000 packages of food or more, per year;

b. Category A-2, food service establishments with 200 or more indoor seats; or

c. Category A-3, retail food stores with 4 or more food preparation areas;

(2) Class B which shall include:

a. Category B-1, retail food stores with 2 to 3 food preparation areas; or

b. Category B-2, food service establishments with 100 to 199 indoor seats;

(3) Class C which shall include:

a. Category C-1, retail food stores with one food preparation area, including, an area for cutting cheese or fudge;

b. Category C-2, caterers serving food off-site;

c. Category C-3, food service establishments with 25 to 99 indoor seats;

d. Category C-4, bars or lounges with a food preparation area, excluding areas used for preparing garnish such as limes and lemons;

e. Category C-5, food processing plants which commercially process less than 100,000 packages of TCS food per year; or

f. Category C-6, cold storage or refrigerating warehouse;

(4) Class D, which shall include:

a. Category D-1, food service establishments with 0 to 24 indoor seats;

b. Category D-2, fraternities and sororities, except those where the members prepare all their own food;

c. Category D-3, mobile food units which cook or prepare food;

d. Category D-4, retail food stores that allow self-service of food, including coffee, hot dogs, or soft drinks;

e. Category D-6, servicing areas; or

f. Category D-7, arena or theater concessions serving TCS food;

(5) Class E which shall include:

a. Category E-1, bed and breakfasts; or

b. Category E-3, lodging facilities serving continental breakfasts;

(6) Class F which shall include:

a. Category F-1, home delivery services of packaged frozen food;

b. Category F-2, pushcarts and other mobile food units, including, those serving packaged food and non-TCS unwrapped foods only;

c. Category F-3, retail food stores with no food preparation areas;

d. Category F-4, wholesalers or distributors of TCS food;

e. Category F-5, on-site vending machines or unattended markets, which serve TCS food;

f. Category F-6, bakeries which do not serve TCS food and have no seats; or

g. Category F-7, farm store;

(7) Class G shall include:

a. Category G-1, bars or lounges without a food preparation area;

b. Category G-2, arena or theater concessions serving non-TCS food;

c. Category G-3, retail food stores serving pre-packaged ice cream;

d. Category G-4, institutions including state, county, and municipal institutions;

e. Category G-5, schools, private schools, and schools whose food service is operated by a caterer;

f. Category G-6, senior meal sites;

g. Category G-7, sellers of pre-packaged frozen meat or poultry that is processed in a USDA-inspected plant; or

h. Category G-8, food processing plants that manufacturer or package non-TCS food;

(8) Class H, Category H-1, shall include non-exempt homestead food operations; and

(9) Class O, Category O-1, shall include municipality-run school cafeterias.

(b) When a food establishment operates more than one type of business, the higher class shall determine the class of license, with Class A being the highest.

(c) When a food establishment has an additional food processing business, each shall be licensed separately, requiring separate applications and separate fees.

(d) When a hospital or school offers food to the general public in addition to its population, then the license class shall be determined by the number of seats the food service establishment has.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; amd by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19; ss by #13428, eff 8-5-22

N.H. Code Admin. R. Ann. He-P 2304.05 Fees

(a) For each class of license requested, the applicant shall pay the following annual fees:

(1) Class A: $875;

(2) Class B: $450;

(3) Class C: $350;

(4) Class D: $225;

(5) Class E: $175;

(6) Class F: $150;

(7) Class G: $100;

(8) Class H: $150; and

(9) Class O: no charge.

(b) An applicant or licensee shall pay a fee of $75 for each plan review submitted under He-P 2304.12.

(c) All fees shall be non-transferable and non-refundable.

(d) Payment of any fee to the department shall meet the following requirements:

(1) Payment shall be made in the form of check, money order, or on-line payment made payable to the “Treasurer, State of New Hampshire” in the exact amount due;

(2) Money order or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds; and

(3) Any payment made to the department by check which is returned for insufficient funds, and which an individual, applicant, or licensee has not made good by submitting a money order or certified check within 2 business days of notification by the department, including any penalty assessment allowed by RSA 6:11-a, shall be grounds for denial of the license.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; amd by #10199-A, eff 10-12-12, paras (a)(1)(7), (9) and (a)-(f) EXPIRED: 2-1-19; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.06 Water System Requirements

(a) Food establishments served by non-community public water systems, as defined by RSA 485:1-a, XV, shall indicate, as part of their application for a license, the Public Water System (PWS) identification number which has been assigned by the New Hampshire department of environmental services (DES).

(b) For an application to be approved, the non-community public water system regulated by DES serving the food establishment shall:

(1) Be in compliance with all applicable water quality standards and monitoring and reporting requirements of Env-Dw707 through 720 and Env-Dw 801 as applicable ; or

(2) Be in compliance with the requested actions in a letter of deficiency, or the required actions of an administrative order, issued by DES and established to obtain compliance with the regulations cited in (1) above.

(c) Food establishments which are classified as public water systems, as defined by RSA 485:1-a, XV, shall indicate, as part of their application for a license, the PWS identification number which has been assigned by DES.

(d) For an application under this paragraph to be approved, the water system shall:

(1) Be in compliance with all applicable water quality standards and monitoring and reporting requirements of Env-Dw707 through 720 and Env-Dw 801 as applicable; or

(2) Be in compliance with the requested actions in a letter of deficiency, or the required actions of an administrative order, issued by the DES and established to obtain compliance with the regulations cited in (1) above.

(e) Food establishments which purchase their water from a community public water systems, as defined by RSA 485:1-a, XV, and therefore do not fall under (a) above, shall indicate this information on the application.

(f) Food establishments which do not fall under (a) through (e), and are instead served by a water source other than a public water system, shall submit with the initial and renewal application the written results of a laboratory analysis of the water intended for use, which tests the level of the following:

(1) Bacteria;

(2) Nitrates; and

(3) Nitrites.

(g) The analyses required by (f) above shall be conducted not more than 6 months prior to the date of the application by a laboratory accredited by DES to perform such tests in accordance with Env-C 300.

(h) For an application to be approved, the results of the water analysis shall be as follows:

(1) The bacteria test required under (f) above shall not exceed the maximum contaminant level (MCL) for drinking water prescribed by Env-Dw 702; and

(2) The nitrate and nitrite tests required under (f) above shall not exceed the MCL for drinking water prescribed by Env-Dw 704 for those 2 contaminants.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.07 Wastewater System Requirements

(a) Food establishments which discharge their wastewater to either public or private wastewater systems which hold either a state surface water discharge permit or a groundwater discharge permit issued by the New Hampshire department of environmental services (DES), shall indicate this information on the application.

(b) Food establishments which do not discharge their wastewater as described in (a) above shall submit the following as part of their application:

(1) The applicant demonstrates that the existing use has not changed since July 1, 1967, by providing:

a. A town property tax record for 1967 or earlier that is authenticated by a current official of the town; or

b. A sworn, notarized affidavit that the existing use has not increased from the use existing as of July 1, 1967 from an individual unrelated to the applicant who owned the structure served by the private sewage or waste disposal system prior to July 1, 1967 or has personal knowledge of the use of the structure prior to July 1, 1967 in an official capacity such as being a tax assessor or code enforcement officer.; or

(2) A copy of the construction approval and the operation approval for the sewage or waste disposal system that indicates that the system is sufficient in capacity to serve the subject food establishment issued by DES in accordance with RSA 485-A:29 and Env-Wq 1000.

(c) If not stated in or (b)(2) above a copy of the sewage or waste disposal system plan specifying use shall be submitted as part of their application.

(d) If there is no increase in the loading of the waste disposal system serving the food establishments in (b) above, and the applicant is unable to produce the documentation required, and has obtained approval of the waste disposal system from DES, the department shall waive the requirement in (b) with written approval from DES.

(e) Any increase in seating capacity in a licensed food establishment which has a private wastewater system shall comply with Env-Wq 1000.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.08 Change in Ownership of a Food Establishment

(a) When there is a change of ownership of a food establishment, the new owner shall submit the items required for initial license applicants under He-P 2304.01 to the department at least 30 days prior to the change of ownership, except food establishments that are not changing the food operation with a menu change or change in number of indoor seats shall not be required to submit wastewater documentation.

(b) Upon receipt and processing of the items required by (a) above, and after an inspection conducted in accordance with He-P 2305 which shall also determine compliance with Chapters 4, 5, and 6 of the Food Code, the department shall issue a provisional license reflecting the change in ownership.

(c) The issuance of a provisional license due to a change in ownership shall void the license of the previous owner on the date the change of ownership occurs.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19; ss by #13883, eff 2-22-24

N.H. Code Admin. R. Ann. He-P 2304.09 Change in Name of a Food Establishment

(a) When a license holder intends to change the name of a food establishment, that license holder shall submit a written request to the department for a new license at least 30 days prior to the intended date of change in name.

(b) The written request shall include:

(1) The reason for requesting a new license;

(2) The name of the food establishment as it appears on the existing license;

(3) The name of the food establishment as the license holder requests it to appear on the new license; and

(4) The date upon which the change in name is intended to occur.

(c) Following receipt of the items required by (b) above, the commissioner shall issue a revised license reflecting the change in name. The establishment number and expiration date shall remain the same as it was on the immediately preceding license.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.10 Change in Location of a Food Establishment

(a) When there is a change of location of a food establishment, the license holder shall submit the items required for initial license applicants under He-P 2304.01 to the department at least 30 days prior to the change of location.

(b) Upon receipt and processing of the items required under (a) above, and after an inspection conducted in accordance with He-P 2305, the department shall issue a provisional license reflecting the change of location.

(c) The issuance of a provisional license due to a change in location shall void the previous license on the date the change of location occurs.

(d) This section shall not apply to mobile food units, pushcarts, or vehicles used to sell retail food.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.11 Change in License Class

(a) A license holder wishing to request an upgrade to a higher-level class of license listed in He-P 2304.04 shall:

(1) Be treated as an applicant for a new license; and

(2) Apply for a new license in accordance with He-P 2304.01.

(b) The issuance of a provisional license due to an upgrade in license class shall void the previous license on the date the upgrade occurs.

(c) A license holder wishing to request a downgrade to a lower level class of license listed in He-P 2304.04 shall submit a written request for downgrade to the department.

(d) The written request in (c) above shall include:

(1) The reason for requesting a downgrade; and

(2) The date upon which the downgrade is intended to occur.

(e) Following receipt of the request under (c) above the licensee shall be issued a revised license reflecting the downgrade in class of license. The establishment number and expiration date shall remain the same as it was on the immediately preceding license.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.12 Submission of Plans and Specifications for New or Remodeled Food Establishments

(a) A new applicant or a current license holder undergoing remodeling of a food establishment, shall submit a “Floor Plan Review Application” (PRAPP February 2024), to the department for review and approval, signed and dated by the applicant or the person who represents the applicant certifying the following:

“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates to the information provided.”

(b) In addition to submitting a completed application in (a) above, an applicant or license holder shall provide the following with the application:

(1) A proposed menu or list of food and beverages to be offered; and

(2) A copy of the plans and specifications for the food establishment, unless exempt under (d) below, to include:

a. Location of all food equipment which clearly identifies the piece of equipment;

b. Location of food preparation areas;

c. Location of all refrigeration, which shall be commercial grade refrigeration only;

d. Location of all sinks including handwashing, food preparation, three compartment and service sinks;

e. Location of toilet facilities and restrooms;

f. Location of warewashing areas;

g. Location of serving and seating areas;

h. Location of changing rooms;

i. Location of janitorial and trash areas;

j. Location of office;

k. Location of storage areas; and

l. Location of any outside equipment of facilities.

(c) The application and attachments in (a) and (b) above shall be submitted at least 45 days prior to:

(1) Constructing a new food establishment;

(2) Converting an existing structure for use as a food establishment;

(3) Remodeling a food establishment; or

(4) Relocating a food establishment when the relocation also involves (1), (2), or (3) above.

(d) The following shall be exempt from submitting a plan review application:

(1) Pushcarts;

(2) Homesteads;

(3) Retail stores with no food prep area;

(4) On-site vending machines serving TCS food;

(5) Sellers of prepackaged frozen USDA meat or poultry; and

(6) Bed and breakfasts.

(e) An applicant or licensee shall pay a fee of $75, submitted with the application, for each plan review application submitted.

(f) The department shall review plans for construction, renovation, or structural alterations of a food establishment for compliance with all applicable sections of RSA 143, RSA 143-A, and He-P 2300 and notify the applicant or licensee as to whether the plan complies with the requirements set forth therein.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; amd by #9857-A, eff 2-1-11, (paras (b)-(e)); amd by #9857-B, eff 2-1-11, (para (a)); ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19; ss by #13883, eff 2-22-24

N.H. Code Admin. R. Ann. He-P 2304.13 Hazard Analysis and Critical Control Point (HACCP) Plan Requirements

(a) The following applicants or licensees shall submit to the department a complete hazard analysis and critical control point (HACCP) plan for approval prior to engaging in an activity that requires such a plan:

(1) Food processing plants that produce potentially hazardous food;

(2) Any food establishment engaging in an activity that requires a variance as specified under Food Code subparagraph 3-401.11 (D)(4), § 3-502.11, or ¶ 4-204.110 (B);

(3) Any food establishment engaging in a food preparation or processing method that the department determines requires a variance, based on the submission of plans and specifications in accordance with He-P 2304.12, an inspection finding, or a variance request;

(4) Any food establishment engaging in an activity specified under Food Code § 3-502.12; and

(5) Any food establishment which is required to have a HACCP plan by law.

(b) A complete HACCP plan shall include the following:

(1) A categorization of the types of TCS foods that are specified in the menu;

(2) A flow diagram by specific food or category type identifying critical control points and providing information on the following:

a. Ingredients, materials, and equipment used in the preparation of that food; and

b. Formulations or recipes that delineate methods and procedural control measures that address the food safety concerns involved;

(3) Food employee and supervisory training plan that addresses the food safety issues of concern;

(4) A statement of standard operating procedures for the plan under consideration including clearly identifying:

a. Each critical control point;

b. The critical limits for each critical control point;

c. The method and frequency for monitoring and controlling each critical control point by the food employee designated by the person in charge;

d. The method and frequency for the person in charge to routinely verify that the food employee is following standard operating procedures and monitoring critical control points;

e. Action to be taken by the person in charge if the critical limits for each critical control point are not met; and

f. Records to be maintained by the person in charge to demonstrate that the HACCP plan is properly operated and managed; and

(5) Additional scientific data or other information, as needed by the department to make its determination under (c) below, supporting the determination that food safety is not compromised by the proposal.

(c) The department shall review HACCP plans for compliance with all applicable sections of RSA 143, RSA 143-A, and He-P 2300 and notify the applicant or licensee as to whether the plan complies with these requirements.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2304.14 Variances

(a) Applicants or license holders seeking variances from specific rules or Food Code items shall complete and submit a “Variance Request Form” (VRFORM, 01-01-11) to the:

Department of Health and Human Services

Division of Public Health Services

Food Protection Section

29 Hazen Dr.

Concord, NH 03301

(603) 271-4589

(b) The variance request shall include:

(1) Specific reference to the rule or Food Code item for which a variance is being sought;

(2) Full explanation of why a variance is necessary;

(3) Full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health as the rule or Food Code item from which a variance is sought; and

(4) A HACCP plan if required under He-P 2304.13.

(c) The commissioner shall approve a request for variance if:

(1) The commissioner concludes that authorizing deviation from strict compliance with the rule or Food Code item from which a variance is sought does not contradict the intent of the rule or Food Code item; and

(2) The alternative proposed by the applicant or license holder ensures that the objective or intent of the rule or Food Code item from which a variance is sought will be accomplished.

(d) If a variance is approved, the license holder’s subsequent compliance with the alternatives approved in the variance shall be considered equivalent to complying with the rule or Food Code item from which a variance was sought.

(e) A variance shall be approved until the expiration of the current license or as specified by the department.

(f) No request for a variance concerning the rules of other state agencies which are referred to in this chapter shall be approved.

He P 2304.15 Trade Secrets and Confidentiality.

(a) The department shall treat as confidential, in accordance with RSA 350-B, information that meets the criteria specified in RSA 350-B for a trade secret and is contained on inspection report forms, in the plans and specifications submitted as specified under He P 2304.12, and in any HACCP plans submitted.

(b) Consumer complaints received regarding illness or sanitation of a food establishment shall have the name, address, and phone number or other identifying information of the individual making the complaint maintained as confidential and such information shall not be released without written permission of the complainant.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; amd by #9857-A, eff 2-1-11, (paras (c)-(f)), EXPIRED: 2-1-19; amd by #9857-B, eff 2-1-11, (paras (a)-(b)); ss by #12729, INTERIM, eff 2-21-19, EXPIRES:8-20-19; ss by #12852, eff 8-20-19
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2305 Inspections and Compliance

N.H. Code Admin. R. Ann. He-P 2305.01 Inspections

(a) For the purpose of determining compliance with RSA 143, RSA 143-A, and He-P 2300, as authorized by RSA 143:4 and RSA 143-A:6, II, the applicant or licensee shall admit and allow any department representative at any time to enter and inspect the following:

(1) The licensed food establishment, including any mobile food units or vehicles used by the licensee for the transportation or retail sale of food; and

(2) Any records required by RSA 143-A and He-P 2300, or pertaining to food and supplies purchased and distributed by the food establishment.

(b) At the time of inspection, or upon request, the applicant or licensee shall provide the department with the following:

(1) A list of persons employed; and

(2) Samples of food for bacteriological, chemical, and physical examination.

(c) The department shall conduct an inspection to determine full compliance with RSA 143, RSA 143-A, and He-P 2300, prior to:

(1) The issuance of a provisional license;

(2) The issuance of a full license:

(3) A change in ownership;

(4) A change in the licensee’s physical location;

(5) An upgrade in the license class;

(6) Occupation of space after construction, renovations, or structural alterations; or

(7) The renewal of a license when the department has determined, in the interest of public health and based on the licensee’s inspection and compliance history, that a renewal inspection is warranted.

(d) In addition to (c) above, the department shall conduct an inspection:

(1) Whenever the department has reason to believe a condition exists that places the food establishment in non-compliance with RSA 143, RSA 143-A, or He-P 2300; and

(2) As necessary to verify compliance with any corrective action plan (CAP) accepted by the department as part of an inspection.

(e) The applicant, owner, or person in charge shall be present at time of inspection.

(f) Upon completion of the inspection, the department shall complete a written inspection report in accordance with Food Code Annex 7, Form 3-A and Guide 3-B, or in the case of food processing plants and homesteads a “Food Processing Plant Inspection Report”.

(g) The inspection report shall contain:

(1) Specific factual observations of deficiencies which violate He-P 2300 or the Food Code and which require correction; and

(2) For all food establishments except food processing plants, a color designation, described in (i) below, based on the results of the inspection findings.

(h) The applicant, owner, or person in charge shall acknowledge receipt of the inspection report by signing the inspection report.

(i) Color designations shall be as follows:

(1) Green if there are no priority item violations identified or if all priority item violations identified are corrected immediately and permanently at the time of the inspection;

(2) Yellow if there are priority item violations identified and are not corrected immediately and permanently at the time of the inspection; and

(3) Red if it is determined that an imminent health hazard exists at the time of the inspection, the establishment has a failed corrective action plan or if the food establishment is found to be operating without a current, valid license.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2305.02 Correction of Deficiencies Identified During an Inspection

(a) All deficiencies identified in the inspection report shall be corrected at the time of inspection, as practicable.

(b) For all food establishments except food processing plants and homesteads, if a priority item violation is found during an inspection and cannot be corrected immediately and permanently in the presence of the inspector, the applicant or licensee shall:

(1) Agree to temporarily correct the priority item violation and to permanently correct it in a specified time frame, not to exceed 10 calendar days after the inspection; or

(2) Complete a CAP in the presence of the inspector in accordance with He-P 2305.03.

(c) For all food establishments except food processing plants and homesteads, if a violation of any items in Chapter 4, 5, or 6 of the Food Code is found during an inspection for an initial license or change of ownership license, and it cannot be corrected immediately in the presence of the inspector, the applicant or licensee shall:

(1) Agree to temporarily correct the deficiency and to permanently correct it in a specified time frame, not to exceed 10 calendar days after the inspection; or

(2) Complete a CAP in the presence of the inspector in accordance with He-P 2305.03.

(d) For food processing plants and homesteads, if any violation is found during an inspection and cannot be corrected immediately and permanently in the presence of the inspector, the applicant or licensee shall:

(1) Agree to temporarily correct the violation and to permanently correct it in a specified time frame, not to exceed 10 calendar days after the inspection; or

(2) Complete a CAP in the presence of the inspector in accordance with He-P 2305.03.

(e) All priority foundation items shall be corrected in a timely manner not to exceed 10 days.

(f) All core items shall be corrected in a timely manner, not to exceed 90 days.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2305.03 Corrective Action Plan

(a) When a deficiency identified in the inspection report cannot be corrected either immediately and permanently in the presence of the inspector or permanently within 10 calendar days after the inspection, pursuant to He-P 2305.02(b), (c), or (d), the licensee shall complete, date, and sign, at the time of inspection, a Corrective Action Plan form (CAPAPP, 01-01-11) provided by the inspector, including:

(1) How the licensee intends to correct each deficiency;

(2) The date by which each deficiency shall be corrected; and

(3) What measures will be put in place to ensure that the deficiency does not recur.

(b) The department shall review and accept each CAP that:

(1) Achieves compliance with RSA 143, RSA 143-A, and He-P 2300;

(2) Addresses all deficiencies and deficient practices as cited in the inspection report;

(3) Prevents a new violation of RSA 143, RSA 143-A, or He-P 2300 as a result of the implementation of the CAP; and

(4) Specifies the date upon which the deficiencies will be corrected.

(c) The department shall verify the implementation of any CAP that has been accepted by:

(1) Reviewing materials submitted by the licensee;

(2) Conducting a follow-up inspection; or

(3) Reviewing compliance during a renewal inspection.

(d) If the department finds the licensee to be out of compliance with the CAP by the specified completion date at the time of the next inspection, the department shall:

(1) Impose applicable fines, in accordance with He-P 2306.02(a)(13);

(2) Revoke the license in accordance with He-P 2306.03(a)(7); and

(3) Deny the application for a renewal of a license, as applicable, in accordance with He-P 2304.03(d)(2).

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; amd by #9857-A, eff, 2-1-11, (paras (b)-(d), EXPIRED: 2-1-19; amd by #9857-B, (para (a)), eff 2-1-11; ss by #12729, INTERIM, eff 2-21-19, EXPIRES:8-20-19; ss by #12852, eff 8-20-19

Part He-P 2306 Enforcement Actions

N.H. Code Admin. R. Ann. He-P 2306.01 Enforcement Actions and Notice of Right to Appeal

(a) The department shall impose enforcement actions for violations of RSA 143, RSA 143-A, or He-P 2300, including the following:

(1) Imposing fines upon an applicant, licensee, or unlicensed individual;

(2) Denying a license application;

(3) Revoking a license; or

(4) Immediately closing the food establishment pursuant to He-P 2306.06.

(b) When imposing a fine, denying a license application, or revoking a license, the department shall send to the applicant or licensee a written notice that sets forth:

(1) The action to be taken by the department;

(2) The reasons for the action, including the identification of each deficiency as applicable; and

(3) The right of the applicant or licensee to request a hearing in accordance with RSA 541-A, He-C 200, and He-P 2306.04 prior to the enforcement action becoming final.

(c) No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 143, RSA 143-A, RSA 541-A:30, III, or He-P 2300.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2306.02 Administrative Fines

(a) The department shall impose fines as follows:

(1) For providing false or misleading information on or with an application, in violation of He-P 2304.01(a), He-P 2311.01(a), or He-P 2304.12(a), the fine shall be $1,000;

(2) For failure to operate a food establishment only in the manner in which licensed to do so, in violation of He-P 2304.02(j), the fine shall be $500;

(3) For failure to cooperate during an inspection of a food establishment, including but not limited to failing to allow department representatives or inspectors to inspect food establishment premises, vehicles, and records at all times, in violation of He-P 2305.01, the fine shall be $2,000;

(4) For failure to notify the department by telephone within 24 hours of any fire or other disaster that jeopardizes the safety or sanitation of food provided in food establishments, in violation of He-P 2306.06(a), the fine shall be $250;

(5) For failure to notify the department pursuant to He-P 2304.08(a) at least 30 days prior to a food establishment ownership change, the fine shall be $500;

(6) For failure to notify the department pursuant to He-P 2304.10(a) at least 30 days prior to the change of location of a food establishment, the fine shall be $500;

(7) For failure to submit a plan for review as required in He-P 2304.12(a) and (b), the fine shall be $300;

(8) For failure to discard food as required by Food Code 3-701.11, the fine shall be $500;

(9) For failure to cease operation upon notification by the department to do so, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(10) For failure to cease operation when an application has been denied, or when a license has been revoked, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(11) For a violation of the same priority item on more than 2 consecutive inspections, the fine shall be $500;

(12) For failure to pay an administrative fine within 30 days of its imposition, or within 30 days of the decision to uphold the imposition of a fine that was appealed, the fine shall be $500. Each day until the expiration of the current license, that a license holder fails to pay such a fine shall be considered a separate offense subject to an additional $500 fine;

(13) For a failure to comply with any CAP that has been accepted by the department, the fine shall be $500;

(14) For operation of a food service establishment without obtaining a food service license, as required by RSA 143-A:4, the fine shall be $1,000. Each day that a food establishment operates without a license shall be considered a separate offense subject to an additional $500 fine;

(15) For failure to submit a HACCP plan for review if required by the department in accordance with He-P 2304.13, the fine shall be $500;

(16) For failure to display a valid license, in accordance with He-P 2304.02(l), the fine shall be $200;

(17) For failure of an applicant, owner, or person in charge to be present at the time of inspection and demonstrate the knowledge required by section 2-102.11 of the Food Code which are pertinent to the risks inherent to the specific food establishment, in violation of He-P 2305.01(e), the fine shall be $250;

(18) For violating a variance approved in accordance with He-P 2304.14, the fine shall be $500;

(19) For failure to submit a timely renewal application, in violation of He-P 2304.03(b), the fine shall be $75;

(20) For failure of an exempt or non-exempt homestead food operation to label products in accordance with He-P 2310.01(d) or He-P 2311.04, the fine shall be $250 per product line;

(21) For failure of a poultry producer or a rabbit producer to comply with training requirements of He-P 2313.02, the fine shall be $500;

(22) For failure to cooperate during an outbreak investigation in violation of He-P 2313.01, the fine shall be $500;

(23) For failure to maintain files, for at least 90 days, on the receipt of purchase of uninspected poultry or uninspected rabbits in accordance with RSA 143-A:15, II, the fine shall be $500;

(24) For failure to correctly label a menu relative to the sale of uninspected, poultry or uninspected rabbits in accordance with He-P 2314.01, the fine shall be $500;

(25) For failure to comply with the requirements for a certified food protection manager in accordance with He-P 2303.02, the fine shall be $250;

(26) For failure to cease operations after a license has expired, the fine shall be $250. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $50 fine;

(27) For failure to label wild mushrooms or retain records in accordance with RSA 143-A:23, the fine shall be $500;

(28) For failure to maintain files, for at least 90 days, on the receipt of purchase of wild mushrooms, in accordance with RSA 143-A:24, the fine shall be $500; and

(29) For identifying, harvesting, or distributing wild mushrooms without having a license in accordance with RSA 143-A:23, the fine shall be $1000.

(b) Except for violations of (a)(19) above, each day that an individual or licensee continues to be in violation of the provisions of RSA 143, RSA 143-A, or He-P 2300 shall constitute a separate violation and shall be fined in accordance with this section.

(c) Payment of any imposed fine to the department shall meet the following requirements:

(1) Payment shall be made in the form of check, money order, or on-line payment made payable to the “Treasurer, State of New Hampshire” in the exact amount due;

(2) Money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds; and

(3) Any payment made to the department by check which is returned for insufficient funds, and which an individual, applicant, or licensee has not made good by submitting money order or certified check within 2 business days of notification by the department, including any penalty assessment allowed by RSA 6:11-a, shall be grounds for revocation of the license.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; amd by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19; ss by #13428, eff 8-5-22

N.H. Code Admin. R. Ann. He-P 2306.03 Denial or Revocation of a License

(a) The department shall deny an application or revoke a license if:

(1) The operation of the licensed establishment immediately endangers public health or safety;

(2) An applicant or licensee has failed to pay any applicable fee in accordance with He-P 2304.05 or any administrative fine imposed under He-P 2306.02 or any other court authorized sanction or fee;

(3) An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee and additional charges in the form of money order or certified check within 2 business days of notification by the department;

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 2304.02(c);

(5) An applicant, licensee, or any representative or employee of the applicant or licensee:

a. Provides false or misleading information to the department;

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

c. Fails to provide, upon request, information or documents to the department;

(6) There is a deficiency identified in the inspection report and the applicant or licensee does not either correct it or complete a CAP in accordance with He-P 2305.02(b) or (c);

(7) The licensee fails to implement or continue to implement a CAP that has been accepted by the department in accordance with He-P 2305.03(d);

(8) The licensee is cited 2 or more times under RSA 143, RSA 143-A, or He-P 2300 for the same priority violation within the last 12 months or the last 5 inspections; or

(9) A food establishment fails to implement an approved HACCP plan in accordance with He-P 2304.13;

(b) Reapplication for a license after revocation, pursuant to RSA 143-A:6, I, shall require submission of:

(1) A written application for a license to the department, completed in accordance with He-P 2304.01;

(2) A corrective action plan, completed in accordance with He-P 2305.03; and

(3) Written proof that subsequent to the revocation, the person in charge has taken and passed a food safety class that meets the standards of The Conference for Food Protection as described in Food Code subparagraph 2-102.20.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2306.04 Request for an Administrative Hearing

(a) An applicant or licensee shall have 10 calendar days after receipt of the notice of an enforcement action to request in writing a hearing to contest the action.

(b) If a written request for a hearing is not received pursuant to (a) above, the applicant or licensee waives his right to a hearing and the action of the department shall become final.

(c) Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

(d) For administrative fines, the fines shall be paid to the department no later than 30 days from the receipt of the notice, unless a hearing has been requested.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2306.05 Effect of Denial of License Application, Revocation of License, or Expired License

(a) Any applicant who has been denied a license or renewal license shall not operate or shall cease operation of the food establishment for which the license or renewal license was denied within 10 calendar days after receipt of the denial notice, unless a timely appeal is submitted.

(b) If a license is revoked by the department, the food establishment shall cease operation of the food establishment within 10 calendar days after receipt of the revocation notice, unless a timely appeal is submitted.

(c) If a food establishment is subject to immediate closure as defined in RSA 143:5-a, the food establishment shall immediately cease operation pending reinspection and pursuant to the adjudicative proceedings provisions of RSA 541-A.

(d) If a license expires without a timely application for renewal having been made, the food establishment shall immediately cease operation of the food establishment.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2306.06 Closure

(a) A licensee shall immediately discontinue operations and notify the department at 603-271-4589, or if at night or during weekends at 603-271-5300, if an imminent health hazard shall exist because of an emergency such as:

(1) Interruption of water service that lasts for 2 or more hours;

(2) Whenever a drinking water sample is found to have E. coli bacteria or exceed the MCL for nitrates or nitrites described by He-P 2304.06(f);

(3) A failed sewer system or a sewage backup into the food establishment;

(4) Interruption of electrical service for 2 or more hours;

(5) A fire affecting a food establishment;

(6) Flooding in a food establishment;

(7) Chemical exposure in a food establishment;

(8) Any other natural disaster or catastrophic event that could result in contamination of the food supply;

(9) An employee has been found to be infected with a communicable disease as described in Food Code subparagraph 2-201.11 (A)(2); or

(10) Any other severe unsanitary conditions that threaten to contaminate the food establishment and its food supply.

(b) A licensee shall not be required to discontinue operations in an area of the food establishment that is unaffected by the imminent health hazard.

