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 815 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID)
Section He-P 815.03 - Definitions

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

(b) "Activities of daily living (ADL)" means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

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

(d) "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 resident for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) "Administrator" means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(f) "Admission" means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(g) "Advance directive" means a directive 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.

(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, or 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 identified under RSA-J:35-37.

(j) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ICF/IID pursuant to RSA 151:2, I(e).

(k) "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 815, or other federal or state requirements.

(l) "Assessment" means an evaluation of the resident to determine the care and services that are needed.

(m) "Care plan" means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if applicable, as a result of the assessment process for the provision of care and services to a resident.

(n) "Certified intermediate care facility" means an intermediate care facility that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 815.

(o) "Change of ownership" means the transfer of the controlling interest of an established ICF/IID to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(p) "Chemical restraint" means a drug or medication that is used as a restriction to manage the residents behavior or restrict the resident's freedom of movement and is not a standard treatment or dosage for the resident's condition.

(q) "Clinical Laboratory Improvement Amendments (CLIA)" means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

(r) "Commissioner" means the commissioner of the New Hampshire department of health and human services or the commissioner's designee.

(s) "Contracted employee" means a temporary employee working under the direct supervision of the ICF/IID but employed by an outside agency.

(t) "Core services" means those minimal services to be provided to any resident that must be included in the basic rate.

(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) "Department" means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

(x) "Direct care" means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(y) "Direct care personnel" means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(z) "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.

(aa) "Discharge" means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

(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 resident 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).

(ac) "Elopement" means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee's personnel.

(ad) "Emergency" means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

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

(af) "Employee" means anyone employed by the ICF/IID and for whom the ICF/IID has direct supervisory authority.

(ag) "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 the non-compliance of RSA 151 or He-P 815.

(ah) "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".

(ai) "Exploitation" means the illegal use of a resident'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 an resident through the use of undue influence, harassment, duress, deception, or fraud.

(aj) "Facility" means "facility" as defined in RSA 151:19, II.

(ak) "Governing body" means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(al) "Guardian" means a parent of a minor or a person appointed in accordance with RSA 464-A or RSA 463 to make informed decisions relative to the resident's health care and other personal needs.

(am) "Health care occupancy" means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical, or mental disability, or because of security measures not under the occupant's control.

(an) "Household member" means the caregiver, all family members, and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days.

(ao) "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.

(ap) "Infectious waste" means those items specified by Env-Sw 103.28.

(aq) "Informed consent" means the decision by a parent, a resident, guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the parent, resident, guardian, agent, or surrogate decision-maker 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.

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

(as) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 815 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 815.

(at) "Laboratory" means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, 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 disease.

(au) "License" means the document issued by the department to an applicant or licensee of an ICF/IID which authorizes operations in accordance with RSA 151 and He-P 815, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

(av) "License certificate" means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds that the ICF/IID is licensed for.

(aw) "Licensed practitioner" means:

(ax) "Licensed premises" means the building(s), or portion thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

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

(az) "Licensing classification" means the specific category of services authorized by a license.

(ba) "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.

(bb) "Mechanical restraint" means locked, secured, or alarmed ICF/IIDs or units within an ICF/IID, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ICF/IID or unit within. These do not include postural supports for residents with inadequate tone or motor control to balance independently.

(bc) "Medical director" means a medical doctor, advanced practice registered nurse, doctor of osteopathy or doctor of naturopathic medicine licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in an ICF/IID.

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

(be) "Mental illness" means "mental illness" as defined in RSA 135-C:2, X, namely "a substantial impairment of emotional processes, or of the ability to exercise conscious control of one's actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by:

(bf) "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.

(bg) "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 a resident.

(bh) "Notice to correct" means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bi) "Nursing care" means the provision or oversight of a resident's physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.

(bj) "Nutritional requirements" means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

(bk) "Orders" means a document, produced verbally, electronically, or in writing, 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.

(bl) "Over-the-counter medications" means non-prescription medications.

(bm) "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.

(bn) "Personal assistance" means providing or assisting a resident in carrying out activities of daily living.

(bo) "Personal representative" means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting a resident in the exercise of any rights.

(bp) "Personnel" means an individual who is employed by the facility, a volunteer, or an independent contractor, and provides direct care or personal care services to residents.

(bq) "Physical restraint" means the use of hands-on or other physically applied technique to physically limit the resident's freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques. Physical restraints does not include postural supports for residents with inadequate tone or motor control to balance independently.

(br) "Physician" means 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.

(bs) "Plan of correction (POC)" means a plan developed and written by the licensee, which specifies the actions that will be taken to correct 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.

(bt) "Point of care testing (POCT)" means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of resident care.

(bu) "Point of care devices" means a system of devices used to obtain medical, diagnostic results. Examples include, but are not limited to:

(bv) "Pro re nata (PRN) medication" means medication taken as circumstances might require in accordance with licensed practitioner's orders.

(bw) "Procedure" means a licensee's written, standardized method of performing duties and providing services.

(bx) "Protective care" means the provision of resident monitoring services, including but not limited to:

(by) "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.

(bz) "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.

(ca) "Renovation" means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

(cb) "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.

(cc) "Reportable incident" means an occurrence of any of the following while the resident is either in the ICF/IID or in the care of ICF/IID personnel:

(cd) "Resident" means any person admitted to or in any way receiving care, services, or both who resides in an ICF/IID.

(ce) "Resident record" means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 815 and as required by other federal and state law.

(cf) "Resident rights" means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

(cg) "Seclusion" means an intervention defined as solitary containment in a fully protective environment with close surveillance by qualified personnel for purposes of safety or behavior management.

(ch) "Service" means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(ci) "Significant change" means a decline or improvement in a resident's status that:

(cj) "State monitoring" means the placement of individuals by the department at an ICF/IID to monitor the operation and conditions of the facility.

(ck) "Supervision" means the process by which the resident is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

(cl) "Therapeutic diet" means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

(cm) "Underwriters Laboratories (UL) listed" means that the global safety certification company UL has confirmed that the product is safe for use.

(cn) "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 those persons who provide religious services or entertainment.