CHAPTER
He-M 300 RIGHTS
PART
He-M 301 CLIENT RIGHTS IN COMMUNITY
PROGRAMS AND COMMUNITY RESIDENCES - RESERVED
Source. #2014, eff 5-14-82;
ss by #2799, eff 8-3-84; rpld by #4410, eff 4-27-88
PART
He-M 302 CLIENT RIGHTS PROTECTION
PROCEDURES - RESERVED
Source. (See Revision Note at part heading for He-M
202); rpld by #5832, eff
5-26-94
PART
He-M 303 EMERGENCY TREATMENT - EXPIRED
Source. #2420, eff 7-12-83,
EXPIRED: 7-12-89
PART
He-M 304 CLIENT RIGHTS IN STATE
FACILITIES - RESERVED
Source. #1504, eff 1-1-80;
ss by #2785, eff 7-31-84; rpld by #4411, eff 4-27-88
PART
He-M 305 PERSONAL SAFETY EMERGENCIES
Statutory
Authority: RSA 135-C:57, V; RSA 135-C:61 XI, XII
He-M
305.01 Purpose. The purpose of these rules is to define the
circumstances in which, and mechanisms by which, involuntary emergency
treatment, seclusion, or restraint can be provided in facilities serving adults
and children with mental illness. These emergency interventions are designed to
be effective, safe, and time-limited and utilized only after all less
restrictive options have been exhausted.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New.
#11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.02 Definitions.
(a) “Advance practice registered nurse (APRN)”
means advanced practice registered nurse as defined in RSA 135-C:2, II-a,
namely, “an advanced practice registered nurse licensed by the board of nursing
who is certified as a psychiatric mental health nurse practitioner by a
board-recognized national certifying body.”
(b) “CMS regional office” means the office of the
U.S. Department of Health and Human Services, Branch Chief, Survey and
Enforcement Branch, Centers for Medicare & Medicaid Services, Room 2275,
John F. Kennedy Federal Building, Boston, Massachusetts 02203.
(c) “Child” means “child” as defined in RSA
126-U:1, I.
(d) “Department” means the department of health
and human services.
(e) “Facility” means New Hampshire hospital,
Glencliff home for the elderly, or any other treatment program designated under
RSA 135-C:26
(f) “Individual” means a person receiving
services from a facility.
(g) “Informed decision” means a choice made
voluntarily by an individual or applicant for services or, where appropriate,
such person's legal guardian, after all relevant information necessary to making
the choice has been provided, when:
(1) The person understands that he or she is free
to choose or refuse any available alternative;
(2) The person clearly indicates or expresses his
or her choice; and
(3) The choice is free from all coercion.
(h) “Nursing staff” means a registered or
licensed practical nurse or other care provider working under the direct
supervision of a registered nurse.
(i) “Personal safety
emergency” means a physical status or a mental status and an act or pattern of behavior
of an individual which, if not treated immediately, will result in serious
physical harm to the individual or others.
(j) “Physician” means a medical doctor licensed
in the state of New Hampshire who is employed by, consultant to, or otherwise under
contract with a facility.
(k) “Restraint” means:
(1) Any drug or medication when it:
a. Is used as a restriction to manage an
individual’s behavior or restrict the individual’s freedom of movement; and
b. Is not a standard treatment or dosage for the
individual’s condition, in that its overall effect reduces an individual’s
ability to effectively or appropriately interact; or
(2) Any manual method, physical or mechanical
device, material, or equipment that immobilizes an individual or reduces the
ability of an individual to move his or her arms, legs, head, or other body
parts freely but does not include devices, such as orthopedically prescribed
devices, surgical dressings or bandages, protective helmets, or other methods
that involve the physical holding of an individual, if necessary, for the
purpose of:
a. Conducting routine physical
examinations or tests;
b. Protecting the individual
from falling out of bed; or
c. Permitting the individual to
participate in activities without the risk of physical harm; or
(3) The term restraint means “restraint” as
defined in RSA 126-U:1, IV as applied to a person who has not reached 18 years
of age, or who is otherwise a child as defined by RSA 126-U:1, I.
(l) “Seclusion” means the involuntary confinement
of an individual who:
(1) With regard to a person who is 18 or older:
a. Is placed alone in a room or area from which
the individual is physically prevented, by lock or person, from leaving; and
b. Cannot or will not make an informed decision
to agree to such confinement; or
(3) The term “seclusion” as defined in RSA
126-U:1, V-a as applied to a person who has not reached 18 years of age, or who
is otherwise a child as defined by RSA 126-U:1, I.
(m) “Training” means provision of education to
staff, based on the specific needs of the individual population, resulting in
demonstrated knowledge and documented competency.
(n) “Treatment” means medical or psychiatric
care, excluding seclusion or restraint, provided by a physician, or a person
acting under the direction of a physician, in accordance with generally
accepted clinical and professional standards.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.03 Emergency Response.
(a) As soon as possible after an admission, the
treatment staff of the facility and the individual shall develop a crisis plan
to:
(1) Identify the individual’s preferred response
to a psychiatric emergency situation in order to avoid
more restrictive interventions;
(2) Identify the individual’s history of
physical, sexual, or emotional trauma, if any;
(3) Minimize the possibility of involuntary
emergency measures; and
(4) If the individual is a child, the plan shall
meet the requirements of RSA 126-U:3.
(b)
Involuntary emergency treatment,
seclusion, or restraint in a facility shall not be implemented unless a
physician determines that a personal safety emergency exists.
(c) A physician shall authorize involuntary
emergency treatment, seclusion, or restraint without consent of the individual
or his or her guardian only following personal examination or observation,
except as provided in He-M 305.04 or He-M 305.05 (b).
(d) No involuntary emergency treatment shall be
administered pursuant to He-M 305 unless it is to take effect within 24 hours
and is expected to alleviate or ameliorate the status or condition which has
caused the emergency.
(e) The emergency response that is administered
pursuant to He-M 305 shall be an intervention that:
(1) Is expected to be effective;
(2) Considers whether any of the following
factors regarding the individual’s condition would require special
accommodation to ensure necessary communication and the individual’s safety:
a. Medical factors;
b. Psychological factors; and
c. Physical factors,
including:
1. Blindness or other limitations of sight;
2. Deafness or other limitations of hearing; and
3. Any other physical limitation that would
require special accommodation;
(3) Is the least restrictive of the individual’s
freedom of movement; and
(4) Gives consideration to
the individual’s preferred response to a psychiatric emergency situation.
(f) Involuntary emergency treatment, seclusion,
or restraint ordered following a personal safety emergency shall be authorized
for no more than is necessary, but in no case for more than 24 hours in
accordance with He-M 305.04(k).
(g) If the individual is a child, and the
emergency response and involuntary emergency treatment set forth in (c) through
(e) above includes the use of restraint or seclusion, that use shall be made in
accordance with RSA 126-U:5, RSA 126 U:5-a, and RSA 126 U:5-b and shall not
include techniques listed in RSA 126-U:4.
(h) If the individual is a child, notification of
the use of restraint or seclusion as part of an emergency response in (a)–(g)
above shall be made to the child’s parent or guardian pursuant to RSA 126-U:7.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.04 Seclusion or Restraint.
(a) An emergency response may include use of
restraint or seclusion.
(b) Restraint or seclusion shall:
(1) Not be imposed longer than is necessary to
resolve a personal safety emergency regardless of the length of the time
identified in the order;
(2) Not exceed 15 minutes unless there is
documented authorization by a physician; and
(3) Only be used with a child according to the
requirements of RSA 126-U:5, and RSA 126-U:5-a, 5-b and shall not include
techniques listed in RSA 126-U:4.
(c) Before seclusion or restraint is employed, an
individual who can make an informed decision to be voluntarily placed in an
unlocked room shall be offered that alternative, if feasible.
(d) Restraint or seclusion shall be used only as
a last resort when no other intervention in an emergency
situation is feasible to protect the immediate safety of the individual
or others.
(e) Seclusion or restraint shall never be used
explicitly or implicitly as punishment for the behavior of the individual.
(f) Individuals in seclusion or restraint shall
be afforded privacy through practices including:
(1) The use of a single room;
(2) Minimizing external stimuli such as noise,
nearby movement, and approaches by other individuals;
(3) Continuous staff observation to assure the
conditions in (2) above are met; and
(4) If the individual in seclusion or restraint
is a child, the conditions of seclusion shall be pursuant to RSA 126-U:5-a,
RSA126-U:5-b, and RSA 126-U:11, and shall not include the techniques listed in
RSA 126-U:4.
(g) Authorization for the use of seclusion or
restraint shall be as follows:
(1) A physician may write an order for the use of
seclusion or restraint; or
(2) A physician may authorize the use of
seclusion or restraint via telephone when the order:
a. Follows deliberate and comprehensive
consultation between the physician and a trained advanced practice registered
nurse (APRN) or registered nurse (RN) who has personally evaluated the
individual by reviewing:
1. The assessments of the individual that have
been performed;
2. The safety issues involved; and
3. The potential antecedents to the seclusion or
restraint;
b. Is for a period not to exceed one hour; and
c. Is countersigned by the ordering physician
within 24 hours of the time such treatment was ordered and;
(3) If authorization is for the use of
seclusion or restraint with a child, the authorization shall be given pursuant
to a written policy consistent with RSA 126-U:2 and authorization and monitoring
pursuant to RSA 126-U:11.
(h) A physician may authorize in writing, on the
physician order sheet, or verbally, by telephone, the extension of an order of
seclusion or restraint if he or she, or a trained APRN or RN, has personally
examined, observed, and assessed the individual for whom the seclusion or
restraint is ordered.
(i) Following an
examination and assessment as required by (g) above, a physician may issue an
order to extend seclusion or restraint if the order is for:
(1) Not more than 4 hours if the individual is at
least 18 years old;
(2) Not more than 2 hours if the individual is at
least 9 but not more than 17 years old; or
(3) Not more than one hour if the individual is
less than 9 years old.
(j) If the individual is a child, then any order
to extend seclusion or restraint in (i) above shall
be subject to the limitations of RSA 126-U:11, III and IV.
(k) A physician who authorizes seclusion or
restraint shall, in collaboration with the attending registered nurse, establish
release criteria for the termination of the seclusion or restraint.
(l) If the condition of the individual does not
improve to meet the criteria for termination, the physician may renew the order
as specified in (h) above for up to the time limits established in (i) above, provided that no individual shall remain in
seclusion or restraint for more than 24 hours from the time such procedure was
initiated unless a physician personally examines, observes and assesses the
individual and renews the order in writing.
(m) Nursing staff trained pursuant to He-M 305.07
shall continually monitor the individual during periods of seclusion or
restraint to ensure that:
(1) In the judgment of the nursing staff, all
reasonable measures are in place to ensure that the individual’s health and safety
is protected during the period of seclusion or restraint;
(2) The individual receives meals and regular
opportunities to move and to utilize the bathroom;
(3) All other basic physiological needs are
identified and met; and
(4) The seclusion or restraint is discontinued as
soon as the emergency is resolved, regardless of the length of time identified
in the order.
(n) Individuals in seclusion or restraint shall
have the right to:
(1) Wear their own clothes, unless clinically
contraindicated; and
(2) Meet with an attorney.
(o) No procedure or device for seclusion or
restraint shall be utilized without the authorization of the clinical managers
of the facility.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.05 Emergency Medication and Other
Emergency Treatment.
(a) A physician or APRN in a facility shall
prescribe medication as a form of emergency treatment, to be administered
without the individual’s consent, only after personally examining or observing
the individual for whom the medication is ordered, except as provided in (b)
below.
(b) A physician or APRN may authorize involuntary
administration of a previously prescribed medication by telephone order at the
time a personal safety emergency is declared. Such authorization shall be countersigned
by the ordering physician or APRN within 24 hours of the order for involuntary
administration of the medication.
(c) When emergency medication is ordered, the
individual shall be offered, whenever feasible, a choice of taking the
medication orally or by injection.
(d) Psychosurgery, electroconvulsive therapy,
sterilization, or experimental treatment of any kind shall not be used as
involuntary emergency treatment.
(e) If a physician or APRN prescribes medication
for a child as stated in He-M 305.02(k)(1)a. and b., the administration shall
be considered a “medication restraint” as defined in RSA 126-U:1, IV(a), and
shall be administered pursuant to the requirements of RSA 126-U.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16;
ss by #12929, eff 11-26-19
He-M
305.06 Review and Documentation of
Emergency Response.
(a) At the time that any emergency treatment,
seclusion, or restraint is administered in a facility pursuant to He-M 305, the
physician administering or directing such treatment, or a person acting under
his or her direction, shall promptly record the circumstances pertaining to the
personal safety emergency.
(b) The person completing a record pursuant to
(a) above shall include the following:
(1) The individual’s name;
(2) The date and time when the report is completed;
(3) The physician’s name;
(4) A description of the individual’s physical or
mental status and the act or pattern of behavior which constitutes the
emergency;
(5) The names of any witnesses other than the
individual;
(6) A description of any alternatives attempted
or considered prior to declaring a personal safety emergency;
(7) Any treatment limitations;
(8) A description of the specific emergency
treatment, seclusion, or restraint ordered; and
(9) The physician’s signature.
(c) As soon as possible following an involuntary
emergency treatment, seclusion, or restraint, facility medical or nursing
staff, or both shall advise the individual’s treating physician regarding the
emergency intervention if such intervention was not ordered by the treating
physician.
(d) As soon as possible following the resolution
of the emergency situation, nursing staff shall:
(1) Address any physical injuries or trauma that
might have occurred as a result of the episode;
(2) Hold and document a discussion with the
individual to:
a. Review the circumstances that led up to the
emergency with the individual involved;
b. Ascertain the individual’s willingness or
desire to involve family or other caregivers in a debriefing to discuss and
clarify their perceptions about the episode and to identify additional
alternatives or treatment plan modifications;
c. Hear and document the individual’s
perspective on the episode;
d. Discuss and clarify any possible
misperceptions the individual or staff might have concerning
the incident;
e. Identify with the individual any
environmental changes or alternative interventions to reduce the potential for
additional episodes; and
f. Ascertain whether the individual’s rights and
physical well-being were addressed during the episode and advise the individual
of the process to address perceived rights grievances; and
(3) Support the individual’s re-entry into the
treatment setting.
(e) Within one business day, nursing staff shall,
after discussion with the individual, modify the treatment plan as needed
through a treatment team review including areas noted in (d)(1)-(3) above and
seek an informed decision on that plan by the individual.
(f) An executive review of the clinical
appropriateness of the use of seclusion or restraint shall be conducted:
(1) As authorized by the facility’s chief
executive officer;
(2) On the next business day following a personal
safety emergency;
(3) To assess compliance with the requirements of
He-M 305;
(4) To consider and take any action needed to
prevent the recurrence of the same or similar personal safety emergencies; and
(5) To include:
a. A member of the individual’s treatment team;
b. A member of nursing management; and
c. The medical director or designee.
(g) If the individual subject to seclusion or
restraint is a child, information shall be collected
and notification made pursuant to RSA 126-U:7 and 126-U:10.
Source. #3095, eff 8-19-85;
EXPIRED: 8-19-93
New. #5204, eff 8-22-91,
EXPIRED: 8-22-97
New. #7183, eff 12-24-99,
EXPIRED: 12-24-07
New. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.07 Training.
(a) Facilities shall provide training for
leadership in strategies toward the elimination of seclusion and restraint.
(b) At a minimum, facilities shall provide
training at the following intervals to all staff who will be involved in the
use of any type of restraint or seclusion:
(1) During initial orientation; and
(2) During annual competency evaluation.
(c)
Staff shall not perform any action
relative to restraint or seclusion without having been trained in the use of
such methods, in accordance with (d) below.