(c) If operations are discontinued as specified in (a) above, the licensee shall obtain approval from the department before resuming operations.

(d) Considering the nature of the potential hazard involved and the complexity of the corrective action needed, the department may agree to continuing operations in the event of an extended interruption of electrical or water service if:

(1) A written emergency operating plan has been approved;

(2) Immediate corrective action is taken to eliminate, prevent, or control any food safety risk and imminent health hazard associated with the electrical or water service interruption; and

(3) The department is informed upon implementation of the written emergency operating plan.

(e) The department shall approve the resumption of operations if the imminent health hazard no longer exists or the licensee has offered a plan to mitigate all threats to health or safety.

(f) The failure to include other violations, practices, circumstances, or events in this section shall not be construed as a determination that other violations, practices, circumstances, or events are not or shall not be considered an imminent health hazard.

(g) The commissioner’s order of an immediate closure of a food establishment shall be in accordance with the provisions of RSA 143:5-a.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2307 Employee Health

N.H. Code Admin. R. Ann. He-P 2307.01 Suspected or Confirmed Foodborne Disease

(a) All suspected or confirmed foodborne illness outbreaks possibly occurring from food prepared or offered by a food establishment shall be reported to the department’s bureau of infectious disease control at 603-271-4496, or if at night or during weekends at 603-271-5300 within 24 hours.

(b) Pursuant to RSA 141-C:9, II, during a suspected or confirmed foodborne disease outbreak, as determined by the department, all food employees in the implicated food establishment shall submit biological specimens upon department request.

(c) During a suspected or confirmed foodborne disease outbreak, as determined by the department, any food employee who has had any of the symptoms specified in Food Code subparagraph 2-201.11 (A)(1) within the previous 2 weeks shall be excluded from work until the appropriate biological specimens requested by the department under RSA 141-C:9, II, are submitted and found to be negative.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2307.02 Reporting by the Person in Charge

(a) The person in charge shall notify the department’s bureau of infectious disease control at 603-271-4496, or if at night or during weekends at 603-271-5300, of a food employee, or a person who applies for a job as a food employee, who is diagnosed with, or suspected of having, an illness or condition specified in Food Code subparagraph 2-201.11 (B), including:

(1) Jaundice;

(2) Norovirus;

(3) Hepatitis A virus;

(4) Shigella spp.;

(5) Enterohemorrhagic or shiga toxin-producing Escherichia coli;

(6) Salmonella Typhi; or

(7) Salmonella nontyphoidal.

(b) The person in charge shall report infectious and communicable disease as required by He-P 301, as applicable.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2308 Special Requirements for Bed and Breakfast Facilities

N.H. Code Admin. R. Ann. He-P 2308.01 Application Requirements

Food service establishments applying for a license as a bed and breakfast facility shall comply with all of the application requirements of He-P 2304.01, except that they shall not be required to submit a plan review application as required under He-P 2304.01(a)(5) and wastewater items as required under He-P 2304.01(a)(4) and He-P 2304.07.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2308.02 Basic Requirements

A bed and breakfast facility shall comply with He-P 2302 through He-P 2307, however the following exceptions to the Food Code shall apply:

(a) Commercial equipment shall not be required;

(b) The kitchen shall be equipped with either:

(1) A 2-compartment sink; or

(2) A residential model dishmachine and a one-compartment sink;

(c) A sink used for food preparation shall not be required to be equipped with an indirect wasteline;

(d) A backflow device shall not be required for kitchen sinks provided with a spray hose;

(e) Coved base at the juncture of the floor and wall shall not be required;

(f) Only those bathrooms which open directly into the kitchen or into any hallway leading into the kitchen shall be required to have self-closing doors and mechanical ventilation;

(g) The kitchen shall not be required to be separated from any living area or sleeping area by complete partitioning or solid, self-closing doors; and

(h) Laundry facilities shall:

(1) Be allowed in the kitchen; and

(2) Not be used during processing, preparing, serving, or packaging of foods related to the business.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2308.03 Sanitization

Dishes, utensils, and food contact equipment and surfaces shall undergo sanitization as required in Food Code 4-703.11, except that sanitization, if done in the 2 compartment sink, shall occur in the second compartment after the dishes, utensils, and food contact equipment have been rinsed with clean water.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2309 Special Requirements for Food Processing Plants

N.H. Code Admin. R. Ann. He-P 2309.01 Application Requirements

A food service establishment applying for a license as a food processing plant shall:

(a) Comply with all of the application requirements described in He-P 2304.01;

(b) Submit with the application a list of all food products to be produced in the food processing plant;

(c) Submit a HACCP plan as part of the application as required by He-P 2304.13; and

(d) Submit a copy of a finished product label.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10867, eff 6-25-15; ss by #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2309.02 Basic Requirements

Food processing plants shall:

(a) Provide an updated list of food products to the department whenever new products are added;

(b) If thermally processing and packaging low-acid foods in hermetically sealed containers, comply with applicable federal regulations under the Code of Federal Regulations in 21 CFR 113 and 21 CFR 117;

(c) If processing acidified foods, comply with applicable federal regulations under Code of Federal Regulations in 21 CFR 114 and 21 CFR 117; and

(d) Maintain production records and distribution records of all products produced.

History

• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2309.03 Food Processing Plant Standards

(a) Those food establishments licensed as food processing plants shall be exempt from the requirements of the Food Code and shall instead comply with the requirements in this section.

(b) All food shall be from an approved source, as follows:

(1) “Approved source” means a source of food that has been inspected by a federal, state, or local agency that has the authority, responsibility, and the technical ability to evaluate food for safety in protection of public health;

(2) Raw agricultural plant commodities and products under the oversight of New Hampshire department of agriculture under RSA 426, RSA 427, RSA 428, RSA 429, and RSA 434 that do not require inspection shall be considered to be from an approved source; and

(3) Poultry that is exempt from federal inspection under the Poultry Products Inspection Act 21 USC 464(c)(4) shall not be considered to be from an approved source.

(c) All food products shall be stored in original containers. If food products are removed from the original container, they shall be stored in labeled and closed containers. Containers shall be of a material that will not cause the food to become adulterated.

(d) All food shall be in sound condition, free from spoilage, filth, or other contamination, and shall be safe for human consumption.

(e) All TCS food shall be refrigerated at 41°F or lower, or held at 135°F or higher, to control bacterial growth.

(f) Food storage facilities shall be kept clean and located to protect food from unsanitary conditions or contamination from any source at all times.

(g) The floors, walls, ceilings, utensils, machinery, equipment, and supplies in the food preparation area and all vehicles used in the transportation of food shall be kept thoroughly clean.

(h) All food contact surfaces shall be kept clean and undergo sanitization as frequently as necessary to protect against the contamination of food.

(i) All food contact surfaces shall be non-toxic, easy to clean, smooth, nonabsorbent, and free of cracks or open seams.

(j) All food shall be protected against insects and rodents at all times. Outside doors, windows, and other openings shall be fitted with screens and self-closing doors, if not otherwise protected. No dogs, cats, or other pets shall be allowed in the room where food is prepared or stored.

(k) All garbage and refuse shall be kept in containers and removed from the premises regularly to prevent insects and rodents, offensive odors, or health or fire hazards. Garbage and refuse containers shall be durable, easy to clean, insect- and rodent-resistant, and of material that neither leaks nor absorbs liquid.

(l) Employees shall be free from contagious or communicable diseases, sores, or infected wounds, and shall keep their hair covered and restrained.

(m) Employees shall keep themselves and their clothing clean. Hands shall be washed as frequently as necessary to maintain good sanitation.

(n) Employees shall not smoke while handling or preparing food or in food preparation or storage areas.

(o) All establishments shall have an adequate supply of hot and cold potable water under pressure from an approved source.

(p) All establishments shall have toilet facilities, which do not open directly into food processing areas, equipped with a hand washing lavatory, complete with hot and cold potable water under pressure and hand soap. A supply of sanitary towels or a hand-drying device providing heated air shall be conveniently located near the hand-washing facility.

(q) Hand sinks shall be conveniently located to all food processing areas.

(r) Adequate lighting shall be provided where food is stored, processed, or examined.

(s) Adequate ventilation shall be provided to eliminate objectionable odors and vapors, including steam, and constructed in such a manner as to avoid possible airborne contamination.

(t) Poisonous or toxic materials shall be stored so they cannot contaminate food, equipment, utensils, linens, and single-service, and single-use articles.

(u) Food processing plants shall comply with all provisions of the state plumbing code as included as part of the state building code defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

History

• #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2309.04 Labeling of All Packaged Foods

All packaged food shall bear a label showing:

(a) The common or usual name of the product;

(b) The name and address of the manufacturer’s, packer’s, or distributor’s business which shall:

(1) In the case of an individual, partnership, or association be the name under which the business is conducted;

(2) In the case of a corporation, be the name of the parent corporation; or

(3) Where the food is not processed by the person whose name appears on the label, the name on the label shall be qualified by a phrase which reveals the connection such a person has with the food, including but not limited to, “Manufactured for _____”, “Distributed by _____”, or any other wording which expresses the facts;

(c) The ingredients in descending order of predominance by weight;

(d) The net weight, volume, or numerical count in both U.S. customary and metric; and

(e) A product code which includes date of manufacture, container size, and product lot or batch number to aid in a recall of product in case of a public health hazard.

History

• #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2309.05 Recall Procedure

(a) The food processing plant shall develop and maintain on file a written procedure for the recall of their product, including procedures for the notification of the department and consumers and the removal of the product from commerce.

(b) Production and distribution records shall be used to enable location of products if a recall is initiated.

(c) A food processing plant shall recall any product which the food processing plant or the department knows or has reason to believe might adversely affect the health and safety of the public.

(d) A food processing plant that knows that the standard of quality has been violated or has reason to believe that circumstances exist which might adversely affect the safety of the product shall notify the department within 24 hours of learning of the violation or circumstances.

(e) Circumstances in (d) requiring notification shall include, but are not limited to, source contamination, spills, accidents, natural disasters, or breakdowns in treatment processes.

(f) If the department determines that the circumstances present an imminent health hazard and that consumer notification or product recall can significantly minimize the threat to health and safety of the public, the department shall advise the food processing plant to initiate a product recall.

(g) In cases of a product recall, the food processing plant shall disseminate notification of the recall to all wholesale and retail outlets to which the product was distributed.

(h) If directed by the department, the food processing plant shall issue notification to consumers who might be affected by the recall using such methods, including the media, as will assure timely notification to the consumers.

History

• #9857-A, eff 2-1-11, EXPIRED: 2-1-19
• #12729, INTERIM, eff 2-21-19, EXPIRES: 8-20-19; ss by #12852, eff 8-20-19

Part He-P 2310 Homestead Food Operations Exempt from Licensure and Inspection

N.H. Code Admin. R. Ann. He-P 2310.01 Exempt Homestead Food Operations Requirements

(a) Pursuant to RSA 143-A:5, VII, homestead food operations selling food, excluding potentially hazardous food, from the homestead residence, at the owner’s farm stand, at farmers’ markets, or at retail food stores shall be exempt from licensure under this subdivision.

(b) Only the following food products shall be produced and sold from exempt homestead food operations:

(1) Baked items, including, breads, rolls, muffins, cookies, brownies, and cakes;

(2) Double-crusted fruit pies;

(3) Candy and fudge;

(4) Packaged dry products, which include spices and herbs;

(5) Acid foods, including vinegars and mustards; and

(6) Jams and jellies.

(c) Exempt homestead food operations shall not produce or sell potentially hazardous foods, including any food which requires refrigeration or processed acidified and low acid canned foods.

(d) All homestead food products made in an exempt homestead food operation shall be sold in packages with individual labels on each package containing the following information:

(1) Name of the homestead food operation;

(2) Address of the homestead food operation;

(3) Phone number of the homestead food operation;

(4) Name of the homestead food product;

(5) All ingredients of the homestead food product in descending order of predominance by weight;

(6) The name of each major food allergen contained in the homestead food product unless it is already part of the common or usual name of the respective ingredient already disclosed in the ingredient statement in (5) above;

(7) The following statement: “This product is exempt from New Hampshire licensing and inspection” in at least the equivalent of 10 point font and a color that provides a clear contrast to the background; and

(8) A product code which identifies the product with a batch number, or a date of manufacture to aid in a recall of the product in case of an imminent health hazard.

(e) Exempt homestead food operations shall follow the standards for non-exempt homestead operations as stated in He-P 2309.03(b) through (t), He-P 2311.06(b) through (i), and shall be exempt from the requirements of the food code.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; amd by #10956, eff 10-22-15; ss by #12852, eff 8-20-19; ss by #13883, eff 2-22-24

Part He-P 2311 Non-Exempt Homestead Food Operations

N.H. Code Admin. R. Ann. He-P 2311.01 Application Requirements

(a) Non-exempt homestead food operations shall apply for a Class H food service license.

(b) Non-exempt homestead food operations applying for a Class H license shall comply with all of the application requirements of He-P 2304.01 except that:

(1) They shall not be required to submit the plan review application required under He-P 2304.01(a)(5) and wastewater items required under He-P 2304.01(a)(4) and He-P 2304.07;

(2) They shall submit process review documentation in accordance with He-P 2311.03, as applicable; and

(3) They shall also submit the following:

a. A copy of one finished product label which meets the requirements of He-P 2311.04 below; and

b. A list of all products to be manufactured.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2311.02 Approved Products

Only the following food products shall be produced and sold from a non-exempt homestead food operations:

(a) Baked items, including, breads, rolls, muffins, cookies, brownies, and cakes;

(b) Double-crusted fruit pies;

(c) Candy and fudge;

(d) Packaged dry products, which include= spices and herbs;

(e) Acid foods, including vinegars and mustards; and

(f) Jams and jellies.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2311.03 Prohibited Products

Non-exempt homestead food operations shall not produce or sell potentially hazardous foods, including any food which requires refrigeration or processed acidified and low acid canned foods.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2311.04 Labeling Requirements

All homestead food products made in a non-exempt homestead food operation shall be sold in packages with individual labels on each package containing the following information:

(a) Name of the homestead food operation;

(b) Address of the homestead food operation;

(c) Phone number of the homestead food operation;

(d) Name of the homestead food product;

(e) All ingredients of the homestead food product in descending order of predominance by weight;

(f) The net weight, volume, or numerical count in both US customary and metric;

(g) The name of each major food allergen contained in the homestead food product unless it is already part of the common or usual name of the respective ingredient already disclosed in the ingredient statement in (e) above;

(h) The following statement: “This product is made in a residential kitchen licensed by NH DHHS” in at least the equivalent of 10 point font and a color that provides a clear contrast to the background; and

(i) A product code which includes date of manufacture, container size and product lot or batch number to aid in a recall of product in the case of an imminent health hazard.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #10867, eff 6-25-15; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2311.05 Process Review Required

(a) Non-exempt homestead food operations which are licensed and produce homestead food products listed in He-P 2311.02(f) that do not use recipes approved by the National Center for Home Food Preservation shall comply with the following:

(1) A process review shall be conducted by a food processing authority on each product prior to its being produced by the license holder. If the food processing authority declares in writing that there are no biological concerns with the food after evaluating the scheduled process, the food shall be allowed to be produced;

(2) License holders shall keep records of all pHs on file and available for review by the regulatory authority upon request;

(3) A process review shall be conducted for a product that has been previously tested if the ingredients are altered or the process changes;

(4) License applicants shall submit process review documentation with the license application in accordance to He-P 2311.01; and

(5) License holders shall keep all process review information on file and available for review by the regulatory authority upon request.

(b) A list of food processing authorities described in (a)(1) above and a list of recipes approved by the National Center for Home Food Preservation, described in (a) above, or a website link to the same, shall be available on the department’s website at https://www.dhhs.nh.gov/dphs/fp/documents/processing-faqs.pdf.

History

• #2802, eff 8-8-84; ss by #5051, eff 1-22-91; EXPIRED 1-22-97
• #6503, Interim, eff 4-25-97; EXPIRED 8-23-97
• #6722, eff 3-27-98; ss by #7893, eff 5-21-03; ss by #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #12852, eff 8-20-19

N.H. Code Admin. R. Ann. He-P 2311.06 Non-Exempt Homestead Standards

(a) Non-exempt homestead food operations shall be exempt from the requirements of the Food Code, and shall instead comply with the requirements of He-P 2309.03 and the requirements in this section.

(b) Commercial equipment shall not be required.

(c) The kitchen shall be equipped with either:

(1) A 2-compartment sink; or

(2) A residential model dishmachine and a one-compartment sink.

(d) A sink used for food preparation shall not be required to be equipped with an indirect wasteline.

(e) A backflow device shall not be required for kitchen sinks provided with a spray hose.

(f) Coved base at the juncture of the floor and wall shall not be required.

(g) Only those bathrooms which open directly into the kitchen or into any hallway leading into the kitchen shall be required to have self-closing doors and mechanical ventilation.

(h) The kitchen shall not be required to be separated from any living area or sleeping area by complete partitioning or solid, self-closing doors.

(i) Laundry facilities shall:

(1) Be allowed in the kitchen; and

(2) Not be used during processing, preparing, serving, or packaging of foods related to the business.

History

• #9857-A, eff 2-1-11; ss by #10199-A, eff 10-12-12; ss by #12852, eff 8-20-19

Part He-P 2312 Poultry Producers and Rabbit Producers Selling Poultry and Rabbits to Restaurants Licensed Under Rsa 143-a

N.H. Code Admin. R. Ann. He-P 2312.01 Requirements for Poultry Producers and Rabbit Producers to Sell to Restaurants Licensed Under RSA 143-A

REVISION NOTE:

Document #12852, effective 8-20-19, readopted, readopted with amendment, or repealed existing rules in Chapter He-P 2300. The rules repealed were Part He-P 2312 titled “Out of State Food Producers in Residential, Non-Commercial Kitchens”, containing He-P 2312.01 titled “Registration of Out-of-State Producers in Residential, Non-Commercial Kitchens.” Document #12852 also readopted with amendment and renumbered Part He-P 2313 and Part He-P 2314 as Part He-P 2312 and Part He-P 2313, respectively.

Document #12852 replaces all prior filings affecting the rules in Chapter He-P 2300. The prior filings affecting the repealed Part He-P 2312 included the following documents:

#2802, effective 8-8-84, EXPIRED 8-8-90

#5051, effective 1-22-91, EXPIRED 1-22-97

#6503, INTERIM, effective 4-25-97, EXPIRED 8-23-97

#6722, effective 3-27-98

#7893, effective 5-21-03

#9857-A, effective 2-1-11, EXPIRED 2-1-19

#9857-B, effective 2-1-11

#10867, effective 6-25-15

Poultry producers and rabbit producers who are exempt from food service licensure under RSA 143-A:5, VIII, but who sell to restaurants licensed under RSA 143-A shall:

(a) Register with the NH department of agriculture, markets, and food pursuant to RSA 143-A:16, I(b);

(b) Complete an education course meeting the requirements of He-P 2312.02 at a minimum of every 5 years;

(c) Maintain production records showing that no more than 20,000 whole poultry or 1,000 rabbits are offered to restaurants within a calendar year;

(d) Label each poultry and rabbit with the following information:

(1) The name of the producer;

(2) The address of the producer;

(3) The date of slaughter of the poultry or rabbit; and

(4) Safe handling instructions as stated in the Food Code Section 3-201.11(F); and

(e) Provide information to the department during an investigation of a foodborne illness outbreak linked to any poultry or rabbits supplied by the producer.

(f) Prior to selling poultry or rabbit to restaurants, poultry and rabbit producers who are exempt and meet the requirements of this section shall obtain documentation from the NH department of agriculture, markets, and food that shows:

(1) Registration with NH department of agriculture, markets, and food; and

(2) Completion of the education course as set forth in He-P 2312.02 below.

(g) Documentation obtained in (f) shall be presented to any licensed restaurant to demonstrate that the producer has met the requirements of RSA 143-A:16, RSA 143-A:17 and these rules.

History

• #10867, eff 6-25-15; ss by #12852, eff 8-20-19 (formerly He-P 2313.01) (See Revision Note at part heading for He-P 2312)

N.H. Code Admin. R. Ann. He-P 2312.02 Education Requirements for Poultry Producers and Rabbit Producers Exempt from Food Service Licensure

(a) Producers shall complete department approved training, offered by UNH Cooperative Extension or another training program which includes training in required slaughtering, processing, packaging, handling, labeling, transportation practices, and any other specific requirements for producers set forth in RSA 143-A:14-16.

(b) Producers shall complete the training in (a) above every 5 years.

(c) A producer shall provide proof of successful completion of the required training to the department of agriculture, markets and food with its registration.

(d) At a minimum, one individual involved in the producer’s operations shall obtain the required training.

(e) The producer shall maintain records of the completed training.

History

• #10867, eff 6-25-15; ss by #12852, eff 8-20-19 (formerly He-P 2313.02) (See Revision Note at part heading for He-P 2312)

Part He-P 2313 Requirements for Restaurants Licensed to Sell Rabbit or Poultry Exempt from Inspection

N.H. Code Admin. R. Ann. He-P 2313.01 Requirements for Restaurants Licensed Under RSA 143-A to Sell Rabbit or Poultry That are Exempt from Inspection Pursuant to RSA 143-A:15

(a) Restaurants shall only offer uninspected poultry or rabbits from poultry producers or rabbit producers that meet the requirements of He-P 2312.

(b) Restaurants shall maintain receipts of purchase of uninspected poultry or uninspected rabbits for 90 days, which include the following information:

(1) The date of purchase;

(2) The name of the poultry producer or rabbit producer;

(3) The address of the producer; and

(4) The phone number of the producer.

(c) The restaurant shall label any menu item containing uninspected poultry or uninspected rabbits in font at least 10 point, and in a color that provides clear contrast to the background, and which states the following: “This product has been raised and processed on a New Hampshire farm and is exempt from state and federal inspection.”

History

• #10867, eff 6-25-15; ss by #12852, eff 8-20-19 (formerly He-P 2314.01) (See Revision Note at part heading for He-P 2312)

Part He-P 2314 Requirements for Wild Mushroom Indentifiers, Harvesters and Distributors of Wild Mushrooms to Food Establishments or Private Individuals as Food

N.H. Code Admin. R. Ann. He-P 2314.01 Initial and Renewal Application Requirements

(a) A person applying for a license to harvest, identify, or distribute tier 1 mushrooms shall complete and submit to the department an “Application for License for Wild Mushroom Harvesters, Identifiers, and Distributors” (June 2022) and the following:

(1) Proof of successful completion of an education course on tier 1 mushrooms as described in He-P 2314.03, meeting the requirements of He-P 2314.02; and

(2) A $75 licensing fee by check, money order, or online payment by credit card at www.dhhs.nh.gov .

(b) A person applying for a license to harvest, identify, or distribute tier 2 mushrooms shall complete and submit to the department an “Application for License for Wild Mushroom Harvesters, Identifiers, and Distributors” (June 2022) and the following:

(1) Proof of successful completion of an education course on tier 2 mushrooms as described in He-P 2314.03, meeting the requirements of He-P 2314.02; and

(2) A $75 licensing fee by check, money order, or online payment by credit card at www.dhhs.nh.gov .

(c) Upon receipt of a completed application, the department shall issue a tier specific license.

(d) A licensee shall only identify, harvest, or distribute mushrooms from the tier list corresponding to the tier license they hold, except a tier 2 licensee who may also identify, harvest, and/or distribute mushrooms from the tier 1 list.

(e) A license shall be valid for 5 years from the date of issuance.

(f) A licensee shall renew their license by submitting to the department at least 30 days prior to their current license expiration:

(1) A completed renewal application, provided by the department for the purpose of updating any contact information;

(2) Proof of completion of an on-line renewal course as described in He-P 2314.02(b); and

(3) A $30 renewal fee.

History

• #13428, eff 8-5-22

N.H. Code Admin. R. Ann. He-P 2314.02 Education Requirements for Wild Mushroom

Harvester, Identifiers, Distributors.

(a) The education course to satisfy the application requirements in He-P 2314.01(a) and (b) for a wild harvested mushroom license shall include the following:

(1) Identification of mushrooms of tier 1 mushrooms as described in He-P 2314.03;

(2) Identification of mushrooms of tier 2 mushrooms as described in He-P 2314.04 for those applicants seeking a tier 2 mushroom license;

(3) Appropriate locations from which to harvest mushrooms;

(4) The safe handling and storage of mushrooms;

(5) Record keeping requirements and ethics of harvesting;

(6) No less than 12 hours of in-person instruction with a mandatory online preparation module developed by the course instructor to include the basics of harvesting and handling of wild mushrooms, accompanied photos of mushrooms listed in He-P 2314.03 and He-P 2314.04, and any other specific requirements for producers set forth in RSA 143-A:21-28 or at least 4 hours with documentation from the course provider for abbreviated course; and

(7) A certificate issued to a student indicating successful completion of the course which shall specify the tier of mushrooms the student has demonstrated proficiency in identifying.

(b) The online refresher education course to satisfy the application requirement He-P 2314.01(g) to renew a wild harvested mushroom license shall include a review of the following topics:

(1) Identification of mushrooms;

(2) Appropriate locations from which to harvest mushrooms;

(3) The safe handling and storage of mushrooms;

(4) Record keeping requirements and ethics of harvesting;

(5) A certificate issued to a student indicating successful completion of the course.

(c) An applicant shall provide proof of successful completion of the required training to the department with license application. Successful completion includes passing a standardized test provided by the course instructor, on course material with a score of at least 70 percent.

(d) Course instructors shall hold a bachelor’s degree in mycology or provide to the department proof of one year of documented instruction of course material with at least 2 references, one character and one professional.

He-P 2314. 03 List of Tier 1 Wild Harvested Mushrooms. Tier 1 mushrooms shall include:

(a) Morel (Morchella spp. - M. americana Clowez & Matherly, M. angusticeps Pk., M. elata Fr., M. punctipes Pk);

(b) Chanterelle (Cantharellus spp. - Cantharellus cinnabarinus (Schwein.) Schwein. C. flavus Foltz & Volk, C. lateritius (Berk.) Singer, C. minor Pk., C. roseocanus (Redhead, Norvell & Danell) Redhead, Norvell & Moncalvo);

(c) Black Trumpet (Craterellus cornucopioides (L.) Pers., C. fallax A.H. Smith);

(d) Lion’s Mane, Bears Head, or Coral Tooth (Hericium spp. - H. americanum Ginns, H. coralloides (Scop.) Pers., H. erinaceus (Bull.) Pers.);

(e) Oyster Mushroom (Pleurotus spp. - Pleurotus ostreatus (Jacq.) Kumm., P. populinus O. Hilber & O.K. Miller, P. pulmonarius (Fr.) Quel.);

(f) King Bolete, Porcini, Cep, Steinpilz (Boletus edulis group (B. edulis Bull., B. atkinsonii Pk., B. chippewaensis A.H. Smith & Thiers, B. nobilis Pk., B. seperans Pk., B. subcaerulescens (E.A. Dick & Snell) Both, Bessette & A.R. Bessette, B. variipes Pk.);

(g) Matsutake (Tricholoma magnivelare (Pk.) Redhead);

(h) Hen-of-the-Woods (Grifola frondosa (Dickson) Gray);

(i) Wine Cap (Stropharia rugosoannulata Farl. ex Murrill);

(j) Cauliflower Mushroom (Sparassis spp. –S. spathulata (Schwein.) Fr., S. americana R.H. Petersen);

(k) Lobster Mushroom (Hypomyces lactifluorum (Schwein.) Tulasne & C. Tulasne);

(l) Green Quilted Russula (Russula virescens, Russula parvovirescens, Russula crustosa);

(m) Jelly Ear (Auricularia americana Parmasto & I.Parmasto);

(n) Blewit (Lepista nuda (Bull.) Cooke;

(o) Shaggy Mane (Coprinus comatus (O.F. Muller) Pers);

(p) Trumpet Chanterelle (Craterellus spp. Pers. Craterellus caeruleofuscus A.H. Smith, Craterellus foetidus A.H. Smith, Craterellus ignicolor (R.H. Petersen, Dahlman, Danell & Spatafora, Craterellus tubaeformis (Fr.) Quel.);

(q) Beefsteak Polypore (Fistulina hepatica (Schaeff.) Wither;

(r) Sweet Tooth (Hydnum repandum L. group (subgenus Hydnum));

(s) Depressed Hedgehog (Hydnum umbilicatum Pk. group (subgenus Rufescentia));

(t) Corrugated-cap Milky (Lactarius corrugis (Pk.));

(u) Orange Milky (Lactarius hygrophoroides Berk. & M.A. Curtis);

(v) Tawny or Voluminous Milky (Lactarius volemus (Fr.) Fr.); and

(w) White Hedgehog (Hydnum albidum Pk. group (subgenus Alba)).

He-P 2314. 04 List of Tier 2 Wild Harvested Mushrooms. Tier 2 mushrooms shall include:

(a) Caesar's Amanita (Amanita jacksonii Pomerleau);

(b) Pear-shaped Puffball (Lycoperdon pyriforme Schaeff);

(c) Crown-tipped Coral (Artomyces pyxidatus (Pers.) Julich);

(d) Russell's Bolete (Aureoboletus russellii (Frost) G.Wu & Zhu L. Yang);

(e) Pallid Bolete (Boletus pallidus Frost);

(f) Butter Bolete (Butyriboletus brunneus (Pk.) D. Arora & J. L. Frank);

(g) Frost's Bolete (Butyriboletus frostii (J.L.Russell) G.Wu, Kuan Zhao & Zhu L. Yang);

(h) Pheasant's Back or Dryad’s Saddle (Polyporus (Cerioporus) squamosus (Huds.) Fr.);

(i) Aborted Entoloma (Entoloma abortivum (Berk. & M.A. Curtis) Donk);

(j) Enoki or Winter Mushroom (Flammulina velutipes (Curt.) Sing);

(k) Chestnut Bolete (Gyroporus castaneus (Bull.) Quel.);

(l) Bluing Bolete (Gyroporus cyanescens (Bull.) Quel.);

(m) Chrome-footed Bolete (Harrya chromapes (Frost) Halling, Nuhn, Osmundson, & M. Binder);

(n) Yellow Scaber-stalk (Hemileccinum subglabripes (Pk.) Halling);

(o) Conifer Tuft (Hypholoma capnoides (Fr.) P. Kumm.);

(p) Brick Cap (Hypholoma lateritium (Schaeff.) P. Kumm.);

(q) Elm Oyster (Hypsizygus ulmarius (Bull.) Redhead);

(r) Elm Oyster (Hypsizygus tesselatus (Bull.) Sing.);

(s) Bay Bolete (Imleria badia (Fr.) Vizzini);

(t) Purple-gilled Laccaria (Laccaria ochropurpurea (Berk.) Pk.);

(u) Maple Milkcap or Burnt-sugar Milky (Lactarius aquifluus Pk. (= L. helvus (Fr.) Fr.));

(v) False saffron Milkcap or Orange-latex Milky (Lactarius deterrimus (Groger));

(w) Chicken-of-the-Woods or Sulphur Shelf (Laetiporus cincinnatus (Morgan) Birds., Banik & T.J.Volk, Laetiporus sulphureus (Bull.) Murrill);

(x) Gem-studded Puffball (Lycoperdon perlatum Pers.);

(y) Platterful Mushroom (Megacollybia rodmanii Petersen, Hughes, & Lickey);

(z) Black-staining Polypore (Meripilus sumstinei (Murrill) M.J. Larsen & Lombard);

(aa) Olive Oysterling (Sarcomyxa serotina (Pers.) V. Papp (= Panellus serotinus (Pers.) P. Kumm.));

(ab) Old Man of the Woods (Strobilomyces Berk. spp.);

(ac) Dotted-stalk Suillus (Suillus weaverae (A.H. Smith & Shaffer) Kretzer & T.D. Bruns (= granulatus (L.) Rouss.)); and

(ad) Spotted Bolete (Xanthoconium affine var. affine Pk. and var. maculosus (Pk.) Sing).

