He-P 809

Home Health Care Providers

This New Hampshire regulation (He-P 809) establishes the licensing requirements for Home Health Care Providers (HHCPs), covering application procedures, license issuance and renewal, branch office requirements, organizational change notifications, inspections, waivers, and complaint investigations. Operators must obtain and maintain a license from the NH Department of Health and Human Services, submit to periodic inspections, and comply with patient care, staffing, and recordkeeping standards. The regulation applies to any organization arranging or providing nursing, home health aide, therapy, personal care, or homemaker services to patients in their places of residence.

PART He-P 809
� 
HOME HEALTH CARE PROVIDERS

��������� 
He
-P 809.01
� 
Purpose
.
� 
The purpose of this part is to set forth the
licensing requirements for all home health care providers (HHCPs) pursuant to
RSA 151:2, I(b).

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; amd by #6240, HB 32, eff
5-3-96, EXPIRED 12-31-98; ss and amd by #7006, INTERIM, eff 5-26-99, EXPIRED:
9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.02 
Scope
. This
part shall apply to any organization, business entity, partnership,
corporation, government entity, association, or other legal entity operating a
HHCP, except:

��������� 
(a) All facilities listed
in RSA 151:2, II(a)-(i);

��������� 
(b) Agencies that are
certified by the department as other qualified agencies delivering personal
care services in accordance with RSA 161-H;

��������� 
(c)
�

Agencies contracted with the department to provide family centered early
supports and services (FCESS), whether area agencies or other entities, in
accordance with He-M 510;

��������� 
(d) Entities that are
licensed under another home health care license and are providing only the
services permitted under that license;

��������� 
(e) A person furnishing or
delivering home medical supplies or equipment that does not involve the
provision of services beyond those necessary to deliver, set up, and monitor
the proper functioning of the equipment and educate the user on its proper use;
and

��������� 
(f) Emergency medical
services units and emergency medical care providers operating under the
jurisdiction and regulatory oversight of the New Hampshire department of
safety, bureau of emergency medical services, in compliance with the �mobile
integrated healthcare protocol� contained in the New Hampshire patient care
protocols, incorporated by reference in Saf-C 7402.01.

Source.
� 
#4073, eff
6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #10939, eff 9-25-15;
ss by #12640, eff 10-3-18; amd by #12893, eff 10-1-19; ss by #14073, eff
9-20-24; ss by #14353, eff 8-26-25, EXPIRES: 8-26-35

��������� 
He-P 809.03
� 
Definitions
.

��������� 
(a)
�

�Abuse� means
� 
any one of the
following:

(1)
� 
�Emotional abuse� means the misuse of power,
authority, or both, verbal harassment, or unreasonable confinement which
results or could result in the mental anguish or emotional distress of a
patient; 

(2)
� 
�Physical abuse� means the misuse of physical
force which results or could result in physical injury to a patient; and

(3)
� 
�Sexual abuse� means contact or interaction
of a sexual nature involving a patient with or without his or her informed
consent.

��������� 
(b)
�

�Activities of daily living (ADL)� means basic daily routine tasks such
as eating, transferring, toileting, bathing, dressing, and self-management of
medications.

��������� 
(c)
�

�Administer� means �administer� as defined by RSA 318:1, I, namely �an
act whereby a single dose of a drug is instilled into the body of, applied to
the body of, or otherwise given to a person for immediate consumption or use.�

��������� 
(d)
�

�Administrator� means the licensee, or an individual appointed by the
licensee, who is responsible for all aspects of the daily operations of the
HHCP.

��������� 
(e)
�

�Admission� means accepted by a licensee for the provision of services
to a patient.

��������� 
(f)
�

�Agent� means an adult to whom authority to make health care decisions
is delegated under an activated durable power of attorney for health care
executed in accordance with RSA 137-J or a surrogate decision-maker in
accordance with RSA 137-J:35.

��������� 
(g)
�

�Applicant� means an individual, agency, partnership, corporation,
government entity, association, or other legal entity seeking a license to
operate a HHCP pursuant to RSA 151.

(h)
� 
�Area of non
-
compliance�
means 
any action, failure to act, or other set of
circumstances that cause a licensee to be out of compliance with RSA 151, He-P
809
, or other federal or state requirements.

��������� 
(i)
�

�Assessment� means an evaluation of the patient to determine the care
and services that are needed.

��������� 
(j)
�

�Branch office� means a location physically separate from the primary
location of the HHCP and that:

(1)
� 
Provides oversight for employees who provide
direct care services to patients in their residential setting; and

(2)
� 
Is under the administration and supervision
of the primary location of the HHCP.

��������� 
(k)
�

�Care plan� means a written guide developed by the licensee, or its
personnel, in consultation with the patient, guardian, agent, or personal
representative, if any, as a result of the assessment process for the provision
of care and services as required by He-P 809.15(o)-(q).

��������� 
(l)
�

�Change of ownership� means a change in the controlling interest of an
established HHCP to a successor business entity.

��������� 
(m)
�

�Commissioner� means the commissioner of the department of health and
human services or his or her designee.

��������� 
(n)
�

"Community health services" means services that are provided
in
� 
community settings, including but not
limited to foot clinics, flu shot clinics, educational programs and nutrition
services.

��������� 
(o) �Critical incident stress
management (CISM)� means an adaptive, short-term psychological helping-process
that focuses solely on an immediate and identifiable problem. Its purpose is to
enable people to return to their daily routine more quickly and with less
likelihood of experiencing 
post-traumatic stress disorder
.

��������� 
(p)
�

�Days� means calendar days unless otherwise specified in the rule.

��������� 
(q)
�

�Department� means the New Hampshire department of health and human
services.

��������� 
(r)
�

�Direct care� means hands-on care and services provided to a patient,
including but not limited to medical, nursing, psychological, or rehabilitative
treatments.

��������� 
(s)
�

�Directed plan of correction� means a plan developed and written by the
department that specifies the necessary actions the licensee shall take to
correct identified areas of non-compliance.

��������� 
(t)
�

�Do not resuscitate order (DNR order)� means an order that, in the event
of an actual or imminent cardiac or respiratory arrest, chest compression and
ventricular defibrillation will not be performed, the patient will not be
intubated or manually ventilated, and there will be no administration of
resuscitation drugs. This term includes "do not attempt resuscitation
order (DNAR order)�.

��������� 
(u)
�

�Drop site� means a location, which does not meet the definition of a
branch office, where materials, equipment, and supplies used in the provision
of services may be temporarily stored.

��������� 
(v)
�

�Emergency plan� means a document outlining the responsibilities of
personnel in an emergency.

��������� 
(w)
�

�Exploitation� means the illegal use of a patient�s person or property
for another person�s profit or advantage, or the breach of a fiduciary
relationship through the use of a person or person�s property for any purpose
not in the proper and lawful execution of a trust, including but not limited
to, situations where a person obtains money, property, or services from a
patient through the use of undue influence, harassment, duress, or fraud.

��������� 
(x)
�

�Guardian� means a person appointed in accordance with RSA 464-A to make
informed decisions relative to the patient�s health care and other personal
needs.

��������� 
(y)
�

�Home health care provider (HHCP)� means any organization or business
entity, whether public or private, whether operated for profit or not, which is
engaged in arranging or providing, directly or through contract arrangement,
one or more of the following services:

(1)
� 
Nursing services;

(2)
� 
Home health aide services; or 

(3)
� 
Other therapeutic and related services, which
can include, but are not limited to;

a.
� 
Physical and
occupational therapy; 

b.
� 
Speech
pathology;

c.
� 
Nutritional
services; 

d.
� 
Medical
social services;

e.
� 
Personal
care services; and

f.
� 
Homemaker
services which may be of a preventative, therapeutic, rehabilitative, health
guidance, or supportive nature to persons in their places of residence.

��������� 
(z)
�

�Homemaker services� means services that are of a supportive nature that
do not routinely require hands-on contact with a patient other than to maintain
the patient�s safety.
� 
Such services may
include, but are not limited to, laundry, housecleaning, cooking, transporting
to and from medical or other appointments, shopping, companion services, and
medication reminders.

��������� 
(aa) 
�
�Incident command system (ICS)� means a
standardized on-scene emergency management system specifically designed to
provide for the adoption of an integrated organizational structure that
reflects the complexity and demands of single or multiple incidents, without
being hindered by jurisdictional boundaries. ICS is the combination of
facilities, equipment, personnel, procedures, and communications operating
within a common organizational structure, designed to aid in the management of
resources during incidents.

��������� 
(ab)
�

�Infectious waste� means those items specified by Env-Sw 904.

��������� 
(ac)
�

�In-service� means an educational program, which is designed to increase
the knowledge, skills, and overall effectiveness of personnel.

��������� 
(ad) �Inspection� means the process
followed by the department to determine an applicant�s or a licensee�s
compliance with RSA 151 and He-P 809 or to respond to allegations, pursuant to
RSA 151:6, of non-compliance with RSA 151 and He-P 809.

��������� 
(ag) 
�
�Investigation� means the process used by the
department to respond to allegations of non-compliance with RSA 151 and He-P
809.

��������� 
(ae)
�

�License� means the document issued by the department to an applicant at
the start of operation as an HHCP which authorizes operation in accordance with
RSA 151 and He-P 809, and includes the name of the licensee, the name of the
business, the physical address, the license classification, the effective date,
and license number.

��������� 
(af) �License certificate� means the
document issued by the department to an applicant or licensee that, in addition
to the information contained on a license, includes the name of the
administrator and the type(s) of services authorized for which the HHCP is
licensed.

��������� 
(ag)
�

�Licensed practitioner� means a:

(1)
� 
Medical doctor;

(2)
� 
Physician�s assistant;

(3)
� 
Advanced practice registered nurse (APRN);

(4)
� 
Doctor of osteopathy;

(5) 
�
Doctor of naturopathic medicine; or

(6) 
�
Any other practitioner with diagnostic and
prescriptive powers licensed by the appropriate state licensing board.

��������� 
(ah)
�

�Licensed premises� means the building(s) that comprises the physical
location the department has approved for the licensee to conduct operations in
accordance with its license. This term includes branch offices. This term does
not include drop sites or the private residence of a patient receiving services
from a HHCP.

��������� 
(ai)
�

�Licensing classification� means the specific category of services
authorized by a license.

��������� 
(aj) �Medication� means a substance
available with or without a prescription, which is used as a curative or
remedial substance.

��������� 
(ak)
�

�Neglect� means an act or omission that results, or could result, in the
deprivation of essential services or supports necessary to maintain the mental,
emotional, or physical health and safety of a patient.

��������� 
(al) �Orders� 
means
a document, produced verbally, electronically or in writing, by a licensed 
practitioner
 for medications, treatments, recommendations, and
referrals, and signed by the licensed practitioner using terms such as
authorized by, authenticated by, approved by, reviewed by, or any other term
that denotes approval by the licensed practitioner.

��������� 
(am)
�

�Owner� means any person, corporation, association, or any other legal
entity, whether organized for profit or not, holding or claiming ownership of,
or title to, a license.

��������� 
(an)
�

�Patient� means any person admitted to or in any way receiving care,
services, or both from a HHCP licensed in accordance with RSA 151 and He-P 809.
Patient includes patient as used in RSA 151:20 and RSA 151:21.

��������� 
(ao) �Patient record� means the
documentation of all care and services, which includes all documentation
required by RSA 151 and He-P 809 and any other applicable federal or state
requirements.

��������� 
(ap)
�

�Patient rights� means the privileges and responsibilities possessed by
each patient provided by RSA 151:21-b.

��������� 
(aq)
�

�Personal care service provider� means a person who provides non-medical
hands-on assistance to a patient, to help with activities of daily living such
as grooming, toileting, eating, dressing, bathing, getting into or out of a bed
or chair, walking, assisting with topical medications, or reminding a patient
to take medications.

��������� 
(ar)
�

�Personal representative� means a person designated in accordance with
RSA 151:19, V, to assist the patient for a specific, limited purpose or for the
general purpose of assisting the patient in the exercise of any rights.

��������� 
(as)
�

�Personnel� means an individual who is employed by the facility, who is
a volunteer, or who is an independent contractor who provides direct care or
personal care services to patients.