(d) Training in the use of restraint or seclusion
shall address at least the following:
(1) Techniques to identify behaviors, events, and
environmental factors regarding individuals and staff that might trigger
circumstances that require restraint or seclusion;
(2) Use of non-physical interventions;
(3) How to identify and choose positive behavioral
supports and the least restrictive intervention based on an individualized
assessment of the individual’s medical or behavioral status or condition;
(4) How to ensure that the individual and staff are able to communicate effectively;
(5) Safe application and use of all types of
restraint or seclusion, including mitigating positional risks that can result
in asphyxia or airway obstruction, in accordance with individual needs;
(6) How to monitor the physical and psychological
well-being of the individual who is restrained or secluded;
(7) How to recognize and respond to signs of
physical and psychological distress;
(8) How to identify clinical changes that
indicate that restraint or seclusion is no longer necessary;
(9) How to monitor respiratory and circulatory
status, skin integrity, and vital signs during restraint; and
(10) Training in first aid techniques and
certification in cardiopulmonary resuscitation (CPR), including CPR
recertification every two years.
(e) Training shall be given by a person who:
(1) As defined in writing by the facility,
possesses the requisite qualifications based upon education, training,
experience, and certification to teach the assessment of, and response to, an
individual’s medical or behavioral status or condition;
(2) Is certified by a nationally recognized
program, such as the American Heart Association, as an instructor in CPR; and
(3) Is trained in crisis prevention utilizing a
nationally recognized program or comparable curriculum.
Source. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.08 Notice and Right of Appeal.
(a) On the business day following administration
of emergency treatment, seclusion, or restraint under He-M 305, the
individual’s case manager or another staff member designated by the program or
facility shall forward the following to the individual or his or her guardian:
(1) A copy of the record completed pursuant to
He-M 305.06(a);
(2) The specific rules that support, or the
federal or state law that requires, the action;
(3) Notice of the individual’s right to complain
against and appeal the administration of emergency treatment as a client rights
violation in accordance with the emergency procedures contained in He-M 204 and He-C 200, rules of practice and procedure;
(4) Notice of the right to have representation in
an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the facility nor the
bureau is responsible for the cost of representation; and
(6) Notice of organizations with their addresses
and phone numbers that might be available to provide legal assistance and
advocacy, including the Disabilities Rights Center and pro bono or reduced fee
assistance.
(b) Appeals of the final decision under He-M 204
shall be forwarded, in writing, to the director of the bureau of behavioral
health in care of the department’s office of client and legal services. An
exception shall be that appeals may be filed verbally if the individual is
unable to convey the appeal in writing.
(c) The director shall immediately forward the
appeal to the department’s administrative appeals unit for action in accordance
with He-C 200. The burden shall be as provided by He-C 203.14. A proposed
decision shall be issued in accordance with He-M 204.
Source. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
He-M
305.09 Reporting of Death.
(a) In accordance with Patient Rights 42 CFR
482.13(g)(1)i and the Protection and Advocacy for
Mentally Ill Individuals Act (PAIMI Act), 42 U.S.C. § 10801-10851, facility
staff shall make a telephone report to the CMS regional office, no later than
the close of the next business day and to the state protection and advocacy
agency within 7 days following knowledge of an individual’s death that:
(1) Occurs while an individual is in restraint or
in seclusion at the facility;
(2) Occurs within 24 hours after the individual
has been removed from restraint or seclusion; and
(3) Occurs within one week after restraint or
seclusion where it is reasonable to assume that the use of restraint or
placement in seclusion contributed directly or indirectly to the individual’s
death including, at a minimum:
a. Death related to restrictions of movement for
prolonged periods of time; and
b. Death related to chest compression,
restriction of breathing, or asphyxiation.
(b) Staff shall document in the individual’s
medical record the date and time the death was reported.
(c) If the individual subject to seclusion or
restraint as part of emergency treatment suffers injury or death, and the
individual is a child as defined in RSA 126-U:1, I, the facility staff shall
provide notification pursuant to RSA 126-U:7 and RSA 126-U:10.
Source. #9120, eff 4-3-08,
EXPIRED: 4-3-16
New. #11102, INTERIM, eff
5-25-16, EXPIRED: 11-21-16
New. #12077, eff 12-28-16
PART
He-M 306 MEDICAL AND PSYCHIATRIC
EMERGENCIES
Statutory
Authority: RSA 135-C:57, III, V; 61, XI
He-M 306.01 Purpose. The purpose of these rules is to establish
procedures by which an individual involuntarily admitted to New Hampshire
hospital has emergency treatment authorized when he or she has been determined
to lack the capacity to make an informed treatment decision.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 89-4-18
New. #13035, EMERGENCY, eff
4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20
He-M 306.02 Definitions.
(a)
"Administrator" means the chief executive officer of New
Hampshire hospital or, in the absence of the administrator, the executive
person in charge of the facility.
(b)
“Advance practice registered nurse (APRN)” means “advanced practice
registered nurse” as defined in RSA 135-C:2, II-a, namely “an advanced practice
registered nurse licensed by the board of nursing who is certified as a
psychiatric mental health nurse practitioner by a board-recognized national
certifying body.”
(c)
"Involuntary admission" means admission to New Hampshire
hospital pursuant to RSA 135-C:34-54.
(d)
"Lack of capacity" means the inability of a person, after
efforts have been made to explain the nature, effects, and risks of the
proposed treatment and alternatives to the proposed treatment, to engage in a
rational decision-making process regarding the proposed treatment as evidenced
by his or her inability to weigh the nature, purpose, risks, and benefits of
the proposed treatment and any available alternatives and the likely
consequences of refusing treatment.
(e)
"Medical emergency" means a physical condition of a patient
which, if not treated, will result in an immediate, substantial, and
progressive deterioration of a serious physical illness.
(f)
“Patient” means a person involuntarily admitted to New Hampshire
hospital by order of a probate court pursuant to RSA 135-C:34-54.
(g)
“Presiding officer” means an individual who has been delegated authority
by the commissioner of the department of health and human services, in
accordance with RSA 126-A:5, III, to render decisions on appeals under RSA
126-A:5, VIII.
(h)
"Psychiatric emergency" means a mental condition of a patient,
resulting from mental illness, which, if not treated promptly, likely will
result in either:
(1) Imminent danger of harm to the patient or
others as evidenced by:
a. Symptoms
that in the past have immediately preceded acts of harm to self or others; or
b. A recent
overt act including, but not limited to, an assault, or self-injurious behavior
when the likelihood of preventing such harm would be substantially diminished
if treatment is delayed;
(2) Deterioration of the patient's mental status
from his or her usual mental status as manifested by exacerbation of
psychiatric symptoms that potentially endanger self or others, or lead to
severe self-neglect, or lead to a failure to function in a less restrictive
environment when the likelihood of stabilizing and reversing such deterioration
would be substantially diminished if treatment is delayed; or
(3) Continued decompensation of the patient’s
mental status from his or her usual mental status as manifested by persistent
psychiatric symptoms that potentially endanger self or others, or lead to
severe self-neglect, or lead to a failure to function in a less restrictive
environment when there is a reasonable likelihood that such symptoms could be
alleviated if treatment could be administered to the patient.
(i) "Treatment" means a form of medical or psychiatric care that:
(1) Is provided by a physician, or a person
acting under the direction of a physician;
(2) Is provided in accordance with generally
accepted clinical and professional standards; and
(3) Does not include:
a. Psychosurgery;
b. Electroconvulsive
therapy;
c. Sterilization;
or
d. Experimental
treatment of any kind.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New.
#7133, eff 11-23-99; ss by #7559, eff 9-25-01;
ss by #9520, eff 8-4-09; amd by #10641, eff 7-18-14 paras
(a), and (c) – (i) EXPIRED: 8-4-18
New.
#13035, EMERGENCY, eff 4-14-20, EXPIRES:
10-11-20; ss by #13108,
eff 9-22-20
He-M 306.03 Emergency Treatment Authorized. A physician, or a person acting under the
direction of a physician, shall administer treatment to a patient, without the
consent of the patient, when authorization is granted by the presiding officer
pursuant to the provisions set forth below.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
New. #13035, EMERGENCY, eff
4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20
He-M 306.04 Criteria for Emergency Treatment.
(a)
A treating physician or APRN shall submit a written request for
treatment authorization to the department’s administrative appeals unit, the
administrator, and the patient if he or she determines that:
(1) The involuntarily admitted patient cannot make a decision regarding his or her treatment due to lack
of capacity;
(2) A medical or psychiatric emergency exists;
(3) The patient does not have a guardian
authorized to make medical decisions; and
(4) A reasonable person would consent to the
administration of emergency treatment.
(b)
A physician’s or APRN’s request for treatment authorization submitted
pursuant to (a) above shall contain the following information:
(1) A description of the efforts that have been
made to inform the patient of the nature, effects, and risks of the proposed
treatment, and facts demonstrating that, despite this effort, the patient lacks
the capacity to make an informed decision with respect to the medical or
psychiatric treatment offered;
(2) A statement of facts which indicate that a
medical or psychiatric emergency exists;
(3) A description of the proposed treatment,
including:
a. Its anticipated therapeutic benefit;
b. Its potentially significant risks; and
c. The nature and severity of possible side
effects;
(4) A statement indicating the supports or
treatment, if any, that the patient has agreed to accept and why provision of
such treatment would not ameliorate the medical or psychiatric emergency; and
(5) The reasons why a delay in treatment would:
a. In the case of a medical emergency, likely
result in an immediate, substantial, and progressive deterioration of a serious
physical illness; or
b. In the case of a psychiatric emergency:
1. Substantially diminish the likelihood of
preventing imminent harm to the patient or others;
2. Substantially diminish the likelihood of
stabilizing or reversing the patient's deteriorating mental status; or
3. Result in continued decompensation of the
patient’s mental status from his or her usual mental status as manifested by
persistent psychiatric symptoms when there is a
reasonable
likelihood that such symptoms could be alleviated if treatment could be
administered to the patient.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; ss by #10641, eff 7-18-14
He-M 306.05 Hearing. Upon receipt of the physician’s or APRN’s
written request for treatment authorization, the presiding officer shall:
(a)
Schedule a hearing to be held as soon as reasonably possible and, in any
event, within 3 working days of the date of receipt of the written request for
treatment authorization;
(b)
Notify the legal staff of
(c)
Conduct a hearing in accordance with He-C 203.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; ss by #10641, eff 7-18-14
He-M 306.06 Decision.
(a)
Within 2 working days of the hearing, the presiding officer shall issue
a written decision.
(b)
The presiding officer shall authorize the proposed treatment if the
presiding officer determines that the state has demonstrated, by clear and
convincing evidence, that each of the following criteria is met:
(l) The patient lacks the capacity to make an
informed decision with respect to the proposed treatment;
(2) A medical or psychiatric emergency exists
that would:
a. In the case of a medical emergency, likely
result in an immediate, substantial, and progressive deterioration of a serious
physical illness; or
b. In the case of a psychiatric emergency:
1. Substantially diminish the likelihood of
preventing imminent harm to the patient or others;
2. Substantially diminish the likelihood of
stabilizing or reversing the patient's deteriorating mental status; or
3. Result in continued decompensation of the
patient’s mental status from his or her usual mental status as manifested by
persistent psychiatric symptoms when there is a reasonable likelihood that such
symptoms could be alleviated if treatment could be administered to the patient;
(3) The proposed treatment is the least
restrictive appropriate alternative available;
(4) The patient does not have a guardian
authorized to make treatment decisions; and
(5) A reasonable person would consent to the
administration of emergency treatment.
(c)
The presiding officer shall not authorize emergency treatment for a
period of more than 45 days.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
New. #13035, EMERGENCY, eff
4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20
He-M 306.07 Guardianship. During the course of
the authorized treatment period, New Hampshire hospital staff shall assess the
patient's need for the appointment of a guardian and take actions consistent
with RSA 135-C:60.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89, EXPIRED:
12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
New. #13035, EMERGENCY, eff
4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20
He-M 306.08 Treatment Limitations.
(a)
No involuntary treatment shall be imposed pursuant to a request for
authority to administer emergency treatment prior to a decision being rendered
by the presiding officer in accordance with He-M 306.06 except in accordance
with He-M 305, personal safety emergencies.
(b)
Treatment shall not be administered to a voluntarily admitted individual
who refuses to accept it.
(c)
The chief medical officer of New Hampshire hospital
shall monitor treatment provided pursuant to He-M 306.03 at least every 7 days through review with the attending physician or APRN and
order discontinuation of the treatment authorization upon determination that
the criteria for treatment authorization no longer exist. The chief
medical officer may delegate these functions to the associate medical director
or to another New Hampshire hospital psychiatrist who is a board-certified
physician and not the attending physician for the patient.
(d) No more than 2 authorizations for emergency
treatment shall be granted during each single involuntary admission.
(e) Authorizations shall not exceed 4 during the
total period of the involuntary admission order.
(f) “Single involuntary admission” means:
(1) The period of initial
involuntary admission following the order of the probate court pursuant to RSA
135 C-34-54; or
(2) Any subsequent period of involuntary admission following an
absolute revocation of conditional
discharge.
(g)
The authorization to provide emergency treatment to the patient shall
immediately expire if a guardian over the person of the patient with authority
to make treatment decisions is appointed during the period of emergency
treatment authorized by the presiding officer.
Source. #3096, eff 8-19-85;
EXPIRED: 8-19-91
New. #4708, eff 12-1-89,
EXPIRED: 12-1-95
New. #7133, eff 11-23-99;
ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; amd
by #10641, eff 7-18-14; paras (a), (b), and (d)-(g) expired: 8-4-18,
New. #13035, EMERGENCY, eff
4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20
PART
He-M 307 - RESERVED
PART
He-M 308 FAIR HEARINGS ON APPEALS
RELATED TO MEDICAID-FUNDED MENTAL HEALTH/DEVELOPMENTAL DISABILITY SERVICES -
RESERVED
Source. #4312, eff 9-25-87,
EXPIRED: 9-25-93 (See Revision Note at part heading for He-M 204)
PART
He-M 309 RIGHTS OF PERSONS RECEIVING
MENTAL HEALTH SERVICES IN THE COMMUNITY
Statutory
Authority: RSA 135-C:5, I, (b), C:13;
C:18; C:61, VI & XI
He-M
309.01 Purpose. The purpose of these rules is to define the
rights of individuals applying for services or individuals who have been found
eligible for services under RSA 135-C:12 and who are receiving services in the
community. Individuals might have
additional rights under RSA 151:21, patients' bill of rights, for residents of
health care facilities.
Source. #4412, eff 4-27-88;
ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
New. #6757, eff 5-27-98;
ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.02 Definitions.
(a) "Abuse" means
an act or omission by an employee, consultant or volunteer of a program which
is not accidental and harms or threatens to harm an individual’s physical,
mental, or emotional health, or safety and includes emotional abuse, physical
abuse, and sexual abuse.
(b) "Attorney" means a member of the
New Hampshire Bar Association who is retained, employed, or appointed by a
court to represent an individual.
(c) “Bureau” means the bureau of behavioral
health within the department of health and human services.
(d) “Client” means “individual” as defined in (l)
below.
(e) "Community" means a non-facility or
non-institutional service setting that is integrated as much as possible into
the service network available to all citizens in the geographic area served by
the program.
(f) "Community residence" means a
residence, exclusive of any independent living arrangement, that:
(1) Provides residential services in accordance
with He-M 426 for at least one individual with a mental illness;
(2) Provides services based on the needs
identified in a resident’s individual service plan (ISP);
(3) Is operated:
a. Directly by a community mental health center
(CMHC);
b. By contract or agreement between a CMHC and
another entity, or
c. Directly by an entity under contract with the
department;
(4) Serves individuals whose services are funded
by the department; and
(5) Is certified pursuant to He-M 1002.
(g) “Department” means the department of health
and human services.
(h) “Direct care” means services provided to
individuals including, but not limited to: assistance with medication,
accompanying an individual to a treatment team or other clinical meeting, and
providing ongoing direct and active support.
(i) “Emotional abuse” means the misuse
of power, authority, or both, verbal harassment, or unreasonable confinement
which results or could result in mental anguish or emotional distress of an
individual.
(j) "Exploitation" means the use of an
individual’s person or property for another's profit or advantage or breach of
a fiduciary relationship through improper use of an individual’s person or
property including situations where a person obtains money, property, or
services from an individual through undue influence, harassment, deception, or
fraud.