PARTS 2315 through He-P 2331 RESERVED

History

• #13428, eff 8-5-22
• #13428, eff 8-5-22; ss by #13883, eff 2-22-24
• #13428, eff 8-5-22; ss by #13883, eff 2-22-24

Part He-P 2350 New Hampshire Cold Storage Rules

N.H. Code Admin. R. Ann. He-P 2350.01 Sanitary Production and Distribution of Food

Statutory Authority: RSA 145

– He-P 2350.04

History

• #8659, eff 6-14-06, EXPIRED: 6-14-14

N.H. Code Admin. R. Ann. He-P 2350.05 Fees

(a) The fee for a cold storage license shall be $350.

(b) All fees paid shall be:

(1) Nontransferable; and

(2) Nonrefundable.

(c) Any instrument of payment returned to the state shall be processed in accordance with RSA 6:11-a.

History

• #8659, eff 6-14-06; ss by #9589, eff 11-5-09, EXPIRED: 11-5-17

N.H. Code Admin. R. Ann. He-P 2350.06 Sanitary Production and Distribution of Food

– He-P 2350.22 Procedure for Administrative Fines.

History

• #8659, eff 6-14-06, EXPIRED: 6-14-14

N.H. Code Admin. R. Ann. He-P 2350.23 Schedule of Fines

History

• #8659, eff 6-14-06 ss by #9589, eff 11-5-09, EXPIRED: 11-5-17

N.H. Code Admin. R. Ann. He-P 2350.24 Sanitary Production and Distribution of Food

– He-P 2350.27 Sanitary Provisions.

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-P 2303.01

U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration’s, “Food Code” (2017 edition)

Publisher: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration’s

Cost: Free of Charge

The incorporated document is available at: https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/UCM595140.pdf

APPENDIX B

Rule

Specific State Statute which the Rule Implements

He-P 2301.01

RSA 143-A; RSA 143-A:3; RSA 143-A:12; and

RSA 143-A:13

He-P 2301.01

RSA 143-A; RSA 143-A:3; RSA 143-A:12; and RSA 143-A:13; RSA 143-A:9, V

He-P 2303.02

RSA 143-A:9, V

He-P 2303.03

RSA 143-A:9, V

He-P 2303.01

RSA 143-A:9, V

He-P 2303.02

RSA 143-A:9, V

He-P 2304.01

RSA 143-A:6, I and V

He-P 2304.01(a)

RSA 143-A:6, I and V

He-P 2304.01(a)(1)

RSA 143-A:6, I

He-P 2304.02

RSA 143-A:4, II; RSA 143-A:6, I-V

He-P 2304.03

RSA 143-A:6, I-V

He-P 2304.01

RSA 143-A:6, I and V

He-P 2304.05

RSA 143-A:6, V; RSA 143-A:9, I-a; RSA 143-A:13, V

He-P 2304.06

RSA 143:3; RSA 143-A:9, V

He-P 2304.07

RSA 143:3; RSA 143-A:9, V; RSA 485-A:29

He-P 2304.08

RSA 143-A:6; RSA 143-A:9, V

He-P 2304.09

RSA 143-A:6; RSA 143-A:9, V

He-P 2304.10

RSA 143-A:6; RSA 143-A:9, V

He-P 2304.11

RSA 143-A:6; RSA 143-A:9, V

He-P 2304.12

RSA 143-A:9, V

He-P 2304.13

RSA 143-A:9, V

He-P 2304.14

RSA 143-A:9, VI

He P 2304.15

RSA 143-A:9, V

He-P 2305.01

RSA 143:4; RSA 143-A:6

He-P 2305.02

RSA 143:7-a; RSA 143-A:10-a

He-P 2305.03

RSA 143:4; RSA 143-A:6

He-P 2306.01

RSA 143:5-a; RSA 143-A:6; RSA 143-A:7; RSA 143-A:9-a, I

He-P 2306.02

RSA 143:7-a; RSA 143-A:10-a

He-P 2306.03

RSA 143-A:6; RSA 143-A:7; RSA 143-A:9-a, I

He-P 2306.04

RSA 143-A:9, IV-c

He-P 2306.05

RSA 143-A:4; RSA 143-A:6; RSA 143-A:11

He-P 2306.06

RSA 143:5-a; RSA 143-A:9, V

He-P 2307.01

RSA 141-C:9, II; RSA 143:5

He-P 2307.02

RSA 141-C:6, III

He-P 2308.01 – He-P 2308.03

RSA 143-A:9, V

He-P 2309.01 – He-P 2309.05

RSA 143-A:9, V

He-P 2310.01

RSA 143-A:12-13

He-P 2311.01 – He-P 2311.06

RSA 143-A:12-13

He-P 2312

RSA 143-A:14-16

He-P 2313

RSA 143-A:14-16

He-P 2314.01

RSA 143-A:28 VI.

He-P 2314.02

RSA 143-A:28 I:III

He-P 2314.03

RSA 143-A:28, IV

He-P 2314.04

RSA 143-A:28, V

History

• #8659, eff 6-14-06, EXPIRED: 6-14-14

Chapter He-P 2500 Catastrophic Illness Program

Part He-P 2501 Purpose

N.H. Code Admin. R. Ann. He-P 2501.01 Purpose

The purpose of the catastrophic illness program (CIP) is to assist residents of the state suffering from catastrophic illnesses in gaining access to needed diagnostic, curative, and rehabilitative health services when these individuals are unable to pay the entire cost of the medical care and treatment required on a continuing basis, despite the existence of various types of hospital and medical insurance, medicare, medicaid, and other governmental assistance programs and private charitable assistance programs.

History

• #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

Part He-P 2502 Definitions

N.H. Code Admin. R. Ann. He-P 2502.01 Definitions

(a) “Annual gross income” means the sum of all before-tax income received by the family as stated on the most recent IRS tax return, excluding the sale of property, house, or car, tax refunds, scholarships, or training stipends.

(b) “Applicant” means the person who makes application to the catastrophic illness program (CIP) and who becomes a recipient if determined eligible.

(c) “Catastrophic illness” means “catastrophic illness” as defined in accordance with RSA 137-G:2, II, namely “cancer, hemophilia, end-stage renal disease, spinal cord injury, cystic fibrosis, or multiple sclerosis, the treatment of which requires extensive medical care such as hospitalization, medication, diagnostic evaluation, surgery, dialysis, therapy, or other associated medical expenses such as transportation to and from medical facilities.”

(d) “Commissioner” means the commissioner of the department of health and human services.

(e) “Date of application” means the date on which the program receives the signed application.

(f) “Dependent” means a person who may legally be claimed on the federal income tax return of another person.

(g) “Department” means the New Hampshire department of health and human services (DHHS).

(h) “Family” means two or more persons related by birth, marriage, or adoption who live together, and all such related persons are considered to be members of one family.

(i) “Financial assistance” means a payment in whole or in part for services received for the treatment of the catastrophic illness.

(j) “Medicaid” means the Title XIX program administered by the department, which makes medical assistance available to eligible individuals who are age 19 or over.

(k) “Medical debt” means the combined out-of-pocket dollar amount paid or owed during the 12-month period for the entire family prior to the date of acceptance into the program for services provided by a licensed physician, nurse, therapist, hospital, clinic, or outpatient treatment center to include medical equipment, medications, dental care, ambulance services, home oxygen, and insurance premiums.

(l) “Recipient” means a person over 21 years of age who meets the standards for eligibility as set forth in these rules.

(m) “Third party” means any private insurer, health maintenance organization, hospital service organization, medical service or health services corporation, governmental agency, or any individual, organization, entity, or agency which is authorized or under legal obligation to pay for medical services for an eligible recipient.

(n) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire under the program entitled medicaid.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

Part He-P 2503 Application Procedure

N.H. Code Admin. R. Ann. He-P 2503.01 Application Procedure

The applicant shall submit the following as part of the application process, before any financial assistance is provided:

(a) A CIP application including:

(1) The applicant’s dated signature, authorizing the release of information and allowing the department to communicate with health care providers; and

(2) The applicant’s dated signature, authorizing the department to collect the applicant’s medical records;

(b) A signed statement verifying that the income information provided on the application in (a) above is correct; and

(c) Written documentation justifying the income information provided on the application form are correct, including:

(1) The most recent income tax return of all those persons whose income is counted in determining family income;

(2) The applicant’s 4 most recent consecutive paycheck stubs, if tax returns are unavailable; or

(3) A letter from the applicant’s most recent employer indicating present gross salary or wages and expected changes during the next 12 months.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2503.02 Commencement, Duration, Redetermination of Eligibility, and Reapplication

(a) When the CIP determines that an applicant is eligible for financial assistance, the applicant shall remain eligible for the 12 months commencing with the date of application, or earlier for quality assurance purposes.

(b) The CIP shall re-determine eligibility for financial assistance prior to the expiration of the 12-month period described in (a) above, pursuant to He-P 2504.

(c) An applicant and/or family who has applied for financial assistance and has been determined to be ineligible may reapply, when and if their financial or medical status changes.

(d) The CIP shall notify the applicant or the applicant’s family in writing within 30 days of receiving the fully completed application that they are determined to be eligible or ineligible, and the amount, if applicable, of medical debt that must be incurred before receiving financial assistance.

(e) The CIP shall notify the applicant or the applicant’s family in writing of any other action that the CIP has decided to take which affects the applicant’s eligibility, including termination of eligibility or change in the amount of medical debt. This written notification shall be sent to the applicant at least 30 days prior to the effective date of the proposed action.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

Part He-P 2504 Eligibility

N.H. Code Admin. R. Ann. He-P 2504.01 Residency

(a) An applicant shall be:

(1) A resident of the state of New Hampshire; and

(2) A United States citizen or a legal alien.

(b) Visitors or persons arriving in the state for special treatment shall not be considered to meet the requirement in (a) above.

History

• #2484, eff 9-26-83; 83; ss by #4167, eff 11-6-86 ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2504.02 Medical Eligibility

(a) An applicant shall be considered medically eligible if he or she is diagnosed as having a catastrophic illness as defined in RSA 137-G:2, II.

(b) An applicant with cancer shall be considered eligible if he or she:

(1) Has undergone active cancer treatment within the last 12 months, defined as undergoing chemotherapy or radiation treatment or cancer surgery; and

(2) Requires oncology monitoring post-active treatment, up to 5 years after undergoing active cancer treatment.

(c) Applicants with a spinal cord injury shall be considered eligible if they are non-ambulatory as a result of the injury.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2504.03 Financial Eligibility

(a) Financial assistance shall be available to:

(1) Single persons with annual gross incomes of $13,500 or less; and

(2) A family of 2 persons with annual gross incomes of $14,500 or less.

(b) For each additional dependent, the amount of allowed income described in (a)(2) above shall increase by $1,000.

(c) Financial assistance shall be available to applicants whose annual gross income is above the allowed income described in (a) and (b) above when the family’s level of medical debt meets or exceeds 80% of the difference between the annual gross income and the allowed income.

(d) The following special considerations shall be made in determining financial eligibility:

(1) Applicants living with adult married children shall be considered a single person family if the applicant is not claimed as a dependent, otherwise, if the applicant is a dependent, gross income of the family household shall be considered; and

(2) If there has been a significant change in family income due to unemployment, decrease in wages, illness, accident, loss due to fire and so forth, income shall be determined on current available financial resources.

(e) Applicants shall be notified in writing as to the amount of medical debt they shall accrue before the CIP can provide assistance.

(f) Applicants shall be ineligible to receive medical assistance if their savings and/or investments exceed $30,000.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2504.04 Eligibility Determination.

An applicant shall be eligible if the applicant meets the eligibility requirements described in He-P 2504.01 through He-P 2504.03.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

Part He-P 2505 Financial Assistance Provided

N.H. Code Admin. R. Ann. He-P 2505.01 Recipients with End-Stage Renal Disease

Recipients with end-stage renal disease shall receive financial assistance as follows:

(a) Mileage reimbursement at $0.21 per mile, including tolls, for transportation to and from the nearest dialysis service facility;

(b) Monthly reimbursement for mileage shall not exceed $208.33; and

(c) Mileage reimbursement shall continue for one year after kidney transplantation

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2505.02 Recipients with Other Catastrophic Illnesses

(a) Recipients with a diagnosis of cancer, cystic fibrosis, spinal cord injury, hemophilia, or multiple sclerosis shall receive financial assistance for the following:

(1) Outpatient hospital services including diagnostic x-ray, radiotherapy, and diagnostic and therapeutic services;

(2) Physician services, including:

a. Surgical and medical services, including routine pre- and post-operative care, provided in a hospital, in a hospital outpatient department, in a physician’s office, or in the individual’s home;

b. Services provided by an assisting physician in connection with an operative procedure;

c. Services provided by an anesthesiologist, if anesthesia is administered by an individual other than the surgeon or assisting surgeon; and

d. Consultation services when requested by the attending physician; and

(3) Other services, including:

a. Ambulance services provided to the nearest hospital when medically justified;

b. Durable medical equipment, including, mastectomy prosthesis(es), wigs, ostomy supplies, or catheters, where medically indicated by a physician for the treatment of the catastrophic illness;

c Drugs and medications when prescribed by a physician, including over-the-counter pharmacy items needed for the recipient’s treatment; and

d. Related services including payment of COBRA insurance premiums, and home health care as requested in writing by the recipient and as required to meet the recipient’s unique needs, subject to the program budget.

(b) Recipients with a diagnosis of cancer, cystic fibrosis, spinal cord injury, hemophilia, or multiple sclerosis shall not receive financial assistance for the following services:

(1) Services which are experimental or considered alternative therapies by current medical practice;

(2) In-patient hospital and emergency room visits;

(3) Funeral expenses;

(4) Dental care; and

(5) Supplemental payment for medicare part B and D.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

Part He-P 2506 Payment for Services

N.H. Code Admin. R. Ann. He-P 2506.01 Eligibility

(a) A recipient shall be eligible for financial assistance if he or she meets the requirements set forth in He-P 2504.

(b) Applicants shall not be eligible for financial assistance if they are covered by any hospital, surgical, medical insurance plan, or health maintenance organization, or would be entitled to such coverage but for any assistance available through the department, to the extent that there are funds or services available through any medical insurance program or policy.

History

• #2484, eff 9-26-83; ss by #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2506.02 Payment Rates and Levels for Recipients with Other Catastrophic Illnesses

(a) The maximum level of assistance in any fiscal year shall not exceed $2,500.00 for any recipient.

(b) All payments shall be paid at 50% of the amount billed, except for medications and medical supplies purchased through a pharmacy or from a durable medical equipment supplier, which shall be paid at the average wholesale price.

(c) Where commercial insurance or medicare is involved, payment by CIP shall not exceed the percentage necessary to bring the combined benefit to 50% of the original charge, except for medications.

(d) Medicaid payments shall not be supplemented.

History

• #4167, eff 11-6-86; ss by #4638, eff 6-26-89, EXPIRED: 6-26-95
• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2506.03 Retroactive Payment

(a) Applicants shall be eligible for payment for services beginning on the date of application.

(b) Nothing in this provision shall prohibit payment for services rendered prior to the date of application.

(c) Under no circumstances shall payment be made for services rendered more than one year from the date of application.

History

• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2506.04 Catastrophic Illness Program as Payor of Last Resort

(a) With respect to medicaid, medicare, or any medical insurance program or policy, the CIP shall be the payor of last resort. Nothing contained in these rules shall authorize or require the CIP to provide payment for drugs or services, which would otherwise be paid for by medicaid, medicare, or any other medical insurance program or policy.

(b) Payment for services shall not be made by the CIP until all third party resources are fully utilized. Providers shall file a claim with the third party insurer prior to billing the CIP. Upon receipt of the third party payment, the provider may forward a bill to CIP if a balance remains. Bills shall be itemized and submitted in duplicate.

(c) Each recipient shall notify CIP in writing within 30 days of any change in the recipient’s medical insurance coverage, which results in coverage for drugs or medical services which are currently being paid for by the CIP.

History

• #8864, eff 4-13-07

N.H. Code Admin. R. Ann. He-P 2506.05 Limitation of Services

Financial assistance to which these rules apply shall be subject to the availability of funds.

History

• #8864, eff 4-13-07

Part He-P 2507 Appeal Process

N.H. Code Admin. R. Ann. He-P 2507.01 Case Review and Appeal Process

(a) If an applicant or recipient is dissatisfied with a determination, the applicant or recipient may request a case review conference within 30 working days of the date upon which the notice of determination was received. The CIP shall notify the applicant or recipient within 14 days after the reconsideration of the determination.

(b) If the applicant or recipient is aggrieved by the results of the consideration, he or she may request an adjudicative proceeding in accordance with He-C 200.

APPENDIX

RULE

STATUTE

He-P 2501

RSA 137-G:1

He-P 2502

RSA 137-G:2; RSA 541-A:7

He-P 2503

RSA 137-G:5; RSA 137-G:5-a, I

He-P 2504

RSA 137-G:5, I; RSA 137:G-5-a, I

He-P 2505

RSA 137-G:5-a, III

He-P 2506

RSA 137-G:5, I; RSA 137-G:5-a

He-P 2507

RSA 541-A:16

APPENDIX II

SAMPLE CALCULATIO FOR HE-P 2404.03, FINANCIAL ELIGIBILITY

For example, if a family consists of a husband, wife, and one child, the allowed family income shall be $15,500. If the annual gross income for the entire family is $20,000, the difference of $4,500 shall be multiplied by 80% to determine the amount of medical debt that shall be incurred before the family shall be deemed eligible for financial assistance. Therefore, in this case, $3,600 shall be the amount of medical debt necessary before any CIP funds shall be used to assist.

History

• #8864, eff 4-13-07

Chapter He-P 2700 Milk Producers, Milk Plants, Producer-Distributors, and Distributors

Part He-P 2701 Producers, Milk Plants, Producer-Distributors, and Distributors

N.H. Code Admin. R. Ann. He-P 2701.01 Definitions

(a) “Bulk milk hauler” means any person who weighs, measures, or samples a producer’s milk for the purpose of determining the amount and quality as a basis for paying for product requiring a license pursuant to RSA 184:76-a.

(b) “Commissioner” means commissioner of the department of health and human services.

(c) “Critical item” means an inspection item that when found out of compliance is more likely than other violations to contribute to food contamination, illness, or environmental health hazard.

(d) “Delegated sampling surveillance officer” (DSSO) means a state regulatory person who has been properly certified by a sampling surveillance officer to inspect bulk milk haulers.

(e) “Department” means “department” as defined in RSA 184:79, XIV.

(f) “Facility” means the building(s) at one location where a permit or license has been issued to conduct all of the required functions that are allowed within the permit or license.

(g) “Federal rating” means a “milk sanitation rating” as defined in RSA 184:79, XXI, that is performed by a federally certified rating officer on Grade A milk plants, producer-distributors, or milk producers.

(h) “Grade A” means “grade A” milk products as defined in the Pasteurized Milk Ordinance pursuant to Mil 301.01.

(i) “Item” means a violation that is debited during an inspection.

(j) “Milk” means “milk” as defined in RSA 184:79, XXII.

(k) “Milk distributor” means “milk distributor” as defined in RSA 184:79, X.

(l) “Milk inspector” means “milk inspector” as defined in RSA 184:79, XVI.

(m) “Milk plant” means “milk plant” as defined in RSA 184:79, XIII.

(n) “Milk producer” means “milk producer” as defined in RSA 184:79, IX.

(o) “Milk producer permit” means the permit that is issued by the commissioner to any milk producer who is operating within the state of New Hampshire.

(p) “Milk products” means “milk products” as defined in RSA 184:79, XXIV.

(q) “Milk route” means any company or individual who purchases milk from producers in this state using the bulk tank collector system of collecting milk and requiring a permit pursuant to RSA 184:60-a.

(r) “Milk sanitation board” means “milk sanitation board” as established by RSA 184:80.

(s) “Milk sanitation rating” means “milk sanitation rating” as defined in RSA 184:79, XXI.

(t) “Non-Grade A” means milk products not listed as “Grade A” in Mil 301, including but not limited to:

(1) Ice cream;

(2) Reduced fat ice cream;

(3) Nonfat ice cream;

(4) Soft cheese;

(5) Hard cheese products;

(6) Butter;

(7) Frozen yogurt; and

(8) Gelato.

(u) “Producer-distributor” means “producer-distributor” as defined in RSA 184:79, XI.

(v) “Sampling surveillance officer” (SSO) means a state regulatory person who has been certified by US Food and Drug Administration (FDA) to inspect bulk milk haulers.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

Part He-P 2702 Application, Permitting, and Inspection of Milk Producers

N.H. Code Admin. R. Ann. He-P 2702.01 Application Submission

(a) A milk producer shall complete and submit a signed and dated “Application for Milk Producer Permit” Form MPAPP (01-01-17) application to the department for a producer permit required under RSA 184:88.

(b) Upon receipt of a signed and dated “Application for a Milk Producer Permit” Form MPAPP (01-01-17) for a milk producer permit, the commissioner shall approve or deny the application in accordance with procedures set forth in RSA 184:89, RSA 184:90, RSA 184:91, and He-P 2702.02 through He-P 2702.04.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.02 Processing of Applications

(a) Applications shall be processed in accordance with RSA 541-A:29.

(b) If all the items required by He-P 2702.01 are received, the application shall be deemed to be complete.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.03 Permit Issuance and Duration

(a) Following the receipt of a completed application, if a sanitary inspection conducted in accordance with He-P 2702.09 results in a score of not less than 95 with no critical violations, a producer permit shall be issued.

(b) All producer permits shall remain in effect:

(1) Unless suspended or revoked; or

(2) Until 6 months have passed since operations have ceased at the permitted facility, except in the case of permanent facilities located at fairgrounds or other locations which are used at least annually.

(c) Producer permits shall not be transferable with respect to persons or locations.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.04 Denial of Permit Applications

(a) The department shall deny a producer permit application if an applicant for a producer permit does not receive a minimum score of 95 on an inspection with no critical item violations set forth in He-P 2702.10.

(b) Producer permit applications shall be denied in accordance with RSA 184:90 and RSA 184:91.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.05 Milking Facility Change of Ownership

(a) If a milking facility changes ownership, a producer permit shall not be issued until after completion of an inspection in accordance with He-P 2702.09.

(b) A producer permit shall not be issued for a change of ownership unless the inspection results in:

(1) A minimum score of 95 on a sanitary inspection; and

(2) There is no violation of any critical items set forth in He-P 2702.10.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.06 Suspension of Milk Producer Permits; Reinstatement

(a) The department shall suspend a producer permit if:

(1) The producer inhibits any inspection or investigation conducted by the department;

(2) Milk from the producer’s farm has exceeded the standards for milk quality pursuant to Mil 301.01 on any 3 out of the last 5 samples;

(3) The producer offers for sale any milk contaminated with antibiotics;

(4) The producer has 4 consecutive violations of the same item and has not entered into a compliance agreement with the department;

(5) The producer is making an insufficient amount of milk such that the milk from the first milking is not properly agitated; or

(6) The producer fails to comply with any compliance agreement entered into in accordance with He-P 2704.01.

(b) Producer permits shall be suspended in accordance with RSA 184:90-a.

(c) Suspended producer permits shall be reinstated in accordance with RSA 184:90-a and when an inspection of the facility or analysis of the milk indicates that the violation(s) which resulted in the suspension has been corrected.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.07 Revocation of Milk Producer Permits; Reinstatement

(a) The department shall revoke a milk producer’s permit when the milk producer’s permit has been suspended 3 times within any 12- month period.

(b) The department shall revoke a milk producer’s permit when the milk producer has offered for sale milk contaminated with antibiotics 3 times within any 12- month period.

(c) The department shall revoke a producer permit in accordance with RSA 541-A:30, II, RSA 184:90, and RSA 184:91.

(d) Any producer who has had a producer permit revoked shall be prohibited from applying to renew the producer permit until 6 months following the date of the revocation.

(e) Rehearings and appeals of decisions of the commissioner, resulting from an adjudicative proceeding, shall be in accordance with RSA 184:94.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.08 Effect of Denial of Application, Suspension, or Revocation

(a) Any applicant who has been denied a producer permit shall not offer milk for sale to any milk plant or cooperative.

(b) If a producer permit has been suspended, the milk producer shall cease operation immediately, in accordance with RSA 184:90-a.

(c) If a producer permit has been revoked, the milk producer shall not offer milk for sale to any milk plant or cooperative.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.09 Inspection of Dairy Farms

(a) Inspections of all milk producers shall be conducted in accordance with RSA 184:82, RSA 184:92, and Mil 301.

(b) Inspections shall be conducted:

(1) Prior to issuance of a producer permit;

(2) At least twice each year in accordance with RSA 184:92; and

(3) Whenever the department has reason to believe a condition exists that places the producer in non-compliance with Mil 301, RSA 184, or He-P 2700.

(c) When violations of critical item are found during an inspection, the department shall conduct a follow-up inspection.

(d) When only non-critical violations are found during an inspection, the next inspection shall take place within 6 months.

(e) If any item is debited 3 consecutive times, a warning letter shall be issued to the milk producer informing them that their producer permit shall be suspended unless one of the following is complied with:

(1) An inspection conducted by the department showing the item or items outlined in the warning letter have been corrected. This inspection shall occur within 21 days from the date of this letter but not before the lapse of 3 days; or

(2) The producer enters into a compliance agreement with the department to correct the item or items outlined in the warning letter prior to the producer permit being suspended.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2702.10 Critical Items

On the “Dairy Farm Inspection” report contained in the Pasteurized Milk Ordinance incorporated by reference in Mil 301.01, the following shall be considered critical items:

(a) Item 1a: Abnormal Milk;

(b) Item 8a - c: Water Supply - 5 point violation which includes:

(1) Improperly constructed or protected wells;

(2) Improper submerged inlets;

(3) Cross connections between safe and unsafe water supplies; and

(4) Water supply does not meet bacterial standards found in the Pasteurized Milk Ordinance pursuant to Mil 301.01(a);

(c) Item 10a: cleaning of utensils and equipment, when marked in conjunction with Item 11a: Sanitization of Utensils and Equipment;

(d) Item 15d, e, or g: drugs and extra-label drugs properly labeled and used; and

(e) Item 18a or c: cooling of milk.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

Part He-P 2703 Application, Licensing, and Inspection of in-State and Out-of-State Milk Plants, Producer-Distributors, and Distributors

N.H. Code Admin. R. Ann. He-P 2703.01 Application Submission

(a) All applicants for licensure under RSA 184:84 shall complete and submit to the department a signed and dated application “Application for Milk Sanitation License” MSLAPP (01-01-17) obtained from the department which shall be typewritten or legibly printed in ink.

(b) The applicant shall provide the following along with the application:

(1) A specific product list;

(2) A copy of the results of the latest federal rating or the facility’s Interstate Milk Shippers code number if the facility is an out-of-state grade A milk plant or producer-distributor;

(3) A copy of the latest facility inspection conducted by the state or local agency with regulatory authority over the facility if the applicant is an out-of-state non-grade A milk plant or producer-distributor;

(4) Payment made by a credit card on line at http://www.dhhs.nh.gov/dphs/fp/index.htm, a check or a money order for the applicable fees in accordance with He-P 2706.01 ; and

(5) A certification by the applicant that:

a. All information provided in or attached to the application is complete, accurate, and up-to-date as of the date of the application;

b. There are no willful misrepresentations of answers to questions therein, and no omissions with respect to any of the answers and questions presented; and

c. The applicant shall immediately notify the food protection section with regard to any changes, corrections, or updates to the information provided in the application.

(c) Upon receipt of an application for the facility, the commissioner shall approve or deny the application in accordance with RSA 184:86, RSA 184:87, He-P 2703.03, and He-P 2703.04.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.02 Processing of Applications

(a) An application shall be processed in accordance with RSA 541-A:29.

(b) If the application does not contain all of the items required by He-P 2703.01, the department shall:

(1) Not process the application; and

(2) Notify the applicant in writing that all required items must be submitted within 30 days in order for the application to be processed.

(c) If all the items required by He-P 2703.01 are received, the application shall be deemed to be complete.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.03 License Issuance and Duration

(a) If the application for an in-state milk plant, distributor, or producer-distributor meets the requirements of He-P 2703.02 and an inspection of the facility conducted in accordance with He-P 2703.10 determines compliance with He-P 2700 and Mil 301, a license shall be issued.

(b) If the application for an out-of-state grade A milk plant or producer-distributor meets the requirements of He-P 2703.02 and if a federal rating conducted on the facility results in a score of 90 or higher, a license shall be issued.

(c) If the application submitted by an out-of-state non-grade A milk plant or producer-distributor meets the requirements of He-P 2703.02 and if the copy of the latest inspection submitted with the application shows compliance with Mil 301, a license shall be issued.

(d) If the application submitted by a distributor meets the requirements of He-P 2703.02, a license shall be issued.

(e) Pursuant to RSA 184:85, all licenses shall remain in effect until the first of January of the year following issuance or until revoked.

(f) Licenses shall not be transferable with respect to persons or locations.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.04 Denial of License Applications

(a) The department shall deny a license for an in-state milk plant, distributor, or producer-distributor if the applicant does not receive a minimum score of 95 on an inspection or has violations of critical items as set forth in He-P 2703.10.

(b) The department shall deny a license for an out-of-state milk plant or producer-distributor if:

(1) The applicant is a grade A milk plant or producer-distributor and does not have a federal rating with a score of 90 or higher; or

(2) The copy of the latest inspection submitted by the applicant, who is a non-grade A milk plant or producer-distributor, does not show compliance with Mil 301.

(c) The department shall deny an application if the application is not complete in accordance with He-P 2703.01 and items requested by the department in accordance with He-P 2703.02 are not received within the time requested.

(d) License applications shall be denied in accordance with RSA 184:86 and RSA 184:87.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.05 Milk Plant, Producer-Distributor, or Distributor Change of Ownership

(a) If an in-state milk plant, distributor, or producer-distributor changes ownership, a license shall not be issued until after completion of an inspection in accordance with He-P 2703.09, and the new owner complies with He-P 2703.01.

(b) If an out-of-state milk plant, distributor, or producer-distributor changes ownership, a license shall not be issued until an application is submitted as required in He-P 2703.01.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.06 Renewal of Licenses

(a) To renew, an applicant shall submit:

(1) All items listed in He-P 2703.01(b) along with any supporting documentation;

(2) Any changes to information provided to the department on the initial application; and

(3) Payment as specified in He-P 2706.01(b).

(b) Licenses for milk plants, producer-distributors, and distributors shall be renewed provided the following conditions exist at the time of renewal:

(1) No milk or milk products from the plant, sampled and analyzed by the department, exceed the quality standards in Mil 301 on 2 of the last 4 samples;

(2) A minimum score of 90 on the last federal rating is obtained by a grade A out-of-state milk plant or producer-distributor license holder;

(3) The copy of the latest inspection submitted by an out-of-state non-grade A milk plants and producer-distributors shows compliance with Mil 301;

(4) The distributor has submitted a complete application as required in (a) above; and

(5) There is no violation of RSA 184:86.

(c) Each licensee wishing to renew his or her license shall apply pursuant to (a) above at least 30 days prior to the expiration of the current license.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #10956, eff 10-22-15; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.07 Revocation of Licenses

(a) Revocation of a milk license shall occur when:

(1) An in-state milk plant, distributor, or producer-distributor has 4 consecutive violations of the same item and has not entered into a compliance agreement with the department;

(2) A minimum score of 90 on a U.S. Public Health rating conducted by a FDA certified milk sanitation rating officer is not obtained by an out-of-state milk plant and producer-distributor license holder;

(3) An in-state milk plant, distributor, or producer-distributor fails to meet the requirements of a compliance agreement entered into in accordance with He-P 2704.01;

(4) An in-state milk plant or producer-distributor fails to meet quality standards in Mil 301 for 3 out of 5 samples of one or more products and does not enter into a compliance agreement as specified in He-P 2704.01(c); or

(5) There is a violation as described in RSA 184:86.

(b) The department shall revoke a license in accordance with the procedures set forth in RSA 541-A:30, II, and RSA 184:86 and 87.