��������� 
(at)
�

�Plan of correction (POC)� means a plan developed and written by the
licensee, which specifies the actions that will be taken to correct 
areas of non-compliance with applicable rules or codes
identified at the time of a clinical inspection conducted pursuant to RSA
151:6-a or during the course of a complaint investigation conducted pursuant to
RSA 151:6
. 

��������� 
(au)
� 
�Point of care testing (POCT)� means
laboratory testing performed using either manual methods or hand held
instruments at or near the site of patient care.

��������� 
(av)
� 
�Point of care devices�
� 
means testing involving a system of devices,
typically including:

(1)
� 
A 
lancing
 or finger stick device to get the blood
sample;

(2)
� 
A 
test
 strip to apply the blood sample; or

(3)
� 
A meter or monitor to
calculate and show the results including:

a.
� 
Blood
 glucose meters, also called �glucometers�;

b.
� 
Prothrombin
 time (PT) and iternational normalized ratio (INR) 
anticoagulation
 meters; or

c.
� 
Cholesterol
 meter.

��������� 
(aw) �Primary location� means the
principal site for the HHCP where the business office and administrative staff
are located.

��������� 
(ax) �Pro re nata (PRN) medication�
means medication taken as circumstances may require in accordance with licensed
practitioner�s
� 
orders.

��������� 
(ay)
�

�Procedure� means a licensee�s written, standardized method of
performing duties and providing services.

��������� 
(az)
�

�Professional staff� means:

(1)
� 
Physicians;

(2)
� 
Physician assistants;

(3)
� 
Advanced practice registered nurses;

(4)
� 
Registered nurses;

(5)
� 
Registered physical therapists;

(6)
� 
Speech therapists;

(7)
� 
Licensed practical nurses;

(8)
� 
Licensed respiratory therapists;

(9)
� 
Occupational therapists;

(10)
� 
Medical social workers; and

(11)
� 
Dietitians.

��������� 
(ba)
�

�
Reportable
 incident� means an occurrence of any of the following
while the patient is in the care of HHCP personnel:

(1)
� 
The unanticipated death of the patient; or

(2)
� 
An injury to a patient that is potentially
due to abuse or neglect.

��������� 
(bb)
�

�Self-administration of medication with assistance� means an act whereby
the patient takes his or her own medication after being prompted by personnel
but without requiring physical assistance from others beyond placing the
container within reach, opening the medication container, reading the
medication label to the patient, and utilizing hand over hand technique
pursuant to Nurs 404.03(b).

��������� 
(bc)
�

�Self-administration of medication without assistance� means the
participant is able to take his or her own medication(s) without the assistance
of personnel, including prompting.

��������� 
(bd)
�

�Self-directed medication administration� means an act whereby a
patient, who has a physical limitation that prohibits him or her from
self-administration of medication without assistance, directs personnel to physically
assist in the medication process, which does not include assisting with
infusions,
� 
injections or filling insulin
syringes. 

��������� 
(be)
�

�Significant change� means a visible or observable change in functional,
cognitive, or daily activity ability of the patient.

��������� 
(bf)
�

�Volunteer� means an unpaid person who assists with the provision of
personal care services, food services, or activities, and who does not provide
direct care or assist with direct care.
�

This term does not include visitors or those persons who provide
religious services or entertainment.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; amd by #6240, HB 32, eff
5-3-96, EXPIRED 12-31-98; ss by #7006, INTERIM, eff 5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.04
� 
Initial License Application Requirements
.

��������� 
(a)
�

Each applicant for a license shall comply with the requirements of RSA
151:4, I-III(a), and submit the following to the department:

(1)
� 
A completed
application form entitled �Application for Residential or Health Care License,�
(September 2018 edition) signed by the applicant or 2 of the corporate officers
affirming and certifying the following:

a.
� 
�I affirm
that I am familiar with the requirements of RSA 151 and the rules adopted
thereunder and that the premises are in full compliance. I understand that
providing false information shall be grounds for denial, suspension, or
revocation of the license, and the imposition of a fine.�;

b.
� 
For any HHCP to be newly licensed: 

�I certify that I have notified the public of the
intent to file this application with a description of the facility to be
licensed by publishing a notice in a newspaper of general circulation covering
the area where the facility is to be located in at least 2 separate issues of
the newspaper no less than 10 business days prior to the filing of this
application.�; and

c.
� 
For any HHCP to be newly licensed and to be
located within a radius of 15 miles of a hospital certified as a critical
access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c): 

�I certify that the facility is to be located within a
radius of 15 miles of a hospital certified as a critical access hospital,
pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice
of the intent to file this application with a description of the facility to be
licensed to the chief executive officer of the hospital by registered mail no
less than 10 business days prior to the filing of this application.�;

(2)
� 
If
applicable, proof of authorization from the secretary of state to do business
in New Hampshire in the form of one of the following:

a.
� 
�Certificate
of Authority,� if a corporation;

b.
� 
�Certificate
of Formation,� if a limited liability company; or

c.
� 
�Certificate
of Trade Name,� where applicable;

(3)
� 
The
applicable $250 fee, in accordance with RSA 151:5, XI(b), payable in cash in
the exact amount of the fee, or, if paid by check or money order, the exact
amount of the fee made payable to the �Treasurer, State of New Hampshire�;

(4)
� 
A resume
identifying the qualifications of and copies of applicable licenses for the
HHCP administrator;

(5)
� 
Written
local approvals as follows:

a.
� 
For the
proposed licensed premises the following written local approvals shall be
obtained no more than 90 days prior to submission of the application, from the
following local officials or if there is no such official(s), from the board of
selectmen or mayor:

1.
� 
The health
officer verifying that the applicant complies with all applicable local health
requirements;

2.
� 
The building
official verifying that the applicant complies with all applicable state and
local building codes and ordinances;

3.
� 
The zoning
officer verifying that the applicant complies with all applicable local zoning
ordinances; and

4.
� 
The fire
chief verifying that the applicant complies with the state fire code, Saf-C
6000, as adopted by the commissioner of the department of safety under RSA 153,
and as amended pursuant to RSA 153:5,I, by the state fire marshal with the
board of fire control and local fire ordinances applicable for a business; and

b.
� 
For a
building under construction, the written approvals required by a. above shall
be submitted at the time of the application based on the local official�s
review of the building plans and upon completion of the construction project;
and

(6)
� 
The results
of a criminal records check from the NH department of safety for the
applicant(s), licensee if different from the applicant, licensee,
� 
and administrator.

��������� 
(b)
�

The applicant shall mail or hand-deliver the documents to:

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.05
� 
Processing of Applications and Issuance of
Licenses
.

��������� 
(a)
�

An application for an initial license shall be complete when the
department determines that all items required by He-P 809.04(a) have been
received.

��������� 
(b)
�

If an application does not contain all of the items required by He-P
809.04(a), the department shall notify the applicant in writing of the items
required before the application can be processed.

��������� 
(c)
�

Any licensing fee submitted to the department in the form of a check or
money order and returned to the state for any reason, shall be processed in
accordance with RSA 6:11-a.

��������� 
(d)
�

Licensing fees shall not be transferable to any other application(s).

��������� 
(e)
�

Unless a waiver has been granted in accordance with He-P 809.10, the
department shall deny a licensing request in accordance with He-P 809.13(b) if
it determines that the applicant, licensee, or administrator:

(1)
� 
Has been
convicted of any felony in this or any other state;

(2)
� 
Has been
convicted of a sexual assault, other violent crime, assault, fraud, theft,
abuse, neglect, or exploitation in this or any other state;

(3)
� 
Has had a
finding by the department or any administrative agency in this or any other
state for assault, fraud, theft, abuse, neglect, or exploitation of any person;
or

(4)
� 
Otherwise
poses a threat to the health, safety, or well-being of patients.

��������� 
(f)
�

An inspection shall be completed in accordance with He-P 809.09 prior to
the issuance of a license.

��������� 
(g)
�

The applicant shall have on hand and available for inspection at the
time of the initial onsite inspection the results of a criminal records check
from the NH department of safety for all current personnel. 

��������� 
(h)
�

Following a clinical inspection, a license shall be issued if the
department determines that an applicant requesting an initial license is in
full compliance with RSA 151 and He-P 809.

��������� 
(i)
�

All licenses issued in accordance with RSA 151 shall be non-transferable
by person or location.

��������� 
(j)
�

A written notification of denial, pursuant to He-P 809.13(b)(1), shall
be sent to an applicant applying for an initial license if it has been
determined by the inspection in (h) above and a maximum of 2 follow-up
inspections that the prospective premises are not in full compliance with RSA
151 and He-P 809.

��������� 
(k)
�

A written notification of denial, pursuant to He-P 809.13(b)(4), shall
be sent to an applicant applying for an initial license if the department has
received no communication from the applicant within 3 months of sending written
notification to the applicant that their application is complete and an
inspection needs to be scheduled.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.06
� 
License Expirations and Procedures for
Renewals
.

��������� 
(a)
�

A license shall be valid on the date of issuance and expire the
following year on the last day of the month prior to the month in which it was
issued unless a completed application for renewal has been received.

��������� 
(b)
�

Each licensee seeking renewal shall: 

(1)
� 
Complete and submit to the department an
application form pursuant to He-P 809.04(a)(1) at least 120 days prior to the
expiration of the current license;

(2)
� 
The current
license number;

(3) A request for renewal of any existing
non-permanent waiver previously granted by the department, in accordance with
He-P 809.10(f), as applicable.
� 
If such a
request is not received, the rule(s) for which the waiver was previously
requested shall not continue to be waived beyond the expiration of the current
license;

(4)
�

A list of any current employees who have a permanent waiver granted in
accordance with He-P 809.17(d); and

(5) A copy of any non-permanent or new variances
applied for or granted by the state fire marshal.

��������� 
(c)
�

Following an inspection, as described in He-P 809.09, a license shall be
renewed if the department determines that the licensee:

(1) Submitted an application containing all the items
required by (c) above, prior to the expiration of the current license; 

(2)
� 
Has
submitted a POC that has been accepted by the department and implemented by the
licensee if areas of non-compliance were cited at the last licensing inspection
or investigation; and

(3)
� 
Is found to
be in compliance with RSA 151 and He-P 809 at the renewal inspection.

��������� 
(d)
�

Any licensee who does not submit a complete application for renewal
prior to the expiration of an existing license and does not intend to cease
operation shall be required to submit an application for initial license
pursuant to He-P 809.04 and shall be subject to a fine in accordance with He-P
809.13(c)(5).

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.07
� 
Branch Offices and Drop Sites
.

��������� 
(a)
�

The HHCP may establish branch offices and drop sites provided that no
direct care is provided to a patient at a drop site. 

��������� 
(b)
�

The HHCP shall notify the department in writing prior to establishing or
operating branch offices with the following information: 

(1)
� 
The branch
office address;

(2)
� 
The branch
office phone number; and

(3)
� 
The license
number of the HHCP.

��������� 
(c)
�

The HHCP shall submit to the department the information required by He-P
809.04(a)(5) for branch offices.

��������� 
(d)
�

Upon receipt of the information required by (b) and (c) above, the
department shall issue a revised license certificate to reflect the addition of
the branch offices, provided the additions do not violate RSA 151 or He-P 809.

��������� 
(e)
�

All records, including those maintained at any branch office, shall be
made available to the inspector at the primary location of the licensed
premises at the time of inspection.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.08
� 
HHCP Requirements for Organizational or
Service Changes
.

��������� 
(a)
�

The HHCP shall provide the department with written notice at least 30
days prior to changes in any of the following:

(1)
� 
Ownership;

(2)
� 
Physical
location of the licensed premises;

(3)
� 
Address; or

(4)
� 
Name.

��������� 
(b) The HHCP shall complete and submit
a new application and obtain a new license and license certificate prior to :

(1)
� 
A change in ownership; or

(2)
� 
A change in licensing classification.

��������� 
(c)
�

When there is a change in address without a change in location, the HHCP
shall provide the department with a copy of the notification from the local,
state, or federal agency that requires the address change.

��������� 
(d)
�

When there is a change in address due to a physical location change ,
the HHCP shall provide the department with:

(1)
� 
A letter which contains the license number,
new address, and date of the move; and 

(2)
� 
Local approval form as specified in He-P
809.04(a)(5).

��������� 
(e)
� 
When there is a change in the name, the HHCP
shall submit to the department a copy of the certificate of amendment from the
New Hampshire secretary of state, if applicable.