(k) "Guardian" means a person,
appointed under RSA 463 or RSA 464-A, or the parent of an individual under the
age of 18 whose parental rights have not been terminated or limited by law in
such a way as to remove the person’s right to make health care decisions on
behalf of the individual.
(l) "Individual" means: A person who is receiving or applying for a
service from a program or community residence.
The term includes “client.”
(m) "Informed decision" means “informed
decision” as defined in RSA 135-C:2, IX, namely, “a choice made
by a client or person seeking to be admitted who has the ability to make such a
choice and who makes it voluntarily after all relevant information necessary to
making the decision has been provided, and who understands that he or she is
free to choose or refuse any available alternative, and who clearly indicates
or expresses his or her choice. The
choice shall be free from all coercion.”
The term includes such decision of an individual, as defined in He-M
309.02(l) above, and the individual’s legal guardian, where appropriate, based
on the same factors as an informed decision made by a client or person seeking
to be admitted.
(n) “Intellectual disability” means “intellectual
disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage
general intellectual functioning existing concurrently with deficits in
adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may
be considered mentally ill provided that no person with an intellectual
disability shall be considered mentally ill solely by virtue of his or her
intellectual disability.”
(o) "Mental illness" means “mental
illness” as defined in RSA 135-C:2 X, namely, "a substantial impairment of
emotional processes, or of the ability to exercise conscious control of one's
actions, or of the ability to perceive reality or to reason, when the
impairment is manifested by instances of extremely abnormal behavior or
extremely faulty perceptions. It does not
include impairment primarily caused by:
(a) epilepsy; (b) intellectual disability; (c) continuous or
noncontinuous periods of intoxication caused by substances such as alcohol or
drugs; or (d) dependence upon or addiction to any substance such as alcohol or
drugs."
(p) "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 of an incapacitated adult. The
term includes neglect toward an individual.
(q) "Program" means any public or
private corporation, person or organization which provides services to
individuals with a mental illness or intellectual disability when such services
are funded in whole or in part or are operated, monitored or regulated by the
bureau.
(r) “Physical abuse” means the use of physical
force which results or could result in physical injury to an individual.
(s) "Service" means any evaluation,
training, counseling, therapy, habilitation, case management, or other type of
assistance, medical care, or treatment provided by a program.
(t) "Service delivery system" means
those facilities and programs funded, in whole or in part, operated, monitored,
or regulated by the bureau.
(u) “Sexual abuse” means contact or interaction
of a sexual nature between an individual and an employee of or a consultant or
volunteer for a program.
(v)
"Treatment" means “treatment” as defined in RSA 135-C:2, XVI, namely,
"examination, diagnosis, training, rehabilitation therapy,
pharmaceuticals, and other services provided to clients in the mental health
services system. Treatment shall not
include examination or diagnosis for the purpose of determining the need for
involuntary emergency admissions pursuant to RSA 135-C:27-33 or involuntary
admissions pursuant to RSA 135-C:34-54."
The term includes treatment provided to individuals in the mental health
services system.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.03 Notice of Individual and
Applicant Rights.
(a) Programs shall inform individuals or their
guardians of the individual’s rights under RSA 135-C and these rules in clearly
understandable language and form, both verbally and in writing.
(b) The notification of rights required under (a)
above shall include, at a minimum, the following measures:
(1) Individuals applying for services shall be
informed of the rights in (a) above relating to evaluations and access to
treatment;
(2) Programs shall provide meaningful and
understandable information about individual rights described in (a) above to
individuals who are minors or who have been adjudicated incapacitated as well
as to their parents, guardians, or attorneys;
(3) Individuals shall be advised of their rights
upon initial participation in any program, and at least once a year after
initial participation;
(4) Every program within the service delivery
system shall post notice of the rights set forth in these rules, as follows:
a. The notice shall be posted continuously and
conspicuously; and
b. The notice shall be presented in clearly
understandable language and form; and
(5) Each program and community residence shall
have on the premises complete copies of He-M 309 available for individual and
staff review.
(c) Each program shall document notifications of
the opportunity to review He-M 309 in the individual’s records.
(d) Any person shall have the right to complain
or bring a grievance on behalf of an individual or a group of individuals
pursuant to He-M 204.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.04 Fundamental Rights.
(a) Any individual receiving treatment for mental
illness shall be entitled to any legal right to which all citizens are entitled
regardless of that individual's admission to the mental health services system.
(b) The legal rights protected shall include, at
a minimum:
(1) The right to freedom of religious preference
and practice, the right to be free from engaging in any religious activity, and
the right to receive reasonable assistance in attending places of worship;
(2) The right to register to vote, if eligible,
in public elections and to receive assistance in registering to vote and in
voting;
(3) The following civil rights, unless a court
has determined that an individual is legally incapacitated pursuant to RSA
464-A, and a guardian has been appointed to make certain decisions, or an
emergency exists under He-M 305, personal safety emergencies:
a. The right to manage affairs;
b. The right to contract;
c. The right to hold professional, occupational,
or motor vehicle driver's licenses;
d. The right to marry or to obtain a divorce;
e. The right to make a will; and
f. The right to exercise any other civil right;
(4) The right to not be discriminated against in
any manner because of race, color, sex, religion, national origin, age, marital
status, disability, sexual orientation, or degree of disability as provided in
state and federal laws, title VII of the civil rights act of 1964, section 504
of the rehabilitation act of 1973, the age discrimination act of 1975, the
Americans with Disabilities Act of 1990, and the provisions of certain block
grants, including:
a. Access to auxiliary aids needed by persons
with disabilities;
b. Services which are accessible to persons of
limited English proficiency; and
c. Service locations that are physically accessible;
and
(5) The right to legal remedies, including the
right to petition for and receive the benefits of a writ of habeas corpus, and
to seek any other remedy provided by law.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15 ss by #10819, eff 4-23-15
He-M
309.05 Personal Rights.
(a) Individuals who are applying for services or
individuals in the service delivery system shall be treated with dignity and
respect at all times.
(b) Individuals shall be free from abuse,
neglect, and exploitation including, at a minimum, the following:
(1) Freedom from any emotional, physical, or
sexual abuse or neglect;
(2) Freedom from the intentional use of physical
force, except the minimum force necessary to prevent harm to the individual or
others, to prevent substantial damage to real property, or to impose emergency
treatment under He-M 305, personal safety emergencies or RSA 135:21-b; and
(3) Freedom from personal or financial
exploitation.
(c) Individuals shall have the right to privacy.
(d) Individuals who are applying for services, or
who are currently, or were previously in the service delivery system shall have
the right to confidentiality of all information and records.
(e) At a minimum, programs shall adhere to the
following confidentiality requirements:
(1) Material safeguarded shall include any
information with respect to an individual or through which an individual can be
identified such as:
a. Names;
b. Addresses;
c. Diagnoses and evaluative data;
d. Medical and clinical records;
e. Individual service plans; and
f. Whether an individual is using or has used a
program’s services;
(2) The individual or his or her guardian shall
be informed that clinical information may be released to the third party payor
to the extent necessary to substantiate charges for care and treatment;
(3) If the individual or his or her guardian
wishes to bear the cost of services privately rather than allow the release of
information to third party payors, the individual or his or her guardian shall
be personally responsible for the full cost of care and treatment;
(4) All program staff shall be informed so as to
know and understand confidentiality and comply with confidentiality statutes
and rules;
(5) Separate, individual records shall be
maintained when group treatment methods are employed and joint records of treatment
activity shall not be maintained;
(6) No program shall photograph, fingerprint, or
record any individual by audio or visual equipment unless the individual or his
or her guardian has consented following an informed decision, nor allow any third
party to photograph, fingerprint, or record any individual by audio or visual
equipment unless the individual or his or her guardian has consented following
an informed decision;
(7) These rules shall not affect the obligation
of programs to release information as required by:
a. RSA 161-F:42-57, protective services to
adults;
b. RSA 169-C:29, report of child abuse;
c. RSA 631:6, report of injury caused by
criminal act; or
d. Other law; and
(8) In accordance with RSA 329:26, RSA 330-A:32,
RSA 329-B:26 and RSA 326-B:35, statements made by individuals to physicians
licensed pursuant to RSA 329, psychologists licensed pursuant to RSA 329-B,
persons licensed pursuant to RSA 330-A, advanced practice registered nurses
licensed pursuant to RSA 326-B, or to those who work under their supervision,
may be disclosed for the purpose of commitment hearings conducted pursuant to
RSA 135-C:27-54 or RSA 464-A.
(f) Access to an individual’s records shall be as
follows:
(1) Information pertaining to an individual shall
be released to the individual or his or her guardian upon request including all
information provided by third parties except that information which was
provided by someone other than a health care provider under an agreement that
the information would not be disclosed and disclosure would be reasonably
likely to reveal the source of the information.
When information is not released, the individual or his or her guardian
shall be provided with a written denial stating the basis for the denial, a
description of how a complaint may be filed, the name, title and address of the
contact person to receive the complaint; and the process for filing a complaint
pursuant to 45 C.F.R. 160.306;
(2) A clinical staff member shall be present at a
record review if:
a. There is a reasonable concern that an
individual will experience a harmful effect as a result of reviewing his or her
record, or reasonable concern that the security of the record is at risk; and
b. The determination that (2)a. above applies
has been made on a case by case basis, and the reasons for the determination
have been documented in writing;
(3) Information shall be released to any person
or organization that has obtained the written consent of the individual or his
or her guardian;
(4) Information shall be released to the
department and funding, licensing, and accrediting agencies by programs within
the service delivery system as necessary for:
a. Determining eligibility for funding;
b. Assisting in accrediting or licensing decisions;
c. Monitoring and evaluating service delivery;
d. Assuring the delivery of appropriate services
to individuals; and
e. Planning future service delivery;
(5) Programs shall not include or release
confidential information in an individual’s record which pertains to other
individuals;
(6) Programs shall include within the records of
an individual any supplemental information provided by the individual or his or
her guardian either clarifying or rebutting information deemed by the
individual to be inaccurate;
(7) An attorney appointed by a court to represent
an individual shall have access to all records and information pertaining to
that individual;
(8) Legal counsel for the department shall have
access to all relevant records and information pertaining to an individual when
such records and information are necessary because the individual:
a. Is the subject of an involuntary commitment
hearing;
b. Is the subject of a guardianship proceeding;
or
c. Has instituted legal action against the state
in regard to care and treatment provided by the mental health service delivery
system;
(9) In cases where an individual, his or her
guardian, an attorney or other advocate representing the individual, after review of
the record, requests copies of the record, such copies in paper format, shall
be made available free of charge for the first 25 pages and not more than 25
cents per page thereafter; or, if available, copies of records electronically
stored and produced, shall be made available free of charge for the first 25
pages and at actual cost per page thereafter. The individual, his or her
guardian, attorney or other advocate representing the individual may choose
whether to receive the record in paper form, or if available in electronic form;
(10)
Information regarding the medical
treatment of an individual shall be released to law enforcement officials or
health facility personnel if necessary to address an emergency situation
involving danger to the individual's health or safety, but only specific
information necessary to the relief of the emergency may be released without
the individual or his or her guardian’s consent;
(11) In accordance with RSA 329:31, RSA 330-A:35,
RSA 329-B:29, and RSA 326-B:33, any of the following persons licensed in New
Hampshire shall make reasonable efforts to disclose to a third party or law
enforcement when an individual has made a serious threat of physical violence
against a clearly identified or reasonably identifiable victim or victims, or a
serious threat of substantial damage to real property:
a. A physician;
b. A psychologist;
c. An advance practice registered nurse;
d. Any person licensed pursuant to RSA 330-A; or
e. Any person who works under the supervision of
any of the above;
(12) In accordance with RSA 135-C:19-a, I, a
community mental health center may disclose to a family member or other person,
if such family member or other person lives with the individual or provides
direct care to the individual information regarding:
a. Diagnosis;
b. Admission to or discharge from a treatment
facility;
c. Functional assessment;
d. The name of the medicine prescribed;
e. The side effects of any medication
prescribed;
f. Behavioral or physical manifestations which
would result from failure of the individual to take such prescribed medication;
g. Treatment plans and goals; and
h. Behavioral management strategies;
(13) Information shall not be released pursuant to
(12) above unless the program first:
a. Provides written notice to the individual or
his or her guardian specifying the information requested, the reason for the
request, and the person making the request;
b. Requests the individual or his or her
guardian’s consent to release the information; and
c. If consent cannot be obtained, the individual
shall be notified in writing prior to the disclosure of:
1. The reason for the intended disclosure;
2. The name of the person(s) to whom the
information will be released; and
3. The specific information intended to be released;
(14) A community mental health center shall
receive or accept communications from family members, friends, or other persons
with information pertaining to the health and safety of the individual, and
shall document such communications in the individual’s record;
(15)
In accordance with RSA 135-C:19-a, II,
when the medical director or designee determines that obtaining information is
essential to the care or treatment of an individual admitted pursuant to RSA 135-C:27-54, a designated
receiving facility may request, and any health care provider which previously
provided services to any individual involuntarily admitted to the facility may
provide, information about such individual limited to medications prescribed,
known medication allergies or other information essential to the medical or
psychiatric care of the individual admitted;
(16) Information shall not be released pursuant to
(15) above unless the program first:
a.
Provides written notice to the individual or his or her guardian specifying the
information requested, the reason for the request, and the person making the
request;
b. Requests, the individual or his or her
guardian's consent to release the information; and
c. If consent cannot be obtained, the facility
shall notify the individual in writing prior to the disclosure of:
1. The name of the care provider who have been
asked to provide information;
2. The reason for the disclosure;
3. The name of the person(s) to whom the
information will be released; and
4. The specific information which will be
released;
(17) In accordance with RSA 135-C:19-a, II-a, when
the medical director, or designee, determines that obtaining information is
essential to the care and treatment of an
individual admitted pursuant to RSA 135-C: 27-54 and the consent of
the individual or his or her guardian
admitted cannot be obtained, the designated receiving facility may request and
any community mental health program which has previously provided services to
such individual shall immediately provide information about the individual including
medications prescribed, known medication allergies, services provided and other
information essential to the medical and psychiatric care of the individual
admitted. The facility may disclose
information necessary to identify the individual and the facility which is
requesting the information; and
(18) In accordance with RSA 135-C:19-a, III, a
community mental health program or state facility may disclose to an
interdisciplinary committee designated by the governor to review child
fatalities, information which is relevant to a case of suicide or traumatic
fatal injury under review by such committee.
Information to be disclosed to such committee shall be limited to the
diagnosis and course of treatment of the child or the person who caused the
fatality. Information disclosed pursuant
to this subparagraph shall remain confidential and shall not be subject to
discovery, subpoena, or admission into evidence in any judicial or
administrative proceeding.
(g) Individuals or their guardians shall have the
right to complain about any alleged violation of a right afforded by these
rules or by any state or federal law or rule or any other matter.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.06 Treatment Rights.
(a) Individuals shall have the right to adequate
and humane treatment, including:
(1) The right of access to treatment including:
a. For those individuals applying for services
the right to evaluation to determine the individual’s need for services and to
determine which programs are most suited to provide the services needed;
b. The right to receive necessary services when
those services are available, subject to the admission and eligibility policies
and standards of each program; and
c. The right to receive services without regard
to race, color, age, religion, sex, marital status, national origin, severity
of disability, sexual orientation or inability to pay except in accordance with
He-M 401.14;
(2) The right to quality treatment including:
a.
Treatment and services provided in accordance with licensing requirements and
applicable rules adopted by the department in He-M 200-1300 and applicable
rules of other state agencies; and
b.
