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 815.04 - Initial License Application Requirements
Universal Citation: NH Admin Rules He-P 815.04
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, Health Care License or Special Health Care
Services" (February 2023), signed by the owner if a private facility, 2
officers if a corporation, 2 authorized individuals if an association or
partnership, or the head of the government agency if a government unit
affirming and certifying the following:
"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.";
(2) A floor plan of
the prospective ICF/IID;
(3) If
applicable, 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," if a sole
proprietorship or if otherwise applicable;
(4) The applicable fee in accordance with
RSA
151:5, VI, payable in cash
or, if paid by check or money order, 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 ICF/IID administrator;
(6) Copies of applicable licenses,
certificates, or both for the ICF/IID 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,
RSA
153:1, VI-a, including the
appropriate occupancy chapter of the life safety code 101 and the uniform fire
code, NFPA 1, as published by the National Fire Protection Association (NFPA)
and as amended by the state board of fire control and ratified by the general
court pursuant to RSA 153:5, and local fire
ordinances applicable for a health care facility; 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 ICF/IID uses a private water
supply, documentation that the water supply has been tested in accordance with
RSA 485 and Env-Dw 702.02,
Env-Dw
704.02, or if a public water supply is used, a copy of
a water bill;
(9) The results of a
criminal records check for the applicant(s), licensee if different than the
applicant, medical director, and the administrator, as applicable;
(10) A copy of the criminal attestation as
described in He-P
815.17(m)(8) for the administrator
and medical director;
(11) If
residents are adults, the results of a BEAS registry check from the bureau of
elderly and adult services for the administrator and medical director;
and
(12) If residents are minors,
the results of the DCYF central registry check of founded report of abuse and
neglect for the administrator and medical director.
(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
Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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