��������� 
(f)
�

An inspection by the department shall be conducted prior to operation
for changes in the following:

(1)
�

Ownership, unless the current licensee is in full compliance then an
inspection shall be conducted as soon as practical by department; or

(2)
� 
A change in licensing classification.

(g)
� 
A new license shall be issued for a change in
ownership.

��������� 
(h)
�

A revised license and license certificate shall be issued for a change
in address.

��������� 
(i)
�

A revised license and license certificate shall be issued for a change
in name.

��������� 
(j)
�

A license and license certificate shall be issued at the time of initial
licensure.

��������� 
(k)
�

A revised license certificate shall be issued for any of the following:

(1)
� 
A change in administrator;

(2)
� 
When a waiver has been granted;

(3)
� 
When there is a change in services; or

(4)
� 
When a branch office has been added.

��������� 
(l)
�

The HHCP shall inform the department in writing no later than 5 days
prior to a change in administrator, or as soon as practicable in the event of a
death or other extenuating circumstances requiring an administrator change
� 
and provide the department with the
following:

(1)
� 
A resume
identifying the name and qualifications of the new administrator;

(2)
� 
Copies of
applicable licenses for the new administrator; 

(3) The results of
a criminal records check from the NH department of safety for the new
administrator; and

(4)
� 
Results of bureau and elderly adult registry
check.

��������� 
(m)
�

Upon review of the materials submitted in accordance with (l) above, the
department shall make a determination as to whether the new administrator meets
the qualifications for the position, as specified in He-P 809.15(d).

��������� 
(n)
�

If the department determines that the new administrator does not meet
the qualifications for his or her position as specified in (m) above, it shall
so notify the licensee in writing so that a waiver can be sought or the
licensee can search for a qualified candidate.

(o)
� 
A restructuring of an established HHCP that
does not result in a transfer of the controlling interest of the facility, but
which might result in a change in the name of the facility or corporation,
shall not constitute a change in ownership and a new license shall not be
required.

��������� 
(p)
�

The HHCP shall inform the department in writing via e-mail, fax, or mail
of any change in the e-mail address as soon as practicable and in no case later
than 10 days of the change as this is the primary method used for all emergency
notifications to the facility.

��������� 
(q)
� 
If a licensee chooses to cease operation of
an HHCP, the licensee shall submit written notification to the department at
least 60 days in advance which shall include a written closure plan that
ensures adequate care of patients until they are transferred or discharged to
an appropriate alternate setting.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.09
� 
Inspections
.

��������� 
(a)
�

For the purpose of determining compliance with RSA 151 and He-P 809, as
authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit
and allow any department representative at any time to inspect the following:

(1)
� 
The
licensed premises;

(2)
� 
All
programs and services provided by the HHCP; and

(3)
� 
Any records
required by RSA 151 and He-P 809. 

��������� 
(b)
�

The department shall conduct an inspection to determine full compliance
with RSA 151, He-P 809, and other federal or state requirements prior to:

(1)
� 
The
issuance of an initial license;

(2)
� 
A change in
ownership except as allowed by He-P 809.08(f)(1);

(3)
� 
A change in
licensing classification; or

(4)
� 
The renewal
of a license.

��������� 
(c)
�

In addition to (b) above the department shall conduct an inspection, as
necessary, to verify the implementation of any POC accepted or issued by the
department.

��������� 
(d)
�

A statement of findings shall be issued when, as a result of an
inspection, the department determines that the HHCP is in violation of any of
the provisions of He-P 809, RSA 151, or other federal or state requirements. 

��������� 
(e)
�

If areas of non-compliance were cited in a statement of findings, the
licensee shall submit a POC, in accordance with He-P 809.12(c), within 21 days
of the date on the letter that transmits the inspection report.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.10
� 
Waivers
.

��������� 
(a)
�

Applicants or licensees seeking waivers of specific rules in He-P 809
shall submit a written request for a waiver to the commissioner that includes:

(1)
� 
The
specific reference to the rule for which a waiver is being sought;

(2)
� 
A full
explanation of why a waiver is necessary; and

(3) A full explanation of alternatives proposed by the
applicant or licensee, which shall be equally as protective of public health
and patients as the rule from which a waiver is sought or provide a reasonable
explanation why the applicable rule should be waived.

��������� 
(b)
�

Waivers shall be permanent unless the department specifically places a
time limit on the waiver.

��������� 
(c)
�

A request for waiver shall be granted if the commissioner determines
that the alternative proposed by the applicant or licensee:

(1)
� 
Meets the
objective or intent of the rule;

(2)
� 
Does not
negatively impact the health, safety, or well-being of the patients; and

(3)
� 
Does not
negatively affect the quality of patient services.

��������� 
(d)
�

The licensee�s subsequent compliance with the alternatives approved in
the waiver shall be considered equivalent to complying with the rule from which
waiver was sought.

��������� 
(e)
�

Waivers shall not be transferable.

��������� 
(f)
�

When a licensee wishes to renew a non-permanent waiver beyond the
approved period of time, the licensee shall apply for a new waiver with the
renewal application or at least 60 days prior to the expiration of the existing
waiver, as appropriate, by submitting the information required by (a) above.

��������� 
(g)
�

The request to renew a waiver shall be subject to (c) through (f) above.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#6240, HB 32, eff 5-3-96, EXPIRED: 12-31-98

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.11
� 
Complaints
.

��������� 
(a)
�

The department shall investigate any complaint that meets the following
conditions:

(1)
�

The alleged violation(s) occurred not more than 6 months prior to the
date the department was made aware of the allegation(s);

(2) 
The complaint is based upon the complainant�s first-hand knowledge
regarding the allegation(s) or on information reported directly to the
complainant by a person who has first-hand knowledge regarding the
allegation(s);

and 

(3)
� 
There is sufficient
specific information for the department to determine that the allegation(s), if
proven to be true, would constitute a violation of any of the provisions of RSA
151 or He-P 809.

��������� 
(b)
�

When practicable, the complaint shall be in writing and contain the
following information:

(1)
� 
The name
and address, if known, of the HHCP, or the alleged unlicensed individual or
entity;

(2)
� 
The name,
address, and telephone number of the complainant; and

(3)
� 
A
description of the situation that supports the complaint and the alleged
violation(s) of RSA 151 or He-P 809.

��������� 
(c)
�

Investigations shall include all techniques and methods for gathering
information which are appropriate to the circumstances of the complaint,
including, but not limited to:

(1)
�

Requests for additional information from the complainant or the
facility; 

(2)
�

Physical inspection of the licensed premises; 

(3)
�

Review of relevant records; and

(4)
�

Interviews with individuals who might have information that is relevant
to the investigation.

��������� 
(d)
�

For a licensed HHCP, the department shall: 

(1)
� 
Provide
written notification of the results of the investigation to the licensee along
with an inspection report if areas of non-compliance were found as a result of
the investigation;

(2)
� 
Notify any
other federal, state, or local agencies of suspected violations of their
statutes or rules based on the results of the investigation, as appropriate;

(3)
� 
Notify the licensee in writing and take no
further action if the department determines that the complaint is unfounded,
under (a) above, or does not violate any statutes or rules; and

(4)
� 
Require the licensee to submit a POC in
accordance with He-P 809.12(c) if the inspection results in areas of
non-compliance being cited.

(e)
� 
The
following shall apply for the unlicensed individual or entity:

(1)
� 
The department shall provide written
notification to the owner or person responsible that includes:

a.
� 
The date of investigation;

b.
� 
The reasons for the investigation; and

c.
� 
Whether or not the investigation resulted in
a determination that the services being provided require licensing under RSA
151:2, IV;

(2)
� 
In accordance with RSA 151:7-a, II, the owner
or person responsible shall be allowed 7 business days from the date of the
notice required by (1) above to submit a completed application for a license;

(3)
� 
If the owner of an unlicensed facility does
not comply with (2) above, the department shall issue a written warning to
immediately comply with RSA 151 and He-P 809; and

(4)
� 
Any person or entity who fails to comply
after receiving a warning as described in (3) above, shall be subject to an
action by the department for injunctive relief under RSA 151:17 and an
administrative fine in accordance with He-P 809.13(c)(1).

��������� 
(f)
�

Complaint investigation files shall be confidential in accordance with
RSA 151:13, and shall not be disclosed publicly but shall be released by the
department on written request only:

(1)
� 
To the
department of justice when relevant to a specific investigation;

(2)
� 
To law
enforcement when relevant to a specific criminal investigation;

(3)
� 
When a
court of competent jurisdiction orders the department to release such
information; or

(4)
� 
In
connection with any administrative or judicial proceedings relative to the
licensee.

Source.
� 
#4073, eff 6-26-86, EXPIRED: 6-26-92

New.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.12
� 
Administrative Remedies
.

��������� 
(a)
�

The department shall impose administrative remedies for violations of
RSA 151, He-P 809, or other applicable licensing rules, including:

(1)
� 
Requiring a
licensee to submit a POC in accordance with (c) below;

(2)
� 
Imposing a
directed POC upon a licensee in accordance with (d) below; 

(3)
� 
Imposing
conditions upon a licensee; or 

(4)
� 
Monitoring of a license.

��������� 
(b)
�

When administrative remedies are imposed, the department shall provide a
written notice, as applicable, which:

(1)
� 
Identifies
each area 
in which the licensee is not in compliance
with RSA 151 or a provision of these rules
 ; and

(2)
� 
Identifies
the specific remedy(s) that has been proposed. 

��������� 
(c)
�

A POC shall be developed and enforced in the following manner:

(1)
� 
Upon
receipt of a statement of findings, the licensee shall submit a written POC for
each item, written in the appropriate place on the statement and containing:

a.
� 
How the licensee intends to correct each area
of non-compliance;

b.
� 
What measures will be put in place, or what
system changes will be made to ensure that the area of non-compliance does not
recur, to include how the measures will be evaluated for effectiveness;

c.
� 
The date by which each area of non-compliance
shall be corrected; and

d.
� 
The position of the employee responsible for
the corrective action.

(2)
� 
The
licensee shall submit a written POC to the department within 21 days of the
date on the letter that transmitted the statement of findings, unless the
licensee requests, either verbally or in writing, and the department agrees, to
extend that deadline, based on the following criteria:

a.
� 
The licensee
demonstrates that he or she has made a good faith effort to develop and submit
the POC within the 21 day period but has been unable to do so; and

b.
� 
The
department determines that the health, safety or well-being of a patient will
not be jeopardized as a result of granting the extension;

(3)
� 
The
department shall review and accept each POC and accept each plan that:

a.
� 
Achieves
compliance with RSA 151 and He-P 809;

b.
� 
Addresses
all 
areas of non-compliance 
as cited in the
statement of findings;

c.
� 
Prevents a
new violation of RSA 151 or He-P 809 as a result of the implementation of the
POC; and

d.
� 
Specifies
the date upon which the areas of non-compliance will be corrected;

(4)
� 
If the POC
is acceptable, the department shall issue a license certificate or provide
written notification of acceptance of the POC, whichever is applicable; 

(5)
� 
If the POC is not acceptable:

a.
� 
The
 department shall notify
the licensee in writing within 14 days, of the reason for rejecting the POC;

b.
� 
The
 licensee shall develop
and submit a revised POC within 14 days of the date of the written notification
from the department that states the original POC was rejected unless, within
the 14-day period, the licensee requests an extension, via telephone or in
writing, and the department grants the extension, based on the following
criteria:

1.
� 
The licensee demonstrates that he or she has
made a good faith effort to develop and submit the POC within the 14-day period
but has been unable to do so; and

2.
� 
The department determines that the health,
safety or wellbeing of a patient will not be jeopardized as a result of
granting the waiver;

c.
� 
The
 revised POC shall comply
with (c)(1) above and be reviewed in accordance with (c)(3) above; and

d.
�

If the revised POC is not acceptable to the department, or is not
submitted within 14 days of the date of the written notification from the
department that states the original POC was rejected, unless the department has
granted an extension, the licensee shall be subject to a directed POC in
accordance with (d) below and a fine in accordance with He-P 809.13(c)(11);

(6)
� 
The
department shall verify the implementation of any POC that has been submitted
and accepted by:

a.
� 
Reviewing
materials submitted by the licensee; 

b.
� 
Conducting
an on-site follow-up inspection; or

c.
� 
Reviewing
compliance during the next annual inspection;

(7)
�

Verification of the implementation of any POC shall only occur after the
date of completion specified by the licensee in the plan; and

(8)
� 
If the POC
or revised POC has not been implemented by the completion date, at the time of
the next inspection the licensee shall be:

a.
� 
Notified by
the department in accordance with He-P 809.12(b); and 

b.
� 
Issued a
directed POC in accordance with (d) below and a fine in accordance with He-P
809.13(c)(11).