Services provided in keeping with generally accepted clinical and professional
standards applicable to the persons and programs providing the treatment and to
the conditions for which the individual is being treated;
(3) The right to receive services in such a manner
as to promote the individual's full participation in his or her community;
(4) The right to receive all services or
treatment in accordance with the time frame set forth in the individual service
plan;
(5) The right to an individual service plan developed,
reviewed, and revised in accordance with He-M 401 which addresses the
individual’s own goals;
(6) The right to receive treatment and services
contained in individual service plans designed to provide opportunities for the
individual to participate in meaningful activities in the communities in which
they live and work;
(7) The right to service and treatment in the
least restrictive alternative or environment necessary to achieve the intended
purposes of treatment including programs which least restrict freedom of
movement, informed decision-making, and participation in the community while
providing the level of security and support needed by the individual;
(8) The right to be served, whenever possible, in
generic, integrated settings rather than specialized programs for persons with
mental illness, except that programs may restrict access by individuals to
various areas to:
a. Ensure the privacy or safety of the
individuals;
b. Achieve other necessary objectives contained
in the individual service plan; or
c. Comply with provisions of law or orders of
court;
(9) The right for the individual or his or her
guardian to be informed of all significant risks, benefits, side effects and
alternative treatment and services and to give consent to any treatment,
placement, or referral following an informed decision except actions taken
under He-M 305 or where otherwise provided by law, such that:
a. Whenever possible, the consent shall be given
in writing; and
b. In all other cases, evidence of consent shall
be documented by the program and be witnessed by at least one person;
(10) The right to refuse to participate in any
form of experimental treatment or research;
(11) The right to be fully informed of one's own
diagnosis and prognosis;
(12) The right to voluntary placement unless RSA
135-C:27-33, 135-C:34-48, or 135-C:51 apply, including the right to:
a. Seek changes in placement, services, or
treatment at any time; and
b. Withdraw from any form of voluntary treatment
or from the service delivery system;
(13) The right to services which promote independence
including services which shall be directed toward:
a. Eliminating, or reducing as much as possible,
the individual’s needs for continued services and treatment; and
b.
Promoting the ability of the individuals to function at their highest capacity and
as independently as possible;
(14) The right to refuse medication and treatment
except emergency treatment provided under the terms and conditions of RSA
135:21-b;
(15) The right to referral for medical care and
treatment including:
a. Assistance in finding such care and treatment
in a prompt and timely manner; and
b. Access to such medical services as is
required in accordance with He-M 401;
(16) The right to consultation and second opinion
including:
a. At the individual's own expense, the
consultative services of:
1. Private physicians;
2. Psychologists;
3. Dentists; and
4. Other health practitioners;
b. Granting to such health practitioners
reasonable access to the individual in programs; and
c. Allowing such health practitioners to make
recommendations to programs regarding the services and treatment provided by
the programs;
(17) The right, upon request, to have one or more
of the following present at any treatment meeting requiring the individual’s
participation and informed decision-making:
a. Guardian;
b. Representative;
c. Attorney;
d. Family member;
e. Friend;
f. Advocate;
g. Consultant; or
h.
Peer;
(18) The right to freedom from restraint including
the right to be free from seclusion and physical, mechanical or pharmacological
restraint; and
(19) If the individual meets the definition of a
“child” in RSA 126-U:1, the right to freedom from restraint and seclusion, as
defined in RSA 126-U:1, IV and V-a, respectively, except as allowed by RSA
126-U.
(b) These rules shall not require any behavioral
health care professional to administer treatment contrary to such
professional's clinical judgment.
(c) Programs shall, whenever possible, maximize
the decision-making authority of the individual.
(d) For individuals who have a guardian, the
following provisions shall apply:
(1) The program shall ensure that, the guardian
and all persons involved in the provision of service are made aware of the
individual’s needs, views, preferences and aspirations;
(2) The program shall comply with the decisions
made by the guardian within the legitimate scope of his or her authority;
(3) A guardian is only allowed to make decisions
that are within the scope of his or her powers pursuant to RSA 464-A:25, RSA
463 and as modified by the court, or as otherwise allowed by law;
(4) The program shall request a copy of the
guardianship order from the guardian and keep the order in the individual’s
record at the program;
(5) If any issues arise relative to the provision
of services and supports which are outside the scope of the guardian’s
decision-making authority as set forth in the guardianship order, the
individual’s choice and preference relative to those issues shall prevail
unless the guardian’s authority is expanded by the court to include those
issues;
(6) A program shall take such steps as are
necessary to prevent a guardian from exceeding the decision-making authority
granted by the court or acting in a manner that does not further the best
interests of the individual, including:
a. Reviewing with the guardian the limits on his
or her decision-making authority; and
b.
If necessary, bringing the matter to the attention of the court that appointed
the guardian; and
(7) In the event that there is a dispute between
the program and the guardian, the program shall inform the guardian of his or
her right to take either or both of the following actions:
a. Appeal the matter pursuant to He-M 204 and
He-C 200; or
b. Bring the dispute to the attention of the probate
court that appointed the guardian.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.07 Termination of Services. Termination of services shall be done only
pursuant to He-M 401.14.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.08 Suspension of Services. Suspension of services shall be done only
pursuant to He-M 401.14.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
He-M
309.09 Individual Rights in Community
Residences.
(a) In addition to the foregoing rights,
individuals in community residences shall also have the following rights:
(1) The right to a safe, sanitary and humane
living environment;
(2) The right to freely and privately communicate
with others, including:
a.
The right to send and receive unopened and uncensored written and electronic
correspondence;
b. The right to have reasonable access to
telephones and to be allowed to make and to receive reasonable numbers of
telephone calls except that community residences may require an individual to
reimburse them for the cost of any long distance calls made by the individual;
c. The right to receive and to refuse to receive
visitors except that community residences may impose reasonable restrictions on
the number and time of visits in order to ensure effective provision of
services; and
d.
The right to engage in social, recreational, and religious activities including
the provision of regular opportunities for individuals to engage in such
activities;
(3) The right to privacy, including the
following:
a. The right to courtesies such as knocking on
closed doors before entering and ensuring privacy for telephone calls,
electronic communications, and visits;
b. The right to opportunities for personal
interaction in a private setting except that any conduct or activity which is
illegal shall be prohibited; and
c.
The right to be free from searches of
their persons and possessions except in accordance with applicable
constitutional and legal standards;
(4) The right to personal choice, including the
following:
a. The right to keep and wear their own clothes;
b. The right to reasonable space for personal
possessions;
c. The right to keep and to read materials of
his or her own choosing;
d. The right to keep and spend their own money;
and
e. The right to be compensated for any work
performed and the right not to work, except that:
1.
Individuals may be required to perform personal housekeeping tasks within the
individual's own immediate living area and equitably shared housekeeping tasks
within the common areas of the community residence, without compensation; and
2.
Individuals may perform vocational
learning tasks or work required for the operation or maintenance of a community
residence, if the work is consistent with their individual service plans and
the individual is compensated for work performed according to laws, rules, and
regulations set by the state and federal governments; and
(5) The right to be reimbursed for the loss of
any money held in safekeeping by the community residence.
(b) Nothing in He-M 309.09 shall require a
community residence to have policies governing the behavior of the residents.
(c) Individuals and guardians shall have the
right to be informed of any house policies prior to admission to the community
residence.
(d) Residents shall have the right to participate
in the development and modification of any house policies. Residents shall formally review the house
policies at least annually.
(e) House policies shall be posted by community
residences.
(f) House policies shall be in conformity with
He-M 309.
(g) House policies shall be periodically reviewed
for compliance with He-M 309 in connection with community mental health program
and department site visits.
Source. #4412, eff 4-27-88; ss by #5093, eff 3-15-91,
EXPIRED: 3-15-97
New. #6757, eff 5-27-98; ss by #8639, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15
PART He-M 310 RIGHTS OF PERSONS
RECEIVING DEVELOPMENTAL SERVICES OR ACQUIRED BRAIN DISORDER SERVICES IN THE
COMMUNITY
Statutory Authority: RSA
171-A:3; 171-A:14, V; 126-A:16, III; 137-K:3, IV
He-M 310.01 Purpose. The purpose of these rules is to define the
rights of applicants for service or persons who have been found eligible for
services under He-M 503.03 or He-M 522.03 and who are being served in the
community or in a state-operated designated receiving facility. Individuals might have additional rights
under RSA 151:21, patients' bill of rights for residents of health care
facilities.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.02 Definitions. The words and phrases used in this part shall
have the following meanings:
(a) “Abuse” means an act or omission by an
employee, consultant, or volunteer of a provider agency which is not accidental
and harms or threatens to harm an individual's physical, mental or emotional
health, or safety and includes emotional abuse, physical abuse, and sexual
abuse;
(b) “Acquired brain disorder” means a disruption
in brain functioning that:
(1)
Is not congenital or caused by birth trauma;
(2)
Presents a severe and life-long disabling condition which significantly
impairs a person's ability to function in society;
(3)
Occurs prior to age 60;
(4)
Is attributable to one or more of the following reasons:
a. External trauma
to the brain as a result of:
1. A motor vehicle
incident;
2. A fall;
3. An assault; or
4. Another related
traumatic incident or occurrence;
b. Anoxic or hypoxic
injury to the brain such as from:
1. Cardiopulmonary
arrest;
2. Carbon monoxide
poisoning;
3. Airway
obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious
diseases such as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial
surgery;
f. Cerebrovascular
disruption such as a stroke;
g. Toxic exposure;
or
h. Other
neurological disorders such as Huntington's disease or multiple sclerosis which
predominantly affect the central nervous system; and
(5) Is manifested by one or
more of the following:
a. Significant
decline in cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of
mood; or
5. Awareness of
deficits;
(c) “Applicant” means any person who requests
services pursuant to He-M 503.04 or He-M 522.04;
(d) “Area agency” means “area agency” as defined
in RSA 171-A:2, I-b;
(e) “Attorney” means a member of the New
Hampshire bar association retained, employed, or appointed by a court to
represent an individual;
(f) “Coercion” means an act by an employee,
contractor, consultant, or volunteer of a provider agency which is designed to
compel an individual to act in clear opposition to the preference of the
individual, excluding requirements otherwise prescribed by law or rule;
(g) “Community residence” means either an agency
residence as defined in He-M 1001.02 (b) or family residence as defined in He-M
1001.02 (p) exclusive of any independent living arrangement that:
(1) Provides residential
services for at least one person with a developmental disability, in accordance
with He-M 503, or acquired brain disorder in accordance with He-M 522;
(2) Provides services and
supervision for an individual on a daily and ongoing basis, both in the home
and in the community, unless the individual’s service agreement states that the
individual may be without supervision for specified periods of time;
(3) Serves individuals whose
services are funded by the department; and
(4) Is certified pursuant to
He-M 1001;
(h) “Designated receiving facility (DRF)” means a
residential treatment program designated by the commissioner pursuant to RSA
171-A:20 and He-M 526 to provide care, custody, and treatment to persons
involuntarily admitted to the state developmental services system;
(i) “Developmental disability” means
“developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:
a. Which is attributable to an
intellectual disability, cerebral palsy, epilepsy, autism, or a specific
learning disability, or any other condition of an individual found to be
closely related to an intellectual disability as it refers to general
intellectual functioning or impairment in adaptive behavior or requires
treatment similar to that required for persons with an intellectual disability;
and
b Which originates before such
individual attains age 22, has continued or can be expected to continue
indefinitely, and constitutes a severe disability to such individual's ability
to function normally in society.";
(j) “Emotional abuse” means:
(1) The misuse of power,
authority or both;
(2) Verbal harassment; or
(3) Unreasonable confinement
which results or could result in the mental anguish or emotional distress of an
individual;
(k) “Exploitation” means the use of an
individual’s person or property for another’s profit or advantage or breach of
a fiduciary relationship through improper use of an individual's person or
property including situations where a person obtains money, property, or
services from an individual through undue influence, harassment, deception, or
fraud;
(l) “Guardian” means a person appointed under RSA
463 or RSA 464-A or who is a parent of an individual under the age of 18 whose
parental rights have not been terminated or limited by law in such a way as to
remove the person’s right to make decisions pursuant to RSA 171-A on behalf of
the individual;
(m) “Habilitation” means “habilitation” as
defined in RSA 171-A:2, IX, namely, “the process by which program personnel
assist clients to acquire and maintain those life skills which enable them to
cope more effectively with the demands of their own persons and of their
environment, to be economically self-sufficient and to raise the level of their
physical, mental and social efficiency.
Habilitation includes but is not limited to programs of formal,
structured education and treatment.”;
(n) “Individual” means a person who has a
developmental disability as defined in (i) above or
an acquired brain disorder as defined in (b) above;
(o) “Individual treatment plan” means, for an
individual receiving treatment pursuant to RSA 171-B:12, a plan developed by
the individual's treatment team to address the individual’s clinical needs and
the behavior or condition which creates a potential danger for others;
(p) “Informed decision” means a choice made
voluntarily by an individual receiving services or an applicant for services
or, where appropriate, such person's legal guardian or representative, after
all relevant information necessary to making the choice has been provided,
when:
(1) The person understands that
he or she is free to choose or refuse any available alternative;
(2) The person clearly
indicates or expresses his or her choice; and
(3) The choice is free from all
coercion;
(q) “Intellectual disability” means “intellectual
disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage
general intellectual functioning existing concurrently with deficits in
adaptive behavior, and manifested during the developmental period. A person
with an intellectual disability may be considered mentally ill provided that no
person with an intellectual disability shall be considered mentally ill solely
by virtue of his or her intellectual disability.”;
(r) “Neglect" means an act or omission which
results or could result in the deprivation of essential services necessary to
maintain the minimum mental, emotional, or physical health of an individual;
(s) “Parent” means the father or mother of an
individual under the age of 18 whose parental rights have not been terminated
or limited by law;
(t) “Physical abuse” means the use of physical
force which results or could result in physical injury to an individual;
(u) “Prescribing practitioner” means a licensed
professional with prescriptive authority, including the following:
(1) Physician;
(2) Advance practice registered
nurse (APRN);
(3) Dentist;
(4) Physician's assistant;
(5) Optometrist; and
(6) Podiatrist;
(v) “Provider agency” means an entity that is
providing services to individuals;
(w) “Resident” means an individual who lives in a community residence;
(x) “Restraint”
means:
(1) Any manual method, physical or mechanical
device, material, or equipment that immobilizes an individual or reduces the
ability of an individual to move his or her arms, legs, head, or other body
parts freely but does not include devices, such as orthopedically prescribed
devices, or other methods that involve the physical holding of an individual,
if necessary, for the purpose of:
a. Protecting the
individual from falling out of bed; or
b. Permitting the
individual to participate in activities without the risk of physical harm; or
(2) Any
drug or medication when it:
a. Is
used as a restriction to manage an individual’s behavior or restrict the
individual’s freedom of movement; and
b. Is
not a standard treatment or dosage for the individual’s diagnosis, in that its
overall effect reduces an individual’s ability to effectively or
appropriately interact; or
(3) “Restraint”
as defined in RSA 126-U:1, IV as applied to a person who has not reached 18
years of age, or who is otherwise a child as defined by RSA 126-U:1, I;
(y) “Representative” means:
(1) The parent or guardian of
an individual under the age of 18;
(2) The legal guardian of an
individual 18 or over; or
(3) A person who has power of
attorney for the individual;
(z) “Seclusion” means
(1) For an individual who is 18 or older:
a. Is
placed alone in a room or area from which the individual is physically
prevented, by lock or person, from leaving; and
b. Cannot
or will not make an informed decision to agree to such confinement; or
(2) “Seclusion”
as defined in RSA 126-U:1, V-a as applied to a person who has not reached 18
years of age, or who is otherwise a child as defined by RSA 126-U:1, I;
(aa) “Service” means any evaluation, training,
counseling, therapy, habilitation, service coordination, or other type of
assistance provided by a provider agency;
(ab) “Sexual abuse” means contact or interaction
of a sexual nature between an individual and an employee of or a consultant or
volunteer for a provider agency;
(ac) “Service agreement” means a written agreement
between the individual, guardian, or representative and provider(s) that is
prepared as a result of the person-centered planning process and describes the services
that an individual will receive and constitutes an individual service agreement
as defined in RSA 171-A:2, X; and
(ad) “Treatment” means medical care provided by a
prescribing practitioner.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.03 Notice of Rights of Individuals and Applicants.
(a) Provider agencies shall inform individuals
and applicants of their rights under these rules in clearly understandable
language and form, both verbally and in writing, on an annual basis.