(c) Rehearing and appeals of decisions of the department, resulting from an adjudicative proceeding, shall be in accordance with RSA 184:94.

(d) Any milk plant, producer-distributor, or distributor which has had a license revoked shall be prohibited from applying to renew their license until 6 months following the date of the revocation.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.08 Effect of Denial of Application or Revocation

(a) Any applicant who has been denied a license shall not operate as a milk plant, producer-distributor, or distributor.

(b) If a license has been revoked, the milk plant, producer-distributor, or distributor shall cease operation immediately, pursuant to RSA 184:84.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.09 Inspection of Milk Plants, Distributors and Producer-Distributors

(a) Inspections of all in-state milk plants, distributors, and producer-distributors shall be conducted in accordance with RSA 184:86 and Mil 301. Inspections of out-of-state milk plants and producer-distributors shall be conducted by the state or local regulatory agency with authority over the facility in accordance with the Pasteurized Milk Ordinance pursuant to Mil 301.

(b) Inspections on all in-state milk plants, distributors, and producer-distributors shall be conducted:

(1) Prior to issuance of a license; and

(2) Whenever the department has reason to believe a condition exists that places the milk plant, distributor or producer-distributor in non-compliance with Mil 301, RSA 184, or He-P 2700.

(c) When critical items are found in violation a follow up inspection shall be conducted.

(d) When only non-critical violations are found during an inspection, the next inspection shall take place within 3 months.

(e) If any item is debited 3 consecutive times, a warning letter shall be issued to the facility informing them that their license shall be revoked in accordance with RSA 184:86 unless one of the following is complied with:

(1) An inspection conducted by the department showing the item or items outlined in the warning letter have been corrected. This inspection shall occur within 21 days from the date of this letter but not before the lapse of 3 days; or

(2) The facility enters into a compliance agreement with the department to correct the item or items outlined in the warning letter.

(f) Non-grade A milk plants and producer-distributors, located within the state, shall be inspected at least twice a year.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2703.10 Critical Items

On the milk plant inspection report contained in the Pasteurized Milk Ordinance incorporated by reference in Mil 301.01, the following shall be considered critical items:

(a) Item 7a - d: water supply;

(b) Item 12a or c: cleaning and sanitizing of containers/equipment;

(c) Item 15b: cross connections;

(d) Item 16a,2, 16b,2, or 16c,2: time and temperature controls;

(e) Item 16b,3 or 16c,3: adulteration controls;

(f) Item 16c: regenerative heating; and

(g) Item 17(a, b, or d): cooling of milk.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

Part He-P 2704 Compliance Agreements

N.H. Code Admin. R. Ann. He-P 2704.01 Procedure for Compliance Agreements

(a) If one or more milk or milk products produced by an in-state milk plant or producer-distributor fail to meet quality standards adopted in Mil 301 for 3 of the last 5 samples of that product, the milk plant or producer-distributor shall enter into a compliance agreement with the department wherein they agree to suspend sale of the product until compliance with the quality standards is achieved.

(b) Compliance agreements shall be completed at the conclusion of an inspection or at a compliance meeting to be held at a later date if the permit or license holder is not available at the time of the inspection and compliance is not already achieved.

(c) The following shall be provided in the compliance agreement:

(1) The date of the agreement;

(2) The name of the establishment;

(3) The permit or license number of the establishment;

(4) The name of the person in charge of the establishment;

(5) The permittee or license’s attestation to the agreement to make such repairs, corrections, and changes that are necessary to bring the establishment into compliance with Mil 301 and He-P 2700, or to suspend sale of milk or milk products that have exceeded quality standards;

(6) A list of each all repairs, corrections, or changes to be made including the date of intended completion;

(7) The signature of the person in charge;

(8) The title of the signee; and

(9) The signature of the inspector or department representative making the agreement.

(d) Failure on the part of the permit or license holder to comply with the signed compliance agreement shall result in action against the permit or license as specified in He-P 2702.06 and He-P 2703.07.

History

• #5695, eff 8-26-93, EXPIRED: 8-26-99
• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

Part He-P 2705 Administrative Fines

N.H. Code Admin. R. Ann. He-P 2705.01 Procedure for Administrative Fines

Whenever the department determines that a violation of RSA 184 or of the provisions of He-P 2700 has occurred, the permit or license holder shall be provided with a written notice:

(a) Identifying each violation;

(b) Informing the permit or license holder of the amount of the assessed fine under He-P 2705.02;

(c) Informing the permit or license holder of the right to appeal the department’s decision to assess a fine by submitting a written request for a hearing to the commissioner no later than 10 calendar days from the date of receipt of the notice;

(d) Informing the permit or license holder of the opportunity to waive the right to a hearing by paying the fine within 10 days of the receipt of the department notice of assessed administrative fine; and

(e) Informing the permit or license holder that if he or she does not request an appeal as specified in (c) above, the department’s decision to assess a fine shall become final after the 10 day period specified in (c) above and the fine shall be paid to the department no later than 10 days from that date.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-1717; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2705.02 Schedule of Administrative Fines

The department shall impose administrative fines as follows:

(a) For willful submission of fraudulent or materially false information on or with an application, in violation of He-P 2702.01 or He-P 2703.01, the fine shall be $1,000;

(b) For failure to cooperate during an inspection of a dairy farm, milk processing plant, or distributor, including but not limited to failing to allow department representatives or inspectors to inspect, at any reasonable hours, all premises and places where milk is produced, handled, processed, or pasteurized, in violation of RSA 184:96, the fine shall be $2,000;

(c) For operating a dairy farm, or milk processing plant, or as a milk distributor in the state without first obtaining a milk producer permit or milk sanitation license, the fine shall be $1,000. Each day that an individual or business continues to operate without obtaining a permit or license shall be considered a separate offense subject to an additional $500 fine;

(d) For failure to cease operation after a milk producer permit has been suspended, or when a permit has been revoked, the fine shall be $1,000. Each day that a permit holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(e) For failure to cease operation after a milk plant, producer-distributor, or distributor license has expired, when an application has been denied, or when a license has been revoked, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine;

(f) For failure to pay an administrative fine within 30 days of its imposition, or the completion of any appeal of the administrative fine, the fine shall be $500 per day until the fine is paid;

(g) For failure to submit a timely license renewal application in accordance with He-P 2703.06(c) the fine shall be $75;

(h) For the same critical violation found at an in-state milk plant, distributor, or producer-distributor on more than 2 consecutive inspections, the fine shall be $500;

(i) For failure to enter into a corrective action plan (CAP) when required to do so by He-P 2703.09(h) the fine shall be $500;

(j) For a failure to comply with any CAP that has been accepted by the department, the fine shall be $500;

(k) For picking up milk, weighing milk, and sampling milk at a dairy farm in the state without first obtaining a bulk milk hauler license from the department, the fine shall be $100. Each day that an individual continues to operate without obtaining a license shall be considered a separate offense subject to an additional $50 fine;

(l) For failure to cease operation after a bulk milk hauler license has been suspended or revoked, the fine shall be $1,000. Each day that a license holder fails to cease operation shall be considered a separate offense subject to an additional $500 fine; and

(m) For violating a variance approved in accordance with He-P 2709, the fine shall be $500.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #9589, eff 11-5-09; ss by #10956, eff 10-22-15; ss by #12101, eff 2-3-17; amd by #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2705.03 Form of Payment of Fees and Administrative Fines

Whenever an applicant or permit or license holder makes a payment to the department in satisfaction of a fee or administrative fine, the following shall apply:

(a) Payment shall be made in the form of cash, check, money order, or credit card for the exact amount due;

(b) Credit card payments for the exact amount due may be made online at http://www.dhhs.nh.gov/dphs/fp/index.htm;

(c) Cash, money order, or certified check shall be required when an applicant or license holder has issued payment to the department by check, and such check was returned for insufficient funds;

(d) Any instrument described in (a) or (b) above shall be made payable to the “Treasurer–State of New Hampshire”; and

(e) Any payment made to the department by check which is returned for insufficient funds, and which a license holder has not made good by submitting cash, money order, or certified check within 2 business days of notification by the department, including any penalty assessment required by RSA 6:11-a, shall result in revocation of the license or permit after notice and opportunity for a hearing.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #12101, eff 2-3-17; ss by #13175, eff 3-2-21

Part He-P 2706 Classifications and Licensure Fees

N.H. Code Admin. R. Ann. He-P 2706.01 Milk Plant, Out-of-State Milk Plant, Distributor, and Producer-Distributor Classification and Licensure Fees

(a) Milk plant, out-of-state milk plant, distributor, and producer-distributor shall be classified as follows:

(1) Milk plant, out-of-state milk plant, distributor, and producer-distributor of over 25,000 pounds of milk, milk products, or both per day shall be designated as Class 1;

(2) Milk plant, out-of-state milk plant, distributor, and producer-distributor of more than 10,000 pounds of milk, milk products, or both per day, but not more than 25,000 pounds per day shall be designated as Class 2;

(3) Milk plant, out-of-state milk plant, distributor, and producer-distributor of more than 1,000 pounds of milk, milk products, or both per day, but not more than 10,000 pounds per day shall be designated as Class 3; and

(4) Milk plant, out-of-state milk plant, distributor, and producer-distributor of not more than 1,000 pounds of milk and/or milk products per day shall be designated as Class 4.

(b) Fees for milk plant, out-of-state milk plant, distributor, and producer-distributor shall be graduated by class in accordance with the following schedule:

(1) Milk plant, out-of-state milk plants, distributor, and producer-distributor contained in Class 1 shall pay a licensure fee of $350;

(2) Milk plant, out-of-state milk plants, distributor, and producer-distributor contained in Class 2 shall pay a licensure fee of $275;

(3) Milk plant, out-of-state milk plants, distributor, and producer-distributor contained in Class 3 shall pay a licensure fee of $175; and

(4) Milk plant, out-of-state milk plants, distributor, and producer-distributor contained in Class 4 shall pay a licensure fee of $100.

(c) Fees for milk plant, out-of-state milk plant, distributor, and producer-distributor licenses shall be annual fees in accordance with RSA 184:85 and shall be non-refundable.

History

• #7315, eff 7-1-00; ss by #9189, INTERIM, eff 7-1-08, EXPIRES: 12-28-08; ss by #9325, eff 11-21-08; ss by #9589, eff 11-5-09; ss by #12101, eff 2-2-17; ss by #13175, eff 3-2-21

Part He-P 2707 Application, Licensing, and Inspection of Bulk Milk Haulers

N.H. Code Admin. R. Ann. He-P 2707.01 Application Submission

(a) All applicants for licensure under RSA 184:76-a shall submit to the department a completed, signed, and dated application “Application for Bulk Milk Hauler License” (March 2019), affirming and certifying the following:

(1) “I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is my responsibility to immediately notify the Food Protection Section, Dairy Program with regard to any changes, corrections or updates to the information provided.”

(b) The applicant shall provide the following along with the application:

(1) If an applicant has a valid out of state milk haulers license, permit, or both:

a. A copy of a valid out of state milk haulers permit or license; and

b. A current copy of a bulk milk hauler evaluation inspection form filled out by a SSO or DSSO;

(2) If an applicant is obtaining licensure for the first time, acknowledgement that they agree to take a written evaluation and be inspected by the department for the purpose of licensure pursuant to He-P 2707.07; and

(3) A check, money order, credit card payment, or online payment for the applicable fees in accordance with RSA 184:77.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.02 Processing of Applications

(a) An application shall be processed in accordance with RSA 541-A:29 and RSA 541-A:29-a.

(b) If the application does not contain all of the items required by He-P 2707.01, the department shall:

(1) Deem the application incomplete; and

(2) Notify the applicant in writing of which items are missing.

(c) The requested items shall be submitted to the department within 30 days in order for the application to be processed.

(d) If all the items required by He-P 2707.01 are received, the application shall be deemed to be complete.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.03 License Issuance and Duration

(a) A license shall be issued if:

(1) The application requirements set forth in He-P 2707.01 have been met and the application has been deemed complete; and

(2) If applicable, the evaluation and inspection of bulk milk haulers conducted in accordance with He-P 2707.07, determines compliance with RSA 184, He-P 2700, and Mil 301.

(b) Pursuant to RSA 184:77, all licenses shall remain in effect for a period of 2 years and be renewed biennially during the month of January.

(c) Licenses shall not be transferable with respect to persons.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.04 Denial of License Applications

(a) The department shall deny an application if the application is not complete in accordance with He-P 2707.01 and items requested by the department in accordance with He-P 2707.02 are not received within the time requested.

(b) The department shall deny a license for a bulk milk hauler if the evaluation and inspection conducted in accordance with He-P 2707.07 deems the applicant non-compliant under RSA 184, He-P 2700, or Mil 301.

(c) Any applicant who has been denied a license shall not operate as a bulk milk hauler.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.05 Renewal of Licenses

(a) To renew, an applicant shall submit all the items in (b) below and any changes to information provided to the department on the initial application.

(b) The applicant shall provide the following along with the application:

(1) A current copy of a bulk milk hauler evaluation inspection form if it was conducted by a SSO or DSSO from another state agency; and

(2) A check, money order, credit card payment, or online payment for the applicable fees in accordance with RSA 184:77.

(c) Licenses for bulk milk haulers shall be renewed provided they have had an inspection within the last 24 months. A copy of this inspection shall be provided with the application if it has been conducted by a SSO or DSSO from an out of state agency.

(d) Each licensee wishing to renew his or her license shall comply with He-P 2707.05(a) and (b) at least 30 days prior to the expiration of the current license.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.06 Revocation of Licenses

(a) The department shall revoke a license in accordance with the procedures set forth in RSA 541-A:30, II, and RSA 184:77.

(b) If a license has been revoked, the bulk milk hauler shall cease operation, pursuant to RSA 184:76-a, immediately.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2707.07 Evaluation and Inspection of Bulk Milk Haulers

(a) A written evaluation of a milk hauler scoring at least 70% in accordance with Mil 300 shall be conducted prior to issuance of a license if the bulk milk hauler does not provide proof of licensing by another state.

(b) Inspection of a bulk milk hauler shall be conducted:

(1) Prior to issuance of a license if the bulk milk hauler does not provide proof of a current inspection by another state;

(2) Whenever the department has reason to believe a condition exists that places the bulk milk hauler in non-compliance with RSA 184, Mil 300, or He-P 2700; and

(3) At least once every 24 months by a SSO or DSSO.

(c) If any item is debited 3 consecutive times, a warning letter shall be issued to the bulk milk hauler informing them that their bulk milk hauler license shall be revoked unless one of the following is complied with:

(1) An inspection conducted by the department showing the item or items outlined in the warning letter have been corrected. This inspection shall occur within 21 days from the date of this letter but not before the lapse of 3 days; or

(2) The bulk milk hauler enters into a compliance agreement with the department to correct the item or items outlined in the warning letter prior to the bulk milk haulers license being revoked.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

Part He-P 2708 Application and Permitting of Milk Routes

N.H. Code Admin. R. Ann. He-P 2708.01 Application Submission

A company or individual requesting a permit under RSA 184:60-a, shall submit a completed, signed, and dated “Application for a Milk Route Permit” (March 2019), affirming and certifying the following:

(a) “I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein, and that I have made no omissions with respect to any of my answers to the questions presented. I have verified all drivers are properly licensed in accordance with RSA 184. I understand that it is my responsibility to immediately notify the Food Protection Section, Dairy Program with regard to any changes, corrections or updates to the information provided.”

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2708.02 Processing of Applications

(a) An application shall be processed in accordance with RSA 541-A:29.

(b) If the application does not contain all of the items required by He-P 2708.01, the department shall:

(1) Deem the application incomplete; and

(2) Notify the applicant in writing of which items are missing.

(c) The requested items shall be submitted to the department within 30 days in order for the application to be processed.

(d) If all the items required by He-P 2708.01 are received, the application shall be deemed to be complete.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2708.03 Permit Issuance and Duration

(a) If the application for a milk route permit meets the requirements of He-P 2708.01, a permit shall be issued.

(b) All permits shall expire on August 1 each year.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

N.H. Code Admin. R. Ann. He-P 2708.04 Revocation of Permit

(a) The department shall revoke a permit in accordance with the procedures set forth in RSA 541-A:30, II.

(b) The department shall revoke a milk route permit for any individual or company who picks up milk in this state from a producer who does not have a valid milk producers permit or has had their milk producers permit suspended or revoked.

(c) If a milk route permit has been revoked, all operations under RSA 184:60-a shall stop.

History

• #12631, INTERIM, eff 9-28-18, EXPIRES: 3-27-19; ss by #12743, eff 3-20-19; ss by #13175, eff 3-2-21

Part He-P 2709 Variances

N.H. Code Admin. R. Ann. He-P 2709.01 Variances

(a) Applicants or license holders seeking variances from specific rules shall contact the department by telephone at (603) 271-4589 or by mail, to obtain a VR Form “Milk Variance Request Form” (February 2021).

(b) Applicants or license holders shall complete and submit to the department VR Form “Milk Variance Request Form” (February 2021) by mailing to:

Department of Health and Human Services

Division of Public Health Services

Food Protection Section

29 Hazen Dr.

Concord, NH 03301

(c) By completing and submitting a VR Form “Milk Variance Request Form” (February 2021), the applicant or licensee holder acknowledges that:

(1) The requested variance pertains to the rule mentioned in the variance request only, and shall not be deemed permission to waiver from any other requirements outlined in the He-P 2700; and

(2) If approved, this variance shall be considered null and void at such time one or more of the following events should occur:

a. Change of ownership;

b. Renovation; or

c. Failure to comply with said variance.

(d) The commissioner shall approve a request for variance if:

(1) The commissioner concludes that authorizing deviation from strict compliance with the rule item from which a variance is sought does not contradict the intent of the rule; and

(2) The alternative proposed by the applicant or license holder ensures that the objective or intent of the rule item from which a variance is sought will be accomplished.

(e) If a variance is approved, the license holder’s subsequent compliance with the alternatives approved in the variance shall be considered equivalent to complying with the rule item from which a variance was sought.

(f) A variance shall be approved until the expiration of the current license or as specified by the department.

(g) No request for a variance concerning the rules of other state agencies which are referred to in this chapter shall be approved.

Appendix

Rule

Specific State or Federal Statutes or Regulations which the Rule Implements

He-P 2701.01

RSA 184:60-a, RSA 184:76-a, RSA 184:79, RSA 184:80 & RSA 184:88

He-P 2702.01

RSA 184:88 & RSA 184:89

He-P 2702.02

RSA 541-A:29 & RSA 184:89

He-P 2702.03

RSA 184:88 & RSA 184:89

He-P 2702.04

RSA 184:90 & RSA 184:91

He-P 2702.05

RSA 184:89

He-P 2702.06

RSA 184:90-a

He-P 2702.07

RSA 541-A:30, II, RSA 184:90, RSA 184:91 & RSA 184:94

He-P 2702.08

RSA 184:90 & RSA 184:90-a

He-P 2702.09

RSA 184:90 & RSA 184:92

He-P 2702.10

RSA 184:89 & RSA 184:90

He-P 2703.01

RSA 184:84 & RSA 184:85, I

He-P 2703.02

RSA 541-A:29 & RSA 184:85, I

He-P 2703.03

RSA 184:85

He-P 2703.04

RSA 184:86 & RSA 184:87

He-P 2703.05

RSA 184:84

He-P 2703.06

RSA 184:85, 86

He-P 2703.07

RSA 184:86, RSA 541-A:30, II, RSA 184:87 & RSA 184:94

He-P 2703.08

RSA 184:84

He-P 2703.09

RSA 184:86, & RSA 184:92

He-P 2703.10

RSA 184:85, II & RSA 184:86

He-P 2704.01

RSA 184:85, II & RSA 184:89

He-P 2705.01

RSA 184:105 & RSA 541-A:31, III

He-P 2705.02

RSA 184:105

He-P 2705.02 intro., (k) and (l)

RSA 184:76-a

He-P 2705.03

RSA 6:11-a, RSA 184:85, III & IV & RSA 184:105

He-P 2706.01

RSA 184:85

He-P 2707.01

RSA 184:76-a

He-P 2707.02

RSA 184:76-a

He-P 2707.03

RSA 184:76-a

He-P 2707.04

RSA 184:76-a

He-P 2707.05

RSA 184:76-a

He-P 2707.06

RSA 184:76-a

He-P 2707.07

RSA 184:76-a

He-P 2708.01

RSA 184:60-a

He-P 2708.02

RSA 184:60-a

He-P 2708.03

RSA 184:60-a

He-P 2708.04

RSA 184:60-a

He-P 2709.01

RSA 184:93

History

• #13175, eff 3-2-21

Chapter He-P 3000 Maternal and Child Health

Part He-P 3008 Newborn Dried Blood Spot Screening, Critical Congenital Heart Disease Screening and Newborn Hearing Screening

N.H. Code Admin. R. Ann. He-P 3008.01 Purpose

The purpose of this part is to describe the requirements for the screening of all newborns pursuant to RSA 132:10-a, RSA 132:10-aa, and for newborn hearing screening pursuant to RSA 132:10-b, V.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.02 Scope

This part shall apply to:

(a) Birth facilities and laboratories performing newborn dried blood spot screening;

(b) Birth facilities performing newborn hearing screening;

(c) Birth facilities performing newborn critical congenital heart disease screening;

(d) Providers, certified midwives, and nurse midwives performing newborn dried blood spot screening, newborn hearing screening, and critical congenital heart disease screening, or providing care to infants or children with abnormal screening results;

(e) Audiologists providing pediatric diagnostic audiology services; and

(f) Organizations and agencies providing intervention and early supports and services to children between the ages of birth and 3 years with hearing conditions.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.03 Definitions

(a) “Birth facility” means the hospital or birthing center where the infant was born.

(b) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(c) “Critical congenital heart disease (CCHD) screening” means screening for 7 different heart disorders that can be detected via pulse oximetry.

(d) “Department” means the department of health and human services, state of New Hampshire.

(e) “Diagnostic hearing evaluation” means comprehensive testing of infants to determine type and classification of hearing loss.

(f) “Dried blood spot (DBS)” means a specimen of blood obtained from an infant through the heel stick procedure, which is then applied to a filter paper and dried.

(g) “Early hearing detection and intervention (EHDI) program” means a department program, which oversees the newborn hearing screening process in New Hampshire.

(h) “EHDI database” means the information collection system used by the department for the reporting of newborn hearing screening, diagnosis, and treatment information.

(i) “Filter paper” means the department-approved specimen collection card which is made specifically for the purpose of collecting an infant’s blood, and which is used by the laboratory for testing.

(j) “Healthcare provider” means the licensed medical doctor, licensed doctor of osteopathy, licensed advanced practice nurse, licensed physician’s assistant, or certified midwife, providing care to a person.

(k) “Laboratory” means the testing facility authorized by the state of New Hampshire to conduct DBS testing on its behalf.

(l) “Newborn hearing screening” means evaluating the hearing status of infants.

(m) “Newborn screening” means the DBS testing of infants.

(n) “Newborn screening program (NSP)” means the department program which has responsibility for managing all aspects of infant DBS screening pursuant to RSA 132:10-a.

(o) “Out of range (OOR) result” means a DBS test result that is outside of the reference range shown on the clinical laboratory report.

(p) “Pediatric audiologist” means a person who specializes in the assessment and rehabilitation of hearing loss in infants and children.

(q) “Unsatisfactory specimen” means a DBS specimen which is unacceptable for issuing a laboratory result interpretation on the formal laboratory report.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.04 Newborn DBS Screening

(a) Newborn screening shall be required for all infants born in the state of New Hampshire, in accordance with RSA 132:10-a, unless the parent(s) or guardian(s) object.

(b) The infant’s health care provider shall inform the infant’s parent or guardian of their right to opt out of the performance of the DBS testing per RSA 132:10-c.

(c) If the infant’s parent or guardian objects to the performance of DBS testing, he or she shall provide a statement of dissent for refusal of newborn screening to the infant’s healthcare provider or designee, subject to the following:

(1) A statement of dissent for refusal of newborn screening shall be signed and dated by the infant’s parent or guardian and include:

a. Name of infant;

b. Birth date;

c. Street address, city, state, and zip code;

d. Hospital of birth;

e. Medical record number; and

f. The following understandings:

1. “I refuse to have blood taken from my baby to determine if he or she might have a disorder that can be detected through newborn screening.”;

2. “I understand that State Law requires Newborn Screening for all infants born in New Hampshire.”;

3. “I have been offered the Newborn Screening Brochure and discussed newborn screening with my baby’s doctor, midwife, a member of the hospital nursing staff, or other healthcare provider.”;

4. “I understand that newborn screening is done for the early detection of treatable disorders and that symptoms sometimes do not appear for several weeks or months.”;

5. “I understand that if undetected and untreated these disorders can cause permanent damage to my child, including serious intellectual disability, growth failure and, in some cases, death.”; and

6. “The benefits of newborn screening and the potential danger of not being screened have been explained to me. My decision to refuse the testing was made freely without force or encouragement by my doctor, my baby's doctor, hospital personnel or State officials.”;

(2) The statement of dissent for refusal of newborn screening shall be included in the infant’s medical record;

(3) The infant’s healthcare provider or designee shall submit a copy of the statement of dissent for refusal of newborn screening to the NSP; and

(4) A copy of the statement of dissent for refusal of newborn screening shall be provided to the parent or guardian.

(d) Newborn screening tests shall be conducted as follows:

(1) The DBS shall be collected from the infant through the heel stick procedure and directly applied to an unexpired filter paper obtained from the NSP; and

(2) If the newborn screening tests are performed by a laboratory other than that used by the NSP, the infant’s healthcare provider shall request all tests required by the NSP and provide a copy of these test results to the NSP.

(e) For homebirths, the attending physician, advanced practice registered nurse, certified midwife, or designee shall be responsible for conducting newborn screening, as described in (a) through (d) above, and the collection of the DBS specimen, as described in He-P 3008.05(a)-(h) below.

(f) The department shall restrict the quantity of filter papers made available to birth facilities during periods when changes to the program are being made.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.05 DBS Collection Procedures

(a) Except as allowed by (b)-(i) below, the infant’s healthcare provider or designee shall collect the DBS between 24 and 48 hours after birth.

(b) The infant’s healthcare provider or designee shall obtain an initial DBS at time of discharge from a birth facility for infants discharged prior to the first 24 hours of life.

(c) When the initial DBS is obtained prior to the first 24 hours of life due to early discharge, the infant’s healthcare provider or designee shall obtain a second DBS within 48 hours of discharge.

(d) For infants who are sick, premature, less than 1500 grams or receiving a higher level of care, the infant’s healthcare provider or designee shall obtain:

(1) An initial DBS between 24 and 48 hours of the infant’s life;

(2) A second DBS at 2 weeks of age;

(3) Additional repeat DBS specimens at 1 month, and monthly thereafter; and

(4) A final DBS specimen upon discharge or transfer from the higher level of care.

(e) Except as allowed by (f) below, the infant’s healthcare provider shall ensure that a DBS is obtained prior to transfer to another medical facility.

(f) If an infant’s medical condition prohibits DBS collection prior to transfer to another medical facility, the transferring birth facility shall:

(1) Notify the receiving medical facility that a DBS has not been obtained; and

(2) Submit a completed filter paper form without the blood specimen and with a comment explaining the circumstances preventing the collection of blood.

(g) Upon notice of non-collection from the birth facility, the receiving medical facility shall obtain a DBS for screening in accordance with He-P 3008.05.

(h) Infants receiving a blood transfusion shall have DBS collection performed in the following manner:

(1) For infants receiving blood transfusions, the infant’s healthcare provider or designee shall obtain a DBS prior to transfusion, regardless of the infant’s age;

(2) If the first DBS is obtained prior to 48 hours after transfusion, then a second DBS shall be obtained 48 hours after transfusion; and

(3) A final DBS shall be collected by the infant’s healthcare provider 60 days after the final transfusion.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.06 Disposition of the DBS

(a) The DBS shall be processed by the infant’s healthcare provider or designee as follows:

(1) The infant’s healthcare provider shall note in the infant’s medical record the date and time the DBS is obtained;

(2) The filter paper shall be filled out completely, including the following information:

a. Whether the DBS is an initial or repeat sample;

b. The name of the birth facility where the infant was born;

c. The infant’s medical record number;

d. The name of the hospital to which the infant has been transferred, if applicable;

e. The infant’s mother’s name, date of birth, address, and telephone number;

f. The name, address, and telephone number of the infant’s healthcare provider;

g. The infant’s first and last name;

h. The infant’s sex;

i. Whether the infant’s birth was a single birth or multiple birth, and if multiple, the infant’s birth order;

j. The date and time of infant’s birth;

k. The date and time of DBS collection;

l. The infant’s birth weight and current weight;

m. Whether the infant was less than 24 hours old at the time the DBS was obtained;

n. Whether the infant has undergone transfusion preceding DBS collection, and, if so, the date of the most recent transfusion;

o. Whether the infant is a patient in a neonatal intensive care unit or special care unit;

p. The infant’s feeding method; and

q. Whether the submitter is the birth facility, the transfer hospital, or the infant’s healthcare provider; and

(3) The filter paper shall be sent within 24 hours of collection to the laboratory providing analysis of the DBS via secure courier service provided by the laboratory.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.07 DBS Analysis

The laboratory conducting analysis of the DBS shall provide such analysis which includes, but is not limited to the following disorders:

(a) Phenylketonuria (PKU);

(b) Maple syrup urine disease (MSUD);

(c) Homocystinuria (HCY);

(d) Galactosemia (GALT);

(e) Congenital hypothyroidism;

(f) Toxoplasmosis;

(g) Hemoglobinopathies;

(h) Biotinidase deficiency (BIOT);

(i) Congenital adrenal hyperplasia (CAH);

(j) Medium chain acyl CoA dehydrogenase deficiency (MCAD);

(k) Cystic fibrosis (CF);

(l) Argininosuccinic aciduria (ASA);

(m) Argininemia (ARG);

(n) Carnitine uptake defect (CUD);

(o) Carnitine palmitoyltransferase II deficiency (CPTII);

(p) Citrullinemia I, (ASA synthetase def) (CIT);

(q) Cobalamin A,B (Cbl A,B);

(r) Glutaric aciduria type I (GAI);

(s) 3-hydroxy-3-methylglutaryl-CoA Lysase deficiency (HMG);

(t) Hyperornithinemia hyperammoninemia, homocitrullinemia syndrome (HHH);

(u) Isovaleric acidemia (IVA);

(v) Long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD);

(w) 3-Methylcrotonyl-CoA carboxylase deficiency (3MCC);

(x) Methylmalonic acidemia (MUT);

(y) Mitochondrial acetoacetyl-CoA thiolase deficiency (BKT);

(z) Multiple acyl-CoA dehydrogenase deficiency (GA2);

(aa) Multiple carboxylase deficiency (MCD);

(ab) Propionic acidemia (PROP);

(ac) Severe combined immunodeficiency disorder (SCID);

(ad) Trifunctional protein deficiency (TFP);

(ae) Tyrosinemia;

(af) Very long chain acyl-CoA dehydrogenase deficiency (VLCAD);

(ag) Spinal muscular atrophy (SMA);

(ah) Mucopolysaccharidosis Type 1 (MPS1);

(ai) X-Linked Adrenoleukodystrophy (X-ALD); and

(aj) Pompe Disease (POMPE).

History

• #8529, eff 12-23-05; ss by #8875, eff 4-25-07; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.08 Procedures for Unsatisfactory and OOR DBS Screening Results

(a) A DBS for re-screening shall be collected by the infant’s healthcare provider or birth facility of record in the following cases:

(1) When an infant’s DBS was obtained prior to the first 24 hours of life;

(2) When an infant was transfused before an initial DBS could be collected; or

(3) When the laboratory deems any specimen as unsatisfactory or any result as OOR.

(b) Upon notification by the NSP, the infant’s healthcare provider shall:

(1) Arrange for the repeat DBS collection or additional testing as requested by the NSP; or

(2) Verify that another provider performs the requested testing.

