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 or Health Care License" (April 2021), signed by
the applicant or 2 of the corporate officers, affirming to the following:
a. "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.";
b. For any new PRTP to
be newly licensed:
"I certify that I have notified the public of the intent to
file this application with a description of the facility to be licensed by
publishing a notice in a newspaper of general circulation covering the area
where the facility is to be located in at least 2 separate issues of the
newspaper no less than 10 business days prior to the filing of this
application."; and
c. For
any PRTP to be newly licensed and to be located within a radius of 15 miles of
a hospital certified as a critical access hospital, pursuant to
42 C.F.R.
485.610(b) and (c):
"I certify that the facility is to be located within a
radius of 15 miles of a hospital certified as a critical access hospital,
pursuant to
42 C.F.R.
485.610(b) and (c), and that
I have given written notice of the intent to file this application with a
description of the facility to be licensed to the chief executive officer of
the hospital by registered mail no less than 10 business days prior to the
filing of this application."
(2) A floor plan of the prospective
PRTP;
(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,
V, 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, qualifications, and copies of applicable licenses for the
PRTP 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,
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 and as amended by the
state board of fire control and ratified by the general court pursuant to
RSA 153:5;
and
b. For a building
under construction, the written approvals required by a. above shall be
submitted at the end of construction based on the local official's review of
the building plans and their final on-site inspection of the construction
project;
(7) If the PRTP
uses a private water supply, documentation that the water supply has been
tested in accordance with RSA 485 and
Env-Dw
702.02 and
Env-Dw
704.02, or if a public water supply is used, a copy of
a water bill; and
(8) The results
of a criminal records check from the NH department of safety for the
applicant(s), licensee if different from the applicant and the administrator
for which the application is submitted.
(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