��������� 
(d)
�

The department shall develop and impose a directed POC that specifies
corrective actions for the applicant or licensee to implement when:

(1)
� 
As a result
of an inspection, areas of non-compliance were identified that require
immediate corrective action to protect the health and safety of the patients or
personnel; 

(2) A revised POC is not submitted within 14 days of
the written notification from the department or such other date as applicable
if an extension was granted by the department; or

(3)
� 
A revised
POC submitted by the licensee has not been accepted.

��������� 
(e)
�

If at the time of the next inspection the directed POC referenced in (d)
above has not been implemented by the completion date stated in the directed
POC, the department shall: 

(1)
� 
Impose a
fine;

(2)
� 
Deny the
application for a renewal of a license 
in accordance
with He-P 809.13
(b); or 

(3)
� 
Revoke the
license in accordance with He-P 809.13(b).

��������� 
(f)
�

The department shall offer an opportunity for informal dispute
resolution to any applicant or licensee who disagrees with an area or areas of
non-compliance cited by the department on a statement of findings, provided
that the applicant or licensee submits a written request for an informal
dispute resolution.

��������� 
(g)
�

The informal dispute resolution shall be requested in writing by the
applicant, licensee
,
 or program director no
later than 14 days from the date the statement of findings was issued by the
department.

��������� 
(h)
�

The department shall change the statement of findings if, based on the
evidence presented, the statement of findings is determined to be incorrect.
The department shall provide a written notice to the applicant or licensee of
the determination.

��������� 
(i)
�

The deadline to submit a POC in accordance
with He-P 809.12(c)(2) above shall not apply until the notice of the
determination in (h) above has been provided to the applicant or licensee.

��������� 
(j)
�

An informal dispute resolution shall not be available for any applicant
or licensee against whom the department has imposed an administrative fine or
initiated action to revoke, deny, or refuse to issue or renew a license.

��������� 
(k)
�

The department shall impose state monitoring under the following
conditions:

(1)
� 
Repeated non-compliance on the part of the
facility in areas that impact the health, safety, or well-being of patients; or

(2)
� 
The presence of conditions in the HHCP that
negatively impact the health, safety, or well-being of patients.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P
809.13
� 
Enforcement Actions and
Hearings
.

��������� 
(a)
�

Prior to taking enforcement action against an applicant or licensee, the
department shall send to the applicant or licensee a written notice that sets
forth:

(1)
� 
The reasons
for the proposed action;

(2)
� 
The action
to be taken by the department; 

(3)
� 
If a fine is imposed, the automatic reduction
of the fine by 25% if the fine is paid within 10 days of the date on the
written notice from the department and the area of non-compliance has been
corrected, or a POC has been accepted and approved by the department; and

(4)
� 
The right
of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA
541-A:30, III, as applicable before the enforcement action becomes final.

��������� 
(b)
�

The department shall deny an application or revoke a license if:

(1)
� 
An
applicant or a licensee violated a provision of RSA 151 or He-P 809 in a manner
which posed a risk of harm to a patient�s health, safety, or well-being of a
patient;

(2)
� 
An
applicant or a licensee has failed to pay an administrative fine imposed by the
department;

(3)
� 
An
applicant or a licensee has had a check returned to the department for
insufficient funds and has not re-submitted the outstanding fee in the form of
cash, money order or certified check;

(4)
� 
After being
notified of and given an opportunity to supply missing information, or schedule
an initial inspection an applicant or licensee fails to submit an application
that meets the requirements of He-P 809.04;

(5)
� 
The
applicant, licensee, or any representative or employee of the applicant or
licensee:

a.
� 
Provides
false or misleading information to the department; 

b.
� 
Prevents,
interferes, or fails to cooperate with any inspection or investigation
conducted by the department; or

c.
� 
Fails to
provide requested files or documents to the department;

(6)
� 
The
licensee failed to implement or continue to implement a POC that has been
accepted or imposed by the department in accordance with He-P 809.12(c), (d),
and (e);

(7)
� 
The
licensee has submitted a POC that has not been accepted by the department in
accordance with He-P 809.12(c)(5) and has not submitted a revised POC as
required by He-P 809.12(c)(5);

(8)
� 
The
licensee is cited a third time under RSA 151 or He-P 809 for the same violation
within the last 5 inspections;

(9)
� 
A licensee,
or its corporate officers, has had a license revoked and submits an application
during the 5-year prohibition period specified in (j) below;

(10)
� 
Unless a
waiver has been granted, upon inspection, the applicant or licensee is not in
compliance with RSA 151 or He-P 809;

(11)
� 
Unless a
waiver has been granted, the department makes a determination that the
applicant, administrator, or licensee has been found guilty of or plead guilty
to a felony assault, theft, fraud, abuse, neglect, or exploitation of any
person, in this or any other state, or had an investigation for abuse, neglect,
or exploitation adjudicated and founded by the department or any administrative
agency in this or any other state; 

(12)
� 
The
applicant or licensee employs an administrator who does not meet the
qualifications for the position under circumstances in which the department has
not granted a waiver; or

(13)
� 
The applicant has had a license revoked by
any division or unit of the department within 5 years prior to the application.

��������� 
(c)
�

The department shall impose fines on unlicensed individuals, applicants,
or licensees as follows:

(1)
� 
For a
failure to cease providing unlicensed services after being notified by the
department of the need for a license, in violation of RSA 151:2, the fine shall
be $2000.00 for an applicant or unlicensed entity;

(2)
� 
For a
failure to cease operations after a denial of a license or after receipt of an
order to cease and desist operations, in violation of RSA 151:2 and RSA
541-A:30, or continuing to operate after a failure to renew the license by the
expiration date, the fine
� 
for an
applicant, unlicensed entity or a licensee shall be $2000.00; 

(3)
� 
For
advertising services or otherwise representing themselves as having a license
to provide services that they are not licensed to provide, in violation of RSA
151:2, III, and He-P 809.14(g), the fine for an applicant, licensee, or
unlicensed entity shall be $500.00;

(4)
� 
For a
failure to comply with the directives of a warning issued by the department, in
violation of RSA 151:7-a and He-P 809.11(e)(4), the fine for an unlicensed
entity or a licensee shall be $500.00;

(5)
� 
For a
failure to submit a renewal application for a license prior to the expiration
date, in violation of He-P 809.06(e), the fine for a licensee shall be $100.00;

(6)
� 
For a
failure to notify the department prior to a change of ownership, in violation
of He-P 809.08(a)(1), the fine for a licensee shall be $500.00; 

(7)
� 
For a
failure to notify the department prior to a change in the physical location, in
violation of He-P 809.08(a)(2), the fine for a licensee shall be $1000.00;

(8)
� 
For a failure to notify the department of a
change in e-mail address, in violation of He-P 809.08(n), the fine shall be
$100.00;

(9)
� 
For a
failure to allow access by the department to the HHCP�s premises, programs,
services, patients, or records, in violation of He-P 809.09(a)(1)-(2), the fine
for an applicant, unlicensed entity or licensee shall be $2000.00;

(10)
� 
For a
failure to submit a POC or revised POC, within 21 or 14 days, respectively, of
the date on the letter that transmits the inspection report, or the date of an
extension as granted, in violation of He-P 809.12(c)(2) or (5), the fine for a
licensee shall be $500.00;

(11)
� 
For a
failure to implement or maintain the corrective action set forth in any POC
that has been accepted or issued by the department, in violation of He-P
809.12(c)(8), the fine for a licensee shall be $1000.00;

(12)
� 
For a
failure to establish, implement, or comply with licensee policies, as required
by He-P 809.14(b), (d), and (s) the fine for a licensee shall be $500.00; 

(13)
� 
For a
failure to provide services or programs required by the licensing
classification and specified by He-P 809.14(c), the fine for a licensee shall
be $500.00;

(14)
� 
For a
failure to transfer a patient whose needs exceeds the services or programs
provided by the HHCP, in violation of RSA 151:5-a, the fine for a licensee
shall be $500.00;

(15)
� 
For
providing false or misleading information or documentation to the department,
in violation of He-P 809.14(f), the fine shall be $1000.00 per offense;

(16)
� 
For a
failure to meet the needs of the patient, as described in
� 
He-P 809.14(i)(2), the fine for a licensee
shall be $1000.00 per patient; 

(17)
� 
For
employing an administrator or other personnel who do not meet the
qualifications for the position, without having a waiver granted by the
department
� 
in accordance with He-P
809.14, the fine for a licensee shall be $500.00; 

(18)
� 
When an
inspection determines that a violation of RSA 151 or He-P 809 for which a fine
was previously imposed, in addition to any other enforcement actions taken by
the department, the fines assessed shall be as follows:

a. If the same area of non-compliance is cited within
2 years of the original non-compliance, the fine for a licensee shall be $1000;
or

b.
� 
If the same
area of non-compliance is cited a third time within 2 years of being fined in
a. above, the fine for a licensee shall be triple the original fine, but not to
exceed $2000.00;

(19)
� 
Each day
that the individual or licensee continues to be in violation of the provisions
of RSA 151 or He-P 809 shall constitute a separate violation and shall be fined
in accordance with He-P 809.13(c); and

(20)
� 
If the
applicant or
� 
licensee is making good
faith efforts to comply with above, as verified by documentation or other
means, the department shall not issue a daily fine.

��������� 
(d)
�

Payment of any imposed fine to the department shall meet the following
requirements:

(1)
� 
Payment
shall be made in the form of check or money order made payable to the
�Treasurer�; and

(2)
� 
Cash, money
order, or certified check shall be required when an applicant or licensee has
issued payment to the department by check, and such check was returned for
insufficient funds.

��������� 
(e)
�

An applicant or licensee shall have 30 days after receipt of the notice
of enforcement action to request a hearing to contest the action.

��������� 
(f)
�

If a written request for a hearing is not made pursuant to (e) above,
the action of the department shall become final.

��������� 
(g)
�

The department shall order the immediate suspension of a license, the
cessation of services, patient when it finds that the health, safety, or
well-being of patients is in jeopardy and requires emergency action in
accordance with RSA 541:A-30.

��������� 
(h)
�

If an immediate suspension is upheld, the licensee shall not resume
operating until the department determines through inspection that compliance
with RSA 151 and He-P 809 is achieved.

��������� 
(i)
�

Hearings under this section shall be conducted in accordance with RSA
541-A and He-C 200.

��������� 
(j)
�

When a HHCP�s license has been denied or revoked, , the applicant,
licensee, or administrator shall not be eligible to apply for a license or be
employed as an administrator for at least 5 years if the denial or revocation
specifically pertained to their role in the program.

��������� 
(k)
�

The 5 year period referenced in (j) above shall begin on:

(1)
� 
The date of
the department�s decision to revoke or deny the license if no appeal is filed;
or

(2)
� 
The date a
final decision upholding the action of the department is issued, if a request
for an administrative hearing is made and a hearing is held.

��������� 
(l)
�

Notwithstanding (j) above, the department shall consider an application
submitted after the decision to revoke or deny becomes final, if the applicant
demonstrates that circumstances have changed to the extent that the department
now has good cause to believe that the applicant has the requisite degree of
knowledge, skills and resources necessary to maintain compliance with the
provisions of RSA 151 and He-P 809.

��������� 
(m)
�

If the department has reasonable information or evidence that a
licensee, applicant, administrator, or others are circumventing (k) above by
applying for a license through an agent or other individual and will retain
ownership, management authority, or both, the department shall deny the
application.

��������� 
(n)
�

No ongoing enforcement action shall preclude the imposition of any
remedy available to the department under RSA 151, RSA 541-A, or He-P 809.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P
809.14
� 
Duties and Responsibilities of
All Licensees
.

��������� 
(a)
� 
The licensee shall comply with all federal,
state, and local laws, rules, codes, and ordinances, including RSA 161-F:49,
and rules promulgated thereunder, as applicable.

