This chapter governs New Hampshire Hospital and related psychiatric facilities, covering: (1) disproportionate share payments to governmental psychiatric hospitals that serve high proportions of uncompensated patients; and (2) conditional discharge procedures for persons involuntarily admitted to psychiatric facilities, including criteria for granting, revising, and revoking conditional discharges and coordinating with community mental health programs. Facility operators must follow specific clinical and procedural requirements—including psychiatrist/APRN/PA involvement, informed consent, and court notification—when managing conditional discharges. The disproportionate share payment rules require qualifying hospitals to demonstrate that 50% or more of service revenue comes from public funds, bad debts, or free care.
View official sourceCHAPTER He-M 600 NEW HAMPSHIRE HOSPITAL PART He-M 601 PAYMENTS TO DISPROPORTIONATE SHARE PSYCHIATRIC HOSPITALS Statutory Authority: RSA 135-C:5, I, (d); 135-C: 61, III He-M 601.01 Definitions . (a) "Disproportionate share psychiatric hospital" means a governmental hospital that: (1) Is primarily engaged in providing, by or under the supervision of a psychiatrist, psychiatric services for the diagnosis and treatment of mentally ill persons; (2) Is located in the state of New Hampshire ; and (3) Qualifies for a disproportionate share payment pursuant to He-M 601.02(a) below. (b) "Disproportionate share payments" means payments made pursuant to 42 CFR 412.106. Source. #8432, eff 11-27-05 (formerly He-W 519), EXPIRED: 11-27-13 He-M 601.02 Requirements for and Amounts of Payments . (a) To qualify for a disproportionate share payment, a disproportionate share psychiatric hospital shall have 50% or more of service revenue attributable to any combination of the following sources : (1) Public funds, excluding Medicare or Medicaid; (2) Bad debts; and (3) Free care. (b) Disproportionate share payments shall be made to a hospital that meets the requirements of (a) above at the rate of 100% of uncompensated care provided by the hospital during that hospital's current fiscal year. Source. #8432, eff 11-27-05 (formerly He-W 519); EXPIRED: 11-27-13 PART He-M 602 VOLUNTARY ADMISSION OF MINORS TO MENTAL HEALTH FACILITIES OF THE DIVISION OF MENTAL HEALTH AND DEVELOPMENTAL SERVICES - RESERVED PARTS He-M 603 and He-M 604 - RESERVED PART He-M 605 TRANSPORTATION OF INDIVIDUALS TO NEW HAMPSHIRE HOSPITAL BY LAW ENFORCEMENT OFFICERS - RESERVED PART He-M 606 PHILBROOK CENTER EDUCATIONAL SERVICES - RESERVED PART He-M 607 ADMISSIONS TO NEW HAMPSHIRE HOSPITAL BY TRANSFER FROM CORRECTIONAL FACILITIES - RESERVED PART He-M 608 - RESERVED PART He-M 609 CONDITIONAL DISCHARGE Statutory Authority: RSA l35-C:52; RSA 135-C:61, X and XII He-M 609.01 Purpose . The purpose of these rules is to define the criteria and procedures for conditional discharge of a person involuntarily admitted to a facility and for the revision and revocation of the conditional discharge. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99 New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; ss by #12014, eff 10-25-16; ss by #13332, eff 1-25-22 He-M 609.02 Definitions . (a) “ Administrator ” means the superintendent or other chief executive officer of a facility or THPS. (b) “Advance practice registered nurse (APRN)” means “advanced practice registered nurse” as defined in RSA 135-C:2, II-a, namely “an advanced practice registered nurse licensed by the board of nursing who is certified as a psychiatric mental health nurse practitioner by a board-recognized national certifying body.” (c) “Clinician” means a person who is qualified to provide community mental health services pursuant to He-M 426.08 (h)-(m). (d) “ Commissioner ” means the commissioner of the department of health and human services. (e) “ Community mental health program (CMHP)” means “community mental health program” as defined in RSA 135-C:2, IV. The term includes the term community mental health provider. (f) “Conditional discharge” means the release of a person from a facility during a period of court-ordered involuntary admission on the condition that the person comply with specific provisions of community-based treatment or be subject to readmission to a facility. (g) “ Department ” means the New Hampshire department of health and human services. (h) “Emergency service staff member” means a CMHP or THPS clinician who provides short-term clinical or psychiatric evaluation, treatment, and referral for persons experiencing acute symptoms of a mental illness and in accordance with He-M 426.08(h)(1). ( i ) “ Facility ” means New Hampshire hospital or any other treatment program designated as a receiving facility under RSA 135-C:26 to receive persons for involuntary admission under RSA 135-C:34-54 and involuntary emergency admission under RSA 135-C:27-33. (j) “ Informed decision” means a choice made voluntarily by a person or applicant for services or, where appropriate, such person’s legal guardian, after all relevant information necessary to making the choice has been provided, when: (1) The person understands that he or she is free to choose or refuse any available alternative; (2) The person clearly indicates or expresses his or her choice; and (3) The choice is free from all coercion. (k) “In need of care” means a situation where a conditionally discharged person no longer requires inpatient treatment but where a prescribed regimen of medical psychiatric or psychiatric care or treatment is required to prevent the recurrence of the circumstances which led to the person’s dangerous condition. (l) “ Involuntary admission” means an order of involuntary commitment made pursuant to RSA l35-C:34-54 by a probate court. (m) “Law enforcement officer” means a person identified in RSA 630:l, II. (n) “ Physician assistant (PA)” means a physician assistant licensed to practice in New Hampshire. (o) “ Psychiatrist ” means “psychiatrist” as defined in RSA 135-C:2, XIII, namely, “a physician licensed to practice in New Hampshire who is either board-certified or board-eligible according to the most recent regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization.” (p) “ Transitional housing program services (THPS)” means a residential program that provides housing and support services to persons with serious and persistent mental illness. (q) “Treatment team member” means a mental health clinician who is qualified pursuant to He-M 426.08 (h)-(m) and who shares ongoing responsibility for the care and treatment of a CMHP client or THPS client. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93; ss by #5863, eff 7-1-94; ss by #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08; ss by #12014, eff 10-25-16, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff 7-18-14; ss by 12014, eff 10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 He-M 609 .03 Grant of Conditional Discharge . (a) The administrator of a facility shall grant a conditional discharge to a person who has been involuntarily admitted to the facility pursuant to RSA l35-C:34-54 when the following criteria have been met: (1) The person is determined to be in need of care; (2) A recommendation for conditional discharge of the person has been made in accordance with the procedures in He-M 609.03(b); and (3) The person or his or her guardian understands and, following an informed decision, consents to the conditions and term of discharge, including any requirement for participation in continuing treatment on an outpatient basis. (b) A recommendation for conditional discharge of a person shall be made to the administrator of a facility by a psychiatrist , APRN, or PA at the facility only after a conference has been held, pursuant to He-M 401.10 or He-M 401.11, in which: (1) The psychiatrist, APRN, or PA participated and concurred in the results thereof; (2) A determination has been made that the person is in need of care and the mental health treatment and supervision needed by the person can be provided in a CMHP, THPS, or other setting which is less restrictive of the person’s freedom and ability to make informed decisions; (3) A recommendation for conditional discharge has been adopted; and (4) The person, community mental health center representative or THPS representative, and designated receiving facility (DRF) staff have agreed to the term of and conditions for discharge. (c) The facility to which the person to be conditionally discharged has been involuntarily admitted shall inform the person and his or her guardian, if any, orally and in writing of the term and conditions of discharge and of the criterion and process for revocation of conditional discharge. (d) No conditional discharge shall be granted by a facility unless the person to be discharged or his or her guardian, if any, has knowledge of and, following an informed decision, consents to the term and conditions of discharge and the provisions of He-M 609. Consent shall be documented in writing. (e) The term of conditional discharge granted to a person under He-M 609 shall not exceed the period of time remaining on the person’s order of involuntary admission made pursuant to RSA l35-C:34-54. (f) Information regarding a person’s conditional discharge shall be shared between the community mental health center or THPS and the facility serving the person as necessary to treat him or her and to otherwise carry out the purposes of RSA 135-C and He-M 609. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99 New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff 7-18-14; ss by #12014, eff 10-25-16; amd by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 He-M 609.04 Grant of Absolute Discharge . (a) The administrator of a facility from which a person has been conditionally discharged shall grant to such person an absolute discharge at the end of the term of the conditional discharge unless the discharge earlier has been revoked in accordance with RSA 135-C:51, VI or He-M 609.06 or unless another order of involuntary admission of the person has been made pursuant to RSA l35-C:34-54. (b) The administrator of a facility from which a person has been conditionally discharged shall grant to such person an absolute discharge when, within the previous 3 days, a psychiatrist, APRN, or PA at the CMHP or THPS providing continuing treatment to the person on an outpatient basis has: (1) Examined the person; (2) Determined that the person is no longer in need of care; and (3) Recommended that an absolute discharge be granted. (c) The administrator, in writing, shall immediately notify the court which made the original order of involuntary admission pursuant to RSA l35-C:34-54 and the person’s guardian, if any, that the person has been granted an absolute discharge. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99 New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff 7-18-14; ss by #12014, eff 10-25-16; amd by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 He-M 609 .05 Revision of Conditions . If at any time the term or conditions of a conditional discharge granted pursuant to He-M 609.03 are revised, such revision shall be in accordance with the following procedures: (a) The revisions shall be proposed by: (1) The CMHP or THPS serving the person conditionally discharged; (2) The person conditionally discharged or his or her guardian, if any; or (3) The facility from which the person was conditionally discharged; (b) The proposed revision shall be forwarded in writing by the proposing party to the other parties; (c) The administrator, or designee , of the CMHP or THPS receiving proposed revisions shall review them and either: (1) Accept the proposed revisions and convey the decision in writing to the party making the proposal; or (2) Decline the proposed revisions or propose amended revisions and convene a conference pursuant to He-M 401.12 to consider the proposed revisions; (d) Revisions of the term or conditions of the conditional discharge shall only be adopted: (1) As a result of a conference; (2) By a psychiatrist, APRN, or PA at the CMHP or THPS; and (3) With the consent, following an informed decision, of the person conditionally discharged or his or her guardian, if any; (e) Any revisions agreed to at the conference shall be in writing and signed by the person subject to the conditional discharge, his or her guardian, if any, and the psychiatrist, APRN, or PA; and (f) The CMHP or THPS shall file a copy of the revisions in the person’s medical record and provide a copy to the person , his or her guardian, if any, and the facility from which the person was conditionally discharged. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99 New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff 7-18-14; ss by #12014, eff 10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 He-M 609. 