1. (a) “Abuse” means any one of the following:

   1. (1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;
   2. (2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and
   3. (3) “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without their informed consent.
2. (b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.
3. (c) “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.
4. (d) “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.
5. (e) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies.
6. (f) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35-37.
7. (g) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a NEWCC pursuant to RSA 151.
8. (h) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.
9. (i) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.
10. (j) “Change of ownership” means the transfer of the controlling interest of an established NEWCC to any individual, agency, partnership, corporation, government entity, association, or other legal entity.
11. (k) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.
12. (l) “Commissioner” means the commissioner of the department of health and human services or their designee.
13. (m) “Contracted employee” means a temporary employee working under the direct supervision of the NEWCC, but employed by an outside agency.
14. (n) “Controlling interest” means greater than 50% ownership interest.
15. (o) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.
16. (p) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.
17. (q) “Days” means calendar days unless otherwise specified in the rule.
18. (r) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.
19. (s) “Department” means the New Hampshire department of health and human services.
20. (t) “Direct care” means hands-on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.
21. (u) “Discharge instructions” means instructions developed as a result of the assessment process in the provision of services.
22. (v) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions required of the licensee to correct areas of non-compliance.
23. (w) “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes “do not attempt resuscitation order (DNAR order)”.
24. (x) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.
25. (y) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 806.
26. (z) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes “fixtures”.
27. (aa) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.
28. (ab) “Facility” means “facility” as defined in RSA 151:19, II.

29. (ac) “Good cause” means any circumstances beyond a person’s control, that the department considers to be circumstances that prevents that person from taking some required action, including:

    1. (1) A death in the person’s immediate family;
    2. (2) Personal injury or serious illness of the person or an immediate family member; or
    3. (3) Another compelling reason or justification.
30. (ad) “Governing body” means a person or group of designated persons that appoints the administrator and is legally responsible for establishing and implementing policies regarding the management and operation of the facility.
31. (ae) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.
32. (af) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).
33. (ag) “Health screening services” means assessment or testing performed for the purpose of assessing a patient’s risk of having a disease or condition and where the patient with an elevated risk is not diagnosed or treated but encouraged to contact a licensed provider for diagnosis and treatment as needed. This term does not include any on-site services provided by a licensed NEWCC.
34. (ah) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.
35. (ai) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.
36. (aj) “Infectious waste” means those items specified by Env- Sw 103.28.
37. (ak) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.
38. (al) “Informed consent” means the decision by a person or their guardian, personal representative, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person, guardian, personal representative, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.
39. (am) “Inspection” means the process followed by the department to determine an applicant or a licensee’s compliance with RSA 151 and He-P 806 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151, and He-P 806.
40. (an) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.
41. (ao) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 806, and includes the name of the licensee, the name of the business, the physical address, the licensing category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number.

42. (ap) “Licensed practitioner” means a:

    1. (1) Medical doctor;
    2. (2) Physician’s assistant;
    3. (3) Advanced practice registered nurse (APRN);
    4. (4) Doctor of osteopathy;
    5. (5) Doctor of naturopathic medicine; or
    6. (6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

43. (aq) “Licensed premises” means a physical location where care and services pursuant to He-P 806 are provided, including:

    1. (1) The building or buildings at a site specific address; or
    2. (2) A mobile vehicle that is registered to a site specific address.
44. (ar) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.
45. (as) “Licensing classification” means the specific category of services authorized by a license.
46. (at) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.
47. (au) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b).
48. (av) “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B, who is responsible for overseeing the quality of medical care and services at the NEWCC.
49. (aw) “Medical staff” means those physicians and other licensed practitioners permitted by law and NEWCC policies to provide patient care services within the scope of their license.
50. (ax) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.
51. (ay) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.
52. (az) “Mobile NEWCC vehicle” means a vehicle capable of traveling under its own power or being towed from site to site and fully equipped to meet all the requirements specific in section He-P 806.22.
53. (ba) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.
54. (bb) “Neglect” means an act or omission, that results or could result in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a patient.
55. (bc) “Non-emergency walk-in care center (NEWCC)” means a medical facility where a patient can receive medical care which is not of an emergency life-threatening nature, without making an appointment and without the intention of developing an ongoing care relationship with the licensed practitioner. This term includes such facilities that are self-described as urgent care centers, retail health clinics, and convenient care clinics. A NEWCC can be a stand-alone entity, an entity located within a retail store or pharmacy or a mobile vehicle, which can be owned and operated by the retail store or pharmacy, or be owned and operated by a third party.
56. (bd) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.
57. (be) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.
58. (bf) “Over-the-counter medications” means non-prescription medications.
59. (bg) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.
60. (bh) “Patient” means any person registered to or in any way receiving care, services, or both from a NEWCC licensed in accordance with RSA 151 and He-P 806.
61. (bi) “Patient record” means documents maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 806 and all documentation compiled relative to the person receiving care and services as required by other applicable federal and state requirements.
62. (bj) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

63. (bk) “Performance-based design” means an engineering approach to fire protection design and construction based on:

    1. (1) Established fire safety goals and objectives;
    2. (2) Deterministic and probabilistic analysis of fire scenarios; and
    3. (3) Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.
64. (bl) “Personal representative” means “patient’s personal representative” as defined in RSA 151:19, V.
65. (bm) “Personnel” means an individual(s) who is employed by the facility, a volunteer of, or an independent contractor of a NEWCC who provides services to a patient.
66. (bn) “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.
67. (bo) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.
68. (bp) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

69. (bq) “Point of care devices” means testing involving a system of devices, typically including, but not limited to:

    1. (1) A lancing or finger stick device to get the blood sample;
    2. (2) A test strip or reagents to apply the blood sample for testing; or

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

       1. a. Blood glucose meters, also called “glucometers”;
       2. b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or
       3. c. A Cholesterol meter.
70. (br) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.
71. (bs) “Professional staff” means staff who are licensed, registered, or certified by the state to provide health care services.
72. (bt) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.
73. (bu) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.
74. (bv) “Register” means the point in time when a patient has been accepted by a licensee for the provision of services.
75. (bw) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that do not result in a reconfiguration of the building spaces within.
76. (bx) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

77. (by) “Reportable incident” means an occurrence of any of the following while the patient is either in the NEWCC or in the care of NEWCC personnel:

    1. (1) The unanticipated death of the patient;
    2. (2) An injury to a patient, that is of a suspicious nature or potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the patient;
    3. (3) The unexplained absence of a patient from the NEWCC who is determined to be a danger to themselves or others;
    4. (4) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;
    5. (5) Medication errors; and
    6. (6) Drug diversion.
78. (bz) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.
79. (ca) “Security provisions” means locked when not in use.
80. (cb) “ Service area” means “service area” as defined in RSA 151:4-a, I (c).
81. (cc) “Stabilize” means to provide medical care to allow the patient to be moved or transferred to another facility.
82. (cd) “State building code” means “state building code” as defined in RSA 155-A:1, IV.
83. (ce) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.
84. (cf) “State monitoring” means the placement of individuals by the department at an NEWCC to monitor the operation and conditions of the facility.
85. (cg) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

Source. #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (a), (i), (j) and (m) EXPIRED: 1-13-03 New. #9655, eff 2-13-10, EXPIRED: 2-13-18 New. #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19 New. #12795, eff 5-30-19; ss by #13987, eff 5-30-24