(b) The notification of rights required pursuant
to (a) above shall include, at a minimum, the following measures:
(1) Provider agencies shall
inform applicants for services of their rights to evaluations and access to
treatment and other services;
(2) Provider agencies shall
provide meaningful and understandable information about rights to individuals
who are minors or who have been adjudicated incapacitated as well as to their
parents, guardians, representatives, or attorneys;
(3) Provider agencies shall
provide information outlining the process of how to file a complaint pursuant
to He-M 202;
(4) Provider agencies shall
advise individuals and their guardians or representatives of individuals’
rights upon initial participation in any service, upon any change in provider
agency or community residence, and at least once a year after initial
participation;
(5) Every provider agency shall
post a notice of the rights set forth in these rules, as follows:
a. The notice shall be posted
continuously and conspicuously; and
b. The notice shall be
presented in clearly understandable language and form; and
(6) Each provider agency and
community residence shall have on the premises complete copies of rules
pertaining to rights of individuals which are available for individuals,
guardians, representatives, and staff to review.
(c) Each provider agency shall document, as
indicated by signature of the individual or his or her parent, guardian, or
representative, notifications of rights in individuals’ records.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.04 Fundamental Rights.
(a) Any person receiving services for a
developmental disability or acquired brain disorder shall be entitled to any
legal right to which all citizens are entitled regardless of that person's
admission to the developmental services system, except as provided by RSA
171-B.
(b) The legal rights protected shall include, at
a minimum:
(1) The right to freedom of
religious preference and practice, the right to be free from engaging in any
religious activity, and the right to receive reasonable assistance in attending
places of worship;
(2) The right to register to
vote, if eligible, in public elections and, as provided in 42 U.S.C. §
1973aa-6, the right to receive assistance from the person of his or her choice
in registering to vote and in voting;
(3) The following civil rights,
unless a court has determined that an individual is legally incapacitated
pursuant to RSA 464-A and a guardian or representative has been appointed to
make certain decisions or a behavior change program, as described in He-M 310.11,
exists that limits an individual’s rights and is approved by a human rights
committee pursuant to RSA 171-A:17, II(c):
a. The
right to manage affairs;
b. The
right to contract;
c. The
right to hold professional, occupational, or motor vehicle driver’s licenses;
d. The
right to marry or to obtain a divorce;
e. The
right to make a will; and
f. The
right to exercise any other civil right;
(4) The right to not be
discriminated against in any manner because of race, color, sex, religion,
national origin, age, disability, marital status, sexual orientation or degree
of disability as provided in state and federal laws, title VII of the civil
rights act of 1964, section 504 of the rehabilitation act of 1973, the age
discrimination act of 1975, the Americans with Disabilities Act of 1990, and
the provisions of certain block grants, including:
a.
Access to auxiliary aids needed by the individual;
b. Services which are accessible to individuals
of limited English proficiency; and
c.
Service locations that are accessible and meet the individuals physical,
sensory, intellectual, or emotional needs; and
(5) The right to legal remedies
including the right to petition for and receive the benefits of a writ of
habeas corpus and to seek any other remedy provided by law.
(c) The legal rights of a person involuntarily
admitted in accordance with RSA 171-B may be limited to the extent necessary to
prevent harm to the individual or others, unless the individual is committed to
the secure psychiatric unit of the New Hampshire state prison.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.05 Personal Rights.
(a) Persons who are applicants for services or
individuals who are receiving services from provider agencies shall be treated
with dignity and respect at all times.
(b) Individuals shall be free from abuse,
neglect, and exploitation including, at a minimum, the following:
(1) Freedom from any emotional,
physical, or sexual abuse or neglect;
(2) Freedom from the
intentional use of physical force except the minimum force necessary to prevent
harm to the individual or others or substantial damage to property or when a
behavior change program exists that limits an individual’s rights and is
approved by a human rights committee pursuant to RSA 171-A:17, II(c); and
(3) Freedom from personal or
financial exploitation.
(c) Individuals shall have the right to privacy.
(d) Individuals shall have the right to be free
from coercion.
(e) Any individual who uses or has used provider
agency services shall have the right to confidentiality of all information and
records.
(f) At a minimum, provider agencies shall adhere
to the following confidentiality requirements:
(1) Material safeguarded shall
include any information with respect to an individual or through which an
individual can be identified such as:
a. Names;
b. Photographic and video
images;
c. Addresses;
d. Diagnoses and evaluative
data;
e. Medical and clinical
records;
f. Service agreements; and
g. Whether a person is using or
has used a provider agency’s services;
(2) Provider agency staff may
disclose to the chief of police in the community in which the individual
resides, or any law enforcement officer, as safety and security of the
individual and others require, or the individual’s legal counsel that an
individual is served by a provider agency if that individual is a victim of a
crime, has been charged with a misdemeanor or felony, or is involuntarily
admitted in accordance with RSA 171-B;
(3) The individual and guardian
or representative shall be informed that clinical information shall be released
to the third party payor to the extent necessary to substantiate charges for
services;
(4) If the individual,
guardian, or representative wishes to bear the cost of services privately
rather than allow the release of information to third party payors, the
individual shall be personally responsible for the full cost of such services;
(5) All employees, consultants,
and volunteers of provider agencies shall be informed so as to know and
understand confidentiality and comply with confidentiality statutes and rules;
(6) Separate, individual
records shall be maintained when group treatment methods are employed and joint
records of treatment activity that identify participants shall not be
maintained;
(7) No provider agency shall
photograph, fingerprint, or record any individual by audio or visual equipment
unless the individual, guardian, or representative has consented following an
informed decision, nor allow any third party to photograph, fingerprint, or
record any individual by audio or visual equipment unless the individual,
guardian, or representative has consented following an informed decision,
except if such monitoring or recording is part of a treatment program for a
person committed in accordance with RSA 171-B;
(8) These rules shall not
affect the obligation of provider agencies to release information as required
by:
a. RSA 161-F:56, protective
services to adults;
b. RSA 169-C:29, report of
child abuse;
c. RSA 631:6, report of injury
caused by criminal act;
d. He-M 202.07 (j); or
e. Other law; and
(9) Statements made by
individuals to physicians licensed pursuant to RSA 329, psychologists licensed
pursuant to RSA 329-B, or persons licensed pursuant to RSA 330-A or to those
who work under their supervision, may be disclosed for the purpose of
commitment hearings.
(g) Access to records shall be as follows:
(1) Information pertaining to
an individual shall be released to the individual and guardian or
representative upon request including all information provided by third parties
except that which was provided prior to May 1982, under an agreement that the
information would not be disclosed;
(2) A provider agency service
coordinator or nurse shall be present at a record review if:
a. There is a reasonable
concern that an individual will experience a harmful effect as a result of
reviewing his or her record, or reasonable concern that the security of the
record is at risk; and
b. The determination that a.
above applies has been made on an individual, case-by-case basis and the
reasons for the determination have been documented in writing;
(3) Information shall be released
to any person or organization that has obtained the written consent of the
individual, guardian, or representative;
(4) Information shall be
released to the department and funding, licensing, and accrediting agencies by
provider agencies under RSA 171-A as necessary for:
a. Determining eligibility for
funding;
b. Assisting in accrediting or
licensing decisions;
c. Delivering appropriate
services to individuals;
d. Monitoring and evaluating
service delivery; and
e. Planning future service
delivery;
(5) Provider agencies shall not
include or release confidential information in an individual's record which
pertains to other individuals;
(6) Provider agencies shall
include within the records of an individual any supplemental information
provided by the individual, guardian, or representative either clarifying or
rebutting information deemed by the individual to be inaccurate;
(7) An attorney appointed by a
court to represent an individual shall have access to all records and information
pertaining to that individual;
(8) Legal counsel for the
department shall have access to all relevant records and information pertaining
to an individual when such records and information are necessary because the
individual:
a. Is the subject of an
involuntary commitment hearing;
b. Is the subject of a
guardianship proceeding; or
c. Has instituted legal action against the state in regard to services
provided by the developmental services system;
(9) In cases where an
individual, or an attorney or other advocate who represents the individual,
after review of the record, requests copies of the record, such copies shall be
made available free of charge for the first 25 pages and for not more than 25
cents per page thereafter;
(10) Information regarding the
medical treatment of an individual shall be released to law enforcement
officials or health facility personnel if necessary to address an emergency
situation involving danger to the individual's health or safety, but only
specific information necessary to the relief of the emergency may be released
without the individual's, guardian’s, or representative’s consent; and
(11) In accordance with RSA
329:31, RSA 329-B:29, and RSA 330-A:35, when an individual has made a serious
threat of physical violence against a clearly identified or reasonably
identifiable victim or victims, or a serious threat of substantial damage to
real property, the following shall be obligated to make reasonable efforts to
disclose the threat to the third party or law enforcement officials:
a. Physicians licensed pursuant
to RSA 329;
b. Psychologists licensed
pursuant to RSA 329-B; and
c. Persons licensed pursuant to
RSA 330-A and those who work under their supervision.
(h) Individuals and guardians or representatives
shall have the right to complain about any alleged violation of a right
afforded by these rules or by any state or federal law or rule or the
unreasonable restriction of a legal, personal, or treatment right of a person
involuntarily admitted in accordance with RSA 171-B, or any other matter.
(i) Any person shall have the right to complain
or bring a grievance on behalf of an individual or a group of individuals. The rules governing procedures for protection
of rights of individuals, He-M 202, shall apply to such complaints and
grievances.
(j) An individual shall have the right to a
hearing pursuant to RSA 171-A and He-C 200 when a recommendation is made to
provide service for that individual in any residential setting that restricts
in any way the liberty or informed decisions of the individual. The individual
shall have a right to representation by legal counsel, except that persons
involuntarily admitted pursuant to RSA 171-B may only challenge that admission
in accordance with procedures set forth in RSA 171-B.
(k) The personal rights of a person involuntarily
admitted in accordance with RSA 171-B shall be restricted where safety or
security requires such limitation.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.06 Service Rights.
(a) Individuals shall have the right to adequate
and humane service and treatment, including:
(1) The right of access to
services including:
a. The right to evaluation to determine the type of services needed
and which provider agencies are most suited to provide those services;
b. The right to receive necessary services when those services are
available, subject to the admission and eligibility policies and standards of
each provider agency; and
c. The right to receive services without regard to race, color, age,
religion, sex, marital status, national origin, severity of disability, sexual
orientation, or inability to pay;
(2) The right to quality
services including services provided in accordance with licensing requirements
and rules adopted by the department in He-M 200-1300 and other applicable rules
of state agencies and services provided in keeping with generally accepted
clinical and professional standards applicable to the individuals’ disabilities
and services;
(3) The right to receive services
in his or her community:
a. To the same degree of access
as persons not receiving services;
b. That will promote the
individual’s full community participation; and
c. Except as limited by
individual treatment plans for individuals involuntarily admitted in accordance
with RSA 171-B;
(4) The right to a
person-centered planning process that:
a. Is directed by
the individual or representative, if applicable;
b. Is intended to identify the strengths, capacities,
preferences, needs, and desired outcomes of the individual;
c. Includes
participants freely chosen by the individual as important contributors;
d. Provides information
and support to assist the individual to direct the process and to make informed
choices and decisions;
e. Reflects
cultural considerations of the individual and is conducted in clearly
understandable language and form;
f. Occurs at times
and location of convenience to the individual;
g. Includes
strategies for solving conflict or disagreement within the process;
h. Offers informed
choices to the individual or representative, if
applicable, regarding services and supports;
i. Involves the family or other participants in
enabling and assisting the individual to identify and access a personalized mix
of paid and non-paid services and supports that will assist him or her to
achieve personally defined outcomes in the most integrated setting appropriate
to the needs of the individual;
j. Includes
identification of the individual’s planning goals to achieve personal outcomes
in collaboration with those whom the individual has identified;
k. Results in a
service agreement that identifies personally defined outcomes and training
supports, therapies, treatments, and other services the individual is to
receive to achieve those outcomes;
l. Includes a
method for the individual to request amendments to the agreement; and
m. Records the
alternative home and community based settings that were considered by the
individual;
(5) The right to a service
agreement developed, reviewed, and revised in accordance with He-M 503;
(6) The right to services in
accordance with the time frame set in the service agreement;
(7) The right to services in a
setting that is:
a. Based on the
individual’s needs and preferences;
b. Chosen by the
individual or his or her representative from among options that are identified
in the service agreement and include non-disability specific settings; and
c. Integrated in,
and supportive of full access of individuals to, the greater community,
including opportunities to:
1. Seek employment
and work in competitive integrated settings;
2. Engage in community life;
3. Control schedules
and activities;
4. Control personal
resources;
5. Receive services
in the community to the same degree of access as the general population; and
6. Live in a private
unit in a residential setting, based on the resources available for room and board;
(8) The right to be informed of
all significant risks, benefits, side effects, and alternative treatment and
services and to give consent to any treatment, behavior change program,
service, or referral following an informed decision, except when action is
necessary to prevent harm to the individual or others or prevent substantial
damage to property or where otherwise provided by law, such that:
a. Whenever it is possible, the
consent shall be given in writing; and
b. In all other cases, evidence
of consent shall be documented by the provider agency and shall be witnessed by
at least one person;
(9) The right to refuse to
participate in any form of experimental treatment or in any research or have
one’s representative refuse on the individual’s behalf;
(10) The right to be fully
informed of one's own diagnosis and prognosis;
(11) The right to voluntary
participation in services, as decided by the individual or his or her
representative, including the right to seek changes in services or provider
agency at any time or to withdraw from any form of service or from a provider
agency, unless the person is involuntarily admitted in accordance with RSA
171-B;
(12) The right to services
which promote independence including services which shall be directed toward:
a. Eliminating or reducing the
individual's need for continued services; and
b. Promoting the ability of the
individuals to function at their highest capacity and as independently as
possible;
(13) The right to receive
medical care and treatment, including ensuring medications are refilled in a
timely manner and avoid expiration;
(14) The right to refuse
medications and treatment, except emergency treatment that is:
a. Necessary to prevent harm to
the individual or others or prevent substantial damage to property; or
b. In accordance with a
behavior change program that limits an individual’s rights and is approved by a
human rights committee;
(15) The right to consultation
and second opinion, including;
a. At the individual's own
expense, the consultative services of:
1.
Private physicians;
2.
Psychologists;
3.
Dentists; and
4.
Other health practitioners;
b. Granting such health
practitioners reasonable access to the individual by provider agencies; and
c. Allowing such health
practitioners to make recommendations to provider agencies regarding the
services and treatment provided;
(16) The right to choose, or
have one’s representative choose, one or more of the following persons to be
present at any person-centered planning meeting or other service planning meeting
requiring the individual’s participation and informed decision-making:
a. Guardian;
b. Representative;
c. Attorney;
d. Family member;
e. Friend;
f. Direct support staff;
g. Advocate;
h. Consultant; or
i. Other
person the individual requests;
(17) The right to freedom from
restraint including:
a. For individuals under the
age of 18, the right to limitations on the use of restraint and seclusion pursuant
to RSA 126-U; and
b. The right to be free from
seclusion and physical, mechanical, or pharmacological restraint except that in
cases of emergency such as the occurrence or serious threat of extreme
violence, personal injury, or attempted suicide where no less restrictive alternative
would be effective:
1.
Such means of restraint as are authorized by a prescribing practitioner
and approved by a human rights committee pursuant to RSA 171-A:17, II(c), may
be used as part of a treatment plan to which the individual or individual’s
guardian or representative, if any, has consented, having made an informed
decision to do so; and
2.
The minimum necessary degree of restraint may also be used:
(i)
In an emergency to prevent harm to the individual or others or prevent
substantial damage to property;
(ii) As part of a behavior
change program that limits an individual’s rights and is approved by a human
rights committee pursuant to RSA 171-A:17, II, (c); or
(iii) When the person is
involuntarily admitted in accordance with RSA 171-B; and
(18) The right to choose with
whom to interact.
(b) Applicants shall have the right to evaluation
to determine an applicant’s eligibility for services and the type of services
needed and to determine which provider agencies are most suited to provide the
services needed.
