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 is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.
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) “Admission” means acceptance by a licensee for the provision of care and services to a patient.
6. (f) “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes “living wills” and “durable powers of attorney for health care”, in accordance with RSA 137-J or a “surrogate decision maker” in accordance with RSA 137-J:35.
7. (g) “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.
8. (h) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker identified under RSA 137-J:35-37.
9. (i) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ESRDDC pursuant to RSA 151.
10. (j) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause(s) a licensee to be out of compliance with RSA 151, He-P 811, or other federal and state requirements.
11. (k) “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach their highest practicable level of physical, mental, and psychosocial functioning.
12. (l) “Care plan” means a documented guide developed by the licensee or their personnel, in consultation with the patient, or the patient’s guardian, personal representative, or agent, if any, as a result of the assessment process, for the provision of care and services to a patient. This term includes “treatment plan”.
13. (m) “Change of ownership” means the transfer of the controlling interest of an established ESRDDC to any individual, agency, partnership, corporation, government entity, association, or other legal entity.
14. (n) “Chemical restraint” means any drug or medication that is used as a restriction to manage a patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.
15. (o) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.
16. (p) “Commissioner” means the commissioner of the department of health and human services or their designee.
17. (q) “Contracted employee” means a temporary employee working under the direct supervision of the ESRDDC but employed by an outside agency.
18. (r) “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

19. (s) “Critical incident stress management (CISM)” means an adaptive, short-term psychological

    helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

20. (t) “Days” means calendar days, unless otherwise specified in the rule.
21. (u) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post-test to the training provided.
22. (v) “Department” means the New Hampshire department of health and human services.
23. (w) “Dialysis” means the passage of a solute through a membrane.
24. (x) “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.
25. (y) “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, psychological, or rehabilitative treatments.
26. (z) “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee needs to take to correct identified areas of non-compliance.
27. (aa) “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.
28. (ab) “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.
29. (ac) "Drug diversion" means the use of controlled substances for anything other than the intended purpose or the person to whom it was prescribed.
30. (ad) “Elopement” means when a patient leaves the licensed premises or a safe area unsupervised or unnoticed without knowledge of the licensee’s personnel, if knowledge and supervision is necessary.
31. (ae) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.
32. (af) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.
33. (ag) “Employee” means anyone employed by the ESRDDC and for whom the ESRDDC has direct supervisory authority.
34. (ah) “End stage renal disease dialysis center (ESRDDC)” means a facility which provides hemodialysis or peritoneal dialysis on an outpatient basis and any other acute or chronic dialysis related procedures as approved by their governing body.
35. (ai) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 811.
36. (aj) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.
37. (ak) “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.
38. (al) “Facility” means “facility” as defined in RSA 151:19, II.

39. (am) “Good cause” means a circumstance beyond a person’s control, that the department considers to be circumstances that prevents that person from complying with RSA 151 or He-P 811 or taking some required action, including:

    1. (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.
40. (an) “Governing body” means a group of designated person(s) functioning as a body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.
41. (ao) “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.
42. (ap) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a).
43. (aq) “Hemodialysis” means a medical procedure that facilitates removal of toxic substances from the blood of persons for whom one or both kidneys are defective or absent by passing it through an artificial kidney, dialyzer, made of semi permeable membranes which are continually bathed by solution, dialysate, which selectively remove unwanted material.
44. (ar) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.
45. (as) “Independent contractor” means an individual or business entity providing service to the licensee or its patients but not employed by the licensee.
46. (at) “Infectious waste” means those items specified by Env-Sw 103.28
47. (au) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.
48. (av) “Informed consent” means the decision by a patient, or their guardian, personal representative, or agent to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.
49. (aw) “Inspection” means the process used by the department to determine an applicant’s or a licensee’s compliance with RSA 151, He-P 811, and all other federal and state requirements or to respond to allegations of non-compliance with RSA 151 or He-P 811.
50. (ax) “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.
51. (ay) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 811, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and the license number.