(c) Upon request by the NSP, the healthcare provider shall report via secure means of transmission such as secure fax to 603-271-4519 or secure file transfer protocol, the following information:

(1) Diagnosis and treatment information for infants whose newborn screening results warranted diagnostic evaluation for a newborn screening disorder;

(2) Any suspected or confirmed case of a genetic condition or metabolic disorder listed on the newborn screening panel; and

(3) Any additional, case follow-up information regarding these diagnoses as requested by the NSP.

(d) If the infant’s healthcare provider elects to utilize a laboratory service other than that utilized by the NSP to perform the retesting, the infant’s healthcare provider shall be responsible for providing the results of this testing to the NSP.

(e) If a requested repeat DBS is not received by the NSP within 4 weeks of the notice in (b) above, the department shall issue a certified letter to the infant’s healthcare provider and birth facility of record indicating that newborn screening testing is incomplete.

(f) The NSP shall cease attempts to obtain the repeat DBS and close its file after notice in (e) above, indicating the DBS was not received after follow-up.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.09 Reporting of Results

Upon receipt of a completed newborn screening report from the department, the birth facility, and infant’s current healthcare provider shall include a copy of the report in the infant’s medical record.

History

• #9725, eff 7-1-10; ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.10 Disposal of DBS Residual

(a) The testing laboratory shall store DBS specimens in sealed bags of low gas permeability containing a desiccant and humidity indicator at -20 degrees Celsius.

(b) The testing laboratory shall destroy DBS specimens 6 months after the collection date, in a manner consistent with applicable federal requirements relating to the disposal of human blood and body fluids per OSHA regulations 29 CFR 1910.1030.

(c) If the storage environment of any DBS specimen is found to have deviated from the required conditions described in (a) above, such that the stability of the specimen is likely to have been affected, the testing laboratory shall first notify the NSP and shall then destroy the DBS specimen.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.09); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.11 Requests for DBS or Related Records

Residual DBS specimens and related records may be retrieved for other purposes only with the written authorization of a parent or guardian.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.10); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.12 Training of Persons Collecting a DBS

All persons performing DBS collection for newborn screening shall comply with the proper collection, handling, short-term storage, and transport of DBS in accordance with the Clinical and Laboratory Standards Institute (CLSI) “NBS 01 Dried Blood Spot Specimen Collection for Newborn Screening, 7th Edition” (April 2021) available as noted in Appendix A.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.11); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.13 Newborn Screening Advisory Committee

(a) The commissioner shall appoint members to a newborn screening advisory committee (NSAC), pursuant to RSA 132:10-a, III.

(b) The NSAC shall be comprised of at least one individual from each of the following:

(1) Health care sub-specialists with expertise relative to newborn screening including, but not limited to, such specialties as:

a. Endocrinology;

b. Pediatric neurology;

c. Genetics;

d. Hematology;

e. Metabolics;

f. Obstetrics; and

g. Neonatology;

(2) A member of the health and human services oversight committee, as established by RSA 126-A:13, appointed by the chair of that committee;

(3) A genetic counselor;

(4) An individual with a genetic or metabolic disorder or a parent or caregiver of a child affected by a genetic or metabolic disorder for which there is a nationally recommended newborn screening test;

(5) A midwife practicing outside the hospital setting;

(6) A representative from the New Hampshire Pediatric Society;

(7) A nurse with child health experience;

(8) A representative from the New Hampshire Hospital Association;

(9) A representative from the department’s public health laboratory;

(10) A representative from the department’s maternal and child health program;

(11) A representative from the department’s children with special health care needs program;

(12) A representative from the department’s medicaid program;

(13) A representative from a health insurance provider; and

(14) A representative from the New Hampshire Academy of Family Physicians.

(c) Additional staff from the department may participate in the NSAC, but shall not be voting members.

(d) The NSAC shall meet at least once annually to:

(1) Advise the department on clinical, educational, and operational aspects of the NSP;

(2) Advise the department on the inclusion of additional disorders in the current newborn screening panel based upon the criteria set forth by RSA 132:10-a, I; and

(3) Offer other advice as requested by the commissioner.

(e) Each member of the NSAC shall have one vote.

(f) The NSAC shall choose, by majority vote, 2 new members to serve as co-chairs for a term of 3 years, including:

(1) One co-chair employed by the department; and

(2) One co-chair not employed by the department.

(g) A quorum shall consist of a majority of all voting members.

(h) A quorum shall be present for a vote to take place.

(i) A majority vote shall be necessary to pass a motion.

(j) Recommendations by the NSAC shall be advisory, but not binding.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.12); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.14 Newborn Screening Test Fees

(a) The department shall establish fees upon hospitals to be paid directly and entirety for the newborn screening tests performed.

(b) Fees for the testing, analysis, and ancillary costs of the newborn screening program shall be determined by calculating the total yearly costs for program services divided by the state-wide annual projection of births.

(c) The department shall re-calculate fee amounts upon commissioner approval of new or changed newborn screening tests.

(d) Any change in the fee amount as a result of adding or changing newborn screening tests shall take effect upon approval by the commissioner.

(e) The department shall notify hospitals of any new or increased fee at least 30 days prior to the fee’s effective date.

History

• #8529, eff 12-23-05; amd by #8875, eff 4-25-07; ss by #9725, eff 7-1-10 (from He-P 3008.13); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.15 Reporting of Newborn Hearing Screening Information to EHDI Program

(a) Within 2 weeks of testing, individuals conducting newborn hearing screening and diagnostic hearing evaluation shall report the following information to the EHDI program via the EHDI database:

(1) Demographic information, including:

a. The infant’s name;

b. The infant’s sex;

c. The infant’s race;

d. The family of the infant’s preferred language for communication;

e. The infant’s date of birth;

f. The infant’s medical record number;

g. The infant’s birth facility;

h. Family contact information; and

i. The infant’s health care provider; and

(2) Results from testing, including:

a. Birth facility;

b. Testing date;

c. Type of testing;

d. Testing results;

e. Diagnosis; and

f. Risk factors for progressive hearing loss.

(b) Birth facilities shall fax to the EHDI program within 48 hours the hearing screening and diagnostic hearing in (a) above for any infant who does not pass the final newborn hearing screening.

(c) Newborn screen and diagnostic hearing information shall be reported via secure means of transmission such as secure fax to 603-271-4519 or secure file transfer protocol.

(d) In addition to the information in (a), above, New Hampshire audiologists providing diagnostic hearing evaluation shall submit to the department the following information:

(1) Referral information for medical, genetic, and early support services; and

(2) Hearing follow-up information, such as post-referral disposition.

(e) In addition to the information in (a) above, New Hampshire organizations and agencies providing intervention and early supports and services to children between the ages of birth and three years with hearing conditions shall submit to the department the following information:

(1) Early supports and services, individual family service plan, start date and discharge date; and

(2) Nature of the services provided and post referral disposition date.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.14); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.16 Critical Congenital Heart Disease (CCHD) Screening

(a) Newborn CCHD screening shall be required for all infants born in the state of New Hampshire in accordance with RSA 132:10-aa.

(b) CCHD screening shall be accomplished by pulse oximetry following the American Academy of Pediatrics (AAP) guidelines and screening algorithm “Strategies for Implementing Screening for Critical Congenital Heart Disease,” (November 2011) available as noted in Appendix A.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.15); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.17 Reporting of CCHD Screening Results

Within 24 hours of screening completion, facilities and individuals performing the screening shall report the results to the NSP, via secure means of transmission such as secure fax to 603-271-4519 or secure file transfer protocol, the following demographic information:

(a) The infant’s name;

(b) The infant’s sex;

(c) The infant’s date of birth;

(d) The infant’s medical record number;

(e) The infant’s birth facility;

(f) Mother’s name and address;

(g) Screening date;

(h) Screening results following AAP guidelines “Strategies for Implementing Screening for Critical Congenital Heart Disease,” (November 2011) available as noted in Appendix A;

(i) Further testing completed for infants with positive screening results; and

(j) Referral and transfer information.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.16); ss by #12632, eff 9-28-18; ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.18 Complaints and Non-Compliance

Upon receiving a complaint that an individual or facility listed in He-P 3008.02(a)-(f) is not practicing in accordance with this part, the department shall:

(a) Investigate the complaint; and

(b) If founded, refer the complaint to a relevant disciplinary body, such as the New Hampshire board of medicine.

History

• #8529, eff 12-23-05; ss by #9725, eff 7-1-10 (from He-P 3008.17); ss by #12632, eff 9-28-18 (formerly He-P 3008.16); ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.19 Bureau of Maternal and Child Health

Confidentiality and Security of Records.

(a) All records maintained by the NSP and EHDI or its contractors, including paper files, facsimile transmissions, or electronic data transfers, shall be strictly confidential.

(b) All confidential information shall be kept in a secured area at all times as follows:

(1) Paper records and external electronic storage media shall be kept in locked file cabinets;

(2) All electronic files shall be password protected; and

(3) All confidential notes or other materials that do not require storage shall be shredded immediately after use.

History

• #12632, eff 9-28-18 (formerly He-P 3008.17); ss by #13530, eff 1-25-23

N.H. Code Admin. R. Ann. He-P 3008.20 Quality Assurance

(a) Birth facilities shall allow periodic reviews of their newborn screening, CCHD, and newborn hearing screening activities by department staff for quality assurance purposes.

(b) Reviews shall include, but not be limited to:

(1) The review of policies and procedures regarding newborn screening, CCHD, newborn hearing screening, and diagnostic hearing evaluation;

(2) Interviews with staff performing any aspect of newborn screening, CCHD, and newborn hearing screening; and

(3) The on-site review of medical records.

(c) The NSP shall provide upon request:

(1) Information regarding acceptable procedures for the collection, handling, short-term storage, and transport of a DBS;

(2) Information regarding newborn screening that shall be given to and reviewed with the parent or guardian of each infant prior to testing; and

(3) Text to be used in statements of dissent for refusal of newborn screening described in He-P 3008.04(c).

(d) The NSP and the EHDI program shall compare the data sets of infants screened with New Hampshire birth certificate files, in order to ensure that every infant born in New Hampshire is screened, or had the opportunity to be screened, for hearing, CCHD, and for those conditions that are determined by DBS testing.

PARTS He-P 3009 – He-P 3010 – EXPIRED

History

• #12632, eff 9-28-18 (formerly He-P 3008.18); ss by #13530, eff 1-25-23
• #2407, eff 6-30-83, EXPIRED: 6-30-85

Part He-P 3011 Bicycle Protective Headgear Regulations

N.H. Code Admin. R. Ann. He-P 3011.01 Purpose

Statutory Authority – RSA 126-A:5, XIII

The purpose of this part is to set forth rules relative to approved protective headgear as required by RSA 126-A:5, XIII.

History

• #8524, eff 1-1-06; ss by #10529, eff 2-27-14

N.H. Code Admin. R. Ann. He-P 3011.02 Definitions

(a) “Label” means a sticker with information identifying the protective headgear as compliant with 16 Code of Federal Regulations (C.F.R.) Part 1203 by the Consumer Product Safety Commission (CPSC).

(b) “Protective headgear” means a bicycle helmet that adheres to the appropriate safety standard set forth in 16 C.F.R. Part 1203 by the CPSC.

History

• #8524, eff 1-1-06; ss by #10529, eff 2-27-14

N.H. Code Admin. R. Ann. He-P 3011.03 Safety Standards for Protective Headgear

All protective headgear shall have a label as required by the CPSC safety standards.

History

• #8524, eff 1-1-06; ss by #10529, eff 2-27-14

N.H. Code Admin. R. Ann. He-P 3011.04 Wear of Protective Headgear

All individuals under the age of 16 shall wear protective headgear pursuant to RSA 265:144, X.

History

• #8524, eff 1-1-06; ss by #10529, eff 2-27-14

Part He-P 3012 Birth Conditions Program

N.H. Code Admin. R. Ann. He-P 3012.01 Purpose

Statutory Authority RSA 141-J:9

The purpose of this part is to establish the requirements of a statewide population-based public health surveillance program on birth conditions. The surveillance program shall carry out the provisions established in RSA 141-J.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.02 Definitions

(a) “Birth condition” means “birth condition” as defined in RSA 141-J:2, I namely, “one or more of the birth conditions recommended by the National Birth Defects Prevention Network and/or the Centers for Disease Control and Prevention.”

(b) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(c) “Confirmed case” means confirmation by a medical record abstractor that an individual with a birth condition meets the criteria for case definition as defined by the National Birth Defects Prevention Network or Centers for Disease Control and Prevention, or both.

(d) “Department” means the New Hampshire department of health and human services.

(e) “Facilities” means health care facilities, clinics, imaging centers, laboratories, medical records departments, and state offices, agencies, and departments, which have information relating to the occurrence of birth conditions in children, infants, or stillborn fetuses.

(f) “Health care professional” means a:

(1) Medical doctor;

(2) Doctor of osteopathy;

(3) Doctor of naturopathic medicine;

(4) Advanced registered nurse practitioner;

(5) Registered nurse;

(6) Physician’s assistant;

(7) New Hampshire certified midwife;

(8) Doctor of audiology or licensed audiologist; or

(9) Optometrist or orthoptist.

(g) “Health information” means “health information” as defined in RSA 141-J:2, IV.

(h) “Individually identifiable health information” means “individually identifiable health information” as defined in RSA 141-J:2, V.

(i) “Medical records abstractor” means a staff person from the New Hampshire birth conditions program, its contractor, or designee who reviews medical information to confirm the presence of a birth condition.

(j) “New Hampshire birth conditions program (NHBCP)” means the entity assigned the responsibility for managing the program pursuant to RSA 141-J under the supervision of the department.

(k) “Opt-out” means the procedure an individual follows to elect not to participate in the NHBCP program, pursuant to RSA 141-J:5 and RSA 141-J:6.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.03 Program Access to Health Information

(a) In accordance with RSA 141-J:3 and this section, health care providers and facilities shall allow the NHBCP access to health information and individually identifiable health information relating to the occurrence of birth conditions in children, infants, and stillborn fetuses.

(b) At least annually, the NHBCP shall direct health care providers and facilities to generate a list of presumed cases of birth conditions. This list shall include only the information allowed by (d)(1) below.

(c) The NHBCP medical records abstractor shall be allowed to conduct on-site reviews of medical records to determine which cases identified in (b) above are confirmed cases as recommended by the National Birth Defects Prevention Network or the Centers for Disease Control and Prevention or both.

(d) For confirmed cases determined in accordance with (c) above, the medical records abstractor shall collect:

(1) The diagnosis, the health care provider’s name and address, and only the following individually identifiable information about the child, infant, or stillborn fetus:

a. Name; and

b. Address, including town or city, state, and postal code at the time of birth; and

(2) Additional non-individually identifiable health information about the child, infant, or stillborn fetus as recommended by the National Birth Defects Prevention Network or the Centers for Disease Control and Prevention or both.

(e) If the NHBCP has not received a completed opt-out form “Birth Conditions Program Registry Form” (12/2017) form from the individual in accordance with He-P 3012.04, the medical records abstractor shall return to the health care provider or facility to conduct a second on-site visit and perform on-site medical record abstraction to collect only that information described in (f) through (i) below. This visit shall be conducted no earlier than 60 days after the opt-out packet was mailed.

(f) For those cases allowed under (e) above, the following additional individually identifiable health information shall be collected for the child, infant, or stillborn fetus:

(1) Date of birth and death, if applicable;

(2) Results of any genetic testing related to the birth condition; and

(3) Medical record number.

(g) For those cases allowed under (e) above, the following individually identifiable information shall be collected for the mother:

(1) First, middle, and last name; and

(2) Date of birth.

(h) For those cases allowed under (e) above, the following individually identifiable health information shall be collected for the father:

(1) First, middle, and last name; and

(2) Date of birth.

(i) If the pregnancy was voluntarily terminated:

(1) No opt-out package shall be sent;

(2) No individually identifiable health information shall be collected; and

(3) Non-individually identifiable health information may be collected except that the following shall not be collected:

a. Physician or other health care provider; and

b. Health care facility.

(j) The NHBCP shall collect health information and individually identifiable health information relating to New Hampshire residents who meet the criteria for confirmed cases as defined in He-P 3012.02(c) only from those health care facilities, birth conditions surveillance programs, or other sources in other states with which the department has entered into an interstate memorandum of agreement in accordance with RSA 141-J:3.

(k) The NHBCP shall collect individually identifiable health information for confirmed cases of birth conditions defined by He-P 3012.02(c). When a child meets the criteria for a confirmed case, but a specialist is evaluating the birth condition further, the program shall maintain the child’s information for up to 2 years while monitoring the outcome of the specialist evaluation. If the outcome of the specialist evaluation indicates the child no longer meets the criteria for a confirmed case, all information on the child shall be expunged.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.04 Election Not to Participate in the NHBCP

(a) If an individual, or the parent or guardian of a minor or an individual who is legally incompetent, objects to the collection of individually identifiable health information by the NHBCP, the individual, or a parent or guardian of a minor or an individual who is legally incompetent, may elect not to participate in the NHBCP program, by completing and submitting an opt-out form “Birth Conditions Program Registry Form” (12/2017) , as defined by He-P 3012.03(e) in accordance with RSA 141-J:5 and RSA 141-J:6, I.

(b) Within 7 business days of case confirmation per He-P 3012.03(d), the NHBCP shall send an opt-out information packet which shall include:

(1) A letter to the individual, or the parent or guardian of a minor or an individual who is legally incompetent, explaining the collection of the birth condition data by the NHBCP under RSA 141:J;

(2) A NHBCP fact sheet about the nature and purpose of the program including the telephone number, fax number, mailing address, and email address of the NHBCP;

(3) Information about state-supported early intervention and prevention services; and

(4) An opt-out form “Birth Conditions Program Registry Form” (12/2017) with:

a. A statement that the failure to complete and return the opt-out form “Birth Conditions Program Registry Form” (12/2017) within 60 calendar days of the date of the letter means that their individually identifiable health information as listed in He-P 3012.03 shall be collected by the NHBCP;

b. A statement that the individual, or the parent or guardian of a minor or an individual who is legally incompetent, may elect not to participate at any time in the future in accordance with RSA 141-J:6, I and He-P 3012.06(a);

c. Information on what will occur as a result of opting out of the program; and

d. Information on the possible risks and benefits of participating in the program.

(c) If information packets described in (b) above are returned to the NHBCP as undeliverable, the program shall contact the individual’s health care provider for the individual’s most current address. The provider shall disclose that information solely for the purpose of the NHBCP contacting the individual regarding the opt-out procedures. Should the information packets described in (b) above be returned undeliverable a second time, the NHBCP shall not retain any information other than that allowed by (e) below.

(d) The NHBCP shall send letters to acknowledge the individual’s decision to opt-out of the NHBCP within 7 business days of receipt of the completed opt-out form.

(e) The NHBCP shall develop a list of individuals who have confirmed birth conditions but who have elected to opt-out of the program, including the dates of such elections, which shall be used only as a means of verifying that the individual or the parent, or guardian of a minor or an individual who is legally incompetent, has opted out in the event that individual’s record is encountered again through routine case finding. This list shall not be disclosed to any entity or individual outside of the NHBCP and shall be purged after 2 years from the date the case was confirmed.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.05 Confidentiality and Security of Records

(a) All records maintained by the NHBCP, including paper files, facsimile transmissions, or electronic data transfers, shall be strictly confidential except as allowed by RSA 91-A.

(b) All confidential information shall be kept in a secured area or safely stored electronically at all times as follows:

(1) Paper records and computer discs shall be kept in locked, cabinets or a medical record room;

(2) All individually identifiable health information stored in electronic files shall be password protected; and

(3) All confidential notes or other materials entered into the NHBCP database, which are not required to be stored, shall be shredded immediately after use.

(c) All staff members of NHBCP and any other persons given access to individually identifiable health information in the records maintained by the NHBCP shall sign a confidentiality agreement specified by the department requiring adherence to this part and the provisions pursuant to RSA 141-J:8, I.

(d) In accordance with RSA 141-J:8, II, the department shall maintain a list of any persons other than NHBCP staff given access to individually identifiable health information.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.06 Rights of Individuals

(a) Requests to exercise any or all of the rights listed in RSA 141-J:6 shall be put in writing and sent to:

Department of Health and Human Services

Division of Public Health Services

Maternal and Child Health Section

29 Hazen Dr.

Concord, NH 03301

(b) The department shall respond to those requests within 10 business days from the receipt of the written request.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.07 Program Ability to Share Data

(a) Health information, including individually identifiable health information available to the NHBCP under He-P 3012.03, shall be used to determine the prevalence and trends of birth conditions, to develop and assess prevention strategies, and to promote scientific collaboration through analyses, investigations, and epidemiological studies on the public health impact and possible causes of birth conditions.

(b) Pursuant to RSA 141-J:3, I, the NHBCP shall not provide individually identifiable health information relating to New Hampshire residents to any similar program operated by any other state or the federal government.

(c) The NHBCP shall maintain the confidentiality of all individually identifiable health information collected, except as allowed pursuant to RSA 141-J:4 and RSA 141-J:7 and in accordance with (d) below.

(d) Health information and individually identifiable health information that is made available to the NHBCP concerning an individual, and any other information maintained by the NHBCP, which, because of a personal identifier, can be readily associated with an individual, shall only be released:

(1) To the individual upon receipt of:

a. A written request which shall be signed by the individual;

b. A certified copy of the birth certificate of the individual; and

c. A copy of the individual’s identification, such as a driver’s license;

(2) If the individual is a minor, to a parent of the individual upon receipt of:

a. A written request, which shall be signed by the parent;

b. A certified copy of the birth certificate of the individual; and

c. A copy of the parent’s identification, such as a driver’s license by the parent;

(3) If the individual has a court-appointed guardian or if the individual is deceased, to the court-appointed guardian or to the executor or administrator of the individual’s estate upon receipt of:

a. A written request, which shall be signed by the court-appointed guardian, executor, or administrator of the estate;

b. A certified copy of the order or decree which appoints the guardian, executor, or administrator; and

c. A copy of identification, such as a driver’s license, of the guardian, executor, or administrator;

(4) To an attorney or other person designated by the individual upon receipt of a written medical release request which shall be signed by the individual;

(5) Pursuant to RSA 141-J:7, relative to a legal proceeding upon receipt of a written authorization from the person about whom the information relates; and

(6) To persons conducting health related research upon receipt and approval of a written request to the department pursuant to He-P 3012.08, which shall be signed by the requestor and include:

a. The following information about the principal investigator:

1. Name, address, and phone number;

2. Organizational affiliation;

3. Professional qualification; and

4. Name and phone number of principal investigator’s contact person, if any;

b. The following information about the data or record copies being requested:

1. Type of event or record copies;

2. Time period of the data or record copies;

3. Specific data items required, if applicable;

4. Medium in which the data or record copies are to be supplied; and

5. Any special format or layout of data required by the principal investigator;

c. A research protocol containing the following:

1. A summary of the background and origin of the research;

2. A statement of the health-related problem or issue to be addressed by the research;

3. The primary research hypothesis to be tested;

4. The research design, which shall include:

(i) Case definition;

(ii) Method of case selection; and

(iii) Method of data analysis;

5. The research methodology, including:

(i) The way in which the requested data will be used; and

(ii) The procedures for follow-back to any persons or facilities named in records, if applicable;

6. Procedures to obtain informed consent from the research participants, if applicable;

7. The procedures that will be followed to maintain the confidentiality and security of any data or copies of records provided to the requester; and

8. The intended completion date;

d. A written statement signed by the principal investigator agreeing to the following:

1. “I am the person in charge of the health-related research project, as described in the written request. I am the custodian of the data responsible for the observance of all conditions of use and for establishment and maintenance of security arrangements to prevent unauthorized use of the data and copies of records obtained”;

2. “I acknowledge that the department is the source of the data in any and all public reports, publications, or presentations generated by me or the written research request from this data”;

3. “I acknowledge and specify that the analyses, conclusions, and recommendations drawn from the data are solely my own or those developed as part of the health related research and are not necessarily those of the department”;

4. “I agree that any copies of data or records provided during the health related research shall not be used for any purpose other than that described in the written request”;

5. “I shall not disclose the identity of individuals revealed in the data or record copies to any persons except as is necessary to perform the research described in the written request”;

6. “I agree to have a procedure in place to require research staff to agree not to disclose the identity of individuals revealed in the data or record copies to any persons except as is necessary to perform the research described in the written request”;

7. “I agree that the data record shall not be further released to any other person or organization without the written consent of and under the terms specified by the commissioner or his designee”; and

8. “I agree that no form of information derived from the data or record copies that identifies any individuals shall be made public.”;

e. A written statement signed by the principal investigator stating: “I agree to indemnify the department accepting all responsibility on behalf of the research project if I or a member of the research staff cause an unauthorized disclosure of individually identifiable health information”; and

f. Documentation of Institutional Review Board (IRB) approval for the study by an IRB formed in accordance with the requirements of the U.S. Department of Health and Human Services Code of Federal Regulations for Protection of Human Subjects, 45 CFR 46.

(e) Persons who fraudulently request data shall be subject to the penalty for unsworn falsifications in accordance with RSA 641:3.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.08 Approval Criteria for Release of Confidential Data for Research Purposes

(a) The commissioner shall review and approve requests for the use of confidential NHBCP data, based on the following criteria:

(1) Completeness of written request, pursuant to He-P 3012.07(d)(6);

(2) Documentation of adequate measures to insure confidentiality of patients, and security of data pursuant to He-P 3012.07(d)(6);

(3) Determination of whether the study, if carried out according to the written request submitted pursuant to He-P 3012.07(d)(6) will be able to answer the research hypothesis as stated in the written request; and

(4) Qualifications of principal investigator(s) and research staff, as indicated by submission of:

a. Documentation of training and previous research, such as peer reviewed publications, in the proposed or related area; and

b. Documentation of an affiliation with a university, medical center or other institution, which will provide sufficient research resources.

(b) The commissioner shall deny a written request in accordance with RSA 541-A:29, II(a), when it has been determined that one or more of the requirements of He-P 3012.07(d)(6) or any of the criteria in (a) above have not been met.

(c) Upon approval by the commissioner, the principal investigator or responsible party shall execute an “NHDHHS Division of Public Health Services Data Use Agreement” (11/1/17) which describes the permitted uses of the data.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

N.H. Code Admin. R. Ann. He-P 3012.09 Release of Aggregate Data

(a) Statistics derived from the NHBCP data shall be considered to be aggregate data if published by towns with a population of 5,500 or more.

(b) Population estimates shall be derived from the most recent decennial census.

(c) If there are 4 or fewer confirmed cases in towns with populations of less than 5,500, then the data at the town level shall not be released, to prevent constructive identification of individuals.

(d) The age-adjusted rates and age-specific rates shall:

(1) Not be calculated for cases fewer than 10; and

(2) Be provided with confidence intervals.

History

• #9404, eff 3-5-09, EXPIRED: 3-5-17
• #12333, INTERIM, eff 7-22-17, EXPIRES: 1-18-18; ss by #12448, eff 1-9-18

Part He-P 3013 Maternal Mortality Review Panel

N.H. Code Admin. R. Ann. He-P 3013.01 Purpose

Statutory Authority: RSA 132:30, VII

The purpose of this part is to establish the requirements of a maternal mortality review panel in order to carry out the provisions established in RSA 132:30, VII.

History

• #10287, eff 3-16-13

N.H. Code Admin. R. Ann. He-P 3013.02 Definitions

(a) “Abstraction team” means a team of professionals designated by the Northern New England Perinatal Quality Improvement Network (NNEPQIN), which abstracts medical information to review and analyze the public health implications of a maternal death.

(b) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(c) “Department” means the New Hampshire department of health and human services.

(d) “Individually identifiable information” means information relating to the occurrence of a maternal death, as described in RSA 132:31, II.

(e) “Maternal death” means any of the following, as defined in RSA 132:29, I–III:

(1) “Pregnancy-associated death” means the death of a woman while pregnant or within one year of the end of pregnancy, irrespective of cause;

(2) “Pregnancy-associated, but not pregnancy-related” means the death of a woman while pregnant or within one year of the end of pregnancy due to a cause unrelated to pregnancy; and

(3) “Pregnancy-related death” means the death of a woman while pregnant or within one year of the end of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by her pregnancy or its management, but not from accidental or incidental causes.

(f) “Medical records” means any related healthcare and mental health record of the mother, including, but not be limited to, audio and video recordings, vital records, hospital discharge data, prenatal, fetal, pediatric, or infant medical records, hospital, medical office, or clinic records, laboratory reports, records of fetal deaths or induced termination of pregnancies, autopsy reports, and emergency response records.

(g) “Northern New England Perinatal Quality Improvement Network (NNEPQIN)” means the entity designated by the department, through a business associates agreement, to oversee the review and abstraction of medical information to review and analyze the public health implications of a maternal death.

(h) “Panel” means the maternal mortality review panel as established and described in RSA 132:30.

History

• #10287, eff 3-16-13

N.H. Code Admin. R. Ann. He-P 3013.03 Identification and Reporting of Maternal Deaths

(a) Facilities, as described in RSA 132:31, II, shall identify and report maternal deaths to the department.

(b) Maternal deaths may be identified and reported to the department through the following sources:

(1) Direct report from a hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center;

(2) Data linkage through a death certificate;

(3) Case finding from a panel member and reported to the department;

(4) Medical examiner’s report; and

(5) Other source.

(c) For maternal deaths identified and reported in (b)(1) above, the hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center shall complete and send a “Maternal Mortality Initial Report” form (2/2013) to the department either by secure fax, electronic, or paper format within 10 business days of a maternal death.

(d) Upon receipt of the initial report form in (c) above, the department shall send the CEO of the hospital or birthing center:

(1) A “Maternal Mortality Case Information Sheet” which includes the identified patient’s name and date of birth; and

(2) A data collection letter which shall include information on the review process to be conducted by the abstraction team.

(e) For deaths identified in (b)(2)–(5) the department shall complete the “Maternal Mortality Initial Report” form (2/2013) and send it and the following to the CEO of the appropriate hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center where the patient received care:

(1) A “Maternal Mortality Case Information Sheet” which includes the identified patient’s name and date of birth; and

(2) A data collection letter which shall include information on the review process to be conducted by the abstraction team.

(f) Reporting under this part shall not preclude the requirement for a hospital or ambulatory surgical center to report an adverse event under RSA 151:37–40 and He-P 802 and He-P 812, respectively, and for a birthing center to report an unusual incident under He-P 810.

History

• #10287, eff 3-16-13

N.H. Code Admin. R. Ann. He-P 3013.04 Program Access to Health Information

(a) In accordance with RSA 132:31, II, the commissioner through NNEPQIN shall have access to individually identifiable health information relating to the occurrence of a maternal death on a case-by-case basis where public health is at risk, as follows:

(1) Upon receipt of the “Maternal Mortality Initial Report” form (2/2013) from the department, NNEPQIN shall assign an abstraction team to the hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center to conduct a review of medical records within 60 days of receipt of the initial report; and

(2) The hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center shall make available all medical records relating to the maternal death to NNEPQIN by a secure fax, electronic, or paper method within 60 days of contact by NNEPQIN.

(b) After the completion of the abstraction process, NNEPQIN shall send the analysis to the department, no later than one week prior to the semiannual maternal mortality review panel meeting, by completing and sending the following forms:

(1) “Maternal Mortality Review Panel Case Abstraction” form (2/2013);

(2) “Maternal Mortality Review Panel Staffing Questions” form (2/2013); and

(3) “Maternal Mortality Review Panel Submission Checklist” (2/2013).

History

• #10287, eff 3-16-13

N.H. Code Admin. R. Ann. He-P 3013.05 Contact with Families

(a) The department shall contact families after the death of the mother to invite them to participate in an interview except when the department determines such an interview would not assist in the root cause analysis of a maternal mortality event. The results and findings of the interview may be included in the case summary presented to the panel per He-P 3013.06.