(c) Provider agencies shall maximize the
decision-making authority of the individual.
(d) Whenever possible, individuals shall be
served in generic, integrated settings rather than specialized programs for
persons with developmental disabilities or acquired brain disorders.
(e) Provider agencies may restrict access by
individuals to various locations to:
(1) Ensure the privacy or
safety of the individuals;
(2) Achieve other necessary
objectives contained in the service agreement; or
(3) Comply with provisions of
law and orders of court.
(f) These rules shall not require any licensed
professional to administer treatment contrary to such professional's clinical
judgment.
(g) The service rights of a person involuntarily
admitted in accordance with RSA 171-B may be restricted where safety or
security requires such limitation.
(h) For individuals who have a guardian or
representative, the following provisions shall apply:
(1) The provider agency shall
ensure that the guardian or representative and all persons involved in the
provision of services are made aware of the individual’s needs, views,
preferences, and aspirations;
(2) The provider agency shall
comply with decisions made by the guardian or representative within the
legitimate scope of his or her authority;
(3) A guardian or
representative is only allowed to make decisions that are within the scope of
his or her powers pursuant to RSA 464-A:25, RSA 463:12, or RSA 137-J:5 and as
modified by the court, or as otherwise allowed by law;
(4) The area agency and
provider agencies shall obtain a copy of the guardianship order or power of
attorney from the guardian or representative and keep the order in the
individual’s record;
(5) If any issues arise
relative to the provision of services and supports which are outside the scope
of the guardian’s or representative’s decision-making authority as set forth in
the guardianship order or power of attorney, the individual’s choice and
preference relative to those issues shall prevail unless the guardian’s or
representative’s authority is expanded by the court to include those issues;
(6) A provider agency shall
take such steps as are necessary to prevent a guardian or representative from
exceeding the decision-making authority granted by the court or acting in a
manner that does not further the best interests of the individual, including:
a. Reviewing with the guardian
or representative the limits on his or her decision-making authority; and
b. If necessary, bringing the
matter to the attention of the court that appointed the guardian; and
(7) In the event that there is
a dispute between the provider agency and the guardian or representative, the provider
agency shall inform the guardian or representative of his or her right to take
either or both of the following actions:
a. Appeal the matter pursuant
to He-M 202 and He-C 200; or
b. Bring the dispute to the
attention of the probate court that appointed the guardian.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.07 Termination of Services.
(a) Except as provided in (g) below, an
individual’s services shall not be terminated unless:
(1) Such termination is deemed
in the best interest of the individual;
(2) The individual can function
independently without such service;
(3) The individual has received
optimal benefit from the service;
(4) The individual or
representative refuses to pay for the services that he or she is receiving
despite having the financial resources to do so; or
(5) The individual or
representative refuses to apply for benefits that could cover the cost of the
services that he or she is receiving despite the fact that the individual is or
might be eligible for such benefits.
(b) Provider agencies shall only terminate
services to individuals in accordance with RSA 171-A:8.
(c) Prior to any termination of service, the
provider agency shall give the individual 30 days’ notice.
(d) The notice shall:
(1) Be in writing;
(2) Contain the reasons for the
termination;
(3) Contain the effective date
of the termination; and
(4) Explain that the
individual, guardian, or representative has the right to appeal the termination
in accordance with He-M 202 and He-C 200.
(e) Services shall be continued
while an administrative appeal under He-M 202 or He-C 200 is pending.
(f) In every instance of termination, the area
agency shall recommend appropriate services or be responsible for contacting
the individual in accordance with RSA 171-A:8, II.
(g) Services to persons involuntarily admitted in
accordance with RSA 171-B shall not be terminated except as provided in RSA
171-A:8, V.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.08 Suspension of Services.
(a) A provider agency shall not suspend services
to an individual unless the individual and guardian or representative have
prior written notice of the specific behaviors and conduct for which suspension
is imposed.
(b) Prior written notice shall be given through
the service agreement process or through written provider agency policies which
are explained to the individual and guardian or representative upon admission.
(c) Upon suspension, the provider agency shall
give the individual and guardian or representative written notice containing
the following:
(1) The reason for the
suspension;
(2) The length of the
suspension; and
(3) An explanation of the right
to appeal in accordance with He-M 202 and He-C 200.
(d) The maximum length of a suspension shall be 5
service days. However, should an
individual, guardian, or representative choose to exercise the right to appeal,
the individual shall be suspended for no longer than one service day pending
resolution of the appeal.
(e) Services to persons involuntarily admitted
under RSA 171-B shall not be suspended.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.09 Rights of Individuals in Community Residences.
(a) In addition to the foregoing rights,
individuals living in community residences shall also have the following
rights:
(1) The right to a safe,
sanitary and humane living environment;
(2) The right to settings that
are physically accessible to the individual;
(3) The right to freely and
privately communicate with others, including:
a. The right to send and receive unopened and uncensored written and
electronic correspondence;
b. The right to have reasonable access to telephones and to be allowed
to make and to receive reasonable numbers of telephone calls;
c. The right to receive and to
refuse to receive visitors; and
d. The right to engage in social, recreational, and religious
activities including the provision of regular opportunities for individuals to
engage in such activities;
(4) The right to privacy in the
individual's sleeping or living unit, including the following:
a. The right to courtesies such
as knocking on closed doors before entering and ensuring privacy for telephone
calls, electronic communications, and visits;
b. The right to entrance doors
lockable by the individual with only appropriate staff having keys to doors;
c. The right to receive
visitors of one’s choosing at any time;
d. The right to opportunities
for personal interaction in a private setting except that any conduct or
activity which is illegal shall be prohibited;
e. The right to receive
personal care in private; and
f. The right to be free from
searches of their persons and possessions except in accordance with applicable
constitutional and legal standards;
(5) The right to individual
choice, including the following:
a. The right to keep and wear
their own clothes;
b. The right to reasonable
space for personal possessions;
c. The right to keep and to
read materials of their own choosing;
d. The right to keep and spend
their own money;
e. The right to be compensated
for any work performed and the right not to work, except that:
1.
Individuals may be required to perform personal housekeeping tasks
within the individual's own immediate living area and equitably shared
housekeeping tasks within the common areas of the community residence, without
compensation; and
2.
Individuals may perform vocational learning tasks or work required for
the operation or maintenance of a community residence, if the work is
consistent with their service agreements and the individual is compensated for
work performed according to laws, rules, and regulations set by the state and
federal governments;
f. The right to choose one’s roommate when bedrooms are shared;
g. The right to furnish and
decorate one’s sleeping or living unit within the limits of the lease or other
agreement; and
h. The freedom and support to
control one’s own activities and schedules, and to access food at any time;
(6) The right to a residency
agreement in accordance with He-M 310.10; and
(7) The right to be reimbursed
for the loss of any money held in safekeeping by the community residence.
(b) In community residences serving persons
involuntarily admitted in accordance with RSA 171-B, restrictions on a person’s
communication, privacy, and personal choice may be imposed if necessary for the
person’s treatment if consistent with the individual treatment plan or the
residence's policies.
(c) Nothing in He-M 310.09 shall require a
community residence to have policies governing the behavior of the residents.
(d) Individuals and guardians or representatives
shall have the right to be informed in writing of any house policies prior to
admission to the community residence.
(e) Residents shall have the right to participate
in the development and modification of any house policies. Residents shall formally review the house
policies at least annually.
(f) House policies shall be in conformity with
He-M 310.
(g) House policies shall be periodically reviewed
for compliance with He-M 310 in connection with provider and department site
visits.
(h) Any modification to (a) (4), (5), or (6)
above shall be supported by a specific assessed need and documentation
described in (i) below, and be reviewed and approved
by the human rights committee of the individual’s provider agency.
(i) A provider agency shall only make
modifications pursuant to (h) above by documenting in the service agreement the
following:
(1) The specific and
individualized assessed need and a description of the condition that is
directly proportionate to the need;
(2) Positive interventions and
supports used prior to any modification to the service agreement;
(3) Less intrusive methods of
meeting the need that have been tried unsuccessfully;
(4) A method for the regular
collection and review of data to measure the ongoing effectiveness of the
modification, and established timelines for periodic reviews to determine
whether the modification is still necessary or can be terminated;
(5) Informed consent of the
individual, guardian, or representative; and
(6) An assurance that the
interventions and supports will not cause harm to the individual.
Source. #4413, eff 4-27-88; ss by #5094, eff 3-15-91;
ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98;
ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06;
ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23
He-M 310.10 Residency Agreement.
(a) Individuals
living in community residences shall enter into a residency agreement with the
provider in accordance with (b)-(d) below.
(b) The individual or resident, legal guardian,
if applicable, and provider shall complete the “New Hampshire Residency
Agreement” (April 2023) outlining the following:
(1) The resident’s right to:
a. Privacy in his or her sleeping and living
unit;
b. Lockable doors to his or her sleeping or
living unit with only appropriate staff having keys;
c.
The ability to have visitors of his or her choosing at any time;
d. The choice of furnishings and decorations in his
or her sleeping or living unit;
e. The choice of roommate, if bedrooms are
shared;
f. Have access to food at any time;
g. An inventory of personal property valued at $25.00
or greater, as well as any item of sentimental value
to the resident, that will occur on the day of move-in and will be updated
quarterly to ensure accuracy; and
h. Modifications of his or her rights in a. through g. above, pursuant
to He-M 310.09(h) and (i);
(2) The responsibilities as a resident to
include:
a. Maintaining cleanliness of his or her
sleeping or living unit and shared living spaces; and
b. Reviewing and signing a complete inventory of
personal property valued at $25.00 or greater, as well as any item of
sentimental value to the resident on the day of move-in, quarterly to ensure
accuracy, and on the day of departure of the residence;
(3) The responsibilities as a provider to
include:
a.
Maintaining a safe residential environment;
b. Always treating the resident with dignity and
respect;
c. Implementing the resident’s approved
individual service agreement and approved behavior support plan;
d. Providing services in accordance with all
applicable state regulations, and the contract with the provider agency; and
e. Assisting, as necessary, the resident to develop
and maintain an inventory of personal property, valued at $25.00 or more, as
well as any item of sentimental value to the resident and ensuring that upon
termination of the residency agreement, the resident receives all personal property
listed on the most recent inventory.
(c) If the provider chooses to end the residency
agreement:
(1) The provider shall notify the resident, legal
guardian, if applicable, and service coordinator in writing of the intended
termination of the residency agreement, and the reason(s) therefor, at least 90
calendar days before the proposed termination date of the residency agreement,
and in an agency residence, inform the
resident that this notice is not an order requiring them to vacate the
residence, and include the rights of the resident to appeal the provider’s decision to terminate the
residency agreement, in accordance with He-M 310.12 below;
(2) The resident or legal guardian, if applicable,
shall have the right to request a team meeting to discuss whether the provider
would reconsider the notice;
(3) Upon receipt of the notice required in (c)(1)
above, the service coordinator shall convene a team meeting within 10 calendar
days to develop a transition plan for the resident in order to ensure an
appropriate transition to an alternative residence;
(4) In cases where the behavior of the resident
poses a serious threat of bodily harm to the provider or others living in the
residence, or substantial damage to the residence or property, the provider
shall notify the resident, legal guardian, if applicable, and the service
coordinator of the situation and provide 72 hours’ notice before the proposed
termination date, and in an agency residence, inform the resident that this notice is not an order requiring them to
vacate the residence, and include the rights of the resident to appeal the provider’s decision to terminate the
residency agreement, in accordance with He-M 310.12 below;
(5) Upon receipt of notification in (4) above,
the service coordinator, or designee, shall immediately convene a team meeting
within 24 hours to determine and take
the appropriate course of action to ensure the resident’s
health and safety, and ensure that
the resident has access to an alternative safe residence;
(6)
In an agency residence, if the resident fails to vacate the residence by the proposed termination date, the
provider shall issue a notice to the resident or legal guardian if applicable,
for the resident to vacate the residence within 3 days, and include the rights
of the resident to appeal the notice in accordance with He-M 310.12 below, and
remain in the residence in accordance with He-M 310.12(d); and
(7)
In the absence of the conditions for termination provided in (4) above, an
agency residence shall only terminate the residency agreement for the following
reasons:
a. If the
termination is necessary for the resident’s welfare and the resident’s needs
can no longer be met at the agency residence;
b. The agency resident ceases to operate; or
c. Other good cause, which need not be based on
the action or inaction of the resident including, but not limited to any
legitimate business or economic reasons.
(d) If the resident chooses to end the residency
agreement:
(1) The resident or legal guardian if applicable,
shall notify the provider and service coordinator in writing of the intended
termination of residency agreement 90 calendar days prior to the proposed
termination date;
(2) In cases where the behavior of the provider
poses a serious threat of bodily harm to the resident or others living in the
residence, or substantial damage to the residence or property, the resident or
legal guardian, if applicable, shall notify the service coordinator of the
situation and the resident, legal guardian, or service coordinator shall provide
72 hours’ notice before the proposed termination date; and
(3) Upon receipt of notification in (2) above,
the service coordinator, or designee, shall immediately convene a team meeting,
in accordance with the requirements of He-M 503, within 24 hours to determine
the appropriate course of action to ensure the residents health and safety, and
that the resident has access to an alternative safe residence and ensure that
the complaint procedure in He-M 202 is initiated.
(e) The residency agreement shall be renewed on
an annual basis, at the time of the annual service agreement.
(f) The resident or provider may request a team
meeting at any time to discuss the terms of the residency agreement.
(g) Upon termination of the residency agreement,
the resident shall be entitled to all personal property as reflected on the
most current inventory of the resident’s property.
Source. #13676, eff 6-24-23
He-M
310.11 Behavior Change Program.
(a) Unless an individual is subject to a
commitment order pursuant to RSA 171-B, and unless otherwise specified in this
rule, an individual’s rights shall not be restricted and no interventions
designed to address challenging behavior unless the requirements of (b) through
(e) below are met.
(b) A behavior change program shall be a written
plan, protocol, or procedure that outlines strategies including:
(1) Physical environment modifications;
(2)
Restrictive strategies;
(3)
Use of monitoring devices; or
(4) Other strategies for altering behavior.
(c) An individual, guardian, or representative
shall agree to the terms of a behavior change program.
(d) A behavior change program approved by the
individual, guardian, or representative shall also be approved by an area
agency human rights committee pursuant to RSA 171-A:17, II(c) prior to
implementation.
(e) A behavior change program shall be reviewed
at least annually at the service agreement planning meeting.
Source. #13676, eff 6-24-23
He-M
310.12 Rights of Individuals in
Agency Residence to Appeal Termination.
(a) A notice to vacate the residence provided in
accordance with He-M 310.10 (c)(6) shall include the following:
(1) The specific reason(s) for the termination in
accordance with He-M 310.10 (c)(4) or (c)(7)a. or c.;
(2) Notice of the resident’s right to appeal
pursuant to He-C 200 within 5 business days, and the process for filing an
appeal, including the contact information to initiate the appeal with the Administrative
Appeals Unit;
(3) Notice of the resident’s right to remain in their residence pending
appeal, when applicable, pursuant to (d) below;
(4) Notice of the right to have legal
representation of the resident’s choosing at an appeal;
(5) Notice that the resident is responsible for
the costs of legal representation; and
(6) Notice of organizations with their addresses
and phone numbers that might be available to provide pro bono or reduced fee
legal assistance and advocacy, including Disability Rights Center – NH.
(b)
Appeals shall be forwarded to the department’s
administrative appeals unit, which shall assign a presiding officer to conduct
a hearing in accordance with He-C 200, within 10 calendar days of receipt of
the appeal.
(c) The burden of proof shall be on the provider
to prove by a preponderance of the evidence that the termination was in
accordance with He-M 310.10 (c)(4) or (c)(7).
(d) If a hearing is requested, the provider shall
continue to provide residential
services to the individual at their
current residence until a decision is rendered by the administrative
appeals unit, unless the reason for termination is the behavior of the resident
posing a serious threat of bodily harm to the provider or others living in the
residence, or substantial damage to the residence or property in accordance
with He-M 310.10(c)(4).
