Section He-P 826.03 - Definitions(a) "Abuse" means any one of the following: (1) "Emotional abuse" means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of clients;(2) "Physical abuse" means the misuse of physical force which results or could result in physical injury to clients; or(3) "Sexual abuse" means contact or interaction of a sexual nature involving clients without his or her informed consent.(b) "Activities of daily living (ADL) " means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.(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 whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.(e) "Administrator" means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.(f) "Admission" means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility.(g) "Advance directive" means a directive 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, or a surrogate decision-maker in accordance with RSA 137-J:35.(h) "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.(i) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a SUD-RTF pursuant to RSA 151.(j) "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 826, or other federal and state requirements.(k) "Building rehabilitation" means any of the following undertaken in an existing building, as defined in this section:(l) "Change of ownership" means a change in the controlling interest of an established SUD-RTF to an individual or successor business entity.(m) "Chemical restraints" means any medication prescribed to control a client's behavior or emotional state without a supporting diagnosis or when used for the convenience of program staff.(n) "Client" means any person admitted to or in any way receiving care, services, or both from a SUD-RTF licensed in accordance with RSA 151 and He-P 826. This includes children residing in a SUD-RTF with a mother who is receiving SUD-RTF services.(o) "Client record" means documents maintained for each client receiving care and services, which includes all documentation required by RSA 151 and He-P 826 and all documentation compiled relative to the client as required by other federal and state requirements.(p) "Commissioner" means the commissioner of the New Hampshire department of health and human services, or his or her designee.(q) "Contracted employee" means a temporary employee working under the direct supervision of the SUD-RTF but employed by an outside agency.(r) "Core services" means those minimal services to be provided to any client by the licensee that must be included in the basic rate.(s) "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.(t) "Days" means calendar days unless otherwise specified in the rule.(u) "Demonstrated competency" means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post test to the training provided.(v) "Department" means the New Hampshire department of health and human services.(w) "Direct care" means hands on care and services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.(x) "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.(y) "Dietitian" means a person who is licensed under RSA 326-H.(z) "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 client 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) ." (aa) "Dual-diagnosis" means a client who has signs and symptoms of a concurrent substance related and mental health disorder.(ab) "Emergency plan" means a document outlining the responsibilities of personnel in an emergency.(ac) "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 826.(ad) "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.(ae) "Evaluation" means a multi-disciplinary assessment of level of function by healthcare professionals licensed or certified in the field of substance use disorder rehabilitation which enables facility staff to plan care that allows the client to reach his or her highest practicable level of physical, mental, and psychosocial functioning.(af) "Exploitation" means the illegal use of a client'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 client through the use of undue influence, harassment, duress, deception, or fraud.(ag) "Facility" means "facility" as defined in RSA 151:19, II.(ah) "Full medical withdrawal management" means clients who receive 24-hour nursing supervision overseen by a licensed practitioner, who may be incapable of evacuating a facility on their own or may have medical conditions that require immediate medical intervention, such as seizures, tremors, delirium, cardiac, or a danger to themselves or others.(ai) "Guardian" means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client's health care and other personal needs.(aj) "Health care occupancy" means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant's control.(ak) "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.(al) "Infectious waste" means those items specified by Env-Sw 103.28.(am) "Informed consent" means the decision by a person, or his or her guardian or agent, or surrogate decision-maker 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.(an) "In-service" means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.(ao) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 826 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 826.(ap) "Intoxication" means a clinical state marked by dysfunctional changes in physiological functioning, psychological functioning, mood state, or cognitive process as a consequence of consumption of a psycho-active substance.(aq) "License" means the document issued by the department to an applicant at the start of operation as a SUD-RTF which authorizes operation of a SUD-RTF in accordance with RSA 151 and He-P 826, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.(ar) "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 SUD-RTF is licensed.(as) "Licensed clinical supervisor" means an RN licensed under the state of New Hampshire pursuant to RSA 326-B, or an individual licensed by the board of licensing for alcohol and other drug use professionals or board of mental health practice to practice and supervise substance use counseling who meets the initial licensing qualifications set forth in RSA 330-C:18.(at) "Licensed counselor" means a master licensed alcohol and drug counselor (MLADC), a licensed alcohol and drug counselor (LADC), or a licensed mental health professional who has demonstrated competency in the treatment of substance use disorders.(au) "Licensed practitioner" means a: (2) Physician's assistant;(3) Advanced practice registered nurse (APRN);(4) Doctor of osteopathy;(5) Doctor of naturopathic medicine; or(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.(av) "Licensed premises" means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.(aw) "Licensee" means any person or other legal entity to which a license has been issued pursuant to RSA 151.(ax) "Licensing classification" means the specific category of services authorized by a license.(ay) "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.(az) "Limited medical withdrawal management" means clients are capable of evacuating the facility without assistance, medically cleared to participate in limited medical withdrawal management by a licensed practitioner prior to or at the time of admission, and not a danger to themselves or others. Clients may be receiving maintenance medication for the symptoms of withdrawal or side effects but not need immediate medical intervention.(ba) "Mechanical restraint" means locked or secured SUD-RTFs or units within a SUD-RTF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the SUD-RTF or unit within.