06 Revocation of Conditional Discharge . (a) Pursuant to RSA 135-C:51, a psychiatrist, APRN, or PA at a CMHP or THPS providing continuing treatment on an outpatient basis to a person conditionally discharged pursuant to RSA 135-C:50 may conduct, or cause to be conducted by a treatment team member or an emergency service staff member, an examination of the person to determine if the conditional discharge should be revoked. (b) An examination pursuant to (a) above shall only be conducted if the psychiatrist, APRN, or PA reasonably believes that: (1) The person has violated a condition of the discharge by: a. Failing or refusing to take medications prescribed by a psychiatrist, APRN, PA, or emergency physician, PA, or APRN as defined in RSA 135-C:2, II-a, to treat his or her psychiatric illness, provided that the psychiatrist, APRN, PA, or emergency physician, PA, or APRN as defined in RSA 135-C:2, II-a is on the list of physicians, PAs, and APRNs as defined in RSA 135-C:2, II-a, maintained by the commissioner pursuant to RSA 135-C:28, who are approved by either a designated receiving facility or a community mental health program approved by the commissioner, whether on behalf of a CMHP, THPS, NH Hospital, DRF, or a hospital emergency room receiving a patient who is on a conditional discharge; b. Failing or refusing to attend scheduled appointments, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment. This shall not apply to peer support which shall be voluntary; c. Failing or refusing to communicate with the CMPH or THPS, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; d. Failing or refusing to immediately participate in lab screenings following a documented verbal request or written request, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; e. Using alcohol or other non-prescription medications/illicit drugs, to the extent it adversely affects or is likely to adversely affect the person’s ability to meaningfully participate in treatment; or f. Failing to comply with a condition specifically written to address patient-specific behaviors that interfere with treatment or continued ability to live in the community; or (2) A condition or circumstance exists which might create a potentially serious likelihood of danger to the person or to others established by demonstrating that: a. The person has inflicted serious bodily injury on themselves or has attempted serious self-injury and there is a likelihood that the act or attempted act will reoccur if the conditional discharge is not revoked; b. The person has threatened to inflict serious bodily injury on themselves and there is a likelihood that an act or attempt of serious self-injury will occur if the conditional discharge is not revoked; c. The person’s behavior demonstrates that they lack the capacity to care for their own welfare; d. The person is a danger to others, which is established by demonstrating that the person has inflicted, attempted to inflict, or threatened to inflict seriously bodily harm on another; or e. The person’s mental status has deteriorated from the person’s usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (c) Before an examination is conducted, the CMHP or THPS shall prepare a written notice identifying the belief, and the reasons therefor , that a violation of the conditional discharge has occurred to include the following: (1) How the violation interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; (2) Any other circumstances or conditions exist which might create a potentially serious likelihood of danger to the person or to others; and (3) How the person’s mental health status has deteriorated from the person’s usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (d) Pursuant to RSA 135-C:51, I(b), a CMHP or THPS representative shall offer and explain the written notice to the person prior to the examination provided such notice can be provided safely, without significant possibility of bodily harm. (e) If it is unsafe to provide and explain the written notice to the person, a description of the circumstances indicating such risk shall be placed in the file. (f) The CMHP or THPS shall make a reasonable effort to locate the person, if they are not immediately available. (g) If the person cannot be located or if consent to an examination cannot be obtained, the psychiatrist or other representative of the CMHP or THPS may sign a complaint to compel examination. (h) Upon issuance of such a complaint, any law enforcement officer shall take custody of the person and immediately deliver him or her to the place specified in the complaint. ( i ) Following the examination, the psychiatrist, APRN, or PA may temporarily revoke the conditional discharge if they find that: (1) The person has either violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; (2) The person is in such a mental condition as a result of a mental illness as to create a potentially serious likelihood of danger to himself or herself or to others; or (3) The person’s mental status has deteriorated from their usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (j) If the conditional discharge is temporarily revoked then: (1) The psychiatrist, APRN, or PA, or his or her designee, shall prepare, offer and explain to the person a written notice giving the reasons for the revocation so long as is can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file; and (2) The written notice shall include the name of the receiving facility to which the person is to be transported upon the facility location being identified. The person shall not be transported to the facility without having received a verbal and written notification identifying the facility to which the person is being transported. (k) A law enforcement officer or ambulance personnel shall take custody of the person whose conditional discharge has been temporarily revoked and shall deliver him or her, together with a copy of the notice, to the receiving facility identified by the psychiatrist, APRN, or PA. (l) The administrator of the facility to which a person has been returned, or his or her designee, shall: (1) Personally examine such person; (2) Review the reasons for temporary revocation of the conditional discharge so long as it can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file; and (3) Revoke absolutely the conditional discharge if he or she finds that the person either: a. Has violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; or b. Is, at the time of examination, in such a mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or to others or the person’s mental status has deteriorated from the person’s usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (m) The examination, review, and determination shall be made within 72 hours, excluding Sundays and state legal holidays, of delivery of a person to a facility pursuant to (j) above. (n) If the administrator of the facility, or his or her designee, determines that an absolute revocation is warranted, he or she shall immediately prepare, offer, and explain to the person the information in a written notice of the revocation and the reasons for the revocation, and notice of the person's right to appeal and right to legal counsel as set forth in He-M 609.07 so long as it can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file. (o) Any administrator, of any facility, may absolutely revoke a person’s conditional discharge, regardless of which facility initially executed the conditional discharge with the person. (p) The person shall be subject to the terms and conditions of the order of involuntary admission made pursuant to RSA 135-C:34-54 from which conditional discharge was granted as if such conditional discharge had not been granted. (q) If the administrator of the facility, or his or her designee , determines that an absolute revocation is not warranted, the facility shall return the person to the location where he or she was taken into custody. (r) If the person is returned, he or she shall then be subject to the term and provisions of conditional discharge that were in effect prior to the temporary revocation of the conditional discharge. (s) A person conditionally discharged may be admitted to a facility through an involuntary emergency admission (IEA) under RSA 135-C:27-33. (t) When a person conditionally discharged has been admitted to a facility by an IEA, the finding of probable cause for IEA by the district court shall authorize the person’s admission for not longer than a 10-day period as provided in RSA 135-C:32, unless during the period of IEA the person’s conditional discharge is absolutely revoked pursuant to (u) below. (u) A facility administrator shall absolutely revoke a person’s conditional discharge when the person has been admitted to a facility by an IEA, so long as the revocation occurs within 10 days of the IEA physician’s certification being signed, and the administrator of the facility, or his or her designee, has personally examined the individual and found that the person either: (1) Has violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; or (2) Is, at the time of examination, in such a mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or others or the person’s mental status has deteriorated from the person’s usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (v) If a conditional discharge is absolutely revoked pursuant to (u) above, the administrator, or his or her designee, shall first prepare, offer, and explain to the person, if it can be done safely without significant possibility of bodily harm, a written notice of the revocation and the reasons therefor and notice of the person’s right to appeal and right to legal counsel as set forth in He-M 609.07. (w) If the written notice in (v) above cannot be explained in person safely, a description of the circumstances indicating such risk shall be placed in the file within 24 hours of the patient receiving notice of absolute revocation of his or her conditional discharge and the right to appeal such revocation, or of the patient requesting an appeal of the absolute revocation, whichever comes first. (x) New Hampshire Hospital (NHH) shall send written notice as required by (v) above by first-class mail, fax, email, or other written or electronic methods to the patient’s guardian. (y) NHH shall make a good-faith effort to reach the guardian to provide oral notice of the patient’s absolute revocation , right to an appeal, and, as applicable, the patient’s decision to request an appeal. (z) If a conditional discharge is absolutely revoked, in addition to the notice given in (v) above, the department shall: (1) Provide legal counsel who are not directly employed by the department, and who contract with the department to represent persons for involuntary emergency admission proceedings at no cost to the person; (2) Provide patient contact information to the assigned private attorney in order for the attorney to: a. Meet with the person, and the person’s guardian if he or she requests, to discuss the implications of the person’s initial decision not to appeal the absolute revocation and the avenues of legal recourse available to the person, including an appeal, and either: 1.. Obtain a written waiver of appeal signed by the person; or 2. Notify the department of the person's final decision to appeal the absolute revocation so that the matter may be referred to the administrative appeals unit and scheduled for a hearing; (3) Provide legal counsel from a list of private attorneys, maintained by the department’s bureau of behavioral health who are not directly employed by the department, and who contract with the department to represent persons in administrative appeals hearings at no cost to the person if: a. The person appeals the absolute revocation; or b. The person’s guardian or the guardian’s attorney appeals the absolute revocation of the conditional discharge; and (4) Provide notice to the person’s guardian, if any, of the person’s decision to waive or exercise his or her option to appeal the absolute revocation of the conditional discharge and provide the guardian with an opportunity to participate in the hearing with or without his or her attorney of choice . (aa ) If the written notices of revocation as referenced in (d), (j), (n), and (v) above cannot be offered to and explained to the person safely without significant possibility of bodily harm, a description of the circumstances indicating such risk shall be provided to the person’s guardian, if any, and placed in the person’s file for each notice. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99 New. #7228, eff 3-31-00; amd by #7627, eff 2-1-02; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; ss by #10386, eff 7-24-13; ss by #12014, eff 10-25-16; ss by #12014, eff 10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 He-M 609.07 Appeal of Revocation . (a) A person or his or her guardian, if any, whose conditional discharge has been absolutely revoked by the administrator of a facility, or his or her designee, pursuant to He-M 609.06(j) may appeal the decision to the commissioner. (b) Upon the request of the person or his or her guardian, a person appealing absolute revocation of conditional discharge may obtain assistance from the facility in effecting the appeal. (c) The appeal shall: (l) Be in writing; (2) State that a hearing is requested; (3) State whether or not assistance of legal counsel is requested at such a hearing; and (4) Include such information related to the basis for the appeal as the person or his or her guardian, at the time, may elect to offer. (d) The facility shall submit the appeal to the commissioner, together with copies of all notices provided to the person pursuant to He-M 609.06 and any other information relevant to the reasons for revocation of the conditional discharge. (e) If a hearing on the appeal has been requested, the commissioner, or his or her designee , shall: (l) Obtain legal counsel for the person; and (2) Conduct a hearing on the appeal within 5 working days of the commissioner’s receipt of the request for a hearing. (f) Hearings on appeals filed under He-M 609.07 shall be conducted in accordance with He-C 203. (g) Following a hearing, the commissioner, or his or her designee , shall, within 3 working days, decide if the person either: (1) Has violated a condition of the discharge, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; (2) Was in such a mental condition at the time of examination, as a result of mental illness that has created a potentially serious likelihood of danger to self or to others; or (3) The person’s mental status has deteriorated from the person’s usual mental status, such that the patient is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given. (h) In reaching a decision, only evidence presented at the hearing shall be considered. ( i ) The burden shall be upon the state to establish that the criterion for revocation of the conditional discharge is met by clear and convincing evidence. (j) The decision made by the commissioner, or his or her designee , shall: (1) Be in writing; (2) State the reasons for the decision; and (3) Be sent promptly to the person appealing, his or her guardian, his or her legal counsel, if any, and the facility and CMHP or THPS that revoked the conditional discharge of the person. Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93; ss by #5863, eff 7-1-94; ss by #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; ss by #10641, eff 7-18-14; ss by #12014, eff 10-25-16; amd by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22 PART He-M 610 - RESERVED PART He-M 611 TRANSFERS TO AND FROM THE SECURE PSYCHIATRIC UNIT Statutory Authority: New Hampshire RSA 171-A:8-a; 135-C:61, IX; 135-C:48; 622:45, II He-M 611.01 Purpose . The purpose of these rules is to define the criteria and procedures for the transfer of involuntarily admitted persons with mental illness or intellectual disability from New Hampshire hospital or any designated receiving facility in the developmental disabilities services system to the secure psychiatric unit in the correctional services system and from the secure psychiatric unit to New Hampshire hospital. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; ss by #13255, eff 8-21-21 He-M 611.02 Definitions . (a) “Administrator” means the staff member responsible for the overall operation of a designated receiving facility, or that person’s designee. (b) “Commissioner” means the commissioner of the department of health and human services or his or her designee. (c) “Corrections commissioner” means the commissioner of the department of corrections or his or her designee. (d) “Designated receiving facility (DRF)” means New Hampshire hospital or a developmental services program designated as a receiving facility under RSA 171-A:20 and He-M 526. (e) “Hearing” means “adjudicative proceeding” as defined by RSA 541-A:1, I, namely “the procedure to be followed in contested cases, as set forth in RSA 541-A:31 through RSA 541-A:36.” (f) “Medical unit director” means the person responsible for the provision, supervision and administration of medical and psychiatric services for the department of corrections and the unit pursuant to RSA 622:43, I, (a). (g) “Unit” means the secure psychiatric unit established by RSA 622:41. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17 He-M 611.03 Categories of Admission or Transfer to the Unit . Persons shall be admitted or transferred to the unit from the jurisdiction of the mental health or developmental services system under the following circumstances: (a) Upon order of a probate court pursuant to RSA 622:45 or 171-B:12; or (b) Upon an order by the chief executive officer of New Hampshire hospital, or designee, to which the person has been involuntarily admitted pursuant to RSA 135-C:27-33 or RSA 135-C:34-54, or by the administrator of a DRF to which the person has been committed pursuant to RSA 171-B:12 when: (1) The transfer has been approved by the commissioner and the corrections commissioner; or (2) An emergency has been determined to exist pursuant to He-M 611.06(b). Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17 He-M 611.04 Admissions by Probate Court . Pursuant to RSA 622:45, I (a) and (c), a probate court may order a person to be involuntarily admitted to the unit. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17 He-M 611.05 Transfers to the Unit . (a) The chief executive officer of New Hampshire hospital, or designee , or the administrator of a developmental services DRF shall transfer a person from the DRF to the unit under the following circumstances: (1) The person was admitted either to New Hampshire hospital or the developmental services DRF by: a. An involuntary emergency admission pursuant to RSA 135-C:27-33; b. An involuntary admission pursuant to RSA 135-C:34-54; c. An involuntary admission pursuant to RSA 171-B; or d. The administrator of a state DRF; (2) The chief executive officer, or designee, or administrator has determined that the person would present a serious likelihood of danger to self or others if retained at either New Hampshire hospital or the developmental services DRF; (3) Such determination of serious likelihood of danger is based upon the behavior(s) of the person to be transferred or other circumstances which create a strong probability that New Hampshire hospital or the developmental services DRF cannot reasonably provide the degree of safety and security necessary to prevent the harm; (4) The person has been informed verbally and in writing of the proposed transfer and the reasons therefor, and has been given the opportunity to consent or object to the transfer in accordance with the requirements in He-M 611.07; and (5) The commissioner and the corrections commissioner, or a third party who is mutually acceptable to the commissioner and corrections commissioner, determine that the criteria in (1)-(4) above have been met. (b) In approving or objecting to a transfer pursuant to (c)-(g) below, the commissioner, corrections commissioner, or third party shall determine whether the criteria in He-M 611.05(a)(1)-(4) have been met. Any transfer that meets such criteria shall be approved. (c) An order for transfer shall be signed by the chief executive officer of New Hampshire hospital, or designee, or by the administrator of the developmental services DRF and sent to the commissioner for approval. If the commissioner objects to the transfer, the transfer shall not be made. If the commissioner approves the transfer, the order for transfer shall be sent to the corrections commissioner. (d) If the corrections commissioner, or his or her designee , objects to the transfer, the transfer shall not be made. However, the commissioner and the corrections commissioner may agree to have the disagreement resolved by a mutually acceptable third party. The decision of the third party shall be binding upon the commissioner and the corrections commissioner . (e) If the third party objects to the transfer, the transfer shall not be made. (f) If the commissioner and the corrections commissioner, or the third party, approve the transfer and the person to be transferred has consented to the proposed transfer, the administrator ordering the transfer shall be notified and shall make arrangements for the transfer in accordance with He-M 611.08. (g) A transfer shall be suspended to the unit until a bed is available. If a transfer is accepted pending bed availability, the unit administrator shall inform the referring DRF within 24 hours of a bed becoming available. . The person shall not be transferred unless the chief executive officer, designee , or other DRF staff familiar with the circumstances necessitating the transfer, or administrator who ordered the transfer determines that the person continues to meet the criteria in He-M 611.05(a)(1)-(4). (h) If the commissioner and the corrections commissioner, or the third party, approve the transfer and the person to be transferred objects to the proposed transfer and requests an appeal of the proposed transfer, the person shall not be transferred. A hearing on the proposed transfer shall be held in accordance with He-M 611.07 and He-C 200 within 5 days, excluding Saturdays, Sundays, and holidays after the transfer has been approved or suspended pending bed availability. Source. #7299, eff 5-25-00; amd by #7504, eff 6-16-01; ss by #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; ss by #13255, eff 8-21-21 He-M 611.06 Emergency Transfers to the Unit . (a) In the event of an emergency as specified by (b) below, a person who has been admitted to New Hampshire hospital by an involuntary emergency admission pursuant to RSA 135-C:27-33 or an involuntary admission pursuant to RSA 135-C:34-54 or to a developmental services DRF pursuant to RSA 171-B:12 shall be transferred to the unit without the prior approval of the commissioner and the corrections commissioner. (b) The chief executive officer of New Hampshire hospital, or designee, or administrator of the developmental services DRF shall determine that an emergency exists when: (1) There is a serious likelihood of danger to the person or to others if the transfer is not made; and (2) An immediate transfer is necessary in order to protect the person or others. (c) The determination of a serious likelihood of danger shall be based upon the behavior(s) of the person to be transferred or other circumstances which create a strong probability that the person will cause or attempt to cause harm to self or others and New Hampshire hospital or the developmental services DRF cannot reasonably provide the degree of safety and security necessary to prevent the harm. (d) Prior to the emergency transfer of the person, the person and his or her guardian, if one has been appointed, shall be informed verbally and in writing of the transfer and reasons therefor, and shall be given an opportunity to consent or object to the transfer in accordance with the requirements in He-M 611.07. (e) Within 24 hours, excluding Saturdays, Sundays and holidays, of an emergency transfer, the chief executive officer of New Hampshire hospital, or designee, or the administrator of the developmental services DRF shall obtain the approval of the commissioner and the corrections commissioner for the transfer of the person. In approving or objecting to an emergency transfer, the commissioner, corrections commissioner, or third party shall determine whether the criteria in He-M 611.05(a)(1) and He-M 611.06(b)-(d) have been met. (f) Exceptions to (e) above shall be as follows: (1) If the commissioner approves an emergency transfer and the corrections commissioner objects to the transfer, they may agree to have the disagreement resolved by a mutually acceptable third party; (2) Except as provided for in (1) above, if the approvals of the commissioner and the corrections commissioner are not obtained within 24 hours after the transfer, excluding Saturdays, Sundays and holidays, the person shall be immediately returned to the DRF from which he or she was transferred; (3) The decision of the third party shall be made no later than 72 hours, excluding Saturdays, Sundays, and holidays, following the emergency transfer and shall be binding upon the commissioner and the corrections commissioner; and (4) If the third party objects to the transfer, the person shall be immediately returned to the DRF from which he or she was transferred. (g) If the commissioner and the corrections commissioner, or the third party, approve the emergency transfer, the person transferred to the unit shall be under the care and custody of the corrections commissioner and the medical unit director. (h) If the person transferred to the unit objects to the transfer, he or she may appeal the decision to the commissioner and be afforded a hearing in accordance with the procedures set forth in He-M 611.07 and He-C 200 within 5 working days, excluding Saturdays, Sundays and holidays, after the transfer has been approved or suspended pending bed availability. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17 He-M 611.07 Transfer from the Unit to New Hampshire Hospital . (a) A person shall have the right to request a transfer to the least restrictive environment necessary to achieve the purposes of treatment. (b) Transfers from the unit to New Hampshire hospital shall be made pursuant to Cor 504.11. (c) If the commissioner denies a transfer, the denial shall be communicated to the person and his or her guardian, if applicable, and include notice of the person’s rights and the procedures to appeal the transfer decision. (d) If the person is denied a requested transfer to the New Hampshire hospital, the person may appeal the decision to the commissioner and be afforded a hearing in accordance with the procedures set forth in He-M 611.08 and He-C 200 within 5 business days after the transfer has been denied or suspended, pending bed availability. Source. #13255, eff 8-21-22 He-M 611.08 Notices and Hearings . (a) If a person objects to a proposed or actual transfer in accordance with He-M 611.05(g) or He-M 611.06(h), or a denial of transfer from the unit to New Hampshire hospital in accordance with He-M 611.07 (c), he or she may request a hearing, on the decision to transfer or the decision to deny a transfer from the unit to New Hampshire hospital, by the commissioner. A person being transferred or denied a transfer from the unit to New Hampshire hospital, and his or her guardian if applicable, shall be provided verbal and written notice of his or her rights including his or her right to appeal. Such notice shall specify that the person has the right to a hearing in which the person may explain why he or she objects, in which witnesses may be called and asked questions, and in which he or she may be represented by a lawyer provided free of charge if he or she chooses. (b) A hearing on the decision to transfer or a denial of transfer from the unit to New Hampshire hospital shall be held in accordance with He-C 200. (c) The hearing shall be scheduled by the commissioner within 5 days of receipt of the request for a hearing by the administrative appeals unit (AAU) excluding Saturdays, Sundays, and holidays. Any request received after close of business shall be considered received on the next business day. (d) If a person objects to a transfer or denial of a transfer from the unit to New Hampshire hospital, requests a hearing, and requests legal counsel, he or she shall be provided with legal counsel at no cost. (e) If the person does not object to the transfer or denial of a transfer from the unit to New Hampshire hospital, does not request a hearing, or does not request legal counsel, within 72 hours of the transfer, excluding Saturdays, Sundays, and holidays, there shall be provided, at no cost to the person, a private attorney not employed by the department of health and human services, department of corrections, or a designated receiving facility. The attorney shall be authorized to schedule a meeting with the person to discuss the person’s procedural rights and either, obtain an informed waiver of one or more of those rights signed by the person, or revoke the person’s initial waiver of any such rights so that a hearing may be scheduled by the department on the person’s objection to the transfer. A waiver revocation shall effectively invalidate the initial waiver. (f) In the case of a proposed transfer, within 15 days following a hearing the commissioner shall issue a written decision and: (1) If the evidence presented is clear and convincing that the criteria set forth in He-M 611.05(a)(1)-(4) are met, the transfer shall be made in accordance with He-M 611.08; or (2) If the evidence presented is not clear and convincing that the criteria set forth in He-M 611.05(a)(1)-(4) are met, the transfer shall not be made. (g) In the case of an emergency transfer, within 10 days following a hearing the commissioner shall issue a written decision and, if the evidence presented does not support a conclusion that the criteria set forth in He-M 611.06(a)-(d) are met, the objection to transfer shall be upheld and the person shall be returned within 72 hours to either New Hampshire hospital or the developmental services DRF from which he or she was transferred. (h) In the case of a denial of transfer from the unit to New Hampshire hospital, the commissioner shall issue a written decision within 15 days following a hearing and: (1) If the criteria set forth in Cor 504.11 are met, the denial of transfer from the unit to the New Hampshire hospital shall be overturned; or (2) If the criteria set forth in Cor 504.11 are not met, the denial of transfer from the unit to the New Hampshire hospital shall be upheld. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17 ; ss by #13255, eff 8-21-21 (formerly He-M 611.07) He-M 611.09 Transfer Procedures . (a) The DRF administrator who has ordered the transfer of a person under the emergency procedures in He-M 611.06 or who has received approval to transfer a person under He-M 611.05 shall promptly inform the unit of the transfer. (b) Persons to be transferred to the unit or returned by the unit to New Hampshire hospital or the developmental services DRF shall be transported by DRF staff, unit staff, or any law enforcement officer empowered to act under RSA 135-C:62 or 171-A:27. The administrator ordering the transfer shall inform the unit, by telephone, of the transfer arrangements at least 2 hours in advance of the transfer. (c) The administrator ordering a transfer shall cause a copy of the emergency order or other approved order of transfer to be delivered with the person to the unit and notify the commissioner and the corrections commissioner when a transfer is made. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.08) He-M 611.10 Readmissions to the Secure Psychiatric Unit . Persons transferred to a mental health or developmental services DRF from the unit pursuant to RSA 622:48 who are transferred back to the unit shall be transferred under the provisions of He-M 611. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.09) He-M 611.11 Jurisdiction . Pursuant to RSA 622:45, IV, persons admitted or transferred to the unit shall be under the care and custody of the corrections commissioner and the medical unit director and shall be subject to the rules of the corrections commissioner. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.11) He-M 611.12 Commitment Limitations . (a) Pursuant to RSA 622:45, IV, no person shall be retained in the unit longer than the period of the order of involuntary admission to the mental health or developmental services system to which he or she was subject at the time of transfer except upon further order of a court. (b) New Hampshire hospital or a developmental services DRF, as applicable, shall collaborate with the unit in order to review each person’s treatment plan and the best location for ongoing care during the period of commitment. When a person ceases to meet criteria for admission to the unit, the DRF that transferred the person to the unit shall facilitate the person’s transfer back to the DRF. If the DRF does not have an available bed, the person shall be placed on the waiting list for the next available bed. Source. #7299, eff 5-25-00, EXPIRED: 5-25-08 New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17 New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.11) PART He-M 612 TRANSFERS BETWEEN RECEIVING FACILITIES Statutory Authority: RSA 135-C:31, V; 135-C:48 He-M 612.01 Purpose . The purpose of these rules is to establish the criteria and procedures for transfers of civilly committed persons between receiving facilities in the mental health services system. Source. #3178, eff 1-21-86; ss by #5483, eff 10-23-92, EXPIRED: 10-23-98 New. #6982, eff 4-22-99, EXPIRED: 4-22-07 New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16 He-M 612.02 Definitions . (a) "Administrator" means the chief executive officer of the facility or, in the absence of the administrator, the executive person in charge of the facility. (b) "Attorney" means a lawyer retained by, employed by, or appointed by a court to represent a client. (c) "Commissioner" means the commissioner of the department of health and human services. (d) “Department” means the department of health and human services. (e) "Guardian" means a person who is appointed by the court to care for the person, property, or both, or property of another person pursuant to RSA 464-A. (f) "Involuntary admission" means admission of a person to a receiving facility on an involuntary basis by an order of the probate court pursuant to RSA 135-C:34-54. (g) "Involuntary emergency admission" means admission to a facility on an involuntary, emergency basis, pursuant to RSA 135-C:27-33, of an individual who is in such mental condition as a result of a mental illness as to pose a likelihood of danger to self or others. (h) "Receiving facility," as defined in RSA 135-C:2, XIV, means “a treatment facility which is designated by the commissioner to accept for care, custody and treatment persons involuntarily admitted to the state mental health services system.” Source. #3178, eff 1-21-86; ss by #5483, eff 10-23-92, EXPIRED: 10-23-98 New. #6982, eff 4-22-99, EXPIRED: 4-22-07 New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16 He-M 612.03 Status Transfers . (a) Receiving facilities shall be designated under RSA 135-C:26 and He-M 405.04 for any one or more of the following purposes: (1) To receive persons for involuntary emergency admission beginning with initial custody and continuing through the day following the probable cause hearing; (2) To receive persons for the period of involuntary emergency admission after the probable cause hearing; and (3) To receive persons for involuntary admission pursuant to RSA 135-C:34-54. (b) Whenever a receiving facility has custody of a person for a period of an involuntary emergency admission or an involuntary admission and the facility has not been designated by the commissioner as a receiving facility for that purpose, the administrator of the receiving facility shall transfer the person to New Hampshire hospital, or another facility which has been designated for that purpose, for any remaining period of involuntary emergency admission or involuntary admission. (c) When a receiving facility is aware that it has custody of a person who requires a transfer under this section, the facility shall immediately notify New Hampshire hospital, or another facility which has been designated for that purpose, of the need to transfer the person; (d) Notification pursuant to (c) above shall be in the form of a transfer order which shall: (1) State the reason for the transfer; (2) Identify the facility to which the person is being transferred; (3) Be signed by the facility administrator or the administrator's designee ; and (4) If the person to be transferred is a child, comply with the requirements of RSA 126-U:12. (e) A copy of the transfer order shall be given to the person being transferred and the person's guardian and attorney, if any. (f) Within 24 hours of receipt of a transfer order, the facility from which a person is being transferred shall arrange for transportation of the person from the facility to New Hampshire hospital or another facility receiving the person. The person shall be transported by facility staff, New Hampshire hospital staff, or any law enforcement officer empowered to transport under RSA 135-C:62. (g) If , prior to taking custody of a person under RSA 135-C:27-33 or RSA 135-C:34-54, a receiving facility determines that it has not been designated for the purpose for which the person is being placed at the facility, the administrator of the facility or the administrator's designee shall: (1) Refuse to accept custody of the person and direct the law enforcement officer transporting the person to deliver the person to a receiving facility which has the requisite designation; or (2) Admit the person to the facility and arrange a transfer pursuant to (c) and (d) above if the administrator or the administrator's designee determines that the refusal to accept custody likely will result in harm to the person or to others. (h) Once transferred, a person shall be subject to RSA 135-C, and RSA 126-U if applicable, as if originally placed in the custody of New Hampshire hospital or another facility to which the person was transferred. ( i ) If a person being transferred under He-M 612.03 objects to the transfer, the challenge shall be treated as a client complaint in accordance with He-M 204. Source. #3178, eff 1-21-86; ss by #5483, eff 10-23-92, EXPIRED: 10-23-98 New. #6982, eff 4-22-99, EXPIRED: 4-22-07 New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16 He-M 612.04 Treatment and Security Transfers . Whenever a facility has custody of a person for a period of involuntary emergency admission or involuntary admission, the administrator of the facility or the administrator's designee shall order the transfer of the person to another receiving facility under the following circumstances and procedures: (a) Transfers for treatment purposes shall be ordered if: (1) A person's condition is such that the facility which has custody cannot reasonably provide the treatment required to stabilize or ameliorate the person's condition; and (2) The administrator or the administrator's designee has determined that the facility to which the person is to be transferred can provide the treatment the person requires; (b) Transfers for security purposes shall be ordered if: (1) A person's behavior is such that the facility which has custody cannot reasonably provide the supervision and control necessary to prevent the person from causing bodily harm to self or others, or significant damage to property; and (2) The administrator or the administrator's designee has determined that the facility to which the person is to be transferred can provide the supervision and control the person requires; (c) All transfers under He-M 612.04 shall only occur following the prior approval of the commissioner or the commissioner's designee ; (d) The commissioner or the commissioner's designee shall grant prior approval for transfer verbally or in writing after: (1) Consideration of the facts upon which the transfer order was based; and (2) Determination that the transfer complies with He-M 612; (e) When a transfer is to be made for treatment or security purposes, the administrator or the administrator's designee shall sign a transfer order which shall state the reasons for the transfer and the facility to which the person is to be transferred; (f) The administrator or the administrator's designee shall give: (1) The person to be transferred: a. A copy of the transfer order; and b. A verbal explanation of: 1. The transfer order; 2. The transfer procedures; and 3. The right to object to the transfer; and (2) The person's guardian and attorney, if any, a copy of the order; (g) The administrator of a facility shall order an emergency transfer of a person without securing the prior approval of the commissioner if: (1) There is serious likelihood that the person or others will be in danger if the transfer is not made; and (2) An immediate transfer is necessary in order to protect the person or others; (h) Immediately following an emergency transfer of a person, the administrator of a facility shall provide to the commissioner or the commissioner's designee a copy of the transfer order required by He-M 612.04 (d); ( i ) Within 48 hours of receipt of a transfer order, the commissioner or the commissioner's designee shall either approve the transfer or disapprove the transfer based upon the criteria listed in (g) (1) and (2), and, if the- transfer is disapproved, the person shall be promptly returned to the facility from which the person was transferred; (j) Objections to transfers under this section shall require emergency action pursuant to He-M 204; (k) Once transferred, a person shall be subject to RSA 135-C as if originally placed in the custody of the facility to which the person was transferred; (l) Transportation of a person under this section shall be arranged by the facility making the transfer; (m) The person shall be transported by staff of the facility from which or to which the person is being transferred or by any law enforcement officer empowered to transport under RSA 135-C:62; and (n) If the person to be transferred is a child, any transportation, notice and documentation shall comply with the requirements of RSA 126-U:12. Source. #3178, eff 1-21-86; ss by #5483, eff 10-23-92, EXPIRED: 10-23-98 New. #6982, eff 4-22-99, EXPIRED: 4-22-07 New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16 He-M 612.05 Transfers to Less Restrictive Settings . (a) Whenever a receiving facility has custody of a person for a period of involuntary emergency admission or involuntary admission, the administrator of the facility or the administrator's designee shall order the transfer of the person to another receiving facility if: (1) That facility can provide an environment which is less restrictive of the person's freedom of movement than the receiving facility having custody of the person; and (2) That facility can provide the care, treatment, and security required for the person. (b) When a transfer is being made to a facility with a less restrictive setting, the administrator or the administrator's designee shall sign an order of transfer. The transfer order shall state the reason for the transfer and the facility to which the person is to be transferred. (c) The administrator or the administrator's designee shall give: (1) The person to be transferred: a. A copy of the transfer order; and b. A verbal explanation of: 1. The transfer order; 2. The transfer procedures; and 3. The right to object to the transfer; and (2) The person's guardian and attorney, if any, a copy of the order; and (3) If the person to be transferred is a child, the required notice and documentation required by RSA 126-U:12. (d) No transfer shall take place under He-M 612.05 without the prior approval, based on the criteria listed in (a) above, of the commissioner and the administrator of the facility to which the person is being transferred. (e) If a person being transferred under He-M 612.05 objects to the transfer, the challenge shall be treated as a client complaint in accordance with He-M 204. (f) Once transferred, a person shall be subject to RSA 135-C as if originally placed in the custody of the facility to which the person was transferred. (g) Transportation of a person under this section shall be arranged by the facility making the transfer. (h) The person shall be transported by staff of the facility from which or to which the person is being transferred or by any law enforcement officer empowered to transport under RSA 135-C:62. Source. #3178, eff 1-21-86; ss by #5483, eff 10-23-92, EXPIRED: 10-23-98 New. #6982, eff 4-22-99, EXPIRED: 4-22-07 New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16 PART He-M 613 ADMISSION TO AND DISCHARGE FROM NEW HAMPSHIRE HOSPITAL Statutory Authority: New Hampshire RSA 135-C:4, III; 16; 61, II, IV He-M 613.01 Purpose . The purpose of this rule is to define standards and procedures for placement at New Hampshire hospital (NHH). Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.02 Definitions . (a) “Absolute discharge” means the complete and unconditional discharge of an individual from NHH. (b) “Advance practice registered nurse (APRN)” means “advanced practice registered nurse” as defined in RSA 135-C:2, II-a, namely “an advanced practice registered nurse licensed by the board of nursing who is certified as a psychiatric mental health nurse practitioner by a board-recognized national certifying body.” (c) “Certificate” means the certificate of a physician or an APRN pursuant to RSA 135-C:28, I, stating that the person to be admitted meets the criteria for IEA specified in RSA 135-C:27. (d) “Certifying practitioner” means a physician or an APRN who issues a certificate of involuntary emergency admission in accordance with RSA 135-C:28, I. (e) "Commissioner" means the commissioner of the department of health and human services. (f) "Community mental health program" (CMHP) means “community mental health program” as defined in RSA 135-C:2, IV, namely, “a program established and administered by the state, city, town, or county, or a nonprofit corporation for the purpose of providing mental health services to the residents of the area and which minimally provides emergency, medical or psychiatric screening and evaluation, case management, and psychotherapy services.” (g) “Conditional discharge” means “conditional discharge” as defined in RSA 135-C:2, V, namely, “the release of an involuntarily admitted person from a receiving facility on the condition that the person accept treatment in the community or be subject to readmission.” (h) “Director” means the director of the bureau of behavioral health of the department of health and human services. ( i ) “District court” means the state court that has the authority pursuant to RSA 135-C:20 to conduct probable cause hearings for involuntary emergency admissions and order an evaluation of a minor pursuant to RSA 169-B:20, RSA 169-B:21, I, RSA 169-C:16, III, and RSA 169-D:14, III. The term also includes the term “circuit court – district court division” which is a state court located in each county of New Hampshire with a district, probate, and family court division. (j) "Informed decision" means a choice made voluntarily by a patient or person for whom admission is sought or, where appropriate, such person's legal guardian, after all relevant information necessary to making the choice has been provided, when: (1) The person understands that he or she is free to choose or refuse any available alternative; (2) The person clearly indicates or expresses his or her choice; and (3) The choice is free from all coercion. (k) “Involuntary admission” means admission of a person to a receiving facility on an involuntary basis by order of the probate court pursuant to RSA 135-C:34-54. (l) “Involuntary emergency admission” (IEA) means admission to a receiving facility on an involuntary, emergency basis, pursuant to RSA 135-C:27-33, of an individual who is in such mental condition as a result of a mental illness as to pose a likelihood of harm to self or others. (m) “Least restrictive alternative” means the program or service which least inhibits a person’s freedom of movement, participation in the community, and informed decision-making while achieving the purposes of treatment. (n) “Medical director” means the person responsible for providing oversight and advice regarding the clinical services and treatment within the state mental health services system. (o) “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 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.” (p) “Minor” means any person under the age of 18 years. (q) “Parent” means a biological or adoptive parent who has legal custody of a minor, including either parent if custody is shared, or a person or agency appointed as a guardian of the person of a minor. (r) “Petition” means a request for the involuntary admission of a person completed in accordance with RSA 135-C:36. (s) “Physician” means “physician” as defined in RSA 135-C:2, XII, namely, “a medical doctor licensed to practice in New Hampshire.” (t) "Preadmission screening" means a review of a nursing home applicant conducted prior to admission pursuant to He-M 1302 that allows the department to confirm the applicant’s diagnosis, identify the necessary level of care, and determine the need for specialized services. (u) “Probate court” means the state circuit court – probate division which has authority to preside over civil commitment and guardianship proceedings. (v) “Psychiatric disorder” means a mental disorder classified in the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, (DSM-5), published by the American Psychiatric Association, with the exception of intellectual disability, organic mental disorders, substance abuse disorders, adjustment disorders, and Z codes. (w) “Psychiatrist” means “psychiatrist” as defined in RSA 135-C:2, XIII, namely, “a physician licensed to practice in New Hampshire who is either board-certified or board-eligible according to the most recent regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization.” (x) “Receiving facility” means “receiving facility” as defined in RSA 135-C:2, XIV, namely, “a treatment facility which is designated by the commissioner to accept for care, custody and treatment persons involuntarily admitted to the state mental health services system.” (y) “Severe personality disorder” means a mental disorder classified in the DSM-V and characterized by personality traits which are inflexible, maladaptive, and cause a severe degree of either functional impairment or subjective distress. (z) “Skilled nursing facility” means a medical facility which provides skilled nursing and rehabilitation services for a limited period of time following inpatient hospital care. (aa) “Superintendent” means the chief administrative officer of NHH. (ab) "Transitional housing services" (THS) means a residential and rehabilitative program that assists people with mental illness who have been discharged from NHH to adjust to living in a non-institutional, community-based setting. (ac) “Voluntary admission” means admission to NHH subsequent to the documented consent of the person being admitted or his or her legal guardian. (ad) “Z codes” means DSM-5 categories that describe clinically-related conditions of a person that are not directly attributable to a mental illness but might interfere with treatment of that illness or otherwise have an effect on the person’s ability to carry out functions of daily living. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.03 Voluntary Admission of Adults to NHH . (a) To be eligible for voluntary admission to NHH, an applicant shall meet the following criteria: (1) The applicant shall be referred by his or her regional CMHP; (2) The applicant shall be certified by the CMHP as eligible for community mental health services pursuant to He-M 401.04 through 401.07; (3) Pursuant to RSA 464-A:25, I (a), if a guardian of the person has been appointed for the applicant: a. The guardian may consent to admission to NHH with prior approval of the probate court; or b. If there is no prior probate court approval, the guardian may consent to admission to NHH provided a psychiatrist or APRN licensed to practice in New Hampshire has certified in writing that placement at NHH is in the ward’s best interests and is the least restrictive placement available; and (4) If the applicant does not have a guardian of the person, the applicant shall make an informed decision to consent to the voluntary admission. (b) A person who refers himself, herself, or another person for admission to NHH shall do so in writing or by telephone to the medical director of NHH or his or her designee. (c) Each referral shall include: (1) A description of the person’s recent clinical history relative to the conditions and events which led to the request for admission; (2) A description of less restrictive alternatives considered by the referring party; (3) A statement which demonstrates why less restrictive alternatives are inappropriately suited to the patient’s needs or are otherwise not available; and (4) A statement why NHH is the least restrictive treatment alternative. (d) An applicant for voluntary admission to NHH shall only be eligible for admission if, as determined by the medical director or his or her designee: (1) NHH is the least restrictive alternative among the available treatment options; and (2) NHH has the capacity, programs, and services to address the applicant’s presenting complaints and symptoms. (e) No voluntary admission shall occur without the written prior approval of the medical director or his or her designee. (f) Pursuant to RSA 135-C:12, III, NHH shall notify an applicant of his or her eligibility for admission within 15 days after receipt of the application. (g) Referring parties shall make every effort to refer applicants for voluntary admission between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday, excluding holidays. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.04 Involuntary Admission of Adults to NHH . (a) Involuntary Emergency Admission (IEA) shall be made according to the following criteria: (1) If the official current Judicial Branch form (NHJB-2826-D) including the petitioner’s statement, the physical examination, mental examination, and certificate of examining physician or APRN requesting admission are complete as to form and content, the admission: a. Shall be made if the person being referred meets the criteria for admission specified in RSA 135-C:27, as judged by the NHH admitting practitioner; or b. Shall be denied if, in the opinion of the admitting practitioner, with the verbal concurrence of the medical director or his or her designee, the person being referred fails to meet the criteria specified in RSA 135-C:27; (2) If an IEA is denied, the denial shall result in the admitting practitioner immediately notifying the certifying practitioner and the CMHP of the reason(s) for the denial; (3) Except as allowed by (4) below, if a practitioner’s certificate or petition requesting admission is not complete as to form and content: a. The person being referred shall not be admitted; b. The person being referred shall be returned to the place where he or she was taken into custody; and c. The admitting practitioner shall notify the certifying practitioner and the community mental health program approving that practitioner of the reasons for the denial of the admission; and (4) Minor deficiencies in the form and content of the petition and practitioner’s certificate including a misplaced or omitted signature, or the failure to transmit to the court the original petition or original practitioner’s certificate, or any other detail that on its own would not result in a denial of admission, shall: a. Not be the cause for denial of an admission pursuant to He-M 613.04 (a) (2) above; and b. Be remedied within 24 hours of admission. (b) Non-emergency involuntary admissions shall be made according to the following criteria: (1) Pursuant to RSA 135-C:34, the person being admitted shall be in such mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or others; and (2) Admissions shall not occur unless ordered by a probate court pursuant to RSA 135-C:45. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.05 Medical Transfer of Involuntarily Admitted Patients . (a) The superintendent or his or her designee shall order the medical transfer of an involuntarily admitted patient to an acute care hospital if the following conditions apply: (1) The patient has acute medical needs requiring treatment which cannot be provided at NHH; (2) The hospital to which the patient is to be transferred can provide the treatment that the patient requires; and (3) One of the following applies: a. The patient has consented to the transfer; b. The patient’s legal guardian, if the guardian has been granted decision-making authority regarding medical care, has consented to the transfer; or c. The patient: 1. Is legally competent; 2. Is unable to consent to the transfer; and 3. Has acute medical needs that require emergency treatment. (b) A patient who is transferred from NHH for medical treatment shall remain under the protective custody of NHH pursuant to the authority under which the patient was involuntarily admitted. (c) If the patient being transferred under He-M 613.05 or his or her guardian objects to the transfer, the challenge shall be treated as a complaint in accordance with He-M 204. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.06 Discharge from NHH Pursuant to Voluntary Admission . (a) Pursuant to RSA 135-C:16, if a person is a patient on a voluntary basis, he or she may withdraw from the receiving facility, whether or not such withdrawal is made against medical advice. (b) A patient who has requested to withdraw shall: (1) Be released upon request if an examination conducted in accordance with RSA 135-C:17 is not ordered; (2) Be released if an examination is ordered but does not occur within the 24-hour period; (3) Be released if an examination determines that the criteria specified in RSA 135-C:27 are not met; or (4) Be held and treated in accordance with the provisions of RSA 135-C:27-33 if an examination determines that the criteria are met. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.07 Discharge Pursuant to IEA . (a) Pursuant to RSA 135-C:32, if a person is admitted on an involuntary, emergency basis, such involuntary confinement shall be limited to a 10-day period, not including Saturdays and Sundays, unless a petition requesting the probate court to issue an order of involuntary admission is filed within the 10-day period. Subsequent to the filing of such petition, confinement shall continue only until issuance of the probate court order or until such time as is specified in that order. (b) Pursuant to RSA 135-C:33, any person involuntarily admitted on an emergency basis shall be granted absolute discharge by the superintendent or his or her designee if the superintendent determines that the person no longer meets the criteria for admission identified in RSA 135-C:27. (c) Absolute discharge shall be made according to the following: (1) NHH shall notify the CMHP in the region from which the person was admitted and the region to which the person was discharged, unless the discharge was pursuant to a finding in court of no probable cause; (2) NHH shall issue written notice to the person discharged and his or her legal guardian, if applicable, that notification pursuant to (1) above was made; and (3) NHH shall arrange or provide transportation of the person to his or her in-state destination of choice unless the person chooses to provide his or her own transportation. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.08 Discharge Pursuant to Non-emergency Involuntary Admission . (a) Pursuant to RSA 135-C:39, if a person is admitted on an involuntary, non-emergency basis, such involuntary confinement shall not continue beyond the time allowed by the probate court order unless a petition requesting the court to issue another order of involuntary admission is filed within the initial period of involuntary admission. Subsequent to the filing of such petition, confinement shall only continue until issuance of the probate court order or until such time as is specified in that order. (b) Any person involuntarily admitted on a non-emergency basis shall be granted absolute discharge by the superintendent or his or her designee if: (1) The person has been examined within 3 days prior to the discharge by the superintendent or his or her designee ; and (2) Following such examination, the superintendent or his or her designee has determined and documented that, in his or her professional opinion, the person does not meet the criteria identified in RSA 135-C:34. (c) Upon the discharge of any person pursuant to (a) and (b) above, the superintendent shall immediately, and in writing, notify the probate court entering the original order of commitment that an absolute discharge has been granted to the person. (d) Conditional discharge of any person who has been involuntarily admitted on a non-emergency basis shall take place in accordance with He-M 609. