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 824 - HOSPICE HOUSE
Section He-P 824.04 - Initial License Application Requirements
Universal Citation: NH Admin Rules He-P 824.04
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, Health Care License or Special Health Care
Service" (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 to the
following:
"I affirm that I am familiar with the requirements of RSA 151 and the rules adopted there under 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 HH;
(3) If
applicable, proof of authorization from the New Hampshire secretary of state to
do business in the state of 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 fee, in accordance with
RSA
151:5, VII, 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) 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 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
again upon completion of the construction project;
(6) If the HH 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;
(7) A resume
identifying the qualifications of the HH administrator and medical
director;
(8) Copies of applicable
licenses for the HH administrator and medical director;
(9) The results of a criminal records check,
for the applicant, licensee if different than the applicant, administrator and
medical director which includes criminal history from the state of New
Hampshire;
(10) A copy of the
criminal attestation as described in
He-P
824.19(k)(7) for the administrator
and medical director; and
(11) The
results of a BEAS registry check from the bureau of elderly and adult services
for the administrator and medical director.
(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
#5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99
New. #9317, eff 11-8-08
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