52. (az) “Licensed practitioner” means:

    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) Other professional licensed by law to prescribe.
53. (ba) “Licensed premises” means the building(s) that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.
54. (bb) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.
55. (bc) “Licensing classification” means the specific category of services authorized by a license.
56. (bd) “Life safety code” means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.
57. (be) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I(b).
58. (bf) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the ESRDDC.
59. (bg) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.
60. (bh) “Medication error” means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a patient’s refusal.
61. (bi) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.
62. (bj) “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.
63. (bk) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.
64. (bl) “Nursing care” means the provision of oversight of a patient’s physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.
65. (bm) “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.
66. (bn) “Over-the-counter medications” means non-prescription medications.
67. (bo) “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.
68. (bp) “Parenteral” means any non-oral means of administration, but is generally interpreted as relating to injecting directly into the body, bypassing the skin and mucous membranes. The common parenteral routes are intramuscular (IM), subcutaneous (SC) and intravenous (IV).
69. (bq) “Patient” means any person admitted to or in any way receiving care, services, or both from a ESRDDC licensed in accordance with RSA 151 and He-P 811.
70. (br) “Patient record” means documents maintained for each patient receiving care and services, which includes all documentation required by RSA 151 and He-P 811 and all documentation compiled relative to the patient as required by other federal and state requirements.
71. (bs) “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.
72. (bt) “Patient’s personal representative” means “patient’s personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having direct or indirect ownership interest in a facility, who is designated in writing by a patient or patient’s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights”. This term includes “personal representative”.

73. (bu) “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.
74. (bv) “Peritoneal dialysis” is a type of dialysis which uses the lining of the abdomen, peritoneum, as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure.
75. (bw) “Personnel” means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a patient(s).
76. (bx) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the patient’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.
77. (by) “Physician” means a medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.
78. (bz) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

79. (ca) “Point of care testing (POCT)” means laboratory testing to obtain medical, diagnostic results performed at or near the site of patient care involving a system of devices, typically including:

    1. (1) A lancing or finger stick device to get the blood sample;
    2. (2) A test strip or regents to apply to a specimen to 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.
80. (cb) “Pro re nata (PRN) medication” means medication administered as circumstances might require in accordance with licensed practitioner’s orders.
81. (cc) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.
82. (cd) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.
83. (ce) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.
84. (cf) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.
85. (cg) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

86. (ch) “Reportable incident” means an occurrence of any of the following while the patient is either in the ESRDDC or in the care of ESRDDC personnel:

    1. (1) The unanticipated death of a patient which is not related to their diagnosis or underlying condition;
    2. (2) A patient’s elopement from the ESRDDC;
    3. (3) Circumstances that resulted in the notification or involvement of law enforcement or safety officials;
    4. (4) Medication errors; and
    5. (5) Drug diversion.
87. (ci) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services.
88. (cj) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.
89. (ck) “Service area” means “service area” as defined in RSA 151:4-a, I (c).

90. (cl) “Significant change” means a decline or improvement in a patient’s status that:

    1. (1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;
    2. (2) Impacts more than one area of the patient’s health status; and
    3. (3) Requires interdisciplinary review or revision of the care plan.
91. (cm) “State building code” means “state building code” as defined in RSA 155-A:1, IV.
92. (cn) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5.
93. (co) “State monitoring” means the placement of individuals by the department at an ESRDDC to monitor the operation and conditions of the facility.
94. (cp) "Surrogate decision-maker" means an adult individual who has health care decision-making capacity, is available upon reasonable inquiry, is willing to make health care decisions on behalf of a patient who lacks health care decision-making capacity, and is identified by the attending practitioner as the person who is to make those decisions in accordance with RSA 137-J. This term includes “surrogate”.
95. (cq) “Transfer” means moving a patient from one licensed facility or entity to another licensed facility or entity.
96. (cr) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.
97. (cs) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

Source. #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20 New. #12985, eff 1-29-20; ss by #14206, eff 2-28-25