1. (a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

   1. (1) Has a bachelor’s degree in business administration or health and human services;
   2. (2) Is a licensed physician in the state of New Hampshire;
   3. (3) Is a certified midwife or certified nurse midwife (CNM) in the state of New Hampshire; or
   4. (4) Is an APRN-CNM in the state of New Hampshire.
2. (b) The administrator shall designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their absence.
3. (c) The administrator shall be responsible for maintaining that the birthing center is in full compliance with federal, state, and local laws, rules, codes, and ordinances at all times.

4. (d) The licensee shall establish a process for verifying the credentials of personnel involved in the direct care of the patient which includes written documentation that:

   1. (1) The individual is licensed or certified to practice health care in New Hampshire, if required; and
   2. (2) The individual has the requisite education and experience to meet the requirements of the position, and required by this section.

5. (e) In addition to (d) above, the licensee shall:

   1. (1) Document that each employee involved in the direct care of patients has been advised of the duties that they might perform and established competency in performing those duties;
   2. (2) Establish in writing the process for updating the scope of practice of personnel as necessary; and
   3. (3) Conduct an annual review of all credentialed personnel and document the review in their file.

6. (f) The licensee shall provide medical services that include the appointment of a medical director who:

   1. (1) Is a physician licensed in the state of New Hampshire;
   2. (2) Is an APRN-CNM licensed in the state of New Hampshire; or
   3. (3) Is a doctor of naturopathic medicine with certification in natural childbirth.

7. (g) The medical director shall:

   1. (1) Participate in the development of policies and procedures for the birthing center;
   2. (2) Participate in the birthing center’s quality improvement program; and
   3. (3) Provide consultation to the birthing center’s personnel.

8. (h) In addition to (f) above, the licensee shall:

   1. (1) Provide qualified personnel sufficient to meet the needs of patients that, at a minimum, shall include:

      1. a. A primary caregiver to attend each birth that is:

         1. 1. An obstetrician;
         2. 2. A family practice physician;
         3. 3. A licensed APRN;
         4. 4. A certified midwife; or
         5. 5. A naturopathic doctor with certification in natural childbirth; and
      2. b. A second person to attend each birth that has been verified by the birthing center as being appropriately credentialed as specified in (d) above;
   2. (2) Have at least 2 persons on call when births are anticipated, one of whom is a person listed under (h)(1)(a) above; and

   3. (3) Provide the following services in the birthing center or at the home of the patient :

      1. a. Orientation to the birthing center, the fees, and the services of the birthing center;
      2. b. Education for pregnancy, labor, breastfeeding, infant care, early discharge, parenting, and sibling preparation;
      3. c. Prenatal care;
      4. d. Intrapartum care;
      5. e. Postpartum care;
      6. f. Follow up care for the mother and newborn; and
      7. g. Medication services in accordance with He-P 810.19.

9. (i) The following services shall be prohibited in the birthing center or at the home of the patient :

   1. (1) Regional or general anesthesia including awake sedation;
   2. (2) Vacuum extraction; and
   3. (3) Chemical induction and augmentation.
10. (j) The licensee shall provide dietary services that include light nourishment during labor and postpartum.
11. (k) The licensee may only perform point of care testing (POCT), that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808.

12. (l) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

    1. (1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and
    2. (2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

13. (m) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

    1. (1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;
    2. (2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, and reporting results; and
    3. (3) All recommended and required quality control procedures for POCT meters and devices.
14. (n) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493.

Source. #8957, eff 7-27-07, EXPIRED: 7-27-15 New. #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.15)