��������� 
(b)
� 
The licensee shall have written policies and
procedures to include: 

(1)
� 
The rights
and responsibilities of admitted patients in accordance with the �Home
Care
� 
Clients�� Bill of Rights� under 
RSA 151:21-b;

(2)
� 
The
 policies described in
He-P 809; and

(3)
� 
A policy that ensures the safety of all
persons present on the licensed premises where firearms are permitted.

��������� 
(c)
� 
The licensee shall define, in writing, the
scope and type of services to be provided by the HHCP, which shall include at a
minimum, the core services listed in He-P 809.15.

��������� 
(d)
� 
The licensee shall develop and implement
written policies and procedures governing the operation and all services
provided by the HHCP and for:

(1)
� 
Reviewing the policies and procedures every 2
years; and

(2)
� 
Revising them as needed.

��������� 
(e)
� 
The licensee shall assess and monitor the
quality of care and service provided to patients on an ongoing basis.

��������� 
(f)
� 
The licensee or personnel shall not falsify
any documentation or provide false or misleading information to the department.

��������� 
(g)
� 
The licensee shall not advertise or otherwise
represent the HHCP as providing services that it is not licensed to provide,
pursuant to RSA 151:2, III.

��������� 
(h)
� 
The licensee shall comply with all conditions
of warnings and administrative remedies issued by the department, and all court
orders.

��������� 
(i)
� 
Licensees shall:

(1)
� 
Manage and operate the HHCP;

(2)
� 
Meet the needs, as determined by the care
plan, of the patient during those hours that the HHCP personnel is in the
patient�s home;

(3)
� 
Initiate action to maintain the HHCP in full
compliance at all times with all relevant health and safety requirements
contained in applicable federal, state, and local laws, rules, regulations, and
ordinances;

(4)
� 
Establish, in writing, a chain of command
that sets forth the line of authority for the operation of the HHCP;

(5)
� 
Appoint an administrator;

(6)
� 
Verify the qualifications of all personnel;

(7)
� 
Accept new patients based upon the
availability of personnel to meet the patients� requested service needs;

(8)
� 
Require all personnel to follow the orders of
the licensed practitioner for every patient that has such orders and encourage
the patient to follow the licensed practitioner�s orders; and 

(9)
� 
Implement any POC that has been accepted or
issued by the department. 

��������� 
(j)
� 
The licensee shall consider all patients to
be competent and capable of making all decisions relative to their own health
care unless the patient:

(1)
� 
Has a guardian or conservator appointed by a
court of competent jurisdiction; or

(2)
� 
Has a durable power of attorney for health
care that has been activated in accordance with RSA 137-J or a surrogate
decision-maker in accordance with RSA 137-J:35.

��������� 
(k)
� 
The licensee shall only accept a patient
whose needs can be met through the program and services offered under the
current license.

��������� 
(l)
� 
If the licensee accepts a patient who is
known to have a disease reportable under He-P 301 or an infectious disease,
which is any disease caused by the growth of microorganisms in the body which
might or might not be contagious, the licensee shall follow the required
procedures and personnel training for the care of the patients, as specified by
the United States Centers for Disease Control and Prevention �2007 Guideline
for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare Settings� (June 2007 edition), available as noted in Appendix A.

��������� 
(m)
� 
The licensee shall report all positive
tuberculosis test results for personnel to the office of disease control in
accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

��������� 
(n)
� 
The licensee shall post the following
documents in a public area:

(1)
� 
The license and current license certificate
issued in accordance with RSA 151:2;

(2)
� 
All inspection reports for the last 12 months
issued in accordance with He-P 809.09(d);

(3)
� 
A copy of the Home Care Patient'� Bill of
Rights specified by RSA 151:21-b;

(4) 
�
A copy of the licensee�s policies and
procedures relative to the implementation of patient rights and
responsibilities;

(5)
� 
A copy of the licensee�s complaint procedure
, including a statement that complaints may be submitted,
in writing, to the:

Department of
Health and Human Services

Office of
Legal and Regulatory Services

Health
Facilities Administration,

129 Pleasant
Street

Concord, NH
 03301 or by calling 1-800-852-3345
; and

(6)
� 
The licensee�s plan for fire safety,
evacuation, and emergencies, identifying the location of, and access to, all
fire exits.

��������� 
(o)
� 
For reportable incidents the licensees shall:

(1)
� 
Complete an investigation to determine if
abuse or neglect could have been a contributing factor to the incident;

(2)
� 
Fax to
271-5574 or, if a fax machine is not available, submit via regular mail,
postmarked within 2 business days of the incident together with a telephone
call to the department reporting the incident and notifying the department of
the mailed report, the following information to the department within 2
� 
business days of a reportable incident:

a.
� 
The HHCP name;

b. A
description of the incident, including identification of injuries, if
applicable;

c.
� 
The name of the licensee(s) or personnel
involved in, witnessing, or responding to the reportable incident; 

d. The name of
the patient involved and the name of any witnesses to the reportable incident;

e.
� 
The date and time of the reportable incident;

f.
�� 
The action taken in direct response to the
reportable incident, including any follow-up;

g.
�� 
If medical intervention was required, by
whom and the date and time;

h.
� 
Whether the patient�s guardian, agent, or
personal representative, if any, was notified; 

i.
�� 
The signature of the person reporting the
reportable incident; and

j.
� 
The date and time the patient�s licensed
practitioner was notified; 

(3)
� 
If abuse or
neglect is suspected, the licensee shall
 notify the
department with a written report within 5 days describing the actions taken by
personnel, the final outcome or continuation of the reportable incident, and
actions taken to prevent a reoccurrence if it was not submitted in the initial
report
;

(4)
� 
Contact the
department immediately by telephone, fax, or e-mail to report the information
required by (1) above in the case of the death of any patient who dies within
10 days of a reportable incident; 

(5)
� 
Provide the
information required by (3) above in writing within 3 business days of the
unexpected death of any patient or the death of any patient who dies within 10
days of a reportable incident if the initial contact was made by telephone or
if additional information becomes available subsequent to the time the initial
contact was made; and

(6)
� 
Submit any
further information requested by the department. 

��������� 
(p)
� 
The licensee shall admit and allow any
department representative to inspect the HHCP and all programs and services
that are being provided at any time for the purpose of determining compliance
with RSA 151 and He-P 809 as authorized by RSA 151:6 and RSA 151:6-a.

��������� 
(q)
� 
The licensee shall, upon request, provide a
patient or their guardian agent, or surrogate decision-maker
� 
if applicable, with a copy of his or her
patient record, pursuant to the provisions of RSA 151:21, X.

��������� 
(r)
� 
All records required for licensing shall be
legible, current, accurate, and be made available to the department during an
inspection or investigation conducted in accordance with RSA 151:6 and RSA
151:6-a.

��������� 
(s)
� 
Any licensee that maintains electronic
records shall develop a system with written policies and procedures to protect
the privacy of patients and personnel that, at a minimum, include:

(1)
� 
Procedures for backing up files to prevent
loss of data;

(2)
� 
Safeguards for maintaining
� 
the confidentiality of information pertaining
to patients and personnel; and

(3)
� 
Systems to prevent tampering with information
pertaining to patients and personnel.

��������� 
(t)
� 
At the time of admission the licensee shall
give a patient and their guardian, agent, or surrogate decision-maker
� 
if applicable, a listing of all applicable
HHCP charges and identify what care and services are included in the charge.

��������� 
(u)
� 
The licensee shall give a patient a written
notice at least 30 days before any increase is imposed in the cost or fees, for
any HHCP services, except for patients receiving Medicaid whose financial
liability is determined by the state�s standard of need, or patients funded by
the department�s Choices for Independence program in accordance with He-E 801
and which limitation shall only pertain to costs and fees under the direction
of these programs. 

Source.
� 
#9466, eff
5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18; amd by #12893, eff
10-1-19

��������� 
He-P 809.15
� 
Required Services
.

��������� 
(a)
�

The licensee shall have a written contractual agreement for all services
provided by arrangement.

��������� 
(b)
�

Any contractual agreement to provide care and services shall:

(1)
� 
Identify
the care and services to be provided;

(2)
� 
Specify the
qualifications of the personnel that will be providing the care and services;

(3)
� 
Require
that the HHCP must authorize the services; and

(4)
� 
Stipulate
the HHCP retains professional responsibility for all care and services
provided.

��������� 
(c)
�

The licensee shall provide staff for the following positions: 

(1)
� 
An
administrator to oversee the HHCP, except as allowed by (e)(1) below; and 

(2)
� 
A director
of patient services.

��������� 
(d)
�

Any new administrator shall possess at least a bachelor�s degree in
business or a health related field, or be a registered nurse (RN). 

��������� 
(e)
�

The administrator shall:

(1)
� 
Designate,
in writing, an alternate administrator who shall assume the responsibilities of
the administrator in his or her absence; and

(2)
� 
Be
permitted to hold more than one position at the HHCP if:

a.
� 
The
individual meets the qualifications of all positions; and

b.
� 
The duties
and responsibilities of the positions can be accomplished by one individual.

��������� 
(f)
�

Any new director of patient services shall have at least 2 years�
experience supervising personnel or providing direct home health care services
and: 

(1)
� 
Be a New
Hampshire�licensed
� 
or compact registered
nurse; or

(2)
� 
Have a
bachelor�s degree in a health related field.

��������� 
(g)
�

The director of patient services shall be responsible for the overall
delivery of patient care and services.

��������� 
(h)
�

At the time of admission, personnel of the HHCP shall:

(1)
� 
Provide,
both orally and in writing, to the patient, or the patient�s guardian or agent,
if applicable, the HHCP�s:

a.
� 
Policy on
patient rights and responsibilities, including a copy of the home care Clients�
Bill of Rights, pursuant to RSA 151:21-b;

b.
� 
Complaint
procedure;

c.
� 
List of
services that are to be provided by the HHCP; and

d.
� 
List of the
care and services that are provided by an independent contractor; 

(2)
� 
Obtain
written confirmation acknowledging receipt of the items in (1) above from the
patient, or the patient�s guardian or agent, if applicable;

(3)
� 
Collect and
record the following information:

a.
� 
Patient�s
name, home address, home telephone number, and date of birth;

b. Name and telephone number of an emergency contact
and guardian or agent, if applicable;

c.
� 
Name of
patient�s primary care provider and the provider�s address and telephone
number, as applicable;

d.
� 
Written and
signed consent for the provision of care and services; and

e.
� 
Copies
of
� 
all legal directives such as durable
power of attorney, guardianship, or living will, as applicable;

f.
� 
Copy of
order activating durable power of attorney, if applicable; and

g.
� 
Copy of DNR
order, if applicable; and

(4)
� 
Obtain
documentation of informed consent and consent for release of information.

��������� 
(i)
�

Each patient shall have a health assessment conducted by professional
personnel in the specific discipline providing care, as authorized by their
provider, to determine the level of care and services required by the patient,
except as allowed by (k) and (l) below: 

(1)
� 
Prior to
initiating care for the specified discipline; 

(2)
� 
At least
every 90 days thereafter; and

(3)
� 
Whenever
there is a significant change in the patient�s condition.

��������� 
(j)
�

The assessment required by (i) above shall contain at a minimum the
following:

(1)
� 
Pertinent
diagnoses including mental status;

(2)
� 
Goals and
objectives of the services that shall be provided by the HHCP;

(3)
� 
Estimated
duration and frequency of care and services;

(4)
� 
Any
equipment required;

(5)
� 
Prognosis;

(6)
� 
Functional
limitations;

(7)
�

Rehabilitation potential;

(8)
� 
Activities
that are limited;

(9)
� 
Nutritional
requirements;

(10)
�

Medications and treatments administered or assisted by personnel of
HHCP; 

(11)
� 
Any safety
precautions; and

(12)
� 
Discharge
planning or referral information as applicable.

��������� 
(k)
�

Patients receiving only homemaker services shall not require an
assessment or a care plan. 

��������� 
(l)
�

For patients receiving only personal care services, the assessment in
(i) above
� 
shall: 

(1) Be performed initially and every 6 months
thereafter by a registered nurse, licensed practical nurse (LPN), or the
director of patient services to determine the services required; and

(2)
� 
At a
minimum include (j)(1), (4), (6), (8), (9), (10), and (11) above. 

��������� 
(m)
�

If the assessment required by (i) or (l)(1)
� 
and (2) above is completed by an LPN or the
director of patient services who is not a registered nurse, the assessment
shall be reviewed and co-signed by the registered nurse or physician
� 
prior to the development of the patient�s
care plan. 