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.09 Admission to Transitional Housing Service . (a) To be eligible for admission to the transitional housing service (THS), an applicant shall meet the following criteria: (1) The applicant shall have been referred from NHH or have been discharged from the THS within the 30 days immediately preceding application; (2) The applicant shall be 18 years of age or older and have a primary diagnosis of: a. Psychiatric disorder or severe personality disorder; or b. Intellectual disability or pervasive developmental disorder as defined in DSM-5 with a secondary diagnosis of psychiatric disorder or severe personality disorder; and (3) The applicant’s individual service plan shall specify that he or she: a. No longer needs the level of care provided by NHH; b. Requires the degree of care and supervision available from the THS; and c. Has an identified goal of community placement. (b) Application for admission to the THS shall be made through the administrator of THS. (c) The administrator of the THS shall accept an applicant for admission to the THS if: (1) The criteria identified in (a) above are met; (2) The THS has the capacity to provide services to the applicant; and (3) The applicant’s CMHP has been informed of the proposed placement of the applicant in the THS . Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.10 Voluntary Admission of Minors to NHH . (a) To be eligible for voluntary admission to NHH, an applicant shall: (1) Be a minor; (2) Be referred by his or her regional CMHP subsequent to a review by a professional team not employed by NHH which shall include at least the following: a. A doctor of psychology , a master’s level social worker, or a registered nurse certified in mental health by the American Nursing Association; and b. A psychiatrist licensed to practice in NH; and (3) Have a determination by the medical director or designee that: a. The applicant has a mental illness; b. Ambulatory care resources available in the community do not meet the treatment needs of the recipient; c. Proper treatment of the recipient’s psychiatric condition requires services on an inpatient basis under the direction of a practitioner; d. The services can reasonably be expected to improve the recipient’s condition or prevent further regression so that the services will no longer be necessary; and e. NHH is the least restrictive alternative among the available treatment options. (b) An application for voluntary admission shall be made by, or with the written consent of, a parent or legal guardian of the minor requesting to be admitted. (c) An application for voluntary admission shall be made in writing and include: (1) The name, address, and telephone number of the parent or legal guardian requesting the admission ; (2) The name and birth date of the minor whose admission is requested; (3) A request for the admission signed by the minor’s parent(s) or legal guardian and witnessed in writing; and (4) If applicable, a copy of the court order granting the legal guardian authority to place the ward. (d) An applicant for voluntary admission shall be reviewed by a professional team not employed by NHH that includes, at a minimum: (1) A doctor of psychology , a master’s level social worker, or a registered nurse certified in mental health by the American Nursing Association; and (2) A psychiatrist licensed to practice in New Hampshire. (e) Following a review pursuant to (d) above, a written report shall be issued that includes: (1) The name, address, telephone number, and professional qualifications of the persons conducting the review; (2) The name, birth date, and address of the minor; (3) The name, relationship to the minor, address, and telephone number of the parent(s) or legal guardian; (4) The following information regarding the minor being reviewed: a. A developmental and social history; b. An evaluation of the family situation; c. A psychiatric history and the results of a mental status examination conducted personally by the team psychiatrist; d. An evaluation of school functioning; e. Any appropriate medical evaluations; and f. A preliminary diagnosis of the type of mental illness from which the minor suffers; (5) A statement regarding the purpose for the admission and any recommendations for treatment that have been developed; (6) A copy of form “Certification of Need for Inpatient Services under 21” MR #109 (8/31/2016) completed with: a. The minor’s name; and b. A statement signed and dated by the team psychiatrist: 1. Certifying that the minor requires inpatient care; and 2. Estimating whether the minor will require such care for either 30 days or more or 29 days or less; and (7) A statement by the professional team performing the review that the admission criteria identified pursuant to He-M 613.03 (d) have been met. (f) The medical director or his or her designee shall: (1) Review each application for voluntary admission within one business day; (2) Attempt to obtain the required information by telephone if the application materials are not complete; (3) Approve the application if: a. The application is complete or the required information has been obtained; and b. The information received demonstrates that the criteria in He-M 613.10 (a) have been met; and (4) Deny the application if the criteria have not been met. (g) If an application for voluntary admission is denied, the medical director or designee shall refer the minor as follows: (1) If denial is based on a reasonable belief that the minor would not benefit from inpatient treatment at NHH, then referral shall be made to a program or services that would most likely benefit the minor; or (2) If denial is based on a reasonable belief that NHH is not the inpatient facility best suited to providing treatment to the minor or is not the least restrictive alternative, then referral shall be made to another mental health program. (h) Following admission, NHH shall conduct periodic reviews of each voluntarily admitted minor to determine if the admission criteria continue to be met. The reviews shall be conducted: (1) In a manner approved by the medical director; (2) In consultation with the treatment staff assigned to the minor; and (3) No later than the first business day following admission and at least every 30 days thereafter until discharge. ( i ) If a determination is made pursuant to (h) above that a voluntarily admitted minor no longer meets the admission criteria, the medical director shall discharge the minor to the custody of the legally responsible party. Source. #4838, eff 6-15-90, EXPIRED: 6-15-96 New. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.11 Involuntary Admission of Minors to NHH . (a) The IEA of minors to NHH shall be made according to (b)-(e) below. (b) If a practitioner’s certificate and a petition requesting the IEA of a minor to NHH are complete as to form and content, the admission shall: (1) Be made if, in the judgment of the admitting practitioner, the criteria specified in RSA 135-C:27 are met; or (2) Be denied if, in the judgment of the admitting practitioner, with the verbal concurrence of the medical director of his or her designee, the minor being referred fails to meet the criteria specified in RSA 135 C:27. (c) If an IEA is denied, the admitting practitioner shall promptly notify the following of the reason(s) for the denial: (1) The certifying practitioner; (2) The legally responsible party; and (3) The CMHP responsible for the applicant, if the certifying practitioner is approved or employed by a CMHP. (d) Except as allowed by (e) below, if a certificate or petition requesting admission is not complete as to form and content: (1) The person being referred shall not be admitted; (2) Arrangements shall be made, in consultation with the parent or guardian and the CMHP, to return the applicant to the sending community; and (3) The admitting practitioner shall promptly notify the certifying practitioner and the CMHP approving or employing that practitioner of the reasons for the denial of admission. (e) Minor deficiencies in the form and content of the petition and the certificate including a misplaced or omitted signature, or the failure to transmit the original petition or original certificate, or any other detail that on its own would not result in a denial of admission, shall: (1) Not be cause for denial of an admission; and (2) Be remedied within 24 hours of admission. (f) Non-emergency involuntary admissions of minors to NHH shall be made according to the following criteria: (1) The minor being admitted shall be in such mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or others; and (2) Admissions shall not occur unless ordered by a probate court pursuant to RSA 135-C:45. (g) Personal and medical information and identifying documents regarding the involuntarily admitted minor shall be released as soon as possible, but within 5 business days, by the CMHP to NHH providing such release has been authorized in writing by the minor’s parent(s) or legal guardian. (h) The information and documents referred to in (d) above shall include, at a minimum, the minor’s : (1) Birth certificate, or photocopy thereof; (2) Medical insurance information; (3) Social security number; (4) Previous psychiatric and psychological evaluations; (5) Previous treatment summaries; (6) Educational records, reports and evaluations; (7) Immunization records; (8) Most recent physical exam; and (9) Psychosocial history. ( i ) Following involuntary admission of a minor pursuant to (b) or (f) above, NHH shall conduct periodic reviews to determine if the criteria for such admission continue to be met. The reviews shall be conducted: (1) In a manner approved by the medical director; (2) In consultation with the treatment staff assigned to the minor; and (3) No later than the first business day following admission and at least every 30 days thereafter until the admission becomes voluntary or until discharge. Source. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.12 Court Ordered Evaluations of Minors . (a) When admission of a minor to NHH for mental health evaluation is ordered by a district court pursuant to RSA 169-B:20, 169-B:21, I, 169-C:16, III or 169-D:14, III, the admission shall be conducted according to the following criteria: (1) Prior to admission, the minor shall be reviewed by a professional team as required by He-M 613.10 (d); and (2) Upon review of the minor by a professional team, the appropriate CMHP shall review the team’s report and forward the report to NHH if the criteria identified pursuant to He-M 613.10 (a) have been met. (b) Pursuant to RSA 135-C:65, admission for an inpatient evaluation at NHH shall only occur following prior approval for such evaluation by the commissioner or his or her designee . (c) The commissioner or his or her designee shall approve admission of a minor if: (1) He or she is in receipt of a copy of the court order and a written report of the professional team pursuant to (a)(1) above; and (2) He or she determines that: a. The criteria identified pursuant to He-M 613.10 (a) have been met; and b. Proper evaluation of the minor’s psychiatric condition requires services on an inpatient basis under the direction of a psychiatrist. (d) Minors admitted for mental health evaluations pursuant to RSA 169-B:20, 169-C:16, III and 169-D:14, III shall be discharged within 60 days of admission or at the time of the dispositional hearing, whichever comes first. Source. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.13 Medical Transfer of Involuntarily Admitted Minors . (a) The medical director or his or her designee shall order the medical transfer of an involuntarily admitted minor to an acute care hospital if the following conditions apply: (1) The minor has acute medical needs requiring treatment which cannot be provided at NHH; (2) The hospital to which the minor is to be transferred can provide the treatment that the minor requires; and (3) The minor’s parent or legal guardian, or the department of health and human services, if that agency has custody of the minor, has approved the transfer. (b) A minor who is transferred from NHH for medical treatment shall remain under the protective custody of NHH pursuant to the authority under which the minor was involuntarily admitted. (c) If the parent or legal guardian of the minor being transferred or the department of health and human services, if that agency has custody of the minor, objects to the transfer, the challenge shall be treated as a client complaint in accordance with He-M 204. Source. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.14 Discharge of Minors from NHH Following An IEA . (a) If a minor is admitted to NHH on an involuntary, emergency basis, such involuntary confinement shall be limited to a 10-day period unless a petition requesting probate court to issue an order of involuntary admission is filed within the 10-day period, or unless the minor becomes a voluntary patient pursuant to He-M 613.10. Subsequent to the filing of such petition, confinement may continue only until issuance of the probate court order or until such time as is specified in that order. (b) Any minor involuntarily admitted to NHH on an emergency basis shall be granted discharge by the superintendent or his or her designee if the superintendent determines that the minor no longer meets the criteria for admission identified in RSA 135-C:27. (c) Such discharge from NHH shall be made according to the following: (1) NHH shall notify the CMHP in the region from which the minor was admitted and the region to which the minor was discharged; (2) NHH shall issue written notice to the minor discharged and his or her parent(s) or legal guardian, or the department of health and human services, if that agency has custody of the minor, that notification pursuant to He-M 613.14 (c) (1) was made; and (3) In consultation with the minor’s parent(s) or legal guardian, or the department of health and human services, if that agency has custody of the minor, NHH shall arrange or provide transportation of the minor to the in-state destination designated by the parent(s) or legal guardian. Source. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 He-M 613.15 Discharge of Minors from NHH Following Non-emergency Involuntary Admission . (a) If a minor is admitted involuntarily to NHH , such involuntary confinement shall not continue beyond the time allowed by the probate court order unless a petition requesting the court to issue another order of involuntary admission is filed within the period of involuntary admission, or unless the minor becomes a voluntary patient pursuant to He-M 613.11. Subsequent to the filing of such petition, confinement shall continue only until issuance of the probate court order or until such time as is specified in that order. (b) Any minor involuntarily admitted to NHH on a non-emergency basis shall be granted discharge by the superintendent upon the approval of the commissioner or his or her designee, if: (1) The minor has been examined within 3 days prior to the discharge by the superintendent or his or her designee ; and (2) Following such examination, the superintendent or his or her designee has clinically determined and documented that, in his or her opinion, the minor does not currently meet the criteria identified in RSA 135-C:34. (c) Upon the discharge of any minor from NHH pursuant to(b) above, the superintendent or his or her designee shall immediately, and in writing, notify the minor’s parent(s), legal guardian, department of health and human services and the probate court entering the original order of commitment that an absolute discharge has been granted to the minor. (d) Any minor who has been involuntarily admitted to NHH on a non-emergency basis shall be conditionally discharged if the conditions specified in He-M 609.03 are met. Source. #7050, eff 6-29-99, EXPIRED: 6-29-07 New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16 PART He-M 614 PROCESS FOR INVOLUNTARY EMERGENCY ADMISSION Statutory Authority: New Hampshire RSA 135-C:4, III; 135-C:61, II He-M 614.01 Purpose . The purpose of this rule is to define the process for involuntary emergency admission (IEA) to a designated receiving facility or New Hampshire Hospital (NHH). Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.02 Definitions . (a) “Certificate” means the document completed by a certifying practitioner pursuant to RSA 135-C:28, I, stating that the person to be admitted meets the criteria for IEA specified in RSA 135-C:27. (b) “Certifying practitioner” means a licensed practitioner who has been approved by either a DRF or a CMHP to have the expertise and qualifications to complete an IEA certificate in accordance with RSA 135-C:28, I, and placed on a list of certifying practitioners by the commissioner. (c) “Commissioner” means the commissioner of the department of health and human services. (d) “Community mental health program” (CMHP) means “community mental health program” as defined in RSA 135-C:2, IV. The term includes the term “community mental health provider”. (e) “Designated receiving facility” (DRF) means a “receiving facility” as defined in RSA 135-C:2, XIV and includes NHH pursuant to RSA 135-C:26. (f) “Incapacitated” means that a person, as a result of the use of alcohol or substances, is in a state of intoxication, or mental confusion resulting from withdrawal, such that: (1) The person appears to need medical care or supervision to assure his or her safety; or (2) The person appears to present a direct active or passive threat to the safety of others. (g) “Informed decision” means an “informed decision” as defined by RSA 135-C:2, IX. (h) “Intoxicated” means a condition in which the mental or physical functioning of an individual is substantially impaired as a result of the presence of alcohol or substances in his or her system. ( i ) “Involuntary admission” means an order of involuntary commitment made pursuant to RSA 135-C:34-54 by a probate court. (j) “Involuntary emergency admission (IEA)” means admission to the state mental health system on an involuntary, emergency basis, pursuant to RSA 135-C:27-33, of a person who is in such mental condition as a result of a mental illness as to pose a likelihood of harm to self or others. (k) “Licensed practitioner” means a physician, physician’s assistant (PA), or advance practice registered nurse (APRN) licensed to practice in this state. (l) “Mental health program” means any program in which mental health services are performed to treat someone with a mental health concern. (m) “Mental illness” means “mental illness” as defined in RSA 135-C:2, X. (n) “Minor” means any person under the age of 18 years. (o) “Parent” means a biological or adoptive legal custodian of a minor, or a person or agency appointed as a guardian of the person of a minor. (p) “Petition” means a written document that requests the IEA of a person and that is completed in accordance with the requirements in RSA 135-C:27-28. (q) “Petition and certificate” means the entire document entitled “Petition and Certificate for Involuntary Emergency Admission (IEA)” created by the State of New Hampshire, Judiciary Branch, Form NHJB-2826-D, (03/17/2022). (r) “Petitioner” means any individual who has petitioned for an examination of a person for the purpose of an IEA, which may include a certifying practitioner who has conducted or caused to be conducted an examination or completed a certificate for purposes of IEA. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.03 Criteria for Involuntary Emergency Admission . (a) A person shall be eligible for an IEA if the person is in such mental condition as a result of mental illness to pose a likelihood of danger to themselves or others. A mental condition that is a result of a mental illness requires that the mental condition be directly linked to mental illness and not the result of any other ailment. (b) A person shall be considered a danger to themselves if any one of the following sets of circumstances exists : (1) Within 40 days of the completion of a petition, the person has inflicted serious bodily injury on himself or has attempted suicide or serious self-injury and there is a likelihood the act or attempted act will recur if admission is not ordered; (2) Within 40 days of the completion of a petition, the person has threatened to inflict serious bodily injury on himself and there is likelihood that an act or attempt of serious self-injury will occur if admission is not ordered; (3) The person's behavior demonstrates that he or she so lacks the capacity to care for his or her own welfare that there is a likelihood of death, serious bodily injury, or serious debilitation if admission is not ordered; or (4) The person meets the following criteria: a. The person has been determined to be severely mentally disabled as determined by their medical practitioner in accordance with the standard of practice that the licensed practitioner must follow for a period of at least one year; b. The person has had at least one involuntary admission, within the last 2 years, pursuant to RSA 135-C:34-54; c. The person has no guardian of the person appointed pursuant to RSA 464-A; d. The person is not subject to a conditional discharge granted pursuant to RSA 135-C:49, II; e. The person has refused the treatment determined necessary by a mental health program, as defined in He-M 614.02(l), approved by the department; and f. A psychiatrist at a CMHP has determined, based upon the person's clinical history, that there is a substantial probability that the person's refusal to accept necessary treatment will lead to death, serious bodily injury, or serious debilitation if admission is not ordered. (c) A person shall be considered a danger to others if, within 40 days of the completion of the petition, the person has inflicted, attempted to inflict , or threatened to inflict serious bodily harm on another. (d) For persons on a conditional discharge from NHH, when a condition or circumstance exists which may create a potentially serious likelihood of danger to the person or to others, a psychiatrist, psychiatrist-supervised PA, or APRN at the CMHP providing the person’s outpatient care shall be authorized to revoke the conditional discharge in accordance with RSA 135-C:51 and He-M 609.06. (e) The CMHP providing outpatient care to a person on a conditional discharge shall be authorized to disclose protected health information as necessary, consistent with the treatment exception in the Health Insurance Portability and Accountability Act (HIPAA), 45 CFR §164.502(a)(1)(ii), to a CMHP, hospital emergency department, or DRF providing treatment to the person. (f) When it is not known whether a person is on a conditional discharge, a petition and certificate shall be authorized. (g) If, prior to the completion of a petition and certificate, it is discovered that a conditional discharge exists and the CMHP providing outpatient care is available, the CMHP shall be authorized to proceed with a revocation of the conditional discharge. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.04 Procedure for Involuntary Emergency Admission . (a) A petitioner may petition for the IEA of a person if the petitioner reasonably believes the criteria in He-M 614.03 are satisfied. (b) The petition and certificate for IEA shall be completed in its entirety by using the State of New Hampshire, Judiciary Branch, Form NHJB-2826-D, (03/17/2022). (c) The petitioner and certifying practitioner may be the same person. (d) The petitioner shall attend the hearing, in-person, or by telephone or video, and shall be available to testify. (e) If a witness is available to testify, the witness’s statement shall be completed by a witness who has observed dangerous acts or behaviors by the person sought to be admitted and the witness shall provide the following information on page 5 of the petition and certificate: (1) Information identifying the witness; and (2) A statement or statements as to specific dangerous acts or behaviors within the last 40 days by the person sought to be admitted observed by the witness. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.05 Completing the Petition and Certificate . (a) The petition shall be completed by the petitioner and consists of the petitioner’s statement. (b) The petitioner’s statement in (a) above shall be completed as follows: (1) The petitioner shall review the instructions to petitioner on page 2, and provide the following information on pages 3 and 4 of the petition and certificate: a. The name of the person sought to be admitted and the date; b. Information identifying the person sought to be admitted and whether the petitioner believes the person is or has been a danger to self or others; and c. Information identifying the petitioner and a description of specific dangerous acts or behaviors within the last 40 days by the person sought to be admitted; and (2) The petitioner shall sign the petition. (c) A statement by a witness, witness’ statement, shall be completed if a witness is necessary and available to testify. (d) If a witness is available to testify, the witness’s statement in (c) above shall be completed by a witness who has observed dangerous acts or behaviors by the person sought to be admitted and the witness shall provide the following information on page 5 of the petition and certificate: (1) Information identifying the witness; and (2) A statement or statements as to specific dangerous acts or behaviors within the last 40 days by the person sought to be admitted observed by the witness. (e) The physical examination shall be conducted within 3 days of the date of the completion of the petition in (a) above, as follows: (1) A licensed practitioner or their designee shall conduct a physical examination of the person sought to be admitted and provide the following information on page 6 of the petition and certificate: a. The name of the person sought to be admitted; b. Information identifying the licensed practitioner or designee such as name, title, phone number, and address; c. A detailed description of the nature of the physical examination, including a list of known past or present medical conditions, positive physical findings, and other pertinent medical information that the mental health facility may need to know; and d. A signed statement that the person sought to be admitted is medically approved for admission to a DRF; and (2) The licensed practitioner or designee shall perform such physical examination in accordance with the standard of practice applicable to the practitioner pursuant to RSA 326-B, RSA 328-D, or RSA 329, and any other applicable laws or rules to ensure that: a. The person sought to be admitted is medically stable for the level of medical care that the DRF is able to provide; and b. The individual’s medical problems are not impacting their mental status in a way that interferes with diagnosing the mental illness. (f) The mental examination shall be conducted within 3 days of the completion of the petition in (a) above, as follows: (1) A licensed practitioner or designee shall conduct a mental examination of the person sought to be admitted and provide the following information on page 7 of the petition and certificate: a. The name of the person sought to be admitted; b. Information identifying the licensed practitioner or designee such as name, title, phone number, and address; c. A detailed description of the nature of the examination, including a list of any past or present mental condition, hospitalizations for psychiatric reasons, psychotropic medications, current mental status, orientation, memory, judgment, speech productiveness, coherence, emotional tone, insight, activity level, appearance, and any other pertinent information on the person’s mental state; and d. The signature of the licensed practitioner or designee ; and (2) The licensed practitioner or designee shall perform such mental examination in accordance with their standard of practice pursuant to RSA 326-B, RSA 328-D or RSA 329, and any other applicable laws or rules. (g) Upon request for IEA by a petitioner, if the person sought to be admitted refuses to consent to a mental examination, a petitioner or a law enforcement officer may request a justice of the peace to order the examination as follows: (1) The request shall be in the form of a complaint and prayer for compulsory mental examination pursuant to RSA 135-C:28, II and NHJB-2826-D (03/17/2022), which shall be signed and sworn to before a justice of the peace; and (2) The complaint shall be submitted to the justice of the peace along with the petition. (h) The certifying practitioner shall not sign the certificate if: (1) The person has untreated medical ailments that may be the cause of the person’s mental health concerns; (2) The person has medical ailments that cannot be safely treated by the medical services available at the DRF; or (3) The person is incapacitated from alcohol or substance use. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.06 List of Licensed Practitioners Approved to Certify Involuntary Emergency Admissions . (a) The commissioner or designee shall maintain a list of certifying practitioners who are approved by either a DRF or a CMHP to certify an IEA. (b) To be approved as a certifying practitioner, the practitioner shall attend an initial and annual training thereafter on involuntary emergency admissions, non-emergency involuntary admissions, and voluntary admissions. (c) Certifying practitioners approved in accordance with (a) and (b) above who are on the list shall be authorized to certify individuals under both RSA 135-C:27-33 and RSA 135-C:36. (d) DRFs and CMHPs in each mental health region of the state shall provide the names of all certifying practitioners they have approved to the department. (e) When a DRF or CMHP accepts or removes approval for a certifying practitioner, it shall provide the name of the new or removed certifying practitioner to the commissioner. (f) The department may remove a certifying practitioner from the list if the certifying practitioner fails to comply with these rules in accordance with the following process: (1) Prior to removing a certifying practitioner from the list, the commissioner shall provide a warning to the certifying practitioner that specifies the non-compliance with this rule and gives the certifying practitioner an opportunity to come into compliance; (2) After receiving the warning, if the certifying practitioner continues to not comply with the rules, the department shall remove the certifying practitioner from the list; and (3) Upon removal of a certifying practitioner, the department or designee shall inform the DRF or CMHP that approved the certifying practitioner that the certifying practitioner has been removed. (g) The DRF or CMHP may reapprove the certifying practitioner after the certifying practitioner receives additional training on involuntary emergency admissions, non-emergency admissions, and voluntary admissions and the DRF or CMHP determines that the certifying practitioner understands how to perform IEAs in accordance with the requirements of this rule. (h) If the DRF or CMHP reapproves a certifying practitioner, it shall inform the department of the new approval. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.07 Completion of Certificate by Certifying Practitioner . (a) The certificate portion of the petition and certificate form shall be completed in accordance with the following: (1) Within 3 days of completion of the petition, a certifying practitioner shall state the following on page 8 of the petition and certificate: a. He or she is a licensed practitioner who is on the list identified in He-M 614.06 as approved to certify IEAs; b. He or she is not a relative of the person named in the petition who is alleged to be mentally ill; c. He or she has conducted or has designated a licensed practitioner to conduct a physical examination of the individual; d. He or she has conducted or has designated a licensed practitioner to conduct a mental examination of the individual; e. The time and date that he or she personally examined the person sought to be admitted and that this time and date are within 3 days of completion of the attached petition; f. Certify that as a result of the physical and mental examinations that the certifying practitioner has completed and/or reviewed, and the acts or behaviors the licensed practitioner has observed or which were reported by the petitioner and/or witness, the criteria of RSA 135-C:27 are satisfied, as the person is in such mental condition as a result of mental illness as defined in He-M 614.02(m), that he or she poses a serious likelihood of danger to self or others as described in He-M 614.03(b); g. He or she understands they may be required to appear in court for a hearing; h. The DRF which can best provide the degree of security and treatment required by the person sought to be admitted; i . That the certifying practitioner informed the person of the DRF to which the person will be or will likely be transported; j. All statements are true; and k. The certifying practitioner’s signature, printed name, address, and phone number; (2) A certifying practitioner shall not complete a certificate for a person who consents to voluntary mental health treatment at any time the individual is under the care of the certifying practitioner, unless the individual withdraws that consent and the practitioner subsequently determines that an IEA is necessary; and (3) A certifying practitioner shall only complete a certificate for a person: a. When the certifying practitioner has determined that the dangerous behavior(s) is not caused by an untreated physical ailment; b. When the certifying practitioner has determined that the dangerous behavior(s) is not caused by the influence or acute withdrawal from alcohol or other substances; c. When the certifying practitioner has determined that the dangerous behavior(s) is not caused by an intellectual disability as defined in RSA 135-C:2, X; d. When the certifying practitioner has determined that the dangerous behavior(s) is not caused by a neurocognitive disorder, such as Alzheimer’s disease or dementia; and e. When the certifying practitioner has reviewed and considered a less restrictive voluntary option for treatment in accordance with He-M 614.10(a). (b) The petition and certificate are not complete until: (1) All requirements of He-M 614.04 through 614.07 are met; (2) The DRF to which the individual is transferring is identified on the petition and certificate. If a DRF bed is not available, the certifying practitioner shall identify on the petition and certificate the DRF which best meets the needs of the patient; and (3) Be signed and dated by the certifying practitioner. (c) The individual shall be admitted to the state mental health system as soon as the petition and certificate are complete. (d) Treatment of individuals within the state mental health system shall be administered in accordance with all applicable federal and state laws and rules, such as: (1) All practitioner or clinical standards of practice such as RSA 329, RSA 328-D, and RSA 326-B and the rules promulgated thereunder; (2) All health facility standards such as RSA 151, He-P 802, and Center for Medicare and Medicaid Services (CMS) conditions of participation; (3) The Emergency Medical Treatment and Labor Act (EMTALA); and (4) Any other federal and state laws and rules that govern the treatment of individuals seeking and receiving mental health treatment from a medical provider. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.08 Filing of Completed Petition and Certificate for Involuntary Emergency Admission . (a) Immediately upon completion of the certificate, the certifying practitioner or designee shall transmit the petition and certificate in its entirety to the DRF identified on the certificate. (b) If NHH is identified as the DRF on the petition and certificate, the completed petition and certificate shall be sent directly to NHH. (c) If another DRF is identified on the petition and certificate, the completed petition and certificate shall be sent to that DRF with a copy of the petition and certificate sent to NHH. (d) If NHH determines prior to filing with the court that the petition and certificate is not completed in accordance with the requirements of this rule, the petition and certificate shall be considered invalid. (e) If a certificate is determined invalid , the individual subject to the certificate shall not be considered in the state mental health services system until a certificate is complete. (f) The certifying practitioner shall be responsible for completing the certificate fully prior to resubmitting to NHH. (g) NHH shall contact the certifying practitioner to notify them that the certificate is invalid and that the individual is not in the custody of the state mental health system. (h) The completed petition and certificate shall be filed with the circuit court that shall schedule a probable cause hearing, even if the individual has yet to be transferred to the DRF. ( i ) If the person is transferred to a different DRF than the one originally identified on the certificate, or discharged to another non-DRF location, the hospital shall notify the original DRF of the transfer immediately upon knowledge of the change. (j) The DRF shall then notify the court in which the petition was filed and inform the court of the disposition and location, if known, of the individual. (k) Only the DRF originally identified on the petition and certificate shall be responsible for filing the completed petition and certificate with the court but any DRF shall consider for admission any completed petition and certificate received by any DRF. (l) The transmission of the petition and certificate to other medical providers as well as the court system shall be done in accordance with HIPAA and any other applicable privacy and confidentiality laws. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.09 Delivery to Receiving Facility . Delivery to a DRF shall be in accordance with RSA 135-C:29. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.10 Rescission of Involuntary Emergency Admission . (a) Following completion of a certificate pursuant to RSA 135-C:28 and before custody of the person is accepted by a law enforcement officer pursuant to RSA 135-C:29, the certificate shall be rescinded if the individual no longer meets the criteria of RSA 135-C:27. (b) Following completion of a certificate pursuant to RSA 135-C:28 and before custody of the person is accepted by a law enforcement officer pursuant to RSA 135-C:29, the certificate may be rescinded and the person who is the subject of the certificate released in any of the following circumstances: (1) A mobile crisis team under contract with the department accepts transfer of the person's care; (2) An assertive community treatment team operated by a CMHP accepts transfer of the person's care; (3) A community-based provider accepts transfer of the person's care; (4) Clinical reasons preclude the continuation of an IEA; or (5) Any other circumstance exists that the certifying practitioner believes addresses the individual’s needs and the individual’s care can be conducted safely outside of inpatient treatment. (c) A rescission shall be completed on form “Involuntary Emergency Admission Invalidation Form” (September 2022) and sent to the DRF identified on the completed petition and certificate, the court, and to NHH. (d) Upon the rescission of the certificate in accordance with (a) or (b) above, the hospital emergency department shall immediately notify the patient that the certificate has been rescinded and that the patient is no longer in custody. (e) Pursuant to RSA 135-C:29-a, no civil action shall be maintained against a person who rescinds an involuntary admission in accordance with (a) or (b) above, provided that the practitioner is acting in good faith within the limits of their authority. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.11 Notice Pursuant to RSA 135-C:30 . (a) Upon completion of the certificate, the certifying practitioner or designee shall provide the patient the notice of rights of person sought to be admitted, included in the IEA Form NHJB-2826-D (03/17/2022) to the individual in custody. (b) The notice identified in (a) above does not replace the notice required to be given by the DRF in accordance with RSA 135-C:30. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.12 IEA Probable Cause Hearings . (a) Within 3 days after completion of the certificate, not including Sundays and holidays, and subject to the notice requirements of RSA 135-C:24, there shall be a probable cause hearing in the circuit court having jurisdiction over the matter to determine if there is probable cause for involuntary emergency admission in accordance with RSA 135-C. (b) For 48 hours prior to the hearing, the person sought to be admitted shall not be given medication or treatment that would adversely affect their judgment or limit their ability to prepare for the hearing unless the person sought to be admitted makes an informed decision to consent to treatment or unless a medical or psychiatric emergency exists in accordance with the following: (1) A person’s judgment is adversely affected or their ability to prepare is limited if they are unable to work with their counsel and unable to understand the reasons why an involuntary emergency admission is sought; and (2) If medication or treatment is given to the person sought to be admitted prior to the probable cause hearing, the physician prescribing the medication shall advise the district court of the nature of the medication, the reason for it, and its probable effect upon the person in writing, prior to the hearing or if at the hearing, presented by the physician. (c) If an individual has received medications within the 48 hour period prior to the hearing, the certifying provider or designee shall complete “48 Hour Rule-MEDICATION LISTING FORM” (September 2022). (d) The medication form identified in (c) above shall be sent to NHH or DRF identified on the certificate so that it can be sent to the court for its review. (e) For good cause, the person or the person’s attorney may file a motion requesting a change of venue or transfer. (f) The hospital or DRF having custody of the person at the time the probable cause hearing is scheduled shall be responsible for ensuring the person has virtual or telephonic access so that the individual may participate in their hearing. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 He-M 614.13 Ten-Day Limitation Period for Involuntary Emergency Admission . (a) The 10-day limitation period for IEAs shall be in accordance with RSA 135-C:32, which states that the 10-day period excludes Saturdays and Sundays. (b) The 10-day period shall begin at the time the petition and certificate are complete. (c) A subsequent petition for IEA containing allegation of specific facts or actions which occurred subsequent to the initial IEA may be completed and certified if necessary in accordance with RSA 135-C:32. Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED: 9-12-22 New. #13456, eff 10-6-22 APPENDIX RULE SPECIFIC STATE STATUTE THE RULE IMPLEMENTS He-M 601.01 RSA 135-C:5, I, (d) He-M 601.02 RSA 135-C:5, I, (d) He-M 609.01 RSA 135-C:13, 18, 56, 57 & 59 He-M 609.02 RSA 135-C:13, 18, 56, 57 & 59 He-M 609.03 RSA 135-C:59 He-M 609.04 RSA 135-C:56 He-M 609.05 RSA 135-C:56 & 57; RSA 135-C: 19-a; RSA 329, 330-A; RSA 329-B; & RSA 326-B He-M 609.06 RSA 135-C:57 He-M 609.07 RSA 135-C:18 He-M 611.01 - 611.02 RSA 135-C:61, IX, RSA 171-A:8-a He-M 611.03 RSA 171-B:15; RSA 135-C:61, IX; RSA 171-A:8-a He-M 611.04 RSA 622:45 He-M 611.05 RSA 135-C:31, V; 48; RSA 171-A:8-a; RSA 171-B:15; RSA 622:45 He-M 611.06 RSA 135-C:31, V; 48; RSA 171-A:8-a He-M 611.07 RSA 135-C:31, V; 48; RSA 171-A:8-a; RSA 171-B:15; RSA 622:45 He-M 611.08 RSA 135-C:61, IX; RSA 171-A:8-a He-M 611.09 RSA 622:45, IV He-M 611.10 RSA 622:45, IV He-M 611.11 RSA 622:45, IV He-M 612.01 - 612.02, 612.03(c) - 612.05 RSA 135-C:31, V; 48 He-M 612.03(a)-(b) RSA 135-C:26 He-M 612.04 RSA 135-C:28 He-M 613.01-613.02 RSA 135-C:4, III He-M 613.03 RSA 135-C:12; 13 He-M 613.04(a) RSA 135-C:27; 28 He-M 613.04(b) RSA 135-C:34; 35 He-M 613.05 RSA 135-C:31, V He-M 613.06 RSA 135-C:16; 17 He-M 613.07 RSA 135-C:32; 33 He-M 613.08(a) RSA 135-C:39 He-M 613.08(b)-(d) RSA 135-C:49 He-M 613.09 RSA 135-C:4, III He-M 613.10 RSA 135-C:12, 13 He-M 613.11 RSA 135-C:12; 13 He-M 613.11(a)(3), (g)-(h) RSA 135-C:27; 28 He-M 613.11(f) RSA 135-C:34; 45 He-M 613.12 RSA 135-C:64, II; 65 He-M 613.13 RSA 135-C:31, V He-M 613.14 RSA 135-C:32; 33 He-M 613.15(a) RSA 135-C:39 He-M 613.15(b)-(d) RSA 135-C:49 He-M 614 RSA 135-C:4, III; 135-C:61, II