New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-P - Former Division of Public Health Services
Chapter He-P 800 - RESIDENTIAL CARE AND HEALTH FACILITY RULES
Part He-P 812 - RULES FOR AMBULATORY SURGICAL CENTERS
Section He-P 812.03 - Definitions

(a) "Abuse" means any one of the following:

(b) "Addition" means an increase in the building area, aggregate floor area, building height, or number of stories of a structure;

(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;

(d) "Administrator" means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises;

(e) "Admission" means the point in time when a patient has been accepted by a licensee for the provision of services;

(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 he or she 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;

(g) "Adverse event" means a negative consequence of care, including any misadministration as defined in He-P 4000, which results in unintended injury which might have been preventable, and which is listed in RSA 151:38;

(h) "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;

(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;

(j) "Ambulatory surgical center (ASC) " means any building, place, or a portion thereof, exclusive of physician or dentist's offices that maintains and operates services for the performance of outpatient surgical procedures;

(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;

(l) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a ASC pursuant to RSA 151:2, I(d) ;

(m) "Area of non-compliance" means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 812, or other federal or state requirements;

(n) "Assessment" means an evaluation of the patient to determine the care and services that are needed;

(o) "Care plan or treatment plan" means a documented guide developed by the licensee, in consultation with personnel, the patient, and/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;

(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;

(q) "Certified Registered Nurse Anesthetist (CRNA) " means an advanced practice nurse who administers anesthesia for surgery or other medical procedures under the direction of an anesthesiologist;

(r) "Change of ownership" means a change in the controlling interest of an established ASC to an individual or successor business entity;

(s) "Commissioner" means the commissioner of the New Hampshire department of health and human services or his or her designee;

(t) "Contracted employee" means a temporary employee working under the direct supervision of the ASC but employed by an outside agency;

(u) "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 effects 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;

(v) "Days" means calendar days unless otherwise specified in the rule;

(w) "Demonstrated competency" means the ability of the employee to demonstrate to an evaluator that he or she is able 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;

(x) "Department" means the New Hampshire department of health and human services;

(y) "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;

(z) "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) ";

(aa) "Emergency plan" means a document outlining the responsibilities of personnel in an emergency;

(ab) "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 RSA 151 or He-P 812;

(ac) "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;

(ad) "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;

(ae) "Facility" means "facility" as defined in RSA 151:19, II;

(af) "Governing body" means a group of individuals who are responsible for policy direction of the ASC;

(ag) "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;

(ah) "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;

(ai) "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;

(aj) "Infectious waste" means those items specified by Env-Sw 904;

(ak) "Informed consent" means the decision by a person or his/her 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;

(al) "In-service" means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel;

(am) "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;

(an) "License" means the document issued by the department to an applicant at the start of operation of an ASC 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 licensing classification, the effective date, and license number;

(ao) "License certificate" means the document issued by the department to an applicant or licensee that contains the information on a license and includes the name of the administrator and the type(s) of services authorized;

(ap) "Licensed practitioner" means a:

(aq) "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;

(ar) "Licensee" means any person or legal entity to which a license has been issued pursuant to RSA 151;

(as) "Licensing classification" means the specific category of services authorized by a license;

(at) "Life safety code" means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

(au) "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;

(av) "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 his or her practice act;

(aw) "Medication" means a substance available with or without a prescription, which is used as a curative or remedial substance;

(ax) "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.

(ay) "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;

(az) "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;

(ba) "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;

(bb) "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;

(bc) "Over-the-counter medications" means non-prescription medications;

(bd) "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;

(be) "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;

(bf) "Patient rights" means the privileges and responsibilities possessed by each patient provided by RSA 151:21;

(bg) "Performance-based design" means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions;

(bh) "Personal representative" means a person 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;

(bi) "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;

(bj) "Physician" means a medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329;

(bk) "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;

(bl) "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;

(bm) "Point of care devices" means testing involving a system of devices, typically including:

(bn) "Procedure" means a licensee's written standardized method of performing duties and providing services;

(bo) "Professional staff" means:

(bp) "Qualified personnel" means any 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;

(bq) "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;

(br) "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;

(bs) "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;

(bt) "Stabilize" means to provide medical care to allow the patient to be moved or transferred to another ASC or general hospital without negative effects;

(bu) "Surgery" means a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedures; and

(bv) "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.