��������� 
(n)
�

For those patients receiving direct care or personal care services, the
licensee shall develop a care plan within 3 business days of admission or prior
to the initiation of services, if later, that is based on the results of the
assessment required by (i) and (l) above. 

��������� 
(o)
�

The care plan required by (n) above shall include:

(1)
� 
The date of
the assessment; 

(2)
� 
A
description of the problem or need;

(3)
� 
The goals
for the patient, if applicable, and identifying which services require medical,
nursing, or other therapeutic professional care and which of these services can
be provided by personal care service providers as defined by He-P 809.03(aq); 

(4)
� 
The action
or approach to be taken by HHCP personnel;

(5)
� 
The
responsible person(s) or position; 

(6)
� 
The date of
re-evaluation, reassessment, and resolution; and

(7)
�

Documentation that the patient and their legal representative, if
applicable, were involved in the development of the care plan and any revisions
made to the plan.

��������� 
(p)
�

The care plan shall be prepared by an interdisciplinary team that
includes:

(1)
� 
The
personnel performing the assessment;

(2)
� 
Other
personnel in disciplines as determined by the patient�s needs; and

(3)
� 
The patient
or the patient�s legal representative.

��������� 
(q)
�

The care plan shall be reviewed and revised at least every 90 days by
the interdisciplinary team, or every 6 months if only personal care services
are provided, and shall be made available to all personnel that assist the
patient in the implementation of the plan.

��������� 
(r)
�

The licensee shall have an order for any service for which such order is
required by the licensing statute of the licensed practitioner. Such orders
shall be renewed at least annually.

��������� 
(s)
�

All personnel of the HHCP shall follow the orders of the licensed
practitioner and carry out the goals stated in the care plan, as applicable.

��������� 
(t)
�

The licensee shall develop a discharge plan with the input of the
patient or the patient�s legal representative, if any, including:

(1)
� 
Date and
reason for discharge;

(2)
� 
Discharge
instructions and referrals, if applicable;

(3)
� 
Discharge
or transfer summary; and

(4)
� 
Written and
signed order for discharge, if applicable.

��������� 
(u)
�

Written notes shall be documented in the patient�s record at the time of
each visit for:

(1)
� 
All care
and services provided by the HHCP including the:

a.
� 
Date and
time of the care or service;

b.
� 
Description
of the care or service;

c.
� 
Progress
notes, including, as applicable:

1.
� 
Changes in
the patient�s physical, functional, and mental abilities;

2.
� 
Changes in
the patient�s behaviors such as eating or sleeping patterns; and

3.
� 
The
patient�s pain management, if applicable; and 

d.
� 
Signature
and title of the person providing the care or service; and

(2)
� 
Any
reportable incident involving the patient when HHCP personnel are in the
patient�s home.

��������� 
(v)
�

For each patient accepted for care and services by the HHCP, a current
and accurate record shall be maintained and include, at a minimum:

(1)
� 
The written
confirmation required by (h)(2) above;

(2)
� 
The
identification data required by (h)(3) above;

(3)
� 
Consent and
medical release forms, as applicable;

(4)
� 
Consent for
release of information, as applicable;

(5)
� 
The record
of the assessments required by (i) or (l) above; 

(6)
� 
All orders
from a licensed practitioner, including the date and signature of the licensed
practitioner required by (r) above;

(7)
� 
All care
plans required by (n) above including documentation that the patient or their
legal representative participated in the development of the care plan;

(8)
� 
All written
notes required by (u) above; 

(9)
� 
All daily
medication records required by He-P 809.16(g)(7)d.
� 
and f.; 

(10)
� 
A
discharge plan or transfer summary as required by (t) above;

(11)
�

Documentation of service authorization, if required, for a patient
receiving third party payment including but not limited to Medicaid waiver
services; and

(12)
�

Documentation of any patient refusal to follow their licensed
practitioner�s written and signed orders.

��������� 
(w)
�

Patient records shall be available to:

(1)
� 
The
patient, the patient�s guardian, the patient�s agent, and the patient's
surrogate decision-maker;

(2)
� 
HHCP
personnel as required by their job responsibilities and subject to the
licensee�s policy on confidentiality;

(3)
� 
Any
individual given written authorization by the patient, the patient�s guardian,
the patient�s agent, or the patient's surrogate decision-maker;

(4)
� 
Any
individual authorized by a court of competent jurisdiction; and

(5)
� 
The
department or any individual authorized by law.

��������� 
(x)
�

The licensee shall develop and implement a method for the written
release of information in patient records that is consistent with federal and
state law. 

��������� 
(y)
�

The HHCP shall store all paper and electronic backup files of patient
records in the primary or branch office except when they are being utilized by
authorized personnel.

��������� 
(z)
�

Paper records shall be safeguarded against loss, damage, or unauthorized
use by being stored in locked containers, cabinets, rooms, or closets except
when they are being used by authorized personnel.

��������� 
(aa)
�

Electronic records shall be maintained as required by He-P 809.14(s).

��������� 
(ab)
�

Records shall be retained for a minimum of 4 years after discharge and
in the case of minors, until one year after reaching age 18, but no less than 4
years after discharge.

��������� 
(ac)
�

The HHCP shall arrange for storage of, and access to, patient records as
required by (ab) above in the event that the HHCP ceases operation.

��������� 
(ad)
�

If the HHCP is providing home hospice care, it shall be licensed in
accordance with He-P 823.

��������� 
(ae)
�

Only personnel with documented phlebotomy training may collect human
blood specimens from patients for laboratory testing.

��������� 
(af)
�

If CLIA-waived laboratory testing is performed by personnel of the HHCP,
the licensee shall obtain a CLIA Certificate of Waiver and follow all CLIA
requirements in the performance of the laboratory testing including the
documentation of training and competency review of all testing personnel.

��������� 
(ag)
�

If the licensee collects human specimens for laboratory testing, it
shall follow the manufacturer's instructions and/or the reference laboratory's
instructions for collection and storage of human specimens.

��������� 
(ah)
�

If the licensee tests human specimens, it shall be licensed as a
laboratory in accordance with He-P 808, except the licensee may perform
� 
CLIA-waived point of care tests without
obtaining a laboratory license in accordance with He-P 809.15(af) and (aj).

(ai)
� 
The HHCP shall follow all manufacturer�s
instructions to include:

(1)
� 
Storage requirements for POC meters and
devices, test strips, test cartridges, and test kits;

(2) Performance of
test specimen requirements, testing environment, test procedure,
troubleshooting error codes and messages, reporting results; and

(3)
� 
All recommended and required quality control
procedures for POC meters and devices.
�

If the manufacturer does not require or recommend procedures for
external quality control performance, the licensee shall perform control
testing using at least 2 levels of liquid quality control material for each
test immediately before the first patient test each calendar day.

��������� 
(aj)
�

Licensee collecting human specimens for laboratory testing shall require
a collecting station license in accordance with He-P 817 except when collected
by a trained registered nurse or licensed nursing assistant.

��������� 
(ak)
�

Training consists of collection, storage, and transport of the
specimens.

��������� 
(al)
�

Training will be done by a registered nurse trained in the collection,
storage and transport of human specimens.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18; amd by #12893, eff
10-1-19

��������� 
He-P 809.16
� 
Medication Services
.

��������� 
(a)
� 
All medications and treatments shall be
administered in accordance with the orders of the licensed practitioner or
other professional with prescriptive powers.

��������� 
(b)
�

HHCP personnel who are not authorized by law to administer medications
may remind and prompt patients to take their medications at the proper time,
place medication container(s), including pill planners, within patient reach,
opening the medication container when patient is present, reading the
medication label to the patient, and utilizing hand over hand technique, as
defined in 809.03 (bb), as per the care plan without requiring documentation of
specific medications taken.

��������� 
(c)
�

If a nurse delegates care, including the task of medication
administration, to an individual not licensed to administer medications, the
nurse and delegate shall comply with the rules of medication delegation pursuant
to Nur 404, as applicable, and RSA 326-B.

��������� 
(d)
�

A licensed nursing assistant (LNA) may perform hand over hand assistance
by following the care plan, as delegated by a licensed nurse, to a competent
and stable patient pursuant to RSA 326-B.

��������� 
(e)
�

The licensee shall allow the patient to self-direct medication
administration, as defined in He-P 809.03(bb), if the patient:

(1)
� 
Has a
physical limitation due to a diagnosis that prevents the patient from
self-administration of medication with or without assistance; 

(2)
� 
Obtains an
annual written verification of the patient�s physical limitation and
self-directing capabilities from the patient�s licensed practitioner or the
assessment performed by an RN according to He-P 809.15(i) and such
documentation is included in the patient record; and

�

(3)
� 
Verbally
directs personnel to:

a.
� 
Assist the
patient with preparing the correct dose of medication by pouring, applying,
crushing, mixing, or cutting; and

b.
� 
Assist the
patient to apply, ingest, or instill the ordered dose of medication.

��������� 
(f) 
�
If personnel, who are authorized by law,
administer medication(s), delegate medication administration, or prepare
medication in advance for administration in accordance with RSA 318:42, XIII
and XIV, the HHCP shall:

(1)
� 
Maintain a
list of medications currently being taken by the patient;

(2)
� 
Administer
all medications in accordance with the orders of the licensed practitioner;

(3)
� 
Maintain an
order, or a copy thereof, in the patient�s record that includes:

a.
� 
The
patient�s name;

b.
� 
The
medication name, strength, prescribed dose, and route of administration;

c.
� 
The
frequency of administration;

d.
� 
The
indications for usage of all PRN medications; and

e.
� 
The date
ordered;

(4)
� 
Only use
medications that have been be kept in the original containers, as dispensed by
the pharmacy, licensed practioner�s samples, or over the counter medications; 

(5)
� 
Require
that any change or discontinuation of medications shall be pursuant to an order
from a licensed practitioner or other individual authorized by law;

(6)
� 
Require
that all telephone orders for medications or treatments are:

a.
� 
Taken only
by a licensed health care professional if such action is within the scope of
their practice act; 

b.
� 
Immediately
transcribed and signed by the individual taking the order; and

c.
�

Counter-signed by the ordering practioner as soon as possible and with a
documented reason if signed more than
� 
30
days after the telephone order being taken;

(7)
� 
Require
that the medication to be administered by HHCP personnel be:

a.
� 
Prepared
immediately prior to administration; and

b.
� 
Prepared,
identified, and administered by the same person in compliance with RSA 318 and
RSA 326-B;

(8)
� 
Require
that when personnel are assisting or administering medication, they remain with
the patient until the patient has taken all of the medication, excluding
infusion therapy; 

(9)
� 
Maintain
documentation for all medications either assisted by or administered by HHCP
personnel that includes: 

a.
� 
The name of
the patient;

b.
� 
A list of
any allergies or allergic reactions to medications; 

c.
� 
The name,
strength, dose, frequency, and route of administration of the medications;

d.
� 
The date and
time medication was taken;

e.
� 
The
signature and identifiable initials and job title of:

1.
� 
The person
assisting or administering the medication; or

2.
� 
The person
administering or assisting the patient taking his or her medication; 

f.
� 
Documented
reason for any medication refusal or omission; and

g.
� 
For PRN
medications, the reason the patient required the medication and the effect of
the PRN medication at the time of the next patient contact; and

(10)
� 
Develop
and implement a system for reporting to the patient�s prescribing, licensed
practitioner any.

a.
� 
Observed
adverse reactions to or side effects of medication; and

b.
� 
Medication
errors such as incorrect medications.