(b) Initial family contact shall occur through a letter from the department to include the following information:

(1) An invitation for the family to participate in a home interview through a voluntary process;

(2) The information obtained shall be used to determine and understand the significant social, economic, cultural, safety, and health care delivery system factors that are associated with maternal mortality;

(3) The information obtained shall be confidential, and the name of the deceased mother and her family and any other individually identifying information shall not be released; and

(4) A family may refuse participation in the home interview

(c) In the event of documented family refusal to participate, or indication of unwillingness to participate, in an interview, the department shall not conduct the interview.

History

• #10287, eff 3-16-13

N.H. Code Admin. R. Ann. He-P 3013.06 Panel Access to Health Information

(a) The department shall prepare and present to the panel a de-identified case summary of each maternal death reported or identified based on the following:

(1) NNEPQIN review;

(2) Family interview as applicable; and

(3) The facility’s root cause analysis of the event if one has been completed.

(c) All members of the panel shall sign a confidentiality agreement regarding case review conduct and assurances of confidentiality.

(d) After each case has been reviewed, the department shall collect all summaries from panel members and shred them immediately after the meeting.

(e) The panel shall provide the hospital, non-emergency walk-in care center, ambulatory surgical center, or birthing center a written copy of the maternal mortality review panel’s general recommendations and conclusions.

Appendix A: Incorporation by Reference Information

Rule

Title

Obtain at:

He-P 3008.12

The Clinical and Laboratory Standards Institute (CLSI), “NBS 01 Dried Blood Specimen Collection for Newborn Screening, 7^th Edition” (April 2021)

Publisher: Clinical and Laboratory Standards Institute

Cost: Members $54-$170/Nonmembers $200

The incorporated document is available at:

https://clsi.org/standards/products/newborn-screening/documents/nbs01/

He-P 3008.16(b) and He-P 3008.17(h)

American Academy of Pediatrics (AAP),

“Strategies for Implementing Critical Congenital Heart Disease”

(November 2011)

Publisher: American Academy of Pediatrics (AAP)

Cost: Free of Charge

The incorporated document is available at:

https://publications.aap.org/pediatrics/article/128/5/e1259/30947/Strategies-for-Implementing-Screening-for-Critical?autologincheck=redirected

APPENDIX B

RULE

STATUTE

He-P 3008.01

RSA 132:10-a, III; RSA 132:10-b, V

He-P 3008.02

RSA 132:1; RSA 132:10-a

He-P 3008.03

RSA 132:1

He-P 3008.04

RSA 132:10-a, I; RSA132:10-c

He-P 3008.05

RSA 132:10-a

He-P 3008.06

RSA 132:10-a

He-P 3008.07

RSA 132:10-a

He-P 3008.08

RSA 132:10-a

He-P 3008.09

RSA 132:10-a

He-P 3008.10

29 CFR 1910.1030

He-P 3008.11

45 CFR 164.524

He-P 3008.12

RSA 132:10-a, I(c)

He-P 3008.13

RSA 132:10-a, III

He-P 3008.14

RSA 132:10-a, II; RSA 541-A

He-P 3008.15

RSA 132:10-b, V; RSA 132:12

He-P 3008.16 and He-P 3008.17

RSA 132:10-aa

He-P 3008.18

RSA 132:3

He-P 3008.19

45 CFR 160 and 45 CFR 164

He-P 3008.20

RSA 132:3

He-P 3011.01 - He-P 3011.04

RSA 126-A:5; RSA 265:144, X

He-P 3012.01

RSA 141-J:1; RSA 141-J:9

He-P 3012.02

RSA 141-J:2; RSA 141-J:9

He-P 3012.03

RSA 141-J:3; RSA 141:J-5; RSA 141:J-9.

He-P 3012.04

RSA 141-J:5: RSA 141:J-6; RSA 141:J-9.

He-P 3012.05

RSA 141-J:7; RSA 141:J-8; RSA 141:J-9

He-P 3012.06

RSA 141-J:6; RSA 141:J-9

He-P 3012.07

RSA 141-J:3; RSA 141:J-4; RSA 141:J-8; RSA 141:J-9.

He-P 3012.08

RSA 141-J:4; RSA 141:J-8; RSA 141:J-9

He-P 3012.09

RSA 141-J:4; RSA 141:J-8; RSA 141:J-9

He-P 3013.01

RSA 132:29-31

He-P 3013.02

RSA 132:29-31

He-P 3013.03

RSA 132:31

He-P 3013.04

RSA 132:30, IV; RSA 132:31

He-P 3013.05

RSA 132:30, VII(c)

He-P 3013.06

RSA 132:30, VII(d); RSA 132:31

History

• #10287, eff 3-16-13

Chapter He-P 3200 Special Supplemental Nutrition Program for Women, Infants and Children (wic)

Part He-P 3201 Definitions

N.H. Code Admin. R. Ann. He-P 3201.01 Definitions

(a) “Above-50-percent” means deriving, or expecting to derive, more than half of annual revenue from the sale of food items from the special supplemental nutrition program for women, infants, and children (WIC) food benefits including WIC gross food sales that exceed, or are likely to exceed, gross food sales derived from the food stamp program.

(b) “Authorized product list (APL)” means an electronic file of all universal product codes (UPCs) and price look up codes (PLUs) authorized by New Hampshire WIC.

(c) “Applicant” means an individual who appears in person or by telephone to request program benefits.

(d) “Authorized vendor” means a vendor that has been approved to redeem WIC benefits as defined in (e) below.

(e) “Benefits” means supplemental foods and formula, nutrition education, health screenings, and referrals designed to improve the health status of women, infants, and children.

(f) “Breastfeeding women” means “breastfeeding women” as defined in 7 CFR 246.2.

(g) “Cash value benefit (CVB)” means a fixed dollar amount on an electronic benefit transfer (EBT) card which is used by a participant to obtain approved fruits and vegetables as defined in 7 CFR 246.2.

(h) “Categorical eligibility” means “categorical eligibility” as defined in 7 CFR 246.2.

(i) “Certification” means “certification” as defined in 7 CFR 246.2.

(j) “Certification period” means the period of program benefits established by federal regulations according to participant category.

(k) “Chain store” means multiple stores owned by the same entity in the State of New Hampshire using the same name or federal tax ID number.

(l) “Children” means “children” as defined in 7 CFR 246.2.

(m) “Competent professional authority” means “competent professional authority” as defined in 7 CFR 246.2.

(n) “Competitive price criteria” means the fair and competitive price level, in comparison with similar type vendors, that vendor applicants meet in order to be eligible for WIC authorization and continue to meet throughout authorization.

(o) “Days” means calendar days unless otherwise specified.

(p) “Department” means the New Hampshire department of health and human services.

(q) “Disqualification” means the act of ending program participation of a participant, authorized vendor, or local agency, whether as a punitive sanction or for administrative reasons.

(r) “Enrollment” means the enlistment of an applicant into the program.

(s) “eWIC cardholder” means an individual authorized to use the WIC participant’s family eWIC card.

(t) “Food delivery system” means the method used by the department and local agencies to provide supplemental foods to participants.

(u) “Homeless” means “homeless individual” as defined in 7 CFR 246.2.

(v) “Inadequate participant access” means there are not at least 5 vendors within a 7 mile radius capable of redeeming food benefits for 20 or more WIC households.

(w) “Incidence” means one isolated instance or single occurrence of a violation of WIC program

rules.

(x) “Infants” means “infants” as defined in 7 CFR 246.2.

(y) “Local agency” means “local agency” as defined in 7 CFR 246.2.

(z) “Nutrition education” means “nutrition education” as defined in 7 CFR 246.2.

(aa) “Nutritional risk” means “nutritional risk” as defined in 7 CFR 246.2.

(ab) “Participants” means “participants” as defined in 7 CFR 246.2 .

(ac) “Participation” means “participation” as defined in 7 CFR 246.2.

(ad) “Peer group” means a classification of authorized vendors into groups based on common characteristics or criteria that affect food prices for the purpose of applying appropriate competitive price criteria.

(ae) “Postpartum women” means “postpartum women” as defined in 7 CFR 246.2 and includes non-breastfeeding women.

(af) “Pregnant women” means “pregnant women” as defined in 7 CFR 246.2.

(ag) “Program” means “program” as defined in 7 CFR 246.2.

(ah) “Proxy” means an individual designated in writing to certify, receive, or redeem a WIC benefit on behalf of a participant or a parent or a caretaker of an infant or child participant.

(ai) “Sanctions” means administrative actions taken against participants and vendors for reasons of program abuse.

(aj) “Single investigation” means 2 or more on-site transactions within a 12-month period, the number of which depends on the severity of the alleged vendor violation, in which a department representative covertly poses as a participant, parent, or caretaker of an infant or child participant, or proxy.

(ak) “Supplemental foods” means “supplemental foods” as defined in 7 CFR 246.2.

(al) “Suspension” means a temporary prohibition from participation in the program.

(am) “Termination” means the removal of a vendor or participant from the program for cause or failure to comply with any WIC program rule or requirement.

(an) “Vendor” means any retail food store or pharmacy authorized to redeem food benefits.

(ao) “Vendor agreement” means a binding legal agreement between the retailer and the state agency.

(ap) “WIC approved” means meets the criteria for approved foods described in 7 CFR Part 246.

(aq) “30day temp participant” means an applicant who is provided a temporary certification of 30 days due to missing one or more of the required proofs used to determine eligibility for the program and benefits.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; amd by #12199, eff 6-3-17; ss by #12858, eff 8-23-19

Part He-P 3202 Participant Eligibility Criteria

N.H. Code Admin. R. Ann. He-P 3202.01 Residence

(a) Except as allowed in (c) below, all WIC applicants shall reside within the jurisdiction of the state of New Hampshire and the service area of the local agency.

(b) As proof of residence, the applicant shall provide to the local agency one of the following documents:

(1) Government issued identification card or driver’s license;

(2) Current utility bill or rent receipt;

(3) New Hampshire resident tax receipt;

(4) Post-marked envelope with the physical address and the name of applicant, or if applicable, the name of the applicant’s parent, guardian, or caretaker;

(5) Mortgage statement containing the address; or

(6) Pay stub with name and address.

(c) A homeless or migrant applicant shall not be required to provide residence documentation.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3202.02 Income

All applicants shall have an income at or below 185 percent of the Federal Poverty Guidelines as published annually in the Federal Register in effect at the time of income determination. Income shall be verified by proof of income such as a paycheck stub, employer verification, or federal tax return or participation in another program for which financial eligibility is at or below the same standard.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3202.03 Category

All applicants shall be pregnant, breastfeeding, or postpartum women, infants, or children under age 5 as verified by information such as one of the following:

(a) Health care provider documentation of applicant’s pregnancy unless visibly pregnant; or

(b) Applicant’s birth certificate containing date of birth as documentation of age.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3202.04 Nutritional Risk

(a) An applicant shall be eligible to participate in the program if the applicant is at nutritional risk as defined by 7 CFR 246.2.

(b) An applicant shall be deemed to be at nutritional risk if a competent professional authority determines that the applicant has any of the conditions listed in 7 CFR 246.7(e).

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3202.05 Priority System

If funding is insufficient for complete participation within the area serviced by the local agency, participation shall be limited by the use of prioritization in accordance with 7 CFR 246.7(e)(4).

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3203 Foods Provided

N.H. Code Admin. R. Ann. He-P 3203.01 Supplemental Foods

(a) Supplemental foods shall be provided to participants based upon category and nutritional need in accordance with 7 CFR 246.10(e)(10) and 7 CFR 246.11(c) where category refers to a pregnant woman, breastfeeding woman, postpartum woman, infant, or child.

(b) Maximum allowable types, quantities, or volumes of foods may be tailored by a competent professional authority, according to an individual’s nutritional status or a licensed healthcare provider’s prescription within a category as specified above.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3203.02 Approved Foods

Food packages and food types shall comply with 7 CFR 246.10(c).

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3203.03 Restrictions

(a) Flavored milk shall not be allowed as an approved supplemental food.

(b) Only 1% low fat milk or skim milk shall be allowed for women and children older than 24 months, except as allowed in (c) below.

(c) If the participant has special medical needs that require whole milk and special formula, for which medical documentation from a licensed healthcare provider is provided to the department, the participant shall be allowed whole milk and special formula.

(d) Dried fruits shall not be allowed as an approved supplemental food.

(e) Fresh bananas as partial substitute for infant foods shall not be allowed as an approved supplemental food.

(f) Foods containing artificial sweeteners such as aspartame, sucralose, or saccharine shall not be allowed as an approved supplemental food.

(g) Low iron infant formula shall not be allowed as an approved supplemental food.

(h) The department shall limit approved supplemental food items if:

(1) Container size or type changes prior to the department annual update of approved foods as described in (i) and (j) below;

(2) The item is not widely available within New Hampshire; or

(3) The foods are included in a cost-containment initiative such as a competitively bid manufacturers’ rebate.

(i) The department shall periodically and as necessary review and approve foods which meet the criteria in He-P 3203.02 and He-P 3203.03.

(j) The department shall limit food brands or items through competitive procurement or cost-containment actions in accordance with Adm 603, provided such actions would reduce actual costs of supplying these foods to participants.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3203.04 Prorating Food Packages

(a) The New Hampshire WIC proration schedule shall be as listed in Table 3200.1 below and subject to the conditions in (b) and (c) below:

Table 3200.1 New Hampshire WIC Proration Schedule

Number of Days Remaining

Percent of Benefits Issued

0-5 days

25%

6-17 days

50%

18-23 days

75%

24-31 days

100% (full package provided)

(b) When a new family member is added to an existing benefited group, the percentage of benefits provided shall be adjusted to match the existing groups benefit cycle.

(c) When an applicant is certified for a 30-day temporary certification and added to an existing family the percentage of benefits provided shall be adjusted to match the existing group’s benefit cycle.

(d) When a participant is terminated or suspended from the program, the system shall prorate according to the following:

(1) If 15 days’ notice of termination or suspension is contained within the current use month, there shall be no proration. Issuance shall be 100% of the current use month and future months shall be voided; or

(2) If the 15 days’ notice of termination or suspension extends into the following use month, the next month’s benefit’s issuance shall be prorated by 50% and future benefits shall be voided.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3204 Local Agency Participation

N.H. Code Admin. R. Ann. He-P 3204.01 Local Agency Requirements

A local health or human service agency shall certify participants and provide them with food benefits, nutrition education, and related benefits under State-approved agreements between the local health and human service agency and the department in accordance with 7 CFR 246.5 and 7 CFR 246.6.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3205 Vendor Participation

N.H. Code Admin. R. Ann. He-P 3205.01 Selection of Vendors

(a) The following procedures shall apply to the selection of vendors for the WIC program:

(1) Retail food stores and pharmacies eligible to be authorized shall submit a written application to the department which includes, at a minimum:

a. Legal name and physical address of store;

b. Billing name and address, if different;

c. Business phone number and owner’s personal phone number;

d. Name(s) of owner(s), type of ownership, and previous ownership(s);

e. Owner’s home address;

f. Owner’s e-mail address;

g. Name and mailing address of landlord;

h. Name of manager;

i. Store square footage;

j. Food establishment class license;

k. Hours of operation;

l. Number of registers and scanners;

m. Annual or estimated sales;

n. List of primary WIC food suppliers, including infant formula;

o. Current food stamp program identification number and authorization status, including any actions pending or under appeal;

p. The full names of any local agency staff who hold dual employment with the store or pharmacy;

q. A full disclosure by the owner, partner, officer, or manager of any convictions or civil judgments outlined in He-P 3205.01(b)(14); and

r. The full names and mailing addresses of any owners, partners, or principle officers;

(2) Vendors shall provide information regarding gross food sales and inventory supplier records for approved foods upon the request by the department in order to evaluate the vendor’s eligibility under He-P 3205.01(a) and (b) and 7 CFR 246.12(h)(xv); and

(3) An on-site review of each new applicant vendor shall be performed by the department in accordance with 7 CFR 246.12(g)(vii)(5) as follows:

a. Department employees who hold dual employment with any WIC-authorized or applicant vendor, regardless of capacity, shall not be involved in the review of vendor qualifications for authorization;

b. The department shall assess the applicant vendor’s qualifications using the selection criteria in accordance with (b) below; and

c. The assessment shall include a price inventory in order to determine whether or not the applicant vendor meets the competitive price selection criteria.

(b) The department shall deny authorization of an applicant vendor or terminate an authorized vendor if any of the following criteria are true at any time:

(1) The store location is not within NH borders;

(2) The applicant vendor or authorized vendor does not provide information regarding gross food sales and inventory supplier records upon request by the department in accordance with He-P 3205.02(a) and 7 CFR 246.12(h)(xvi);

(3) The department determines that the applicant vendor or authorized vendor is not able to meet all program requirements or existing selection criteria as evidenced by:

a. Sanction points obtained under He-P 3207.03;

b. Category I violations as described in He-P 3207.03(b);

c. Monitoring requirements in accordance with He-P 3206;

d. Failure to attend face-to-face training upon initial application as set forth in 7 CFR 246.12(i)(1); or

e. Failure to attend face-to-face training as scheduled by the department thereafter as described in He-P 3205.04;

(4) The store’s annual revenue from sales of WIC-approved food meets the “above 50 percent” threshold, as defined in He-P 3201.01(a), unless inadequate participant access exists;

(5) The applicant vendor or authorized vendor does not purchase all infant formula from the department’s approved list of manufacturers, distributors, and retailers;

(6) A minimum quantity and variety of foods as listed in the vendor agreement and approved in accordance with He-P 3203.02 and He-P 3203.03 are not available for purchase at a retail food store, even if inadequate participant access would be a result of such denial;

(7) The price ranges of foods approved in accordance with He-P 3203.02 and He-P 3203.03 in retail food stores are not comparable to or lower than currently authorized vendors in the same peer group;

(8) The applicant vendor or authorized vendor is not open for business at least 9 hours per day, 6 days a week;

(9) A conflict of interest exists in that a retail store employee is dually employed by the WIC program;

(10) The applicant vendor or authorized vendor has prior, pending, or under appeal WIC or food stamp program disqualifications, civil money penalties, unpaid civil money penalties, or other sanctions;

(11) For retail food stores only, the applicant vendor or authorized vendor is not participating in the supplemental nutrition assistance program (SNAP);

(12) The applicant vendor or authorized vendor does not accept, at a minimum, cash for food purchases from the general public as well as WIC participants;

(13) The majority of comments and recommendations from local agency staff and participants indicate a negative assessment;

(14) In accordance with 7 CFR 246.12(g)(3)(ii), the current owner(s), officer(s), or manager(s) have been criminally convicted of or had a civil judgment for any of the following in the previous 6 years:

a. Fraud;

b. Antitrust violations;

c. Embezzlement;

d. Theft;

e. Forgery;

f. Bribery;

g. Falsification or destruction of records;

h. Making false statements;

i. Receiving stolen property;

j. Making false claims;

k. Obstruction of justice; or

l. Any other criminal conviction or civil judgment that indicates a lack of business integrity pursuant to 7 CFR 12(g)(3)(ii);

(15) The authorized vendor has 5 or more sanction points currently pending, assigned, or under appeal;

(16) For retail food stores only, the applicant vendor or authorized vendor does not provide a variety of staple foods for sale including fresh, frozen, or canned fruits and vegetables, fresh, frozen, or canned meats, dairy products, and grain products such as bread, rice, and pasta;

(17) For retail stores only, the applicant or authorized vendor does not meet the minimum stocking requirements as stated in the WIC vendor agreement;

(18) Failure to maintain a card acceptor device that is certified by the State’s online eWIC processor to accept and process the eWIC card using either a stand-beside POS terminal or an Integrated Electronic Cash Register System;

(19) Transactions are not performed in accordance with published operating rules, standards, and technical requirements for WIC EBT to include the American National Standards Institute (ANSI) “ANSI X9.93-2014” (Part 1 and Part 2) and by the United States Department of Agriculture, Food and Nutrition Service, “WIC-Electronic Benefits Transfer (EBT) Guidance and Resources” https://www.fns.usda.gov/wic/wic-electronic-benefits-transfer-ebt-guidance, available as noted in Appendix A;

(20) For retail food stores only, the vendor’s monthly average volume of WIC business over the most recent 12 months is less than $200.00 and another authorized vendor is located within 2 miles, unless inadequate participant access is determined as defined in He-P 3201.01(w);

(21) The department determines that the store location was sold or had a change in ownership to circumvent a WIC sanction in accordance with 7 CFR 246.12(g)(6);

(22) The vendor or store owner has prior, pending, or under appeal disqualifications or sanctions by other US Department of Agriculture, Food and Nutrition Service Programs; or

(23) The applicant vendor provides false or misleading information on the vendor application or other required program documents.

(c) Pending or current disqualification from or sanction by other US Department of Agriculture, Food and Nutrition Service Programs or failure to meet rules or standards of another state agency or local health agency which results in suspension of license shall constitute sole grounds for denial of authorization.

(d) A store that has been denied authorization initially or terminated during the course of a current agreement period based on (b) or (c) above shall not reapply for the later of the following:

(1) A minimum of 6 months from the date of vendor receipt of the department’s notice; or

(2) Six months from the date of an appeal decision upholding the department’s decision to deny authorization or terminate.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3205.02 Written Agreement

(a) Written agreements shall include the requirements of 7 CFR 246.12(h) and the following:

(1) The vendor shall stock sufficient quantities of all categories of foods approved in accordance with He-P 3203.02 and He-P 3203.03 to meet participant demands;

(2) The vendor shall maintain minimum inventory in accordance with He-P 3203.02 and He-

P 3203.03; and

(3) The vendor shall:

a. Provide only the brand, type, and size of infant formula, and WIC-approved foods approved in the New Hampshire authorized product list (APL) and benefits issued to the family;

b. Provide supplemental foods at the current cash price or at less than the current price charged to other customers and deduct the value of manufacturer or store coupons presented by eWIC cardholder from the purchase amount charged to the WIC program;

c. Purchase all infant formula from the approved infant formula supplier list updated and maintained by the department;

d. Clearly indicate the retail price of all WIC approved food items, either individually on each item or at the shelf or point of display;

e. Maintain a functioning cash register or sales machine that imprints the date of redemption and the products purchased on the receipt to be provided to the eWIC cardholder;

f. Provide the department information on inventory records for foods approved in accordance with He-P 3203.02 and He-P 3203.03 and gross food sales, upon request during the term of the current vendor agreement and for 3 years from the expiration of the current vendor agreement;

g. Comply with the following:

1. Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.);

2. Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.);

3. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794);

4. Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.);

5. All provisions required by the implementing regulations of the US Department of Agriculture;

6. Department of Justice Enforcement Guidelines; and

7. Food Nutrition Services (FNS) directives and guidelines to the effect that no person shall, on the ground of race, color, national origin, age, sex, or handicap, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity for which the department receives Federal financial assistance from FNS;

h. Give assurance that the vendor will immediately take measures necessary to effectuate this agreement. If there are any violations of this assurance, the US Department of Agriculture shall have the right to seek judicial enforcement;

i. Provide WIC customers the same courtesies provided to non-WIC customers;

j. Attend training on WIC program procedures as scheduled by the department with at least one opportunity to reschedule;

k. Ensure that cashiers and all other staff are fully trained and understand WIC program requirements;

l. Ensure that WIC-approved items sold to an eWIC cardholder are not expired;

m. Provide WIC-approved items at prices that are fair and competitive in comparison with vendors in their peer group;

n. Be monitored by the department for compliance with WIC program rules;

o Provide ready access to WIC redemption information at the request of the department;

p. Not charge the department for an amount of a specific WIC-approved food that exceeds the store’s documented inventory of that food for a specific period of time;

q. Not charge the department for foods not received by the eWIC cardholder;

r. Not provide cash, change, unapproved foods, or other items in lieu of foods prescribed to WIC participants;

s. Submit a WIC vendor price survey every 6 months or upon request by the department;

t. Notify the department in writing at least 2 weeks in advance of the vendor ceasing operations or changing ownership, name of store, or location, thereby permitting the department to terminate the vendor agreement in accordance with 7 CFR 246.12 (h)(3)(xvii);

u. Maintain a copy of the current NH WIC-approved foods list at each cash register or checkout lane;

v. Not use manufacturers’ shelf tags, promotional materials, or incentive items with the WIC acronym or logo;

w. Not offer incentive items solely to WIC participants and not to other customers in an effort to obtain WIC business; and

x. Allow an alternate form of payment, such as a SNAP/food stamps card, cash, credit card, or check for fruit and vegetable benefits when the amount purchased exceeds the dollar value of the benefit.

(b) The department shall issue a pharmacy agreement requiring pharmacies to stock, or have the capability to immediately order and provide special infant formula within 48 hours of request to meet participant demands.

(c) Pursuant to changes in federal or state statutes, rules, or other requirements, the department shall revise all current agreements, and the amended agreements shall include the original expiration date without prejudice.

(d) Vendors who fail to reapply by signing and returning their new vendor agreement prior to the expiration of their current vendor agreement shall no longer be authorized due to an expired vendor agreement.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by 8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; amd by #12199, eff 6-3-17; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3205.03 Periodic Review of Vendor Qualifications

The department shall conduct reviews at least once during a current vendor’s agreement period using the selection criteria as described in He-P 3205.01.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by 8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3205.04 Vendor Training

The department shall provide training to vendors pursuant to 7 CFR 246.12(i) by implementing the following:

(a) The department shall provide vendors with initial face-to-face training;

(b) At least one representative of the vendor shall participate in WIC program training annually as described in (d) below;

(c) Annual training by the department shall communicate changes in pertinent regulations, rules, and procedures and keep vendors informed of problems and suggestions to improve food delivery;

(d) Annual training shall be provided by the department in a variety of formats, including newsletters, videos, or train-the-trainer formats;

(e) At least one representative of the vendor shall participate in a face to face interactive training at least once every 3 years;

(f) At least one alternative date on which to attend face-to-face training shall be provided to vendors;

(g) The department and local agency shall be available for further vendor training and education as requested by the vendor or as deemed necessary as a result of vendor monitoring activities;

(h) The vendor shall notify the department and request additional training if, in the opinion of the owner or manager, vendor staff does not adequately understand WIC procedures; and

(i) Mandatory training shall be deemed necessary by the department as a result of repeated vendor violations or as a result of vendor monitoring activities.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by 8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3206 Vendor Monitoring

N.H. Code Admin. R. Ann. He-P 3206.01 Types of Vendor Monitoring

(a) Food benefits presented for payment shall be audited for the following:

(1) Food benefit costs in relation to the vendor’s reported food prices;

(2) Foods received by an eWIC cardholder;

(3) Adherence to state and federal regulations and rules; and

(4) Other such factors as determined by individual circumstances including risk factors as described in (d) below.

(b) Department staff shall annually monitor a representative selection of authorized vendors to survey WIC operations and to take corrective action as needed in accordance with 7 CFR 246.12(j).

(c) Vendors who meet one or more of the risk factors identified in (d) below shall be reviewed for continued authorization or sanctioned in accordance with He-P 3207.03.

(d) Risk factors shall include one or more of the following:

(1) Recurring written or verbal complaints by participant(s) or local agency representatives;

(2) Specific written or verbal complaints of category II violations as specified in He-P 3207.03(d) or category III violations as specified in He-P 3207.03(f) or violations listed under He-P 3207.03(h);

(3) Food costs that are inconsistent with or above the vendor’s most recently transacted prices and peer group;

(4) Vendors whose annual revenue from sales of WIC-approved food meets the “above 50 percent” threshold, as defined in He-P 3201.01(a);

(5) Changes in patterns of program participation including volume or costs of food benefits redeemed and participant usage;

(6) Designation as a high risk vendor by the US Department of Agriculture, Food and Nutrition Service; and

(7) Recurring incidence of non-compliance with program rules and federal regulations.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3206.02 Monitoring Procedures

The department shall tailor monitoring procedures to each vendor’s compliance history by including one or more of the following in accordance with past violations to ensure current compliance with He-P 3200:

(a) Review of vendor participation, transaction history, and related correspondence;

(b) Overt or covert observation of food benefit redemption procedures;

(c) Interviews with vendor staff involved with WIC operations;

(d) Review of vendor WIC-approved food shelf or point of display prices including later comparison to food benefits subsequently redeemed;

(e) Review of shelf tags or other promotional material with the WIC acronym or logo;

(f) Review of gross food sales information or supplier records;

(g) Review of physical inventory and inventory records, including comparison to quantities of foods purchased at retailer location;

(h) Participant contact to verify purchases;

(i) Covert purchases by the department or representatives to verify compliance with WIC procedures; and

(j) Coordination with the US Department of Agriculture, Food and Nutrition Service.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3207 Sanctions

N.H. Code Admin. R. Ann. He-P 3207.01 Local Agencies

The department shall disqualify a local agency under the criteria specified in 7 CFR 246.5(e).

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #11003, eff 12-23-15; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3207.02 Participants

(a) Participant sanctions shall be as follows:

(1) All periods of suspension, termination, or disqualification shall commence with the next one-month benefit issuance following notice to the participant provided that the food package for that month will be prorated in accordance with these rules should the next set of food benefits be provided during the notice period;

(2) If a period of suspension exceeds the expiration of the current certification period, the participant shall be disqualified from reapplication until the period of suspension has been completed;

(3) The actions of a participant, a parent, or caretaker of an infant or child participant, a proxy, or an eWIC cardholder shall be binding on the participant in the determination of violations and imposition of sanctions;

(4) Sanctions shall only be imposed on those participants for whom the evidence supports the sanction and not to all participating family members, even though the violations might have been committed with food benefits issued to one member;

(5) When more than one violation is involved, the sanction shall be based on the highest category violation;

(6) Excluding (h) and (i) below, if a local agency competent professional authority submits a recommendation stating that the imposition of the disqualification would create an extreme nutritional hardship for the participant, the department shall waive a disqualification provided such waiver does not conflict with RSA 132:12-a, II;

(7) The competent professional authority’s recommendation described in (a)(6) above shall be made in writing to the department;

(8) The department shall grant or deny a waiver, requested in accordance with (a)(6) and (a)(7) above, within 15 days; and

(9) When a waiver has been requested, sanctions shall not be imposed pending waiver decision.

(b) Category I violations shall include actions related to misuse of program benefits or disruptive participant behavior such as:

(1) Failure to follow proper redemption procedures such as:

a. Attempting to purchase WIC food benefits without an eWIC card present; or

b. Attempting to purchase or purchasing non-WIC approved benefit orfoods not available on the family’s benefit list; and

(2) Behavior within a store or WIC clinic that is disruptive but not abusive or threatening.

(c) Category I violations shall be subject to the following sanctions:

(1) Written warning for the first occurrence within a 12-month period, unless a violation of Category II (d)(1) below for abusive behavior has been issued within a 12-month period, then (e)(2) below shall be implemented;

(2) A one-month suspension for the second occurrence within a 12-month period following warning;

(3) A 3-month disqualification for the third occurrence within a 12-month period following a one-month suspension for the second occurrence; and

(4) A participant disqualified for a Category I violation but for whom disqualification has been waived in accordance with (a)(6) and (a)(7) above shall be issued food benefits on a monthly basis for a 3-month period beginning at the next food benefit pickup or certification.

(d) Category II violations shall include actions related to more serious misuse of program benefits or abusive participant behavior such as:

(1) Abusive or threatening behavior that includes, for example, swearing, hitting, or threatening over the phone, within a store, or at a WIC clinic, that is directed towards WIC staff, retail vendors, or other WIC participants; and

(2) Purchasing non-WIC-approved foods.

(e) Category II violations shall be subject to the following sanctions:

(1) Written warning for the first actual or attempted occurrence;

(2) A 3-month disqualification for any subsequent actual or attempted occurrence within a 12-month period following warning; and

(3) A participant disqualified for a Category II violation, but for whom disqualification has been waived in accordance with (a)(6) and (a)(7) above shall be issued food benefits on a monthly basis for a 3-month period beginning at the next food benefit pickup or certification.