(bb) "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 SUD-RTF.(bc) "Medically cleared" means a determination made within 24 hours prior to admission by the medical director that an individual is physically capable of participating in facility activities and programming and not at risk of medical complications that would be unmanageable by the facility.(bd) "Medication" means a substance available with or without a prescription, which is used as a curative or remedial substance.(be) "Modification" means the reconfiguration of any space, the addition, relocation, 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.(bf) "Neglect" means an act or omission that 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 a client.(bg) "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.(bh) "Nursing care" means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.(bi) "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.(bj) "Over-the-counter medications" means non-prescription medications.(bk) "Patient rights" means the privileges and responsibilities possessed by each client provided by RSA 151:21. This term includes "resident rights" and "client rights."(bl) "Personal care" means personal care services that are non-medical, hands-on services provided to a client 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.(bm) "Personal representative" means a person designated in accordance with RSA 151:19, V to assist the client for a specific limited purpose or for the general purpose of assisting the client in the exercise of any rights.(bn) "Personnel" means and individual who is employed by the facility, a volunteer, or an independent contractor who provides direct or personal care services to clients.(bo) "Physical restraint" means the use of hands-on or other physically applied technique to physically limit the client's freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques.(bp) "Plan of correction (POC) " means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.(bq) "Point of care testing (POCT) " means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.(br) "Point of care devices" means testing involving a system of devices, typically including: (1) A lancing or finger stick device to get the blood sample;(2) A test strip to apply the blood sample; or(3) A meter or monitor to calculate and show the results; including: a. Blood glucose meters, also called "glucometers";b. Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or(bs) "Procedure" means a licensee's written, standardized method of performing duties and providing services.(bt) "Pro re nata (PRN) medication" means medication taken as circumstances may require in accordance with licensed practitioner's orders.(bu) "Protective care" means the provision of client monitoring services which includes: (1) Knowledge of client whereabouts;(2) Minimizing the likelihood of accident or injury; and(3) Other means of ensuring client safety.(bv) "Qualifications" means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.(bw) "Qualified personnel" means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control or kitchen staff trained in food safety protocols.(bx) "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. (by) "Removal" means requesting an individual to remove himself/herself to an area with fewer distractions until he/she can participate in activities without disrupting the client's current social environment according to a written behavioral program.(bz) "Renovation" means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces. (ca) "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.(cb) "Reportable incident" means an occurrence of any of the following while the client is either in the SUD-RTF or in the care of SUD-RTF personnel: (1) The unanticipated death of the client;(2) An injury to a client, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or(3) The unexplained absence of a client from the SUD-RTF who is determined to be a danger to themselves or others.(cc) "Residential treatment" means clients receive clinical treatment for substance use disorder in a residential setting but do not require limited or full medical withdrawal management. Clients may or may not require medication supervision and general oversight with regard to knowing the clients whereabouts but do not require medications for the signs and symptoms of withdrawal. This also includes residential treatment facilities where the residence has paid staff who provide clinical services, 24-hour structure, staff available as needed, urine drug testing conducted, documentation maintained, and clinical treatment services that are required as a condition of residency and provided by the person, owner, developer, business organization, or any subsidiary thereof. This does not apply to intensive outpatient services certified per He-W 513.(cd) "Self administration of medication with assistance" means the client takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.(ce) "Self administration of medication without assistance" means an act whereby the client takes his or her own medication(s) without the assistance of another person.(cf) "Self-directed medication administration" means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions, injections, or filling insulin syringes.(cg) "Service" means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client. (ch) "Significant change" means a change in cognitive or physical capabilities that decreases a client's ability to care for himself beyond an episodic event.
(ci) "Social or non-medical withdrawal management" means a treatment service provided by appropriately trained staff who provide 24-hour supervision, observation, and support for clients who are intoxicated or experiencing withdrawal with no staff-administered medication.(cj) "State monitoring" means the placement of individuals by the department at a SUD-RTF to monitor the operation and conditions of the facility.(ck) "Substance use disorder residential treatment facility" (SUD-RTF) means a place, excluding hospitals as defined in RSA 151-C:2, which provides residential substance use disorder treatment relating to the individual's medical, physical, psychosocial, vocational, and educational needs.(cl) "Therapeutic diet" means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the client.(cm) "Treatment plan" means a written guide developed by the licensee, in consultation with the licensed practitioner, personnel, the client, or the client's guardian, agent, surrogate decision-maker, or personal representative, if any, as a result of the evaluation process for the provision of care and services.(cn) "Unlicensed staff" means those staff working at the SUD-RTF that perform direct care to clients but do not hold a license issued by the State of New Hampshire.(co) "Unexplained absence" means an incident involving a client leaving the premises of the SUD-RTF without the knowledge of the SUD-RTF personnel in a manner that is contrary to their normal routine.(cp) "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.(cq) "Withdrawal management" means a residential treatment service provided by appropriately trained staff who provide 24-hour supervision, observation, and support for clients who are intoxicated or experiencing withdrawal with prescription medication administered based on the results of an appropriate evaluation tool.N.H. Admin. Code § He-P 826.03
Derived From Volume XXXVIII Number 45, Filed November 8, 2018, Proposed by #12658, Effective 11/1/2018, Expires 11/1/2028.