(e) If a resident fails to appeal a notice within
5 business days of receipt of the notice required in (a) above, the resident loses
their appeal rights and shall vacate the premises immediately.
(f) The hearings officer shall render a decision
within 3 business days of the hearing.
(g) If the hearings officer finds that the
provider met the burden of proof, the resident shall vacate the premises within
3 business days of the decision, unless the resident files a notice of intent
to file a motion to reconsider with the administrative appeals unit within 3
business days of the hearings officer’s decision.
(h)
If a resident files a motion to reconsider, the resident shall not be required
to vacate the premises until a decision has been issued on a motion to
reconsider. Additionally, if a resident
does not prevail on a motion to reconsider and within 3 business days after receipt of the decision on the motion
to reconsider files with the administrative appeals unit a notice of
intent to appeal to the supreme court, the resident shall not be required to
vacate the premises until a decision is rendered by the supreme court.
(i) In the event a resident does not file either a motion to
reconsider or an appeal with the supreme court after filing an intent to do so,
the resident shall vacate the premises within 3 business days of the expiration
of the time period for filing such reconsideration or appeal.
Source. #13676, eff 6-24-23
PART He-M 311 RIGHTS OF PERSONS IN STATE MENTAL HEALTH
FACILITIES
Statutory
Authority: RSA 135-C:5, I, (b); C:13;
C:16; C:18, C:58; C:61, V, VI & XI.
He-M 311.01 Purpose. The purpose of these rules is to define the
rights of individuals receiving services in state mental health facilities
which include New Hampshire hospital, Glencliff home, and any receiving
facility so designated by the commissioner pursuant to RSA 135-C:26.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New. #6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
He-M 311.02 Definitions.
(a) "Abuse" means
an act or omission by an employee, consultant or volunteer of a mental health
facility or designated receiving facility which is not accidental and harms or
threatens to harm an individual’s physical, mental or emotional health or
safety and includes emotional abuse, physical abuse, and sexual abuse.
(b) "Attorney" means a member of the
New Hampshire Bar Association who is retained, employed, or appointed by a
court to represent an individual.
(c) “Bureau” means the bureau of behavioral
health within the department of health and human services.
(d) “Client” means “individual” as defined in (l)
below.
(e) “Community residence” means a residence,
exclusive of any independent living arrangement, that:
(1) Provides residential services in accordance
with He-M 426 for at least one individual with a mental illness;
(2) Provides services based on the needs
identified in a resident’s individual service plan (ISP);
(3) Is operated directly by a facility or by
contract or agreement between a facility and another entity;
(4) Serves individuals whose services are funded
by the department; and
(5) Is certified pursuant to He-M 1002.
(f) “Department” means the department of health
and human services.
(g) “Direct care” means services provided to
individuals including, but not limited to: assistance with medication,
accompanying an individual to a treatment team or other clinical meeting, or
providing ongoing direct and active support.
(h) “Emotional abuse” means the misuse of power,
authority or both, verbal harassment, or unreasonable confinement which results
or could result in mental anguish or emotional distress of an individual.
(i)
"Exploitation" means the use of an individual’s person or
property for another's profit or advantage or breach of a fiduciary
relationship through improper use of an individual’s person or property
including situations where a person obtains money, property, or services from
an individual through undue influence, harassment, deception, or fraud.
(j) "Facility" means New Hampshire
hospital, Glencliff home, and any receiving facility so designated by the
commissioner pursuant to RSA 135-C:26.
(k) "Guardian" means a person appointed
under RSA 463, or RSA 464-A, or who is a parent of an individual under the age
of 18 whose parental rights have not been terminated or limited by law in such
a way as to remove the person’s right to make health care decisions on behalf
of the individual.
(l)
"Individual" means: A person who is receiving or applying for
a service from a facility. The term
includes “client.”
(m) "Informed decision" means “informed
decision” as defined in RSA 135-C:2, IX namely, “a choice made
by a client, an individual, or person seeking to be admitted who has the
ability to make such a choice and who makes it voluntarily after all relevant
information necessary to making the decision has been provided, and who
understands that he or she is free to choose or refuse any available
alternative, and who clearly indicates or expresses his or her choice. The choice shall be free from all coercion.” The term also includes such decision of an
individual, as defined in He-M 311.02(l) above, and the individual’s legal
guardian, where appropriate, based on the same factors as an informed decision
by an individual or person seeking to be admitted.
(n) "Mental illness" means “mental
illness” as defined in RSA 135-C:2 X, namely, "a substantial impairment of
emotional processes, or of the ability to exercise conscious control of one's
actions, or of the ability to perceive reality or to reason, when the
impairment is manifested by instances of extremely abnormal behavior or
extremely faulty perceptions. It does
not include impairment primarily caused by: (a) epilepsy; (b) intellectual
disability; (c) continuous or noncontinuous periods of intoxication caused by
substances such as alcohol or drugs; or (d) dependence upon or addiction to any
substance such as alcohol or drugs."
(o) "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 of an
incapacitated adult. The term also
includes neglect toward an individual.
(p) “Physical abuse” means the use of physical
force which results or could result in physical injury to an individual.
(q) "Program"
means any public or private corporation, person or organization which provides
services to individuals with a mental illness or intellectual disability when such
services are funded in whole or in part or are operated, monitored or regulated
by the bureau.
(r) "Service" means any evaluation,
training, counseling, therapy, habilitation, case management, or other type of
assistance, medical care, or treatment provided by a facility.
(s) "Service
delivery system" means those facilities and programs funded, in whole or
in part, operated, monitored, or regulated by the bureau.
(t) “Sexual abuse” means contact or interaction
of a sexual nature between an individual and an employee of or a consultant or
volunteer for a facility.
(u) “Treatment" means “treatment” as defined
in RSA 135-C:2, XVI, namely, "examination, diagnosis, training,
rehabilitation therapy, pharmaceuticals, and other services provided to individuals
in the mental health services system.
Treatment shall not include examination or diagnosis for the purpose of
determining the need for involuntary emergency admissions pursuant to RSA
135-C:27-33 or involuntary admissions pursuant to RSA 135-C:34-54.” The term includes treatment provided to
individuals in the mental health system.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New.
#6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
He-M 311.03 Notice of Individual and Applicant Rights.
(a) Facilities shall inform individuals or
guardians of the individual’s rights under RSA 135-C and these rules in clearly
understandable language and form, both verbally and in writing.
(b) The notification of rights required pursuant
to (a) above shall include, at a minimum, the following measures:
(1) Individuals applying for services shall be
informed of the rights in (a) above relating to evaluations and access to
treatment;
(2) Facilities
shall provide meaningful and understandable information about the rights
described in (a) above to individuals who are minors or who have been
adjudicated incapacitated as well as to their parents, guardians, or
attorneys;
(3) Individuals shall be advised of their rights
upon entry into any facility, upon change from one facility to another, and at
least once a year after entry;
(4) Every facility within the service delivery
system shall post a notice of the rights set forth in these rules, as follows:
a. The notice shall be posted continuously and
conspicuously; and
b. The notice shall be presented in clearly
understandable language and form;
(5) Each facility and community residence shall
have on the premises complete copies of He-M 311 available for individual and
staff review; and
(6) Individuals admitted to a receiving facility
pursuant to RSA 135-C:27-33 shall be given immediate notice by the facility
administrator or his/her designee in simple language he/she understands, and
written notice within 12 hours, of the following rights:
a. To be represented by legal counsel;
b. To have legal counsel appointed for him or
her if he or she is indigent;
c. To apply for admission on a voluntary basis;
d. To consult with legal counsel prior to a
change in admission status;
e. That involuntary emergency admission shall
not exceed a period of 10 days unless the period is extended pursuant to RSA
135-C:32; and
f. That no treatment shall be administered
during involuntary emergency admission unless the individual makes an informed
decision to consent to treatment, or unless a medical or psychiatric emergency
exists in accordance with He-M 305.
(c) Each facility shall document notifications of
He-M 311 in the individual’s records.
(d) Any person shall have the right to complain
or bring a grievance on behalf of an individual or a group of individuals
pursuant to He-M 204.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New. #6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
He-M 311.04 Fundamental Rights.
(a) Any individual receiving treatment for mental
illness shall be entitled to any legal right to which all citizens are entitled
regardless of that person's admission to the mental health services system.
(b) The legal rights protected shall include, at
a minimum:
(1) The right to freedom of religious preference
and practice, the right to be free from engaging in any religious activity, and
the right to receive reasonable assistance in attending places of worship;
(2) The right to
register to vote, if eligible, in public elections and to receive assistance in
registering to vote and in voting;
(3) The following
civil rights, unless a court has determined that an individual is legally
incapacitated pursuant to RSA 464-A, and a guardian has been appointed to make
certain decisions, or an emergency exists under He-M 305, personal safety
emergencies or He-M 306, medical and psychiatric emergencies:
a. The right to manage affairs;
b. The right to contract;
c. The right to hold professional, occupational,
or motor vehicle driver's licenses;
d. The right to marry or to obtain a divorce;
e. The right to make a will; and
f. The right to exercise any other civil right;
(4) The right to not be discriminated against in
any manner because of race, color, sex, religion, national origin, age, marital
status, disability, sexual orientation or degree of disability as provided in
state and federal laws, title VII of the civil rights act of 1964, 42 U.S.C.
2000e et. seq.; section 504 of the rehabilitation act of 1973, 29 U.S.C. 791
et. seq.; the age discrimination act of 1975, 29 U.S.C. 621; the Americans with
Disabilities Act of 1990, 42 U.S.C. 12101; and the provisions of certain block
grants, including:
a. Access to auxiliary aids needed by persons
with disabilities;
b. Services which are accessible to persons of
limited English proficiency; and
c. Service locations that are physically
accessible; and
(5) The right to legal remedies, including the
right to petition for and receive the benefits of a writ of habeas corpus, and
to seek any other remedy provided by law.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New. #6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
He-M 311.05 Personal Rights.
(a) Individuals who are individuals in the
service delivery system shall be treated with dignity and respect at all times.
(b) Individuals shall be free from abuse,
neglect, and exploitation including, at a minimum, the following:
(1) Freedom from any emotional, sexual, or
physical abuse or neglect;
(2) Freedom from the intentional use of physical
force, except the minimum force necessary to prevent harm to the individual or
others, or to impose emergency treatment under He-M 305, personal safety
emergencies; and
(3) Freedom from personal or financial
exploitation.
(c) Individuals shall have the right to privacy.
(d) Individuals applying for services, or who are
currently, or were previously in the service delivery system shall have the
right to confidentiality of all information and records.
(e) At a minimum, facilities shall adhere to the
following confidentiality requirements:
(1) Material safeguarded shall include any
information with respect to an individual or through which an individual can be
identified such as:
a. Names;
b. Addresses;
c. Diagnoses and evaluative data;
d. Medical and clinical records;
e. Individual service plans; and
f. Whether an individual is using or has used a
facility’s services;
(2) Clinical information shall be released by the
facility to a third party payor in order to substantiate both need for and
charges for care and treatment rendered to the individual by the facility;
(3) All staff shall be trained so as to know and
understand confidentiality and shall comply with confidentiality statutes and
rules;
(4) Separate, individual records shall be
maintained when group treatment methods are employed and joint records of
treatment activity shall not be maintained;
(5) No facility shall photograph, fingerprint, or
record any individual by audio or visual equipment unless the individual has
consented following an informed decision, nor allow any third party to photograph,
fingerprint, or record any individual by audio or visual equipment unless the
individual has consented following an informed decision;
(6) These rules shall not affect the obligation
of facilities to release information as required by:
a. RSA 161-F:42-57, protective services to
adults;
b. RSA 169-C:29, report of child abuse;
c. RSA 631:6, report of injury caused by
criminal act; or
d. Other law; and
(7) In accordance with RSA 329:26, RSA 330-A:32,
RSA 329-B:26, and RSA 326-B:35, statements made by individuals to physicians
licensed pursuant to RSA 329, psychologists licensed pursuant to RSA 329-B,
persons licensed pursuant to RSA 330-A, advanced practice registered nurses
licensed pursuant RSA 326-B, or to those who work under their supervision, may
be disclosed for the purpose of commitment hearings.
(f) Access to records shall be as follows:
(1) Information pertaining to an individual shall
be released to the individual or his or her guardian upon request including all
information provided by third parties except that information which was
provided by someone other than a health care provider under an agreement that
the information would not be disclosed and disclosure would be reasonably
likely to reveal the source of the information.
When information is not released, the individual or his or her guardian
shall be provided with a written denial stating the basis for the denial, a
description of how a complaint may be filed, the name, title and address of the
contact person to receive the complaint, and the process for filing a complaint
pursuant to 45 CFR 160.306;
(2) A clinical staff member shall be present at a
record review if:
a. There is a reasonable concern that an
individual will experience a harmful effect as a result of reviewing his or her
record, or reasonable concern that the security of the record is at risk; and
b. The determination that (2)a. above applies
has been made on a case by case basis and the reasons for the determination
have been documented in writing;
(3) Information shall be released to any person
or organization that has obtained the written consent of the individual or his
or her guardian;
(4) Information shall be released to the
department and funding, licensing, and accrediting agencies by facilities
within the service delivery system as necessary for:
a. Determining eligibility for funding;
b. Assisting in accrediting or licensing
decisions;
c. Monitoring and evaluating service delivery;
d. Assuring the delivery of appropriate services
to individuals; and
e. Planning future service delivery;
(5) Facilities shall not include or release
confidential information in an individual's record which pertains to other
individuals;
(6) Facilities shall include within the records
of an individual any supplemental information provided by the individual either
clarifying or rebutting information deemed by the individual or his or her
guardian to be inaccurate;
(7) An attorney appointed by a court to represent
an individual shall have access to all records and information pertaining to
that individual;
(8) Legal counsel for the department shall have
access to all relevant records and information pertaining to an individual when
such records and information are necessary because the individual:
a. Is the subject of an involuntary commitment
hearing;
b. Is the subject of a guardianship proceeding;
or
c. Has instituted legal action against the state
in regard to care and treatment provided by the mental health service delivery
system;
(9) In cases where an individual, his or her
guardian, attorney or other advocate who represents the individual, after
review of the record, requests copies of the record, such copies in paper
format, shall be made available free of charge for the first 25 pages and not
more than 25 cents per page thereafter; or, if available, copies of records
electronically stored and produced, shall be made available free of charge for
the first 25 pages and at actual cost per page thereafter. The individual, his or her guardian, attorney
or other advocate who represents the individual may choose whether to receive
the record in paper form, or if available in electronic form;
(10) Information regarding the medical treatment
of an individual shall be released to law enforcement officials or health
facility personnel if necessary to address an emergency situation involving
danger to the individual's health or safety, but only specific information
necessary to the relief of the emergency may be released without the
individual's consent;
(11) In accordance with RSA 329:31, RSA 330-A:35,
RSA 329-B:29, and RSA 326-B:33, any of the following persons licensed in New
Hampshire shall make reasonable efforts to disclose to a third party or law
enforcement when an individual has made a serious threat of physical violence
against a clearly identified or reasonably identifiable victim or victims, or a
serious threat of substantial damage to real property:
a. A physician;
b. A psychologist;
c.
An advance practice
registered nurse;
d. Any person licensed pursuant
to RSA 330-A; or
e. Any person who works under the supervision of
any of the above;
(12) In accordance with RSA 135-C:19-a, I, a
facility may disclose to a family member or other person, if such family member
or other person lives with the individual or provides direct care to the
individual, information regarding:
a. Diagnosis;
b. Admission to or
discharge from a treatment facility;
c. Functional
assessment;
d. The name of the medicine
prescribed;
e. The side effects of any
medication prescribed;
f. Behavioral or physical
manifestations which would result from failure of the individual to take such
prescribed medication;
g. Treatment plans and goals; and
h. Behavioral management strategies;
(13) Information shall not be released pursuant to
(12) above unless the facility first:
a. Provides
written notice to the individual or his or her guardian specifying the
information requested, the reason for the request, and the person making the
request;
b. Requests the individual or
his or her guardian's consent to release the information; and
c. If consent cannot be obtained, the facility
shall notify the individual in writing prior to the disclosure of:
1. The reason for the disclosure;
2. The name of the person(s) to whom the
information will be released; and
3. The specific information which will be
released;
(14) The facility shall receive or accept
communications from family members, friends, or other persons with information
pertaining to the health and safety of the individual, and shall document such
communications in the individual’s record.