(f) Category III violations shall include actions related to fraud or abuse of the WIC program such as:

(1) Misrepresentation of eligibility for program benefits;

(2) Purchase of non-food items;

(3) Purchase of alcohol or tobacco products;

(4) Exchange of WIC benefits for cash or credit from retail vendors;

(5) Sale,attempted sale, or exchange of WIC foods, WICformula, or an eWIC card for cash, goods, or services; and

(6) Returning WIC foods or WIC formula to non-authorized retail store(s) for cash or store credit.

(g) Category III violations shall be subject to the following sanctions:

(1) A 3-month disqualification for any actual or attempted occurrence, except as allowed by (j); and

(2) A participant disqualified for a Category III violation, but for whom disqualification has been waived in accordance with (a)(6) and (a)(7) above, shall be issued food benefits on a monthly basis for a 3-month period beginning at the next food benefit issuance or certification.

(h) Except as allowed by (j) below, the department shall disqualify a participant for one year in

accordance with 7 CFR 246.12(u)(2) when:

(1) There is dual participation as defined in 7 CFR 246.2;

(2) The department determines that program benefits have been obtained or disposed of improperly and these benefits total more than $100.00; or

(3) There is a second or subsequent demand for repayment of any amount.

(i) The department shall collect improperly obtained benefits when there is a loss of funds as follows:

(1) In accordance with 7 CFR 246.23(c)(1), the department shall demand repayment, in writing, from the participant or parent or caretaker of an infant or child participant equal to the full value of these benefits;

(2) The department shall issue a second demand for repayment if full restitution is not made or a repayment schedule is not agreed upon within 30 days of receipt of the demand for repayment as described in (i)(1) above; and

(3) If no written or oral response has been received from the participant or parent or caretaker of an infant or child participant after the second demand for repayment as described in (i)(2) above, the department shall refer the matter to the New Hampshire department of justice.

(j) The department shall permit the participant to continue participation in lieu of a mandatory disqualification when:

(1) Full restitution is made within 30 days;

(2) A payment plan is agreed to within 30 days of receipt of the letter demanding repayment; or

(3) For participants under the age of 18 and infant and child participants, the department approves proxies.

(k) If full restitution is made or a repayment schedule is agreed upon before the end of a mandatory disqualification period as described in (j) above, the department shall allow a disqualified participant to reapply for the program.

(l) Failure to make full and timely payment, as agreed upon in (j) or (k) above, shall result in disqualification for the remaining disqualification period established in the original disqualification notice.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #11003, eff 12-23-15; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3207.03 Vendors

(a) Vendor investigations shall include the following:

(1) In accordance with 7 CFR 246.12(l)(1)(xii), if the department is investigating an allegation that a vendor has committed at least one violation as described in (h) below, and if during that investigation the department verifies that the vendor has committed a less serious violation or violations set forth in (b)–(j) below, the department shall:

a. Not provide the vendor with warning or impose sanction points for the less serious violation or violations listed in (b)–(g) below prior to the completion of the single investigation;

b. Include in the notice of proposed disqualification all violations found in the course of the single investigation and the vendor’s opportunity to request an administrative hearing; and

c. Include in the notice of proposed disqualification that the vendor shall be disqualified for the most serious federally mandated violation if at the conclusion of the single investigation the department determines that the vendor has committed a violation set forth in (h) below;

(2) Violations alleged and sanction points issued by the department shall be subject to appeal by the vendor in accordance with He-P 3208, He-C 200 and 7 CFR 246.18;

(3) The department shall provide written notice of warning of initial violation for violations requiring a pattern of occurrences in order to impose a sanction prior to documenting another violation unless the department determines that notifying the vendor will compromise an investigation as described in (a)(1) above;

(4) Except for those violations committed in accordance with (a)(1) above, the department shall:

a. Issue sanction points in accordance with violations listed in (b)–(j) below; and

b. Notify the vendor in writing of the imposition of sanctions or the assignment of sanction points and the specific violation(s) for which they were assigned;

(5) Except for violations as listed in (h)–(i) below the department shall apply the period of vendor disqualification in accordance with violation category description in (b)–(g) below to apply sanction points and retention of these points;

(6) When a vendor has been assigned sanction points, the following shall apply:

a. When a vendor has accumulated 6 or more sanction points, the department shall disqualify that vendor from participation as a WIC vendor;

b. Sanction points shall be assigned for each Category II and III violation;

c. Sanction points shall be cumulative regardless of the category;

d. The department shall disqualify a vendor from participation as a WIC vendor for a period of one calendar month for each sanction point as stated in (a)(6)a. above; and

e. The sanction points shall be retained on the vendor’s record in accordance with (b)–(j) below;

(7) Vendors may appeal or request an administrative hearing in accordance with He-P 3208, He-C 200, and 7 CFR 246.18;

(8) In accordance with 7 CFR 246.12(l)(1)(viii), the department shall not accept voluntary termination of the vendor agreement or use non-renewal of the vendor agreement in lieu of disqualification, but shall enter the disqualification on the record;

(9) Disqualification shall include terminating any current vendor agreement;

(10) Vendors who are disqualified for any reason shall be required to reapply in writing;

(11) A previously disqualified vendor who is reauthorized within one year of the end of the period of disqualification shall be assigned 3 sanction points to be retained for a period of 12 months following the date of reauthorization;

(12) Prior to imposing a disqualification, the department shall determine whether the disqualification would result in inadequate participant access;

(13) With the exception of (a)(14) below, when the department determines, in accordance with (a)(12) above, that a disqualification of a vendor would result in inadequate participant access, the department shall impose a civil money penalty in lieu of disqualification as allowed by 7 CFR 246.12(l)(l)(vii);

(14) A civil money penalty shall not be imposed by the department in lieu of disqualification when the vendor has violated (h)(1) below, or violated (h)(2)–(h)(4) for a pattern of 3 incidences or more within a 12 month period;

(15) In accordance with 7 CFR 246.12(l)(1)(x), the amount of a civil money penalty shall equal 10% of the average monthly WIC redemptions for the most recent 6 month period multiplied by the number of months for which the vendor would have been disqualified;

(16) The civil money penalty issued in accordance with (a)(15) above shall not exceed $the amount specified by the Secretary of Agriculture in 7 CFR 3.91(b)(3)(v) for each violation;

(17) In accordance with 7 CFR 246.12(l)(1)(x)(C), if multiple violations are revealed by a single investigation, the department shall impose a civil money penalty, not to exceed $ the amount specified by the Secretary of Agriculture in 7 CFR 3.91(b)(3)(v) if disqualification would result in inadequate participant access;

(18) If a vendor does not fully pay a civil money penalty or an unauthorized costs claim within 30 days of the notice, the vendor shall be disqualified:

a. For the length of the disqualification corresponding to the violation for which the civil money penalty was assessed; or

b. For a period corresponding to the most serious violation in cases where a mandatory sanction included the imposition of multiple civil money penalties as a result of a single investigation;

(19) When a vendor, who had previously been assessed a sanction based on a violation as listed in (h)(2)–(h)(4) below, receives another sanction based on having committed the same or other violation as listed in the same section, the department shall double the sanction for the second violation;

(20) Civil money penalties shall only be doubled up to the amount specified by the Secretary of Agriculture in 7 CFR 3.91(b)(3)(v)as limited by (a)(15) through (a)(18) above;

(21) When a vendor, who had previously been assessed 2 sanctions based on violations as listed in (h)(2)–(h)(4) below, receives another sanction based on having committed the same or other violations as listed in (h)(2)–(h)(4) below, the department shall double the sanction for the third violation;

(22) In accordance with 7 CFR 246.12(l)(1)(vi), the department shall not impose a civil money penalty in lieu of disqualification for committing a third violation even if inadequate participant access would result;

(23) The department shall treat a fourth or subsequent violation in the same manner as the third except that the sanction shall be doubled; and

(24) Money received by the department as a result of civil money penalties assessed against a vendor shall be considered program income in accordance with 7 CFR 246.15(b).

(b) Category I violations shall consist of the following:

(1) Failure to submit inventory and price information requested by the department within 30 days;

(2) Requiring participants to purchase a specific brand of an approved food when more than one approved brand is available;

(3) Failure to provide promotional specials or accept manufacturer or store coupons for WIC purchases, except that cash-only promotions may be denied to participants if denied to other non-cash paying customers;

(4) Failure to make staff available for training in program rules and procedures;

(5) Failure to clearly indicate the retail price of all WIC-approved items, either individually on each item or at the shelf or point of display;

(6) Providing WIC-approved food during a WIC transaction that is beyond the expiration or last sell date imprinted on the product packaging by the product’s manufacturer;

(7) Failure to train all employees who handle WIC transactions and to ensure their knowledge regarding WIC program procedures set forth in training materials and manuals provided by the department;

(8) Failure to follow proper redemption procedures;

(9) Asking for a eWIC cardholder identification to complete an eWIC transaction;

(10) Failure to provide the WIC cardholder with a receipt at the end of the transaction containing required receipt elements pursuant to section 5.5 of the United States Department of Agriculture, Food and Nutrition Service “Operating Rules Women, Infants and Children (WIC) Electronic Benefits Transfer (EBT)” (September 2014) https://fns-prod.azureedge.net/sites/default/files/wic/WIC-EBT-Operating-Rules-September-2014.pdf, available as noted in Appendix A; and

(11) Failure to provide the WIC cardholders with a balance receipt showing the current available benefit balance upon request without requiring a purchase to be made.

(c) Category I violations shall accrue 2 points per violation to be retained for 12 months.

(d) Category II violations shall consist of the following:

(1) Contacting participants in an attempt to have them return to the store to fix a vendor error or to seek reimbursement for food costs not paid by the department;

(2) Accepting the return of items purchased with a WIC food benefit for cash or credit towards other purchases;

(3) Requiring participants to use special checkout lanes;

(4) Substituting a WIC approved UPC or PLU for a non-WIC approved UPC or PLU during an eWIC transaction;

(5) Failure to allow department or local agency representatives to complete on-site monitoring;

(6) Failure to maintain the minimum stock of WIC-approved foods;

(7) Asking for or entering a cardholder’s PIN number, unless the cardholder has requested assistance;

(8) Failure to keep all WIC cardholder information confidential;

(9) Failure to ensure the current New Hampshire APL/PLU is uploaded in the store’s POS system and is being used for eWIC transactions;

(10) Charging the cardholder a fee either directly, or indirectly, arising out of or associated with operating, maintaining, or processing eWIC card transactions;

(11) Failure to provide infant formula within forty-eight (48) hours of request by a WIC cardholder; and

(12) Scanning a UPC code as a substitute, replacement, or scanning a UPC code that is not affixed to the product, such as a UPC codebook or reference sheet.

(e) Category II violations shall accrue 3 points per violation to be retained for 12 months.

(f) A Category III violation shall consist of a failure to provide access to redeemed eWIC transaction information or store inventory records upon request.

(g) Category III violations shall accrue 12 points per violation and result in a one-year disqualification.

(h) Federally mandated sanctions shall include:

(1) A vendor convicted in court for the crime of trafficking in food benefits or for selling firearms, ammunition, explosives, or controlled substances, as defined in section 102 of the Controlled Substances Act, 21 U.S.C. 802, in exchange for food benefits shall be permanently disqualified from program participation, effective on the date of receipt of the notice of disqualification;

(2) A vendor shall be disqualified from program participation for 6 years for a single incidence of buying or selling food benefits for cash trafficking or a single incidence of selling firearms, ammunition, explosives, or controlled substances as defined in section 102 of the Controlled Substances Act, 21 U.S.C 802, in exchange for food benefits;

(3) A vendor shall be disqualified for 3 years for:

a. A single incidence of the sale of alcohol or alcoholic beverages or tobacco products in exchange for food benefits; or

b. A pattern of 3 or more incidences within a 12-month period of:

1. Claiming reimbursement for the sale of an amount of a specific supplemental food item that exceeds the vendor’s documented inventory;

2. Charging the department more for an approved supplemental food than non-WIC customers or charging the department more than the current shelf price permitted under the vendor agreement;

3. Receiving, transacting, or redeeming food benefits outside authorized channels, including the use of an unauthorized vendor or an unauthorized person;

4. Charging the department for supplemental food not received by the participant; or

5. Providing credit or non-food items, other than those listed in (h)(1), (h)(2) and (h)(3)a. above, in exchange for food benefits;

(4) A vendor shall be disqualified for one year for a pattern of 3 or more incidences within a 12 month period of providing unapproved food items in exchange for food benefits, including charging for supplemental food provided in excess of those listed on the food benefit;

(5) In accordance with 7 CFR 276.12(l)(1)(vii) a vendor who has been disqualified from SNAP shall:

a. Be disqualified from WIC program participation for the same length of time as the food stamp program disqualification; and

b. Not appeal the WIC program disqualification to federal administrative or judicial tribunals;

(6) A vendor who has been assessed a SNAP civil money penalty for hardship in lieu of disqualification from SNAP shall be disqualified from WIC program participation, the length of which shall correspond to the period for which the vendor would otherwise have been disqualified in SNAP; and

(7) In accordance with 7 CFR 246.12(l)(2)(ii)B., if the department determines that disqualification of the vendor for (h)(6) above would result in inadequate participant access, the vendor shall not be disqualified and a civil money penalty shall not be imposed.

(i) Failure to meet rules or standards of another New Hampshire state agency or New Hampshire health agency which results in suspension of license shall result in a disqualification period not to exceed the federal limit as cited in 7 CFR 246.12(l)(2)(iii) of one year in length and remain in effect until such rules or standards are met and license reinstated.

(j) A vendor who is disqualified from participation in another program administered by the state shall be disqualified for a period not exceeding one year from program participation for an equal number of months as the other program disqualification.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Part He-P 3208 Notices and Appeal

N.H. Code Admin. R. Ann. He-P 3208.01 Local Agencies

(a) The administrative appeal process for local agencies shall comply with 7 CFR 246.18 and the administrative appeal process as described in He-C 200.

(b) In accordance with 7 CFR 246.18(a)(1)(i), a full administrative appeal shall be provided for the following, if an appeal is requested:

(1) The denial of an application for authorization;

(2) A disqualification during the course of a contract period; and

(3) Any other adverse action taken by the department in relation to an agency’s authorization, with the exception of the provisions found in (c) below.

(c) In accordance with 7 CFR 246.18(a)(3)(ii), the following shall not be subject to administrative appeal:

(1) Expiration of the local agency agreement; and

(2) Denial of a local agency’s application if the department’s local agency selection is subject to the procurement procedures applicable to the department.

(d) In accordance with 7 CFR 246.18(a)(3)(iii), the department shall make denials of local agency applications effective immediately.

(e) Except as described in (f) below, the local agency shall have 30 days from receipt of written notification from the department to request an administrative appeal on a proposed adverse action.

(f) The local agency shall have 60 days from receipt of written notification from the department to request an administrative appeal on a proposed disqualification.

(g) Except as allowed by (d) above, the department shall make adverse actions effective:

(1) No earlier than 60 days and no later than 90 days after date of notice of adverse action; or

(2) When the local agency has requested an administrative appeal in accordance with (e) and (f) above, on the date the local agency receives the written administrative appeal decision.

(h) In accordance with 7 CFR 246.18(b)(4), local agencies shall have at least one opportunity to reschedule a previously scheduled hearing. In doing so, the local agency shall waive the time limits outlined in (g) above.

(i) Requesting an administrative appeal for any proposed adverse action shall not relieve the local agency from the responsibility for continuing compliance with the terms of the written agreement with the department.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3208.02 Participants

(a) Administrative appeal procedures for participants shall comply with 7 CFR 246.9 and He-C 200.

(b) Participants shall have 60 days from the date the department mails or personally serves the notice of proposed adverse action to request an administrative appeal.

(c) The adverse action shall become final after 60 days if the participant fails to request an appeal.

(d) Notice of proposed adverse action shall be sent to or made at the most recent address provided by the participant.

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

N.H. Code Admin. R. Ann. He-P 3208.03 Vendors

(a) Administrative appeal procedures for vendors shall comply with the administrative review process as described in 7 CFR 246.18 and the administrative appeal process as described in He-C 200.

(b) In accordance with 7 CFR 246.18(a)(2), except for disqualifications based on violations described in He-P 3207.03(h)(1) which shall become effective within 15 days of receipt of the notice of adverse action, the vendor shall be provided 15 days to request an administrative appeal after receipt of the notice.

(c) Disqualification of a vendor from SNAP in accordance with 7 CFR 246.12(l)(1)(vii) shall result in disqualification from the WIC program.

(d) Disqualification from the WIC program, in accordance with (c) above, shall not be subject to federal, administrative, or judicial appeal under WIC program rules in accordance with 7 CFR 246.12(l)(1)(vii).

(e) In accordance with 7 CFR 246.18(b)(4), vendors shall have at least one opportunity to reschedule a previously scheduled hearing. In doing so, the vendor shall waive the right to a decision pursuant to the timeline in (f) below.

(f) Within 90 days of receiving the vendor request for an administrative appeal, the department shall provide the vendor with a written notification of the appeal decision.

(g) In accordance with 7 CFR 246.18(a)(2) and 7 CFR 246.18(e), the sanctions shall be effective on the date the vendor receives written notification of the appeal decision if the adverse action has not previously taken effect.

(h) The department shall not be responsible for losses incurred by the vendor as a result of adverse action taken by the department.

(i) A full administrative appeal shall be provided for the following, if an appeal is requested:

(1) Denial of authorization based on failure to meet federal or department established vendor selection criteria as described in He-P 3205.01;

(2) Termination of an agreement for noncompliance or cause;

(3) Any disqualification of a vendor by the department, including:

a. Disqualification based on the imposition of a SNAP civil money penalty for hardship;

b. Disqualification based on a mandatory sanction imposed by another WIC agency in another state; and

c. Disqualification based on He-P 3207.03(h)(1); and

(4) Imposition of a civil money penalty in lieu of disqualification by the department.

(j) In accordance with 7 CFR 246.18(a)(1)(iii), the following shall not be subject to administrative appeals:

(1) The department’s determination of whether or not a vendor had an effective policy and program in effect to prevent trafficking and whether the vendor was aware, had approved of, or was involved in the violation;

(2) The validity or appropriateness of the department’s vendor selection criteria listed in He-P 3205.01;

(3) The validity or appropriateness of the department’s criteria for determining whether an applicant vendor or authorized vendor’s annual revenue from sales of WIC-approved food meets the “above 50 percent” threshold, as defined in He-P 3201.01(a);

(4) The validity or appropriateness of the department’s participant access criteria and the department’s inadequate participant access determinations as defined in He-P 3201.01(w) and He-P 3205.01(b)(18);

(5) WIC disqualification based on SNAP disqualification;

(6) Expiration of the vendor agreement; or

(7) Disputes regarding food benefit payments and claims.

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-P 3205.01(b)(19)

American National Standards Institute (ANSI) “ANSI X9.93-2014” (Part 1 and 2)

Publisher: American National Standards Institute (ANSI)

Cost: $60.00 per part or $120.00 for the set

The incorporated document is available at: https://webstore.ansi.org/standards/ascx9/ansix993set

He-P 3205.01(b)(19)

United States Department of Agriculture, Food and Nutrition Service “WIC-Electronic Benefits Transfer(EBT) Guidance and Resources”

Publisher: United States Department of Agriculture, Food and Nutrition Service

Cost: Free to the Public

The incorporated document is available at: https://www.fns.usda.gov/wic/wic-electronic-benefits-transfer-ebt-guidance

He-P 3207.03(b)(10)

United States Department of Agriculture, Food and Nutrition Service “Operating Rules Women, Infants and Children (WIC) Electronic Benefits Transfer(EBT)” (September 2014)

Publisher: United States Department of Agriculture, Food and Nutrition Service

Cost: Free to the Public

The incorporated document is available at:

https://fns-prod.azureedge.net/sites/default/files/wic/WIC-EBT-Operating-Rules-September-2014.pdf

APPENDIX B

Rule

Specific State Statute the Rule Implements

He-P 3201

7 CFR 246.2 and 246.7

He-P 3202

7 CFR 246.7

He-P 3203

7 CFR 246.10

He-P 3204

7 CFR 246.5 and 246.6

He-P 3205

7 CFR 246.12 and RSA 132:10-b, I

He-P 3206

7 CFR 246.12

He-P 3207.01

7 CFR 246.2, 7 CFR 246.7

He-P 3207.02

7 CFR 246.5, 246.12, 246.15 and 246.23(b), and 246.23(c)

He-P 3207.03

7 CFR 246.5, 246.12, 246.15 and 246.23

He-P 3208

7 CFR 246.9, 246.12, 246.18 and 278.6

History

• #4518, eff 10-28-88; EXPIRED 10-28-94
• #6226, eff 4-24-96; ss by #7489, eff 5-11-01; ss by #7774, eff 10-8-02; ss by #8580, eff 3-11-06; ss by #9556, eff 10-1-09; ss by #10583, eff 10-1-14; ss by #12858, eff 8-23-19

Chapter He-P 3300 Farmers’ Market Nutrition Program for Women, Infants and Children

Part He-P 3301 Purpose and Scope.

N.H. Code Admin. R. Ann. He-P 3301.01 Purpose

These rules set forth the standards and requirements for the distribution of eligible foods from farmers to eligible recipients participating in the farmers’ market nutrition program (FMNP) as authorized by RSA 132:12-f, and in compliance with 7 CFR 248.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3301.02 Scope.

These rules shall apply to eligible recipients seeking to obtain, and those farmers seeking to distribute, locally grown fresh fruits, vegetables, and cut herbs at designated New Hampshire farmers’ markets.

History

• #14200, eff 2-26-25

Part He-P 3302 Definitions

N.H. Code Admin. R. Ann. He-P 3302.01 Definitions

(a) “Change in ownership” means any time a controlling interest in a sole proprietorship, joint venture, partnership, corporation, limited liability company, or any other kind of entity is transferred to or merged with another sole proprietor, joint venture, partnership, corporation, limited liability company, or any other kind of entity.

(b) “Corrective action plan” means a plan developed and written by the farmer, which specifies the actions that will be taken to correct identified deficiencies.

(c) “Department” means the New Hampshire department of health and human services.

(d) “Eligible foods” means fresh, nutritious, unprepared, locally grown fruits, vegetables, and herbs for human consumption that are not processed or prepared beyond their natural state except for usual harvesting and cleaning processes.

(e) “Face-to-face training” means an education session(s) held at a physical location with farmers physically present. This term includes “in person training”.

(f) “Farmer” means an individual authorized to sell produce at participating farmers' markets or roadside stands. This term includes “producer”.

(g) “Farmer designee” means a farm co-owner, manager, or supervisor authorized to attend department training in order to train other employees on the requirements of the farmers’ market nutrition program.

(h) “Farmers' market” means one or more local farmers who assemble at a defined and authorized location for the purpose of selling their produce directly to consumers.

(i) “Farmers’ market nutrition program season” means the time during which FMNP benefits can be redeemed.

(j) “Food and Nutrition Service (FNS) of the U.S. Department of Agriculture” means the federal agency that authorizes state nutrition programs.

(k) “Good cause” means any circumstance beyond a person’s control that prevents that person from complying with these rules, including:

(1) A death in the person’s immediate family;

(2) Personal injury or serious illness of the person or an immediate family member; or

(3) Another compelling reason or justification.

(l) “Household” means the same as that of “family” defined in 7 CFR 246.2.

(m) “Local agency” means any nonprofit entity or local government agency which issues FMNP benefits, and provides nutrition education or information on operational aspects of the FMNP to recipients.

(n) “Nutrition education” means individual or group education sessions and the provision of information and educational materials designed to improve health status, achieve positive change in dietary habits, and emphasize relationships between nutrition and health, all in keeping with the individual's personal, cultural, and socioeconomic preferences.

(o) “Recipient” means a WIC participant or person chosen by the department to receive FMNP benefits.

(p) “Roadside stand” means a location at which an individual farmer sells their produce directly to consumers.

(q) “Special Supplemental Nutrition Program for Women, Infants and Children (WIC)” means the federal program authorized by section 17 of the Child Nutrition Act of 1966, as amended (42 U.S.C. 1771 et. seq.) that provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5 who are found to be at nutritional risk.

(r) “WIC Farmers' Market Nutrition Program” means the program authorized by section 17(m) of the Child Nutrition Act of 1966 (CNA), 42 U.S.C. 1786(m), as amended, to allow WIC benefits at state farmers’ markets.

History

• #14200, eff 2-26-25

Part He-P 3303 Recipient Eligibility and Benefits

N.H. Code Admin. R. Ann. He-P 3303.01 Recipient Eligibility

(a) An individual who is currently receiving WIC benefits or who is on the waiting list to receive WIC benefits pursuant to He-P 3202, excluding infants younger than 6 months of age, shall be eligible to receive FMNP benefits.

(b) Recipient benefits shall be provided to recipients based upon approved categories as specified in He-P 3202.03.

(c) The department shall limit recipient certifications, as necessary, by imposing additional eligibility requirements in accordance with 7 CFR 248.6(b), due to funding restrictions that impact the state of New Hampshire’s ability to fund all eligible FMNP recipients.

(d) In accordance with 7 CFR 248.8(b), the value of the federal FMNP benefit received by each recipient shall not be less than $10 per year and not more than $30 per year.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3303.02 Eligible Foods

(a) Eligible foods shall comply with 7 CFR 248.8(a).

(b) Eligible foods shall:

(1) Be grown within the state of New Hampshire; and

(2) Include fresh, unprepared, locally grown fruits, vegetables, and cut herbs.

(c) In accordance with 7 CFR 248.8(a), the following foods shall be considered ineligible:

(1) Honey:

(2) Maple syrup:

(3) Cider;

(4) Nuts and seeds;

(5) Eggs;

(6) Cheese;

(7) Meats;

(8) Seafood;

(9) Dried herbs;

(10) Herb plants;

(11) Pickled vegetables;

(12) Those foods grown outside the state of New Hampshire, the United States and its territories; and

(13) Other foods identified as not eligible by the FNS.

History

• #14200, eff 2-26-25

Part He-P 3304 Local Wic Agency Participation

N.H. Code Admin. R. Ann. He-P 3304.01 Local Agency Requirements

A local health or human service agency shall:

(a) Identify FMNP recipients and provide them with FMNP benefits, nutrition education, and related benefits under state-approved agreements between the local WIC agency and the department in accordance with 7 CFR 248.9; and

(b) Adhere to monitoring of FMNP policies and procedures once every 2 years in accordance with 7 CFR 248.10(e)(4).

History

• #14200, eff 2-26-25

Part He-P 3305 Farmer Participation

N.H. Code Admin. R. Ann. He-P 3305.01 Selection of Farmers

(a) The following procedures shall apply to the selection of farmers for FMNP:

(1) Farmers eligible to be authorized shall complete and submit the application form, “New Hampshire FMNP Farmer Application” (February 2025), to the department, certifying the following:

“I understand that this is only a request to participate in the New Hampshire FMNP and does not constitute a contract. All information on this application is true, accurate, and correct to the best of my knowledge. I understand that any false information on this application or attached supporting documentation may lead to rejection of this application”; and

(2) The department shall review each new applicant farmer for participation in the FMNP as follows:

a. Department employees who hold dual employment with any FMNP-authorized or applicant farmer, regardless of capacity, shall not be involved in the review of farmer applications for authorization;

b. If the department receives an incomplete application, the department shall notify the applicant in writing within 30 days of receipt of any errors or omissions, request any additional information that the agency is permitted by law to require, and notify the applicant of the name, official title, address, and telephone number of an agency official or employee who may be contacted regarding the application;

c. The applicant shall have up to 30 days from the date of the department’s request to respond to the request for additional information;

d. The department shall assess the applicant farmer’s qualifications using the selection criteria in accordance with (b)(1)-(12) below; and

e. The assessment shall include a review of the list of fresh fruits, vegetables, and cut herbs offered by the farmer in order to determine whether or not the applicant farmer meets the eligibility criteria in accordance with 7 CFR 248.

(b) The department shall deny authorization of an applicant farmer, or terminate an authorized farmer, if any of the following criteria are true at any time:

(1) The farm’s location is not within NH borders;

(2) The applicant farmer or authorized farmer does not provide information regarding eligible foods sold at the farmers’ market;

(3) The department determines that the applicant farmer or authorized farmer is not able to meet application program requirements or existing selection criteria as evidenced by:

a. Sanction points obtained under He-P 3307.02;

b. Failure to meet monitoring requirements in accordance with He-P 3306;

c. Failure to attend face-to-face training upon initial application as set forth in 7 CFR 248.10(d); and

d. Failure to attend training as required by the department in accordance with He-P 3305.04;

(4) The authorized farmer has failed to provide eligible foods at the current price or less than the current price charged to other customers;

(5) A conflict of interest exists in that a farm employee is dually employed by the WIC program;

(6) The farmer does not grow at least one eligible fruit, vegetable, or cut herb that is fresh, locally grown, and unprepared during the FMNP season in accordance with 7 CFR 248.8;

(7) T he applicant farmer or authorized farmer does not accept, at a minimum, cash for food purchases from the general public as well as the FMNP recipient;

(8) The applicant farmer or authorized farmer does not maintain a smart phone or tablet with the ability to scan a quick response (QR) code or bar code with an internet or data connection to accept and process the FMNP electronic benefit;

(9) The applicant farmer or authorized farmer does not attend the market(s) on the dates, and times identified on the application;

(10) The applicant farmer or authorized famer has prior, pending, or under appeal sanctions;

(11) The department determines that the farm was sold or had a change in ownership to circumvent a FMNP sanction in accordance with 7 CFR 248;

(12) The applicant farmer provides false or misleading information on the farmer application or other required program documentation; or

(13) The applicant farmer was asked to provide additional information to the department and failed to do so within 30 days.

(c) A farmer that has been denied authorization initially or terminated during the course of a current authorization period shall not reapply for authorization until:

(1) The FMNP season following the date of the farmer’s receipt of the department’s notice; or

(2) The FMNP season following the date of an appeal decision upholding the department’s decision to deny authorization or terminate.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3305.02 Written Agreement

(a) Written agreements shall include the requirements of 7 CFR 248.10(b) and the following:

(1) The farmer shall provide at least one of the eligible foods pursuant to He-P 3302.01(a) and (b);

(2) The farmer shall attend the markets on the dates as identified in the application; and

(3) The farmer shall:

a. Provide eligible foods at the current price or less than the current price charged to customers;

b. Accept cash for food purchases from the general public as well as the FMNP recipient;

c. Maintain a smart phone or tablet with the ability to scan a QR code or bar code;

d. Use an active email account capable of receiving the FMNP agreement and program information;

e. Use a smart device for the purpose of processing benefits;

f. Provide the department information on inventory records for eligible foods and sales for the authorized FMNP season;

g. Display the FMNP authorized poster at the farmers’ market;

h. Label and price the eligible food available for sale at the farmers’ market;

i. Comply with the following:

1. Title VI of the Civil Rights Act of 1964 (42 U.S.C 2000d et seq.);

2. Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.)

3. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C 794);

4. Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.);

5. Department of Agriculture regulations on non-discrimination (7 CFR parts 15, 15a, and 15b); and

6. FNS directives and guidelines to the effect that no person shall, on the grounds of race, color, national origin, age, sex, or handicap, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity for which the department received federal assistance from FNS;

j. Provide FMNP customers the same courtesies provide to non-FMNP customers;

k. Attend training on FMNP procedures as scheduled by the department ;

l. Ensure that cashiers and all other staff are fully trained and understand the FMNP requirements;

m. Ensure that only FMNP eligible foods are sold to recipients;

n. Provide FMNP eligible goods at prices that are fair and competitive in comparison with farmers in their peer group;

o. Be monitored by the department for compliance with FMNP program rules;

p. Provide ready access to FMNP redemption information at the request of the department;

q. Not charge the department for non-eligible foods;

r. Not charge the department for foods not received by recipient;

s. Not provide cash, change, non-eligible foods, or other items in lieu of eligible foods to recipients;

t. Notify the department in writing within 15 days of the farmer ceasing operations or a change in ownership, name of farm, or location, thereby permitting the department to terminate the vendor agreement in accordance with He-P 3305.01(b)(11);

u. Maintain a copy of the current NH FMNP approved goods at each cash register or check out line; and

v. Not offer incentive items solely to FMNP recipients and not to other customers in an effort to obtain FMNP business.

