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 819 - CASE MANAGEMENT AGENCIES
Section He-P 819.04 - Initial License Application Requirements
Universal Citation: NH Admin Rules He-P 819.04
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 applicant or 2 of the corporate
officers affirming 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) 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 company; or
c. "Certificate of Trade Name," where
applicable;
(3) The
applicable fee, in accordance with
RSA
151:5, XXII 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";
(4) A resume identifying the qualifications
of the CMA administrator;
(5)
Copies of applicable licenses for the CMA administrator;
(6) 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 and local fire
ordinances; and
b. For a
building under construction, the written approvals required by a. above shall
be submitted at the time of application based on the local official's review of
the building plans and again upon completion of the construction project;
and
(7) For the
applicant(s), licensee, and administrator, the results of a criminal records
check. Results shall include criminal history from the state of New
Hampshire.
(b) The applicant shall mail or hand-deliver the documents to:
Department of Health and Human Services
Bureau of Licensing and Certification
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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