In this part, the following words have the following meanings, unless context clearly indicates otherwise:

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, pursuant to 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 the point in time when a patient has been accepted by a licensee for the provision of services;
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. The term “advance directive” 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) “Adverse event” means a negative consequence of care, including any misadministration as defined in He-P 4047.03(t), which results in unintended injury which might have been preventable, and which is listed in RSA 151:38;
8. (h) “Affiliated 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. This term includes “related parties”;
9. (i) “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;
10. (j) “Ambulatory surgical center (ASC)” means any building, place, or a portion thereof, exclusive of physician’s or dentist’s offices that maintains and operates services for the performance of outpatient surgical procedures;
11. (k) “Anesthesiologist” means a physician who is licensed to practice medicine in the state of New Hampshire and who is accredited by the American Board of Anesthesiology, the American College of Anesthesiology, or the American Osteopathic Board of Anesthesiology;
12. (l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ASC pursuant to RSA 151:2, I(d);
13. (m) “Area of non-compliance” means any action or failure to act, that cause a licensee to be out of compliance with RSA 151, He-P 812, or other federal or state requirements;
14. (n) “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;
15. (o) “Care plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, or the patient’s guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services to the patient. This term includes “treatment plan”;
16. (p) “Certified ASC” means an ASC certified by the Centers for Medicare and Medicaid Services (CMS) to provide Medicare or Medicaid funded care or services;
17. (q) “Certified Registered Nurse Anesthetist (CRNA)” means an advanced practice nurse who administers anesthesia for surgery or other medical procedures;
18. (r) “Change of ownership” means a change in the controlling interest of an established ASC to an individual or successor business entity;
19. (s) “Chemical restraint” means any medication that is used for discipline or staff convenience, in order to alter a patient’s behavior such that the patient requires a lesser amount of effort or care, and is not in the patient’s best interest, and not required to treat medical symptoms;
20. (t) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which sets forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens;
21. (u) “Commissioner” means the commissioner of the New Hampshire department of health and human services or their designee;
22. (v) “Contracted employee” means a temporary employee working under the direct supervision of the ASC but employed by an outside agency;
23. (w) “Controlling interest” means greater than 50% ownership interest;
24. (x) “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;
25. (y) “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;
26. (z) “Days” means calendar days unless otherwise specified in the rule;
27. (aa) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided;
28. (ab) “Department” means the New Hampshire department of health and human services;
29. (ac) “Direct care” means hands-on care or services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments;
30. (ad) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance;
31. (ae) “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)”;
32. (af) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention;
33. (ag) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency;
34. (ah) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license, or suspension of a license in response to non-compliance with RSA 151 or He-P 812;
35. (ai) “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;
36. (aj) “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;
37. (ak) “Facility” means “facility” as defined in RSA 151:19, II;

38. (al) “Good cause” means any circumstances beyond a person’s control, 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;
39. (am) “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;
40. (an) “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;
41. (ao) “Health care occupancy” means occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupants’ control;
42. (ap) “Health care services” means “health care services” as defined in RSA 151:4-a, I(a);
43. (aq) “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;
44. (ar) “Independent contractor” means an individual or business entity providing service to the licensee or its clients but not employed by the licensee;
45. (as) “Infectious waste” means those items specified by Env-Sw 904;
46. (at) “Informed consent” means the decision by a person or their guardian, agent, or surrogate decision maker, 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;
47. (au) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel;
48. (av) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 812 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 812;
49. (aw) “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;
50. (ax) “License” means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 812, 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;

51. (ay) “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 New Hampshire state licensing board;
52. (az) “Licensed premises” means the building(s) that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license;
53. (ba) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151;
54. (bb) “Licensing classification” means the specific category of services authorized by a license;
55. (bc) “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;
56. (bd) “Material adverse impact” means "material adverse impact" as defined in RSA 151:4-a, I (b);
57. (be) “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329 and certified by the American Board of Medical Specialties or certified by the American Osteopathic Association in the field of surgery or anesthesia, who is responsible for overseeing the quality of medical care and services at the ASC;
58. (bf) “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;
59. (bg) “Medical staff” means those physicians and other licensed practitioners permitted by law and ASC policies to provide patient care services independently within the scope of their practice act;
60. (bh) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance;
61. (bi) “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;
62. (bj) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any 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 or oversight by a nurse of a patient’s physical, mental, or emotional condition by diagnosis as confirmed by a licensed practitioner;
65. (bm) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for any or all medications, treatments, recommendations, or 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) “Patient” means any person admitted to or in any way receiving care, services, or both from an ASC or provider of any special health care service licensed in accordance with RSA 151 and He-P 812;
69. (bq) “Patient record” means documents maintained for each person receiving care, services, or both, which includes all documentation required by RSA 151 and He-P 812 and all documentation compiled relative to the patient as required by other federal and state requirements;
70. (br) “Patient rights” means “patient rights” as defined in RSA 151:19, VI namely, “those rights established under RSA 151:21or RSA 151:21-b, as applicable;

71. (bs) “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;
72. (bt) “Personal representative” means “personal representative” as defined in RSA 151:19, V namely, “a person other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose or for the general purpose of assisting a patient in the exercise of any rights”;
73. (bu) “Personnel” means individual who is employed by the facility, a volunteer, or an independent contractor, who provides direct or personal care or services to a patient;
74. (bv) “Physician” means a medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329;
75. (bw) “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 code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6;
76. (bx) “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;

77. (by) “Point of care devices” means testing 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 reagents to apply the blood sample for testing; or

    3. (3) A meter or monitor to calculate and show the results; including but not limited to:

       1. a. Blood glucose meters, also called “glucometers”;
       2. b. Prothrombin Time (PT) and International Normalized Ration (INR) anticoagulation meters; or
       3. c. Cholesterol meter;
78. (bz) “Procedure” means a licensee’s written standardized method of performing duties and providing services;

79. (ca) “Professional staff” means:

    1. (1) Physicians;
    2. (2) Physician assistants;
    3. (3) Advanced practice registered nurses;
    4. (4) Licensed nurses;
    5. (5) Physical therapists;
    6. (6) Speech therapists;
    7. (7) Respiratory therapists;
    8. (8) Occupational therapists;
    9. (9) Social workers; and
    10. (10) Dieticians;
80. (cb) “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;
81. (cc) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or 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;

82. (cd) “Rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

    1. (1) Addition;
    2. (2) Modification;
    3. (3) Reconstruction;
    4. (4) Renovation: and
    5. (5) Repair;
83. (ce) “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures, that does not result in reconfiguration of the building spaces within;
84. (cf) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purposes of maintaining such materials, elements, equipment, or fixtures in good or sound condition;
85. (cg) “Retention” means the date on which the retainer has been paid securing the independent contractor’s services;
86. (ch) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient;
87. (ci) “Service area” means “service area” as defined in RSA 151:4-a, I (c);
88. (cj) “Stabilize” means to provide medical care to allow the patient to be moved or transferred to another ASC or general hospital without negative effects;
89. (ck) “State building code” means “state building code” as defined in RSA 155-A:1, IV;
90. (cl) “State fire code” means “state fire code” as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5;
91. (cm) “State monitoring” means the placement of individuals by the department at an ACS to monitor the operation and conditions of the facility;
92. (cn) “Surgery” means a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedures; and
93. (co) “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 persons who provide religious services or entertainment.

Source. #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraphs (g), (p) and (q) EXPIRED: 6-27-05 New. #9727-A, eff 6-18-10, EXPIRED: 6-18-18 New. #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18 New. #12926, eff 11-26-19; ss by #14042, eff 8-6-24