��������� 
(g)
�

If the HHCP provides �self-administration of medication with assistance�
medication services to a patient as defined by He-P 809.03(bb), the HHCP shall:

(1)
� 
Maintain,
in the home, a list of medications currently being taken by the patient;

(2)
� 
Assist with
self-administration of medications in accordance with the orders of the
licensed practitioner;

(3)
� 
Maintain
either the original order, or a copy thereof, in the patient�s record that
includes:

a.
� 
The
patient�s name;

b.
� 
The
medication name, strength, prescribed dose and route of administration;

c.
� 
The
frequency of administration;

d.
� 
The
indications for usage of all PRN medications; and

e.
� 
The date
ordered;

(4)
� 
Not allow
personnel to assist with self-administration of medications if anyone other
than a pharmacist has changed prescription medication container labels except
as allowed by (7)f. below;

(5)
� 
Require
that any change or discontinuation of medications shall be pursuant to an
� 
order;

(6)
� 
Require
that all telephone orders for medications or treatments are:

a.
� 
Taken only
by a licensed health care professional if such action is within the scope of
their practice act;

b.
� 
Immediately
transcribed and signed by the individual taking the order; and

c.
�

Counter-signed by the ordering practioner within 30 days or with a
documented reason if more than 30 days; 

(7)
� 
Allow a
patient to self-administer medication with assistance by personnel, as directed
by the care plan, and which personnel shall be required to:

a.
� 
Remind the
patient to take the correct dose of his or her medication at the correct time
from the original medication bottle;

b.
� 
Place the
medication container within reach of the patient; 

c.
� 
Remain with
the patient to observe them taking the appropriate number and type of
medication as ordered by the licensed practitioner; 

d.
� 
Record that
they have supervised the patient taking their medication on the patient�s daily
medication record;

e.
� 
Document in
the patient�s record any observed or reported side effects, adverse reactions,
refusal to take medications, and medications not taken; and

f.
� 
Require that
if the licensed practitioner or other professional authorized by law changes
the dose of a medication and personnel of the HHCP are unable to obtain a new
prescription label:

1.
� 
The RN shall
clearly and distinctly mark the original container, for example, with a colored
sticker that does not cover the pharmacy label, in a manner consistent with the
HHCP�s written procedure, indicating that there has been a change in the
medication order;

2.
� 
The RN shall
cross out the previous order on the daily medication record, indicating that
the dose has been changed, and write the new order in the next space available
on the medication record; and

3.
� 
The change
in dosage, without a change in prescription label as described in (1) and (2)
above, shall be allowed for a maximum of 90 days from the date of the new
medication order, until the medications in the marked container are exhausted
or, in the case of PRN medications, until the expiration date on the container,
whichever occurs first;

(8)
� 
Maintain
documentation for all medications assisted by HHCP personnel that includes:

a.
� 
The name of
the patient;

b.
� 
A list of
any allergies or allergic reactions to medications;

c.
� 
The name,
strength, dose, frequency, and route of administration of the medications;

d.
� 
The date and
time medication, including PRN medications, was taken;

e.
� 
The
signature, identifiable initials, and job title of the person assisting the
patient taking his or her medication; and

f.
� 
Documented
reason for any medication refusal or omission;

(9)
� 
Develop and
implement a system for reporting to the patient�s prescribing, licensed
practitioner any:

a.
� 
Observed
adverse reactions to or side effects of medication; or

b.
� 
Medication
errors such as incorrect medications; and

(10)
� 
Require
LNAs who assist patients with self-administration of medications
� 
to comply with the board of nursing
requirements according to RSA 326-B

��������� 
(h)
�

A home health personal care service provider shall successfully complete
a medication assistance education program taught by a licensed nurse, licensed
practitioner, or pharmacist, whether in person or through other means such as
electronic media, prior to assisting a patient with self-administration of
medication with assistance, self-directed medication administration, or
administration via nurse delegation.

��������� 
(i)
�

The medication assistance education program required by (h) above shall,
at a minimum, include training on the following subjects:

(1)
� 
Infection
control and proper hand washing techniques;

(2)
� 
The 5
rights, including:

a.
� 
The right
patient;

b.
� 
The right
medication;

c.
� 
The right
dose;

d.
� 
Administered
at the right time; and

e.
� 
Administered
via the right route;

(3)
�

Documentation requirements;

(4)
� 
General
categories of medications such as antihypertensive medications or antibiotics;

(5)
� 
Desired
effects and potential side effects versus adverse effects of medications; and

(6)
� 
Medication
precautions and interactions.

��������� 
(j)
� 
For patients who qualify for the use of
therapeutic cannabis, the licensee shall keep a copy of the registry
identification card in the patient�s record.

��������� 
(k)
� 
The licensee shall develop, maintain, and
implement a patient specific policy relative to the therapeutic use of cannabis
that identifies how the cannabis will be handled and
� 
administered to the patient.

��������� 
(l)
� 
If allowed by the policy in (k) above,
cannabis shall be treated
� 
in a manner
similar to controlled medications with respect to assisting qualifying patients
with the therapeutic use of cannabis.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.17
� 
Personnel
.

��������� 
(a)
�

The licensee shall develop a job description for each position in the
HHCP containing:

(1)
� 
Duties of
the position; 

(2)
� 
Physical
requirements of the position; and 

(3)
�

Qualifications and educational requirements of the position.

��������� 
(b)
�

For all applicants for employment, for all volunteers, and for all
independent contractors who will provide direct care or personal care services
to patients the licensee shall: 

(1)
� 
Obtain a
criminal record check from the New Hampshire department of safety, except,
pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of
nursing;

(2)
� 
Review the
results of the criminal records check in (1) above in accordance with
(c)(1)-(2) below; and

(3)
� 
Verify the
qualifications of all applicants prior to employment.

��������� 
(c)
�

Unless a waiver is granted in accordance with He-P 809.10 and (e) below,
the licensee shall not offer employment, contract with, or engage a person in
(b) above,for any position if the individual:

(1)
� 
Has been
convicted of any felony in this or any other state;

(2)
� 
Has been
convicted for sexual assault, other violent crime, assault, fraud, theft,
abuse, neglect, or exploitation in this or any other state;

(3)
� 
Has had a
finding by the department or any administrative agency in this or any other
state for assault, fraud, theft, abuse, neglect, or exploitation of any person;
or 

(4)
� 
Otherwise
poses a threat to the health, safety, or well-being of patients.

��������� 
(d)
�

If the information identified in (c) above regarding any person
identified in (b) above,
� 
is learned
after the person is hired, contracted with, or engaged, the licensee shall
immediately notify the department and either:

(1)
� 
Cease employing, contracting with, or
engaging the person; or

(2)
� 
Request a waiver of (c) above.

��������� 
(e)
�

If a waiver of (c) above is requested, the department shall review the
information and the underlying circumstances in (c) above and shall either: 

(1)
� 
Notify the licensee that the person cannot or
can no longer be employed, contracted with, or engaged by the licensee, after
investigation, it determines that the person poses a threat to the health,
safety, or well-being of a patient; or

(2)
� 
Grant a waiver of (c) above if, after
investigation, it determines that the person does not pose a current threat to
the health, safety, or well-being of a patient(s).

��������� 
(f)
�

The licensee shall:

(1)
� 
Not employ, contract with, or engage, any
person in (b) above who is listed on the BEAS state registry unless a waiver is
granted by BEAS;

(2)
� 
Only employ, contract with, or engage board
of nursing licensees who are listed on the
�

nursing assistant registry or licensing site with the NH board of
nursing. 

��������� 
(g)
�

In lieu of (b) and (f) above, the licensee may accept from independent
agencies contracted by the licensee to provide direct care or personal care
services a signed statement that the agency�s employees have complied with (b)
and (f) above and do not meet the criteria in (c) and (f) above. 

��������� 
(h)
�

All personnel shall:

(1)
� 
Meet the
educational and physical qualifications of the position as listed on their job
description; 

(2)
� 
Not have
been convicted of a felony, sexual assault, other violent crime, assault,
fraud, theft, abuse, neglect, or exploitation of any person in this or any
other state by a court of law or had a complaint investigation for abuse,
neglect, or exploitation adjudicated and founded by the department or any
administrative agency in this or any other state;

(3)
� 
Be
licensed, registered, or certified as required by state statute;

(4)
� 
Receive an
orientation prior to contact with a patient that includes:

a.
� 
The HHCP�s
policy on patient rights and responsibilities and complaint procedures as
required by RSA 151:20;

b.
� 
The duties
and responsibilities of the position they were hired for;

c.
� 
The HHCP�s
policies, procedures, and guidelines;

d.
� 
The HHCP�s
infection control program;

e.
� 
The HHCP�s
fire evacuation
� 
and emergency plans
which outline the responsibilities of personnel in an emergency;

f.
� 
The
mandatory reporting requirements such as RSA 161:F:46-48 and RSA 169-C:29-31;
and

g.
� 
Body
mechanics training;

(5)
� 
Complete
mandatory annual in-service education, which includes a review of the HCCP�s:

a.
� 
Policies and
procedures on patient rights and responsibilities;

b.
� 
Infection
control program; and

c.
� 
Fire and
emergency procedures;

(6)
� 
Be at least
18 years of age if working as direct care personnel unless they are:

a.
� 
An LNA
working under the supervision of an RN in accordance with Nur 700; or

b.
� 
Part of an
established educational program working under the supervision of an RN;

(7)
� 
Prior to
contact with patients or food, submit to the HHCP the results of a physical
examination or health screening performed by a licensed nurse or a licensed
practitioner and 2-step tuberculosis (TB) testing, mantoux method, or other
method approved by the Centers for Disease Control, both conducted not more
than 12 months prior to employment, contract, or engagement;

(8)
� 
Be allowed
to work while waiting for the results of the second step of the TB test when
the results of the first test are negative for TB; and

(9)
� 
Comply with
the requirements of the Centers for Disease Control and Prevention �Guidelines
for Preventing the Transmission of 
M.
tuberculosis
 in Health-Care Settings� (2005 edition), available as noted in
Appendix A, if the person has either a positive TB test, or has had direct
contact or potential for occupational exposure to M. tuberculosis through
shared air space with persons with infectious tuberculosis.

��������� 
(i)
�

In lieu of (h)(8) above, independent agencies contracted by the facility
to provide direct care or personal care services may provide the licensee with
a signed statement that its employees have complied with (h)(7) and (9) above
before working at the HHCP.

��������� 
(j)
�

The scope of services provided by a personal care service provider shall
be as follows:

(1)
� 
Basic personal care and
grooming to include:

a.
� 
Sponge
bathing;

b.
� 
Gathering
and handing the patient materials related to bathing;

c.
� 
Regulating
the bath or shower water temperature and running the water;

d.
� 
Hair care
including shampooing;

e.
� 
Skin care to
include application of preventive skin care products;

f.
� 
Filing of
nails;

g.
� 
Assisting
with oral hygiene;

h.
� 
Shaving of
patient using an electric razor; and

i.
� 
Dressing to
include putting on or removing clothing, shoes, and stockings;

(2)
� 
Transfer assistance as
follows:

a.
� 
Weight
bearing assistance such as steadying the patient and arranging items to assist
the transfer of the patient; and

b.
� 
Non-weight
bearing assistance on a case-by-case basis as specified by the HHCP; 

(3)
� 
Mobility assistance as
follows:

a.
� 
Accompanying
the patient as he or she moves from one location to another, removing obstacles
from his or her path, opening doors, and handing the patient his or her cane or
walker;

b.
� 
Pushing a
wheelchair which has been fitted to the patient; and

c.
� 
On a
case-by-case basis steadying the patient as he or she ambulates;

(4)
� 
Assistance with toileting and
toileting hygiene measures as follows:

a.
� 
Assistance
with the use of the toilet, commode, bedpan, and urinal;

b. Assistance with the use of products related to
hygiene care such as disposable incontinent briefs or pads;

c.
� 
Assistance
with cleaning after elimination;

d.
� 
Assisting
 with cleaning the patient after 
instances
 of vomiting, diarrhea, and
 incontinence;

e.
� 
Assistance
with ostomy care in a long term, well healed, trouble free ostomy, such as
assisting in application of the stoma bag on a case-by-case basis as
individually trained by the appropriate professional staff; and

f.
� 
Assistance
with catheter care only by emptying the urinary drainage bag on a case-by-case
basis as individually trained by the appropriate professional staff;

(5)
� 
Assistance with personal
appliances as follows:

a.
� 
Insertion
and cleaning dentures;

b.
� 
Insertion
and cleaning hearing aids;

c.
� 
Cleaning and
putting on eye glasses; and

d.
� 
Assisting
with application of some types of braces, splints, slings, and prostheses on a
case-by-case basis as determined by the HHCP and individually trained by the
appropriate professional staff; and 

(6)
� 
Assistance with nutrition,
hydration, and meal preparation as follows:

a.
� 
Preparation
of the meal;

b.
� 
Arranging
food including cutting up or mashing the food;

c.
� 
Filling the
patient�s fork or spoon;

d.
� 
Encouraging
the patient to eat or drink; and

e.
� 
Feeding the
patient by mouth on a case-by-case basis as determined by the agency.

