Current through Register No. 40, October 3, 2024
(a) Each
applicant for a license shall comply with the requirements of RSA 151:4II(a),
I-I, and submit the following to the department:
(1) A completed application form entitled
"Application for Residential or Health Care License," (May 2017 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 ALR-RC to be newly licensed on or
after July 1, 2016:
"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 ALR-RC to be newly licensed on or after July 1, 2016 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) A floor plan of the prospective
ALR-RC;
(3) If applicable, proof of
authorization from the New Hampshire secretary of state to do business in the
state of 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 corporation; or
c. "Certificate of Trade Name," where
applicable;
(4) The
applicable fee, in accordance with
RSA 151:5,
IX, payable in cash or, if paid by check or
money order, in the exact amount of the fee made payable to the "Treasurer,
State of New Hampshire";
(5) A
resume identifying the qualifications of the ALR-RC administrator;
(6) Copies of applicable licenses for the
ALR-RC administrator;
(7) Written
local approvals as follows:
a. For an existing
building, 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 and
drinking water and wastewater requirements;
2. The building official verifying that the
applicant complies with all applicable state building codes and local building
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,
including, at a minimum, the One and Two Family Dwelling chapter or the
Residential Board and Care chapter of the life safety code, and local fire
ordinances applicable for an assisted living residence-residential care;
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;
(8) If the ALR-RC uses
a private water supply, documentation that the water supply has been tested in
accordance with RSA 485 and
Env-Dw
702.02 and
Env-Dw
704.02, or if a public water supply, a copy of a water
bill; and
(9) The results of a
criminal records check from the NH department of safety for the applicant(s),
licensee if different than the applicant, administrator, and household
members.
(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
#2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by
#4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED:
5-28-92
