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 827 - FREESTANDING MEGAVOLTAGE RADIATION THERAPY FACILITY
Section He-P 827.03 - Definitions

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

(b) "Accredited hospital" means a hospital accredited by the organizations deemed by the Centers for Medicare and Medicaid Services (CMS) as accrediting organizations.

(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, by an individual authorized by law, whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.

(e) "Administrator" means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the FMRTF.

(f) "Admission" means accepted by a licensee for the provision of services to a patient.

(g) "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.

(h) "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.

(i) "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 or other companies as the commissioner shall decide.

(j) "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.

(k) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a FMRTF pursuant to RSA 151:2, I(a) and RSA 151:2-e.

(l) "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 827, or other federal or state requirements.

(m) "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, surrogate, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(n) "Change of ownership" means a change in the controlling interest of an established FMRTF to an individual or successor business entity.

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

(p) "Core services" means those minimal services to be provided to any patient by the licensee that must be included in the basic rate.

(q) "Critical incident stress management (CISM) " means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(r) "Days" means calendar days unless otherwise specified in the rule.

(s) "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 such as a certificate of completion of course material or a post-test to the training provided.

(t) "Department" means the New Hampshire department of health and human services.

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

(v) "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.

(w) "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 patient 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) ."

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

(y) "Employee" means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(z) "Enforcement action" means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license in response to non-compliance with RSA 151 or He-P 827.

(aa) "Equipment or fixtures" 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.

(ab) "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.

(ac) "Facility" means any hospital, building, residence, or other place or part thereof, where services are provided under the provisions of RSA 151:2-e.

(ad) "Freestanding megavoltage radiation therapy facility (FMRTF) " means a facility, geographically separate from the parent hospital(s), which is owned or operated, directly or indirectly, by the parent hospital(s) and that performs megavoltage therapy radiation services.

(ae) "Governing body" means a group of individuals who are responsible for policy direction of the licensee.

(af) "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.

(ag) "Hospital" means "hospital" as licensed under in RSA 151:2, I(a) .

(ah) "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.

(ai) "Independent contractor" means an individual providing service to the licensee or its clients but employed by an outside agency.

(aj) "Infectious disease" means any disease caused by the growth of microorganisms in the body which might or might not be contagious.

(ak) "Infectious waste" means those items specified by Env-Sw 904.

(al) "Informed consent" means the decision by a person or his/her guardian or agent 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.

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

(an) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 827 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 827.

(ao) "License" means the document issued by the department to an applicant at the start of operation as an FMRTF which authorizes operation of an FMRTF in accordance with RSA 151 and He-P 827, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

(ap) "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 for which the FMRTF is licensed.

(aq) "Licensed practitioner" means a:

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

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

(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 licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a FMRTF.

(av) "Medical staff" means those physicians and other licensed practitioners permitted by law and policies to provide patient care services independently within the scope of their practice acts.

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

(ax) "Megavoltage" means energy levels equal to or greater than 1.0 million electron volts or one MeV. MeV stands for megavolts.

(ay) "Megavoltage radiation therapy equipment" means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues. The term includes but is not limited to Cobalt-60 and linear accelerator machines.

(az) "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.

(ba) "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.

(bb) "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.

(bc) "Nursing care" means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.

(bd) "Orders" means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, 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.

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

(bf) "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.

(bg) "Parent hospital" means the hospital which owns and operates a FMRTF.

(bh) "Patient" means any person admitted to or in any way receiving care, services or both from a hospital or provider of special health care services licensed in accordance with RSA 151 and He-P 827.

(bi) "Patient record" means documents maintained for each person receiving care and services, which includes all documentation required by RSA 151, He-P 827 and all documentation compiled relative to the patient as required by other federal and state requirements.

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

(bk) "Personal care" means personal care services that are non-medical, hands-on services provided to a patient to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, or walking.

(bl) "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.

(bm) "Personnel" means an individual(s), who is employed by the FMRTF, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to patients.

(bn) "Physician" means medical doctor currently licensed in the state of New Hampshire pursuant to RSA 329.

(bo) "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 at the time of 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.

(bp) "Previously operating special health care service" shall mean a special health care service as defined by RSA 151:2-e that was being offered prior to July 1, 2016 and has continued to be offered since July 1, 2016.

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

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

(bs) "Qualified personnel" means personnel that have been trained to adequately perform the tasks which they perform, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bt) "Radiographic images" means x-rays or other images which are either on film, discs, paper, or stored electronically.

(bu) "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.

(bv) "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.

(bw) "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.

(bx) "Reportable incident" means an occurrence of any of the following while the patient is either in the FMRTF or in the care of personnel:

(by) "Service" means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

(bz) "Special health care service" shall mean cardiac catheterization laboratory services, open heart surgery or coronary artery bypass graft surgery, or megavoltage radiation therapy.

(ca) "Staff" means those employees of the licensee who are not subject to the credentialing process.

(cb) "State monitoring" means the placement of individuals by the department at a FMRTF to monitor the operation and conditions of the facility.

(cc) "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.