��������� 
(k)
�

The HHCP shall determine the patient-related training required by the
personal care service provider, in addition to the basic training described in
(m) below, in order to provide the personal care services which are on a
case-by-case basis as described in (j) above.

��������� 
(l)
�

Prior to assisting patients with transfers, bathing, feeding, or
dressing, personal care service providers, whose duties include the
aforementioned tasks, shall attend a minimum 8-hour training in the performance
of these duties, the clinical portion of which shall be conducted by a licensed
professional such as an LPN or RN.

��������� 
(m)
�

The training in (j) above shall include at a minimum:

(1)
� 
Orientation to home care
including the role of the personal care service provider and the general
orientation required by (h)(4) above;

(2)
� 
Communication with 
patients
, and understanding 
patient
 needs;

(3)
� 
Personal and home safety
including environmental safety and emergency response;

(4)
� 
Personal care skills
including:

a.
� 
Supervision
and verbal prompting;

b.
� 
Assisting in
bathing, dressing, grooming, mouth care, hair care, and skin care;

c.
� 
Assisting in
elimination including cleaning the patient after elimination and use of
products related to hygiene care;

d.
� 
Moving and
transferring patients;

e.
� 
Nutrition,
the mechanics of eating, hydration, and how to prepare, serve, and encourage
the patient to eat and drink;

f.
� 
Use of
assistance devices;

g.
� 
Fall
prevention; and

h.
� 
Medication
reminder training; and

(5)
� 
Responsibility,
accountability, and record keeping.

��������� 
(n)
�

LNAs who are working as personal care service providers shall be deemed
as already having received the training required in (m) above but shall be
required to receive the training required by (h)(4) above.

��������� 
(o)
�

The HHCP shall maintain a record for training of each personal care
service provider.

��������� 
(p)
�

The HHCP shall provide supervision of the personal care service provider
every 6 months.

��������� 
(q)
�

The director of patient services shall: 

(1)
� 
Coordinate the individual
training required for personal care services provided on a case-by-case basis;
and

(2)
� 
Assure that the care plan is
being carried out.

��������� 
(r)
�

All personnel shall sign a statement at the time the initial offer of
employment is made and then annually thereafter stating that they:

(1)
� 
Do not have
a felony conviction in this or any other state;

(2)
� 
Have not
been convicted of a sexual assault, other violent crime, assault, fraud, theft,
abuse, neglect, or exploitation or pose a threat to the health, safety, or
well-being of a patient; and 

(3)
� 
Have not
had a finding by the department or any administrative agency in this or any
other state for assault, fraud,theft, abuse, neglect, or exploitation of any
person.

��������� 
(s)
�

Personnel, volunteers, or independent contractors hired by the licensee
who will have direct care contact with patients or food who have a history of
TB or a positive skin test shall have a symptomatology screen in lieu of a TB
test.

��������� 
(t)
�

All personnel shall follow the
�

orders of the licensed practitioner for each patient and encourage
patients to follow the practitioner�s order.

��������� 
(u)
�

Current, separate, and complete employee files shall be maintained and
stored in a secure and confidential manner at the HHCP licensed premises.

��������� 
(v)
�

The employee records required by (u) above shall include the following:

(1)
� 
A completed
application for employment or a resume, including:

a.
�

Identification data, including date of birth; and

b.
� 
The
education and work experience of the employee;

(2)
� 
A signed
statement acknowledging the receipt of the HHCP�s policy setting forth the
patient rights and responsibilities and acknowledging training and
implementation of the policy as required by RSA 151:20; 

(3)
� 
A job
description signed by the individual that identifies the:

a.
� 
Position
title;

b.
�

Qualifications and experience; and

c.
� 
Duties
required by the position;

(4)
� 
Record of
satisfactory completion of the orientation program required by (h)(4) above and
any required continuing education program;

(5)
� 
A copy of
each current New Hampshire license, registration, or certification in a health
care field, if applicable;

(6)
�

Documentation that the required physical examination or health
screening, and TB test results or radiology reports of chest x-rays, if
required, have been completed by the appropriate health professionals;

(7)
�

Documentation of annual in-service education as required by (h)(5)
above;

(8)
�

Documentation of training as required by (m) above;

(9)
� 
The
statement signed at the time of the initial offer of employment and renewed
annually thereafter by all personnel as required by (r) above;

(10)
�

Documentation of the criminal records check; and

(11)
� 
The
results of the registry checks in (f) above.

��������� 
(w)
�

The HHCP shall maintain the records, but not necessarily a separate
file, for all volunteers and for all independent contractors who provide direct
care or personal care services to patients or who will be unaccompanied by an
employee while performing non-direct care or non-personal care services within
the facility, as follows:

(1)
� 
For volunteers, the information in (v)(2) and
(6)-(10) above; and

(2)
� 
For independent contractors, the information
in (v)(2), and (4)-(12) above, except that the letter in (h) and (j) above may
be substituted for (v)(6), (9), and (10) above, if applicable.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.18
� 
Quality Improvement
.

��������� 
(a)
�

The HHCP shall develop and implement a quality improvement program that
reviews policies and services and maximizes quality by preventing or correcting
identified problems.

��������� 
(b)
�

As part of the HHCP quality improvement program, a quality improvement
committee shall be established.

��������� 
(c)
�

The HHCP shall determine the size and composition of the quality
improvement committee based on the size of the facility and the care and
services provided.

��������� 
(d)
�

The quality improvement committee shall:

(1)
� 
Determine
the information to be monitored;

(2)
� 
Determine
the frequency with which information will be reviewed;

(3)
� 
Determine
the indicators that will apply to the information being monitored;

(4)
� 
Evaluate
the information that is gathered;

(5)
� 
Determine
the action that is necessary to correct identified problems;

(6)
� 
Recommend
corrective actions to the licensee; and

(7)
� 
Evaluate
the effectiveness of the corrective actions.

��������� 
(e)
�

The quality improvement committee shall meet at least quarterly.

��������� 
(f)
�

The quality improvement committee shall generate dated, written minutes
after each meeting.

��������� 
(g)
�

Documentation of all quality improvement activities shall be maintained
on-site for at least 2 years.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.19
� 
Infection Control and Sanitation
.

��������� 
(a)
�

The HHCP shall develop and implement an infection control program that
educates and provides procedures for the prevention, control, and investigation
of infectious and communicable diseases.

��������� 
(b)
�

The infection control program shall include written procedures for:

(1)
� 
Proper hand-washing techniques; 

(2)
� 
The
utilization of universal precautions;

(3)
� 
The management of patients with infectious or
contagious diseases or illnesses; 

(4)
� 
The
handling, storage, transportation, and disposal of those items identified as
infectious waste in Env-Sw 904; and

(5)
� 
Reporting
of infectious and communicable diseases as required by He-P 301.

��������� 
(c)
�

The infection control education program shall address at a minimum the:

(1)
� 
Causes of
infection;

(2)
� 
Effects of
infections;

(3)
�

Transmission of infections; and

(4)
� 
Prevention
and containment of infections.

��������� 
(e)
�

Personnel infected with a disease or illness transmissible through food,
fomites, or droplets, shall not prepare food or provide direct care in any
capacity until they are no longer contagious unless they utilize appropriate
infection control equipment as required by the facility�s policy and procedures
on infection control.

��������� 
(f)
�

Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux
tuberculosis skin test or a diagnosis of suspected active pulmonary or
laryngeal tuberculosis shall be excluded from the workplace until a diagnosis
of tuberculosis is excluded or until the person is on tuberculosis treatment
and has been determined to be non-infectious by a licensed practitioner.

��������� 
(g)
�

Personnel with an open wound who prepares food or provides direct care
in any capacity shall cover such wound at all times by an impermeable, durable,
tight-fitting bandage.

��������� 
(h)
�

Personnel infected with scabies or lice/pediculosis shall not provide
direct care to patients or prepare food until such time as they are no longer
infected. 

��������� 
(i)
�

If the HHCP has an incident of an infectious disease reported in (b)(5)
above, the HHCP shall contact the public health nurse in the county in which
the patient resides and follow the instructions and guidance of the nurse.

��������� 
(j)
�

Sterile supplies and equipment shall:

(1)
� 
Be stored
in dust-proof, moisture-free storage areas; and

(2)
� 
Not be
mixed with dirty supplies.

��������� 
(k)
�

If the HHCP has soiled items at itslicensed premises, they shall be
disposed of according to the facility�s infection control policies.

��������� 
(l)
�

If equipment needs to be cleaned in order to prevent contamination, the
HHCP shall develop and maintain written procedures for safe and effective
cleaning of the equipment.

��������� 
(m)
� 
The HHCP shall develop and implement a point
of care testing policy, if they provide POCT that educates and provides
procedures for the proper handling and use of POCT devices, as well as
prevention, control, and investigation of infectious and communicable diseases.

��������� 
(n)
�

The HHCP shall not re-use any equipment or supplies that require
sterilization.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P 809.20
� 
Physical Environment and Emergency
Preparedness
.

��������� 
(a)
�

The licensee shall comply with all federal, state, and local laws,
rules, codes, and ordinances for:

(1)
� 
Building;

(2)
� 
Health,
including waste disposal and water;

(3)
� 
Fire; and

(4)
� 
Zoning.

��������� 
(b)
�

The HHCP shall keep all entrances and exits to the licensed premises
accessible at all times during hours of operation.

��������� 
(c)
�

The HHCP shall be clean, maintained in a safe manner and in good repair,
and kept free of hazards.

��������� 
(d)
�

Each licensee shall develop a written emergency plan that covers any
situation that prevents the HHCP from providing patient services and which:

(1)
� 
Includes
site-specific plans for the protection of all persons on-site in their licensed
premises in the event of fire, natural disaster, severe weather, and
human-caused emergency to include, but not be limited to, a bomb threat; 

(2)
� 
Is approved
by the local emergency management director or fire department, as appropriate;

(3)
� 
Is
available to all personnel;

(4)
� 
Is based on
realistic conceptual events;

(5)
� 
Is modeled
on the incident command system (ICS) in coordination with local emergency
response agencies;

(6)
� 
Provides
that all personnel designated or involved in the emergency preparedness plan of
the facility shall be supplied with a means of identification, such as vests,
baseball caps, or hard hats, which shall be worn at all times in a visible
location during the emergency;

(7)
� 
Includes
the HHCP's response to both short-term and long-term interruptions in the
availability of utility service in the disaster or emergency, including
establishing contingency plans for continuity of essential building systems or
evacuation to include the following, as applicable:

a.
� 
Electricity;

b.
� 
Water;

c.
� 
Ventilation;

d.
� 
Fire protection systems;

e.
� 
Fuel sources; and

f.
� 
Communications systems;

(8)
� 
Includes a
plan for alerting and managing personnel in a disaster, and accessing critical
incident stress management (CISM), if necessary;

(9)
� 
Includes a
policy detailing the responsibilities of personnel for responding to an
emergency while on duty in the home of a patient;

(10)
� 
Includes
an educational, competency-based program for personnel, to provide an overview
of the components of the emergency management program and concepts of the ICS
and the personnel�s specific duties and responsibilities; and

(11)
� 
If the
HHCP is located within 10 miles of a nuclear power plant and is part of the New
Hampshire Radiological Emergency Response Plan (RERP), includes the required
elements of the RERP.

��������� 
(e)
�

Each licensee shall annually review and revise, as needed, its emergency
plan.

Source.
� 
#9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

New.
� 
#12640, eff 10-3-18

��������� 
He-P
809.21
� 
Community Health Services
.

��������� 
(a)
� 
The following rules shall not apply to the
HHCP when providing community health services:

(1)
� 
He-P 809.14
(b), The Home Care Patients Bill of Rights; and

(2)
� 
He-P
809.15:

a.
� 
Paragraphs (a) and (b) on contractual
agreement with patients;

b.
� 
Subparagraph (h)(1)a. on
� 
provision of the home care client Bill of
Rights, procedures, and policies;

c.
� 
Subparagraph (h)(3)e. on obtaining copies of
advance directives;

d.
� 
Paragraphs (i) and (j) on conducting health
assessments;

e.
� 
Paragraphs (n), (o), (p), and (q) on plan of
care;

f.
� 
Paragraph (t) on discharge plans; and

g.
� 
Paragraphs (u), (v), and (w) on
record-keeping requirements.

Source.
� 
#12640, eff 10-3-18