Current through Register No. 40, October 3, 2024
(a)
Each applicant for a license shall comply with the requirements of
RSA
151:4, I-III-a, and submit the following to
the department:
(1) A completed application
form entitled "Application for Residential or Health Care License" (8/4/2016
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 a
license, or imposition of a fine.";
b. For any birthing center 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 birthing center 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. section 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.
section 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 birthing
center including the location of all beds;
(3) Proof of authorization from the New
Hampshire secretary of state to do business in 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 $150.00 fee, in accordance with
RSA
151:5, XXI, 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 name and
qualifications of the birthing center administrator and medical
director;
(6) Copies of applicable
licenses, certificates, or both, for the birthing center administrator and
medical director;
(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 local applicable zoning
ordinances; and
4. The fire chief
verifying that the applicant complies with the state fire code, including the
ambulatory health care chapter of National Fire Protection Association (NFPA)
101 as adopted by the department of safety, and local fire ordinances
applicable for a birthing center; or
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
again upon completion of the construction project;
(8) If the birthing center uses a private
water supply, documentation that the water supply has been tested in accordance
with RSA 485 and Env-Dw 702.02 and 704.02, or if
a public water supply, a copy of a water bill; and
(9) For a birthing center 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. section
485.610(b) and (c) , a
letter from the chief executive officer of the hospital stating that the
proposed new birthing center will not have a material adverse impact on the
essential health care services provided in the service area of the critical
access hospital.
(b) The
applicant shall mail or hand-deliver the documents to:
Department of Health and Human Services
Health Facilities Administration
129 Pleasant Street
Concord, NH 03301
