Section He-P 820.04 - Initial Registration Application Requirements(a) Each applicant for registration shall comply with the requirements of RSA 151:9-a, XII, and submit the following to the department: (1) A completed application form entitled "Application for Individual Home Care Service Provider Registration" (January 2023) that is signed by the applicant and which states: "I affirm that I am familiar with and in full compliance with the provisions of RSA 151:2, V, and He-P 820. I also affirm that I have not been convicted of a felony in this or any other state, have not been convicted for sexual assault, other violent crime, assault, fraud, abuse, neglect, exploitation or any other criminal offense that suggests that they may pose a threat to the health, safety or well-being of a client, and have not been found to have committed assault, fraud, abuse, neglect or exploitation by the department or any other administrative agency in this or any other state. I understand that providing false information shall be grounds for denial or revocation of my registration and the imposition of a fine.";
(2) The applicable fee, in accordance with RSA 151:5, XI, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the "Treasurer, State of New Hampshire.";(3) The results of a criminal records check, for the applicant. Results shall include the criminal history from the state of New Hampshire;(4) The results of the state registry check, which is maintained by the department's bureau of elderly and adult services pursuant to RSA 161-F:49;(5) Qualifications, including education, experience and copies of all applicable licenses for the administrator; and(6) 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; orc. "Certificate of Trade Name," where applicable.(b) The application in He-P 820.04(a)(1) shall include the following advisory: "Advisory: The New Hampshire Department of Health and Human Services is authorized to require all licensed home care providers to read and understand the Home Care Clients' Bill of Rights set forth in RSA 151:21-b, and to distribute the law to all of their clients. The Department recommends that all individual homecare service providers read and understand the Home Care Clients' Bill of Rights and share the information with their clients."
(c) 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
N.H. Admin. Code § He-P 820.04
#10013, eff 10-22-11; ss by #10206, eff 10-20-12
Amended by Number 6, Filed February 9, 2023, Proposed by #13531, Effective 1/25/2023, Expires 1/25/2033.