(b) Pursuant to changes in federal or state statutes, rules, or other requirements, the department shall revise all current agreements, and the amended agreements shall include the original expiration date without prejudice.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3305.03 Periodic Review of Farmer Participation

The department shall conduct reviews at least once during a current farmer’s participation period using the selection criteria as described in He-P 3305.01(b).

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3305.04 Farmer Training

The department shall provide training to farmers pursuant to 7 CFR 248.10(d) by implementing the following:

(a) The department shall provide farmers with initial face-to-face training for all farmers who have never previously participated in the program prior to their commencing participation in the FMNP;

(b) At least one representative of the farmer shall participate in FMNP training annually as described in (d) below;

(c) Annual training by the department shall communicate changes in pertinent regulations, rules, and procedures and keep farmers informed of problems and suggestions to improve eligible food availability, such as:

(1) Eligible foods;

(2) Proper FMNP benefit redemptions procedures;

(3) Equitable treatment of FMNP recipients, including the availability of produce to FMNP recipients that is of the same quality and cost as that sold to other customers;

(4) Civil rights compliance and guidelines; and

(5) Other training topics that relate to compliance with the requirements of the FMNP;

(d) Annual training shall be provided by the department in a variety of formats such as:

(1) Face-to-face training;

(2) Live webinar;

(3) Self-paced learning module;

(4) Newsletter; or

(5) Other formats as developed by the department;

(e) At least one alternative date on which to attend face-to-face training shall be provided to farmers;

(f) The department shall be available for further farmer training and education that is:

(1) Requested by the farmer; or

(2) Deemed necessary as a result of farmer monitoring activities;

(g) The farmer shall notify the department and request additional training at any time during the participation period if, in the opinion of the farmer, farmer staff does not adequately understand FMNP procedures; and

(h) Mandatory training shall be deemed necessary by the department as a result of repeated farmer violations or as a result of farmer monitoring activities.

History

• #14200, eff 2-26-25

Part He-P 3306 Farmer Monitoring

N.H. Code Admin. R. Ann. He-P 3306.01 Types of Farmer Monitoring

(a) Food benefits presented for payment from a farmer participating in the FMNP shall be audited by the department for the following:

(1) The food benefit redemption costs in relation to the farmer’s posted prices;

(2) The foods received by the FMNP recipient;

(3) The farmer’s adherence to state and federal regulations in accordance with 7 CFR 248.10(e), and 7 CFR 248.17(c); and

(4) Other such factors as determined by individual circumstances including risk factors as described in (d) below.

(b) Department staff shall annually monitor 10 percent of the authorized farmers and take corrective action as needed in accordance with 7 CFR 248.10(e).

(c) Farmers that meet one or more of the risk factors identified in (d) below shall be reviewed during the FMNP season for:

(1) Continued authorization; or

(2) Sanctioning in accordance with He-P 3307.

(d) Risk factors shall include one or more of the following:

(1) Recurring written or verbal complaints by recipient(s) or local agency representatives;

(2) Sanctions received during the previous FMNP season;

(3) High volume of FMNP redemptions by a farmer or farmers’ market in comparison to other farms and farmers’ markets across the state;

(4) Farmers in their first year of FMNP operation;

(5) A recurring incidence of non-compliance with program rules and federal regulations; and

(6) Other concerns brought to the department for review such as but not limited to, recurring written or verbal complaints by market managers or community members and transactions being completed after business hours reported on the application.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3306.02 Monitoring Procedures

The department shall establish monitoring procedures for each farmer’s compliance history by including one or more of the following in accordance with past violations to ensure current compliance with 7 CFR 248.10(e):

(a) Review of farmer participation, transaction history, and related correspondence;

(b) Overt or covert observation of farmer compliance with program requirements;

(c) Interviews with farmer staff involved with FMNP operations;

(d) Review of farmer pricing; and

(e) FMNP recipient contact to verify purchases.

History

• #14200, eff 2-26-25

Part He-P 3307 Sanctions

N.H. Code Admin. R. Ann. He-P 3307.01 Recipients

(a) Recipient sanctions shall be as follows:

(1) The actions of a recipient, a parent, or caretaker of an infant or child recipient, a proxy, or an FMNP benefit holder shall be binding on the recipient in the determination of violations and imposition of sanctions;

(2) Sanctions shall only be imposed on those recipients for whom the evidence supports the sanction and not to all participating family members, even though the violations might have been committed with food benefits issued to one member; and

(3) When more than one violation is involved, the sanction shall be based on the highest category violation.

(b) Category I violations shall include actions related to misuse of program benefits or disruptive recipient behavior such as:

(1) Failure to follow proper redemption procedures such as attempting to purchase or purchasing non-eligible FMNP foods; and

(2) Behavior within a farmers’ market that is disruptive but not abusive or threatening.

(c) Category I violations shall be subject to the following sanctions:

(1) Written warning for the first occurrence of violation within the FMNP season, unless a violation of Category II pursuant to (d)(1) below for abusive behavior has been issued within the same FMNP season, then (e)(2) below shall be implemented; or

(2) Disqualification of the remaining FMNP season for the second occurrence of any violation within the same FMNP season as the warning letter in (c)(1).

(d) Category II violations shall include actions related to more serious misuse of program benefits or abusive recipient behavior such as:

(1) Abusive or threatening behavior that includes, for example, swearing, hitting, or threatening at a farmers’ market, that is directed towards WIC staff, the farmer, or other FMNP recipients;

(2) Misrepresentation of eligibility for FMNP benefits;

(3) Exchange of FMNP benefits for cash or credit from farmers; and

(4) Sale, attempted sale, or exchange of FMNP eligible foods for cash, goods, or services.

(e) Category II violations shall be subject to the following sanctions:

(1) Written warning for the first actual or attempted occurrence of violation; or

(2) Disqualification for the remainder of the current FMNP season and the following FMNP season for the second occurrence of any violation within the same FMNP season as the warning letter (e)(1).

(f) The department shall collect reimbursement for improperly obtained items as follows:

(1) In accordance with 7 CFR 248.20, the department shall demand repayment, in writing, from the recipient or parent or caretaker of an infant or child recipient equal to the full value of these benefits;

(2) The department shall issue a second demand for repayment if full restitution is not made, or a repayment schedule is not agreed upon within 30 days of receipt of the demand for repayment as described in (f)(1) above; and

(3) If no written or oral response has been received from the recipient, parent, or caretaker of an infant or child recipient after the second demand for repayment as described in (f)(2) above, the department shall refer the matter to the New Hampshire department of justice for enforcement.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3307.02 Farmer Sanctions

(a) Farmer sanctions shall be as follows:

(1) Failure to allow monitoring;

(2) Failure to clearly identify pricing of fruits, vegetables, and cut herbs;

(3) Failure to identify fruits, vegetables, and cut herbs grown out of state that are not eligible for FMNP benefits;

(4) Selling fruits, vegetables, and cut herbs to a FMNP recipient that are not grown in New Hampshire;

(5) Selling anything that is not an eligible food to a FMNP recipient;

(6) Failure to follow proper redemption procedures;

(7) Asking an FMNP recipient for identification or to share their PIN to complete a FMNP transaction;

(8) Failure to attend farmers’ markets, on the dates identified on the FMNP application without good cause;

(9) Failure to remain open during reported business hours at farmers’ markets without good cause;

(10) Charging sales tax on FMNP approved foods;

(11) Contacting recipients in an attempt to have them return to fix a farmer error or to seek reimbursement for a FMNP food cost not paid by the department;

(12) Failure to keep all FMNP recipients’ information confidential; or

(13) Failure to treat FMNP recipients like any other customers.

(b) The department shall:

(1) Issue sanctions in accordance with violations listed in He-P 3307.02(a) above; and

(2) Notify the farmer in writing of the imposition of sanctions and the specific violation(s) for which they were assigned.

(c) When a farmer has been assessed their first sanction, the department shall issue a:

(1) Written notice of the sanction; and

(2) Requirement to receive additional training related to the sanction.

(d) When a farmer has been assessed for a second sanction within the same season as the first sanction, the department shall issue a:

(1) Written notice of the sanction; and

(2) Requirement to provide a corrective action plan within 30 days to be approved by the department to include the steps that the farmer will be taking in order to correct the sanction and how they will conduct business moving forward to achieve compliance with the farmer agreement.

(e) The farmer’s failure to provide a corrective action plan pursuant to (d) above shall result in disqualification for the remainder of the current season.

(f) When a farmer has been assessed a third identical sanction within the same season, the farmer shall be disqualified for:

(1) The remainder of the current season; and

(2) The following season.

(g) A farmer committing fraud or abuse of FMNP shall be liable to prosecution under applicable federal, state, or local laws. Farmers who have willfully misapplied, stolen, or fraudulently obtained program funds shall automatically:

(1) Receive a third sanction; and

(2) Be disqualified for:

a. The remainder of the current season; and

b. The following season.

History

• #14200, eff 2-26-25

Part He-P 3308 Notices and Appeal

N.H. Code Admin. R. Ann. He-P 3308.01 Recipients

(a) Administrative appeal procedures shall comply with 7 CFR 248.16 and the administrative appeal process as described in RSA 541-A and He-C 200.

(b) If a recipient appeals the termination of benefits, the recipient shall continue to receive FMNP benefits until the hearing officer reaches a decision or the expiration of the current FMNP season, whichever occurs first.

(c) Written notification of the adverse action, the cause(s) for the action, and the effective date of the action shall be mailed to the most recent address provided by the recipient. The notice shall contain the option to appeal the decision.

(d) Recipients shall have 10 days from receipt of the notice of an enforcement action to request an administrative appeal in writing.

(e) The adverse action shall become final after the 10 days in (d) above, if the recipient fails to request an appeal.

(f) Advanced notice of the time and place of the hearing shall be provided to all parties involved to give them sufficient time to prepare for the hearing.

(g) In accordance with 7 CFR 248.16(c)(4), recipients shall have at least one opportunity to reschedule a previously scheduled hearing. In doing so, the recipient shall waive the right to a decision pursuant to the timeline in (h) below.

(h) Written notification of the decision in the appeal shall be provided to the recipient within 60 days from the date of receipt of the request for a hearing.

History

• #14200, eff 2-26-25

N.H. Code Admin. R. Ann. He-P 3308.02 Farmers

(a) Administrative appeal procedures shall comply with 7 CFR 248.16 and the administrative appeal process as described in RSA 541-A and He-C 200.

(b) If an appeal is requested, agency action shall not be finalized until the hearing officer reaches a decision or the expiration of the current FMNP season, whichever occurs first.

(c) All notices of enforcement action from the department to the farmer and listed in (i) below shall be in writing and contain the option to appeal.

(d) The farmer shall have 10 days from receipt of the notice of an enforcement action to submit an appeal, in writing, to the department.

(e) The adverse action shall become final after the 10 days in (d) above, if the farmer fails to request an appeal.

(f) In accordance with 7 CFR 248.16 (c)(4), farmers shall have at least one opportunity to reschedule a previously scheduled hearing. In doing so, the farmer shall waive the right to a decision pursuant to the timeline in (g) below.

(g) Within 60 days of receiving the farmer’s request for an administrative appeal, the department shall provide the farmer with a written notification of the appeal decision.

(h) The department shall not be responsible for losses incurred by the farmer as a result of adverse action taken by the department.

(i) A full administrative appeal shall be provided for the following, if an appeal is requested:

(1) Imposing a sanction as described in He-P 3307.02;

(2) Termination of an agreement for noncompliance or cause;

(3) Denial of authorization based on failure to meet federal, or department established vendor selection criteria as described in He-P 3305.01; or

(4) Any disqualification of a farmer by the department.

(j) Expiration of an authorized agreement and the validity or appropriateness of the department’s vendor selection criteria listed in He-P 3305.01, shall not be subject to appeal in accordance with 7 CFR 248.16(a).

APPENDIX

RULE

STATE STATUTE OR FEDERAL REGULATION IMPLEMENTED

He-P 3301

RSA 132:12-f

He-P 3302

RSA 132:12-f; RSA 541-A; 42 USC 1771; 7 CFR 248

He-P 3303

RSA 132:12-f; 7 CFR 248.6; 42 CFR 248.8

He-P 3304

RSA 132:12-f; 7 CFR 246.5; 7 CFR 246.6

He-P 3305

RSA 132:12-f; 7 CFR 248.7; 7 CFR 248.9; 7 CFR 248.10

He-P 3306

RSA 132:12-f; 7 CFR 248.10; 7 CFR 248.17

He-P 3307

RSA 132:12-f; 7 CFR 248.18; 7 CFR 248.20

He-P 3308

RSA 132:12-f; 7 CFR 248.19; 7 CFR 248.16

History

• #14200, eff 2-26-25

Chapter He-P 6000 Ophthalmic Dispensing

Part He-P 6001 Definitions

N.H. Code Admin. R. Ann. He-P 6001.01 Definitions

(a) “Commissioner” means “commissioner” as defined in RSA 327-A:1, V, or his or her designee.

(b) “Continuing education credit” means one hour of continuing education approved by the commissioner.

(c) “Department” means “department” as defined in RSA 327-A:1, VI.

(d) “Ophthalmic dispenser” means “ophthalmic dispenser/optician” as defined in RSA 327-A:1, VII.

(e) “Ophthalmic dispensing” means “ophthalmic dispensing” as defined in RSA 327-A:1, I.

(f) “Plano lenses” means “plano lenses” as defined in RSA 327-A:1, IX.

(g) “Prescription” means “prescription for spectacle lenses” and “prescription for contact lenses” as defined in RSA 327-A:1, III and IV.

(h) “Registrant” means a person who is registered as an ophthalmic dispenser pursuant to He-P 6000.

History

• #5199, eff 8-7-91; EXPIRED 8-7-97
• #6567, INTERIM, eff 8-22-97, EXPIRED 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

Part He-P 6002 Application Procedure and Fees

N.H. Code Admin. R. Ann. He-P 6002.01 Initial Application

(a) Each applicant for registration under RSA 327-A shall make application on a form provided by the commissioner.

(b) The submitted application for registration shall contain the following:

(1) Name of applicant;

(2) Home address and phone of applicant;

(3) Date of birth of applicant;

(4) The applicant’s social security number, which:

a. Is required by RSA 161-B:11; VI-a;

b. Is used only for enforcement of the laws governing child support; and

c. Shall be held confidential by the department;

(5) The name, address, and phone of the business where the applicant is employed as an ophthalmic dispenser;

(6) If a partnership, the name and address of each partner;

(7) If a corporation, the name and address of each corporate officer;

(8) The name of each state where the applicant holds or has held a license or registration to practice ophthalmic dispensing and the dates the applicant has practiced in each state;

(9) A statement as to whether the applicant has ever been denied a license or registration to practice ophthalmic dispensing, has had an ophthalmic dispensing license or registration revoked or suspended, or has had any other disciplinary action taken against his or her ophthalmic dispensing license or registration in this or any other state;

(10) Recent 2” x 2” photograph of applicant’s face; and

(11) Signature of applicant and date signed.

(c) The completed application shall be submitted to the commissioner and shall be accompanied by the registration fee set forth in He-P 6002.06 (a) (1).

(d) The commissioner shall either accept the application as being complete or notify the applicant in writing within 30 days of receipt of the application, that the application is incomplete, specifying what the applicant needs to submit to complete the application.

(e) Applicants who submit a complete application in accordance with He-P 6002.01 (a) through (c) and pay the registration fee set forth in He-P 6002.06 (a) (1) shall be granted registration as an ophthalmic dispenser.

(f) Registrations issued by the commissioner shall be effective for 2 full calendar years from the date of approval.

(g) Notwithstanding (e) above, the commissioner shall deny any application if the applicant:

(1) Has not met any one of the requirements of RSA 327-A or He-P 6002; or

(2) Has engaged in behavior justifying denial under RSA 327-A:9.

(h) The commissioner shall send the decision to deny the application to the applicant at the address shown on the application.

(i) Notification of denial shall be in accordance with He-P 6003.03 (a), (b) and (c).

History

• #5199, eff 8-7-91; EXPIRED 8-7-97
• #6567, INTERIM, eff 8-22-97, EXPIRES 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6002.02 Renewal Application

(a) An ophthalmic dispenser who wishes to maintain his/her registration shall submit an application for renewal to the commissioner in accordance with RSA 327-A:14.

(b) At least 60 days prior to the expiration of a registration, the commissioner shall:

(1) Notify, in writing, the registrants whose registrations are to expire that their registrations are due to expire; and

(2) Include an application for renewal of registration with the written notice.

(c) At least 30 days prior to the expiration of a registration, the registrant shall submit to the commissioner:

(1) An application that contains the following:

a. The applicant’s first, middle and last name;

b. The applicant’s home mailing address;

c. The name and address of the business where the applicant is employed as an ophthalmic dispenser;

d. The name of each state where the applicant holds or has held a license or registration to practice ophthalmic dispensing and the dates the applicant has practiced in each state;

e. A statement as to whether the applicant has ever been denied a license or registration to practice ophthalmic dispensing, has had an ophthalmic dispensing license or registration revoked or suspended, or has had any other disciplinary action taken against his or her ophthalmic dispensing license or registration in this or any other state;

f. Signature of applicant certifying that the information on the application is true and accurate; and

g. The date signed;

(2) The following documentation of having met the continuing education requirements of RSA 327-A:14 and He-P 6002.05:

a. The completed continuing education section of the application form provided by the commissioner which contains the following:

1. The name of the continuing education event;

2. The location of the event;

3. The date(s) of the event;

4. The name and address of the sponsor of the event;

5. The number of continuing education hours for each event; and

6. The signature of the registrant; and

b. Copies of all certificates of continuing education credits listed on the form required by a. above; and

(3) The renewal fee required by He-P 6002.06 (a) (2).

(d) The commissioner shall either accept the application as being complete or notify the applicant in writing within 30 days that the application is incomplete, specifying what the applicant needs to submit to complete the application.

(e) Applications for renewal shall be approved if:

(1) The application contains the information and fee required by He-P 6002.02 (c) and He-P 6002.06 (a) (2);

(2) The registrant is in compliance with He-P 6000 and RSA 327-A; and

(3) The registrant has not engaged in an act that would result in denial under RSA 327-A:9.

(f) Renewal registrations shall be effective for 2 years from the date of expiration of the prior registration.

(g) The commissioner shall deny any application in accordance with He-P 6003.03 if the applicant:

(1) Has not met any one of the requirements of RSA 327-A:7 and RSA 327-A:14 or He-P 6002.02; or

(2) Has engaged in behavior justifying denial under 327-A:9.

(h) Notification of denial of renewal shall be in accordance with He-P 6003.03 (a), (b) and (c).

History

• #5199, eff 8-7-91; EXPIRED 8-7-97
• #6567, INTERIM, eff 8-22-97, EXPIRES 12-20-97 (formerly He-P 6301.02)
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6002.03 Expired Registration

(a) If an application for renewal is received after the expiration date of the registration, the registration shall be expired.

(b) An ophthalmic dispenser whose registration has expired in accordance with (a) above shall not practice ophthalmic dispensing until he or she has obtained a registration in accordance with RSA 327-A and He-P 6000.

(c) An ophthalmic dispenser whose registration has expired in accordance with (a) above, and wishes to reapply for a registration, shall reapply for an initial ophthalmic dispensing registration in accordance with He-P 6002.01.

(d) If an ophthalmic dispenser reapplies for an initial registration in accordance with (c) above, the applicant shall also include with the initial application documentation of having met the continuing education requirements of He-P 6002.05.

History

• #5199, eff 8-7-91; EXPIRED 8-7-97
• #6567, INTERIM, eff 8-22-97, EXPIRES 12-20-97 (formerly He-P 6301.03)
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6002.04 Change of Address and Timely Submission of Application.

(a) Registrants shall immediately notify the commissioner when a change of home or office address occurs.

(b) Failure to receive an application for renewal of the current registration sent by the department shall not excuse the ophthalmic dispenser from the obligation to submit an application for renewal at least 30 days prior to the expiration of the current registration in accordance with He-P 6002.02 (c).

History

• #7119, eff 10-16-99; ss by #7353, eff 8-24-00; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6002.05 Continuing Education.

(a) Registered ophthalmic dispensers shall complete a minimum of 8 continuing education credits during the 2 year period prior to each renewal of registration in accordance with RSA 327-A:14.

(b) At least 5 of the continuing education credits shall be earned through live didactic courses.

(c) Home study programs shall include audio, video, or computer programs with successful completion of a written examination.

(d) Applicants for renewal shall submit documentation concerning continuing education credits with the application for renewal in accordance with He-P 6002.02 (c) (2).

(e) Continuing education events approved by the American Board of Opticianry or the National Contact Lens Examiners shall be accepted by the commissioner for continuing education credits.

(f) Events which are not approved by the American Board of Opticianry or the National Contact Lens Examiners shall be pre-approved by the commissioner as described in (g) through (j) below in accordance with RSA 327-A:14 for continuing education credits.

(g) Requests for pre-approval for continuing education credits shall be submitted by the association or organization sponsoring the event.

(h) Associations and organizations requesting pre-approval for continuing education credits shall submit their requests to the commissioner, in writing, at least 60 days prior to the scheduled event.

(i) Requests for pre-approval for continuing education credits pursuant to RSA 327-A:14 shall include:

(1) The name of the course, seminar, or event;

(2) The location of the course, seminar, or event;

(3) The sponsor or presenter of the course, seminar or event;

(4) The address and telephone number of the sponsor or presenter;

(5) A complete description of the course, seminar, or event;

(6) The date(s) of the course, seminar, or event; and

(7) The number of continuing education credits being requested.

(j) The commissioner shall approve the proposed continuing education course if the course:

(1) Is sponsored by any national, regional, or state optical company, trade, or professional group; and

(2) Contributes to the advancement, extension, or enhancement of the professional skills and the technical knowledge of opticians.

(k) Continuing education requirements shall be completed prior to the expiration date of the registration.

(l) Registrants shall maintain accurate records of continuing education credits.

(m) Certificates and documents of evidence of continuing education credits shall be retained by the registrant for a period of 3 years.

(n) Original certificates and documents of evidence of continuing education hours shall be subject to inspection by the department upon request.

(o) Excess continuing education credits earned throughout the registration period shall not be carried forward into the next registration period.

History

• #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6002.06 Fees.

(a) The registration fees shall be as follows:

(1) The initial registration fee shall be $100; and

(2) The renewal registration fee shall be $100.

(b) Registration fees shall be non-refundable pursuant to RSA 327-A:7.

History

• #8593, eff 3-28-06; ss by #10453, eff 10-31-13

Part He-P 6003 Complaints, Disciplinary Action, Revocation, Denial

N.H. Code Admin. R. Ann. He-P 6003.01 Complaint Procedure

(a) Any person may file a complaint against an ophthalmic dispenser, or against a person who is practicing ophthalmic dispensing without a registration.

(b) All complaints filed in accordance with (a) above shall be in writing.

(c) The complainant shall include the following in his or her complaint:

(1) The name of the ophthalmic dispenser or unregistered person;

(2) The business address and telephone number of the ophthalmic dispenser or unregistered person;

(3) The name and address of the complainant; and

(4) The specific facts or circumstances giving rise to the complaint.

(d) Complaints received by the department which are not in accordance with He-P 6003.01 (a) through (c) shall not be accepted.

(e) A copy of He-P 6003.01 (a) through (d) shall be conspicuously posted, along with the following address and phone number, in each ophthalmic dispensing office and store:

Philbrook Building

121 South Fruit Street

Concord New Hampshire 03301

(603) 271-9480

History

• #6567, INTERIM, eff 8-22-97, EXPIRED: 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6003.02 Complaint Investigation

(a) Complaints alleging a violation of RSA 327-A and/or He-P 6000 shall be investigated by the commissioner.

(b) If the complaint is accepted, the commissioner shall contact and individually question the complainant and the registrant, or unregistered person, about the complaint in an effort to determine if the complaint can be substantiated.

(c) The registrant, or unregistered person, shall cooperate with the department by providing the department with any information requested by the commissioner relative to the complaint.

(d) Upon the completion of the investigation, the commissioner shall make a determination based on information received during the investigation as to whether the complaint is substantiated.

(e) Copies of the investigative findings shall be sent to the complainant and the registrant, or unregistered person, indicating whether the complaint is substantiated.

(f) Except in the case of violations which warrant revocation pursuant to He-P 6003.03 (j) (1), if the complaint is substantiated, the registrant shall submit to the commissioner and implement a written plan of correction within 15 days of the receipt of the findings.

(g) A written plan of correction shall be required if the registrant:

(1) Has failed to follow the order of a prescription of an ophthalmologist or optometrist;

(2) Has made a material false statement or concealed a material fact in connection with his or her application for registration;

(3) Has used dishonest or misleading advertising; or

(4) Has failed to comply with any other provisions of He-P 6000 or RSA 327-A.

History

• #6567, INTERIM, eff 8-22-97, EXPIRED: 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6003.03 Revocation, Denial, and Disciplinary Action

(a) Prior to an administrative action against an applicant, registrant, or unregistered person such as denial, suspension or revocation of registration, or the imposition of a fine, the department shall send to the applicant, registrant, or unregistered person a written notice which sets forth:

(1) The reason(s) for the proposed action;

(2) The action to be taken by the department; and

(3) The rights of the applicant, registrant, or unregistered person to an adjudicative proceeding.

(b) Failure of the applicant, registrant, or unregistered person to request a hearing within 30 days of receipt of the notice shall result in the proposed action becoming final and immediately imposed.

(c) If the applicant, registrant, or unregistered person requests a hearing in writing within 30 days of receipt of the notice, no action shall be imposed on the applicant, registrant, or unregistered person pending the completion of an adjudicative process conducted in accordance with RSA 541-A and He-C 200.

(d) The commissioner shall suspend a registration in accordance with (a) through (c) above if the registrant:

(1) Fails to submit and implement a plan of correction within 15 days pursuant to He-P 6003.02 (f) and (g);

(2) Fails to maintain a plan of correction;

(3) Does not cooperate with an investigation by the commissioner to the extent required by these rules;

(4) Has given false information on his or her renewal application relative to continuing education; or

(5) Fails to pay an administrative fine in accordance with He-P 6003.04.

(e) If a registration is suspended in accordance with (d) (1) above, and the registrant requests a hearing in accordance with (c) above, the scope of the hearing shall be on the violations of He-P 6000 or RSA 327-A that resulted in the requiring of a plan of correction.

(f) If the outcome of a hearing held in accordance with (e) above is that the department did not have valid grounds to order the submission and implementation of a plan of correction, then the suspension shall not be imposed.

(g) If the outcome of a hearing held in accordance with (e) above is that the department’s order requiring the submission of corrective action is upheld, the suspension shall take effect immediately and remain in effect until such time as the corrective action is submitted and approved in accordance with (h) below.

(h) The length of suspension shall be until such time as the registrant:

(1) Complies with the requirements for which the suspension was issued; and

(2) Has paid all fines, if any, associated with the suspension; or

(3) Has his/her registration revoked in accordance with He-P 6003.03 (j) (2).

(i) Upon reinstatement of a suspended registration, the applicant shall not be required to pay an additional registration fee, and the expiration date shall be the expiration date of the previously suspended registration.

(j) The commissioner shall revoke a registration in accordance with (a) through (c) above if the registrant:

(1) Has been found guilty of fraud or fraudulent practices in accordance with RSA 327-A:9, III; or

(2) Has failed to comply with any conditions for the removal of a suspension within 90 days of the suspension taking effect.

(k) Upon suspension or revocation of a registration, the registrant shall return his or her certificate of registration in accordance with RSA 327-A:10.

(l) Pursuant to RSA 327-A:11, if a registration is revoked or an application is denied, no such registration shall be issued to such former registrant or applicant for at least 6 months from the date the revocation or denial was deemed final.

(m) An ophthalmic dispenser whose registration has been revoked or denied and who wishes to reapply for a registration in accordance with (l) above shall reapply for an initial ophthalmic dispensing registration in accordance with He-P 6002.01.

(n) In addition to (m) above, a registration shall not be granted to any applicant until the applicant has complied with the requirements for which the revocation or denial was issued, and has paid all fines, if any, associated with the revocation or denial.

History

• #6567, INTERIM, eff 8-22-97, EXPIRED: 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6003.04 Administrative Fines

(a) When the commissioner has determined that a violation or violations of RSA 327-A or He-P 6000 have occurred, the commissioner shall impose an administrative fine of $250.00 for each offense in accordance with RSA 327-A: 17.

(b) If the person, applicant or registrant who is fined waives the right to a hearing and chooses to pay the imposed fine, the fine shall be paid to and received by the department within 30 days of receipt of the notice of fine.

(c) The fine payment shall be sent to the commissioner.

(d) Administrative fines shall be imposed in accordance with RSA 327-A:17 and He-P 6003.04 (a) for violations of RSA 327-A or He-P 6000, including, but not limited to, the following:

(1) Submitting false or fraudulent information on or with an application;

(2) Falsification of a registration to practice ophthalmic dispensing;

(3) Practicing ophthalmic dispensing, including the dispensing of plano lenses, without a registration;

(4) Failure to submit a plan of correction in accordance with He-P 6003.02 (f);

(5) Failure to implement and maintain a plan of correction;

(6) Failure to cooperate during an investigation;

(7) Failure to display certificate of registration in accordance with RSA 327-A:8; and

(8) Failure to display the complaint procedures in accordance with He-P 6003.01 (e).

History

• #6567, INTERIM, eff 8-22-97, EXPIRED: 12-20-97
• #6728, eff 4-1-98; ss by #7119, eff 10-16-99; ss by #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13

N.H. Code Admin. R. Ann. He-P 6003.05 Waivers

(a) Applicants or registrants seeking waivers of specific rules in this chapter shall submit a written request for waiver to the commissioner which includes the following:

(1) Specific reference to the rule for which a waiver is being sought;

(2) Full explanation of why a waiver is necessary; and

(3) Full explanation of alternatives proposed by the applicant or registrant, which shall be equally as protective of public health as the rule from which a waiver is sought.

(b) The commissioner shall approve a request for waiver if:

(1) The commissioner concludes that authorizing deviation from strict compliance with the rule from which waiver is sought does not contradict the intent of the rule;

(2) The alternative proposed by the applicant or registrant ensures that the objective or intent of the rule from which waiver is sought will be accomplished: and

(3) The alternative proposed by the applicant or registrant does not violate any statutory provision.

(c) If a waiver is approved, the applicant’s or registrant’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

(d) No waiver shall be granted for a period to exceed 2 years.

APPENDIX

RULE

STATUTE

He-P 6001

RSA 327-A:12

He-P 6002.01

RSA 327-A:2; RSA 327-A:3; RSA 327-A:5,I; RSA 327-A:6;

RSA 327-A:7; RSA 327-A:9; RSA 327-A:12, I

He-P 6002.01 (b)(4)

RSA 161-B:11, VI-a

He-P 6002.02

RSA 327-A:3; RSA 327-A:5, II; RSA 327-A:6; RSA 327-A:7;

RSA 327-A:9; RSA 327-A:12, II

He-P 6002.03

RSA 327-A:2; RSA 327-A:3

He-P 6002.04

RSA 327-A:14

He-P 6002.05

RSA 327-A:12, II; RSA 327-A:14

He-P 6002.06

RSA 327-A:6; RSA 327-A:7; RSA 327-A:12, III; RSA 327-A:14

He-P 6003.01

RSA 327-A:5:IV; RSA 327-A:12, VIII

He-P 6003.02

RSA 327-A:5, IV; RSA 327-A:12, V and VIII

He-P 6003.03

RSA 327-A:9; RSA 327-A:10; RSA 327-A:11, I;

RSA 327-A:12, VII, VIII, and X

He-P 6003.04

RSA 327-A:12, VI; RSA 327-A:17

He-P 6003.05

RSA 327-A:12, XII

History

• #7894, eff 5-21-03; ss by #8593, eff 3-28-06; ss by #10453, eff 10-31-13