(15) In accordance with RSA 135-C:19-a, II, when
the medical director or designee determines that obtaining information is
essential to the care or treatment of an individual admitted pursuant to RSA
135-C:27-54, a designated receiving facility may request, and any health care
provider which previously provided services to any individual involuntarily
admitted to the facility may provide, information about such individual limited
to medications prescribed, known medication allergies or other information essential
to the medical or psychiatric care of the individual admitted;
(16) Information shall not be released pursuant to
(15) above unless the program first:
a. Provides
written notice to the individual or his or her guardian specifying the
information requested, the reason for the request, and the person making the
request;
b. Requests the individual or his or her
guardian's consent to release the information; and
c. If consent cannot be obtained, the individual
shall be notified prior to disclosure in writing of:
1. The reason for the disclosure;
2. The name of the person(s) to whom the information
will be released; and
3. The specific information which will be
released;
(17) In accordance with RSA 135-C:19-a, II-a, when
the medical director, or designee, determines that obtaining information is
essential to the care and treatment of a individual
admitted pursuant to RSA 135-C: 27-54 and the consent of the individual
admitted cannot be obtained, the designated receiving facility may request and
any community mental health program which has previously provided services to
such individual shall immediately provide information about the individual
including medications prescribed, known medication allergies, services provided
and other information essential to the medical and psychiatric care of the
individual admitted. The facility may
disclose information necessary to identify the individual and the facility which
is requesting the information; and
(18) In accordance with RSA 135-C:19-a, III, a
community mental health program or state facility may disclose to an
interdisciplinary committee designated by the governor to review child
fatalities, information which is relevant to a case of suicide or traumatic
fatal injury under review by such committee.
Information to be disclosed pursuant to this subparagraph shall be
limited to the diagnosis and course of treatment of the child or the person who
caused the fatality. Information
disclosed pursuant to this paragraph shall remain confidential and shall not be
subject to discovery, subpoena, or admission into evidence in any judicial or
administrative proceeding.
(g) Individuals shall have the right to complain about
any alleged violation of a right afforded by these rules or by any state or
federal law or rule or any other matter.
(h) Individuals shall have the right to freely
and privately communicate with others, including:
(1) The right to send and receive unopened and
uncensored written correspondence except that if there are reasonable grounds
to believe that incoming mail contains items or substances which might be
harmful to the individual or others, the facility shall direct reasonable
examination of the mail in the presence of the individual or, wherever
possible, permit the individual to open the mail in the presence of a staff
person provided that the facility shall not read the mail but may regulate the
disposition of the items or substances;
(2) The right to stationery, writing implements,
and postage in reasonable amounts upon request;
(3) The right to have reasonable access to
telephones and to make and to receive reasonable numbers of telephone calls,
except that facilities shall require an individual to reimburse them for the
cost of any long distance calls made by the individual if the individual has
the financial ability to do so;
(4) The right to receive and to refuse to receive
visitors except that:
a. Facilities
shall impose reasonable restrictions on the number and time of visits as
necessary to ensure effective provision of services; and
b. A parent,
guardian, individual representative, or court-appointed attorney may visit
without the consent of the individual except as provided in (5) below;
(5) The right to receive visits from any person
unless the facility has documented that a visit with that particular person or
visits in general present a serious likelihood of physical harm to the
individual or other individuals in the facility;
(6) The right to opportunities for personal
interaction in a private setting except that any conduct or activity which is
illegal shall be prohibited; and
(7) The right to engage in social, recreational,
and religious activities including the provision of regular opportunities for
individuals to engage in such activities;
(i) Individuals shall
have the right to be free from searches of their persons and possessions except
where reasonably necessary for the protection of the safety of the individual
or others, to prevent the introduction of contraband, and as in (k) below.
(j) Facilities shall conduct searches of
individuals or visitors according to the following:
(1) Searches conducted without the consent of the
individual and without a warrant shall be performed only under the following
circumstances:
a. A physician shall order that a search of an
individual's person or possessions be made upon determination that a search is
necessary to protect the safety of the individual or others based on reliable
information that the individual possesses contraband;
b. The individual, nurse coordinator, and one
other staff member shall be present during the search, except that, in an
emergency, the individual need not be present;
c. A written inventory of the property searched
shall be made and a copy of the inventory shall be documented in the
individual's record;
d. At the time of the search the staff members
conducting the search shall sign the inventory and the individual shall be
asked to sign the inventory; and
e. The facility coordinator shall, within 24
hours of the search, forward a report of the search, together with the
rationale for the search, to the unit director and superintendent;
(2) Facilities shall require a visitor, upon notice,
to submit to a search prior to a visit or restrict visitors to a secure area,
or both, when the facility reasonably believes, based upon reliable
information, that the visitor may be introducing contraband such as drugs,
weapons, toxic substances, explosives, and instruments of escape; and
(3) Facilities which have individuals committed
through the criminal justice system shall subject visitors to a search by
electronic means as necessary to prevent the introduction of contraband such as
weapons, toxic substances, explosives, and instruments of escape into the
facility provided that the facility has the means to conduct electronic
searches.
(k) Individuals shall have the right to individual
choice including, at a minimum, the following:
(1) The right to keep and wear their own clothes
except:
a. Where necessary to prevent the individual
from causing harm to himself or herself; and
b. Where the need for such restriction is documented
in the individual's record;
(2) The right to keep personal possessions not
otherwise prohibited by law or facility policy in accordance with He-M
311.05(j) and the right to reasonable space for personal possessions;
(3) The right to keep and to read materials of
their own choosing; and
(4) The right to keep and spend their own money
unless a medical determination of incapacity to handle funds has been approved
by the state or federal agency which administers those funds except that
reasonable limits shall be imposed on the amount of money kept by individuals on
their persons or in their rooms in order to prevent the individuals from
causing harm to themselves or to prevent theft.
(l) Individuals shall have the right not to work
and to be compensated for any work performed, except that:
(1) Individuals shall be required to perform
personal housekeeping tasks within the individuals’ own immediate living areas
and equitably shared housekeeping tasks within the common areas of the
community residence, without compensation, unless the facility determines that
it would be clinically or medically contraindicated or inappropriate to
require an individual to perform such
tasks; and
(2) Individuals may have the option to perform
pre-vocational or vocational learning tasks or work required for the operation
or maintenance of a community residence if:
a. The work is consistent with their individual
service plans; and
b. The individuals
are compensated for work performed according to laws, rules, and regulations
set by the state and federal governments.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91;
amd by #6220, eff 4-13-96, EXPIRES: 12-31-98; ss by
#6759, eff
5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES:
11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14,
EXPIRES: 5-14-15;
ss by #10820, eff 4-23-15
He-M 311.06 Treatment Rights.
(a) Individuals shall have the right to adequate
and humane treatment, including:
(1) The right to access to treatment including:
a. For those applying for services the right to
evaluation to determine the individual ’s need for services and to determine
which programs are most suited to provide the services needed;
b. The right to receive necessary services subject
to the admission and eligibility policies and standards of each facility; and
c. The right to receive services without regard
to race, color, age, religion, sex, national origin, type or severity of
disability, sexual orientation or inability to pay except in accordance with
He-M 311.07;
(2) The right to quality treatment including:
a. Treatment and services provided in accordance
with licensing requirements and applicable rules adopted by the department in
He-M 200-1300 and applicable rules of other state agencies; and
b. Services provided in keeping with generally
accepted clinical and professional standards applicable to the persons and
facilities providing the treatment and to the conditions for which the
individual is being treated;
(3) The right to receive all services or
treatment in accordance with the time frame set forth in the individual’s
individual service plan;
(4) The right to quality treatment such that
where state rules adopted pursuant to RSA 541-A do not set a different requirement,
the quality of services and treatment at New Hampshire Hospital shall be in
accordance with “The Joint Commission Comprehensive Accreditation Manual for
Hospitals” (January 2015) published by Joint Commission Resources, Inc. One
Renaissance Boulevard,
(5) The right to an individual service plan
developed, reviewed and revised in accordance with RSA 135-C:19 and “The Joint
Commission Comprehensive Accreditation Manual for Hospitals” (January
2015) published by Joint Commission
Resources, Inc. One Renaissance Boulevard,
(6) The right to receive service and treatment in
the least restrictive alternative or environment necessary to achieve the
intended purpose of treatment including services and treatment which least
restrict freedom of movement, informed decision-making, and participation in
the community while providing the level of security and support needed by the
individual;
(7) The right to be served in the least restrictive
program or facility and also the least restrictive setting within a program or
facility, except that a facility may restrict access by individuals to various
areas as necessary to:
a. Ensure the privacy or safety of the
individuals;
b. Achieve other necessary objectives contained
in the individual service plan; or
c. Comply with provisions of law and orders of
court;
(8) The right to be informed of all significant
risks, benefits, side effects, and alternative treatments and services and to
give consent to any treatment, placement, or referral following an informed
decision, except actions taken under He-M 305 or otherwise permitted by law,
such that:
a. Whenever it is possible, the consent shall be
given in writing; and
b. In all other cases, evidence of consent shall
be documented by the facility and be witnessed by at least one person;
(9) The right to refuse to participate in any
form of experimental treatment or in any research;
(10) The right to be fully informed of one's own
diagnosis and prognosis;
(11) The right to voluntary placements and to seek
changes in placement, services, or treatment except that:
a. Placements shall not be voluntary if RSA
135-C:27-48 or 135-C:51 apply; and
b. Withdrawal shall be restricted as provided in
RSA 135-C:17;
(12) The right to services which promote
independence including services which shall be directed toward:
a. Eliminating, or reducing as much as possible,
the individuals' needs for continued services and treatment; and
b. Promoting the ability of the individuals to
function at their highest capacity and as independently as possible;
(13) The right to prompt medical care and
treatment as the person's condition requires;
(14) The right to consultation and second opinion
including:
a. At the individual's own expense, the
consultative services of:
1. Private physicians;
2. Psychologists;
3. Dentists; and
4. Other health practitioners; and
b. Granting to such health practitioners of
reasonable access to their individuals in facilities; and
c. Allowing such health practitioners to make
recommendations to facilities regarding the services and treatment provided by
the facilities;
(15) The right, upon request, to have one or more
of the following present at any treatment meeting requiring the individual’s
participation and informed decision-making:
a. Guardian;
b. Representative;
c. Attorney;
d. Family member;
e. Friend;
f. Advocate;
g. Consultant; or
h. Peer;
(16) The right to refuse medication and treatment
except emergency treatment under the terms and conditions provided in He-M 305,
He-M 306 and RSA 135:21-b;
(17) The right to freedom from restraint including
the right to be free from seclusion and physical, mechanical or pharmacological
restraint except that:
a. Such means of seclusion and restraint may be
used as part of a service plan to which the individual or individual’s
guardian, if any, has consented having made an informed decision to do so; and
b. Physical restraint may also be used as a form
of emergency treatment following the requirements of He-M 305, personal safety
emergencies;
(18) If the individual meets the definition of a
“child” in RSA 126-U:1, I, the right to freedom from restraint and seclusion,
as defined in RSA 126-U:1, IV and V-a, respectively, except as allowed by RSA
126 U; and
(19) The right to a safe, sanitary and humane
living environment.
(b) These rules shall not require any medical or
behavioral health care professional to administer treatment contrary to such
professional's clinical judgment.
(c) Facilities shall, whenever possible, maximize
the decision-making authority of the individual.
(d) The following provisions shall apply to
individuals for whom a guardian has been appointed by a court of competent
jurisdiction:
(1) The facility shall ensure that the guardian
and all persons involved in the provision of services are made aware of the
individual’s needs, views, preferences and aspirations;
(2) The facility shall comply with decisions made
by the guardian or representative within the legitimate scope of his or her
authority;
(3) The facility shall request a copy of the
guardianship order from the guardian and keep the order in the individual’s
record at the facility;
(4) If any issues arise relative to the provision
of services and supports which are outside the scope of the guardian’s
decision-making authority as set forth in the guardianship order, the
individual’s choice and preference relative to those issues shall prevail
unless the guardian’s authority is expanded by the court to include those
issues;
(5) A facility shall take such steps as are
necessary to prevent a guardian from exceeding the decision-making authority
granted by the court or acting in a manner that does not further the best
interests of the individual, including:
a. Reviewing with the guardian the limits on his
or her decision-making authority; and
b. If necessary,
bringing the matter to the attention of the court that appointed the guardian;
and
(6) In the event that there is a dispute between
the facility and the guardian, the facility shall inform the guardian of his or
her right to take either or both of the following actions:
a. Appeal the matter pursuant to He-M 204 and
He-C 200; or
b. Bring the dispute to the attention of the
probate court that appointed the guardian.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New. #6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff
11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
He-M 311.07 Termination of Services.
(a) All individuals shall be provided with
reasonable notice before services are terminated.
(b) A termination notice shall:
(1) Be in writing;
(2) Contain the reasons for, and the effective
date of, the termination; and
(3) Explain that the individual has the right to
appeal the termination in accordance with He-M 204.
(c) Services shall not be terminated while an
administrative appeal under He-M 204 is pending.
(d) Services shall be terminated:
(1) When termination is in the best interests of
the individual;
(2) When the individual cannot benefit from the
service;
(3) If the individual endangers or threatens to
endanger other individuals s or staff;
(4) If the individual or his or her guardian
refuses to pay for the services that he or she is receiving despite having the
financial resources to do so; or
(5) If the individual or his or her guardian
refuses to apply for benefits that could cover the cost of the services that he
or she is receiving despite the fact that the individual is or might be
eligible for such benefits.
(e) A facility shall offer, when feasible,
alternative, appropriate treatment or services before terminating an individual.
Source. #4414, eff 4-27-88; ss by #5095, eff 3-15-91,
EXPIRED: 3-15-97
New. #6759, eff 5-27-98; ss by #8641, INTERIM, eff
5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM,
eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15
PARTS
He-M 312-313 - RESERVED
PART
He-M 314 Rights of Persons Using Emergency Shelters
Statutory
Authority: RSA 126-A:31
He-M 314.01 Purpose. The purpose of these rules is to define the
rights of persons requesting or receiving emergency shelter or shelter services
from shelter providers that receive funding from the State of New Hampshire and
to establish the responsibilities of shelter providers relative to such rights.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.02 Definitions. The words and phrases used in this chapter
shall have the following meanings:
(a)
“Emergency shelter” means any facility, the primary purpose of which is
to provide temporary shelter for homeless individuals or families. The term “emergency shelter” does not include
transitional housing designed to provide housing as well as educational or
rehabilitative programs and services for a person or family for at least 6
consecutive months.
(b)
“Guest” means a homeless person who is receiving shelter services from
an emergency shelter.
(c)
“Homeless” means:
(1) An individual or family who lacks a fixed,
regular, and adequate nighttime residence; or
(2) An individual or family who has a primary
nighttime residence that is:
a. A supervised publicly or privately operated
shelter designed to provide temporary living accommodations, including:
1. Welfare hotels; and
2. Congregate shelters;
b. An institution other than a penal facility
that provides temporary residence for individuals intended to be
institutionalized; or
c. A public or private place not designed for,
or ordinarily used as, a regular sleeping accommodation for human beings.
(d)
“Shelter services” means:
(1) Provision of the following:
a. Adequate bedding and mattress;
b. Basic food at no cost to the guest;
c. Soap and hot water for personal hygiene; and
d. First aid; and
(2) Additional services the shelter elects to
provide, including:
a. Assistance in obtaining permanent housing;
b. Medical and psychological counseling and
supervision;
c. Employment counseling;
d. Nutritional counseling;
e. Substance abuse intervention, treatment and
counseling;
f. Assistance in obtaining other federal, state,
and local assistance; and
g. Other services related to obtaining
self-sufficiency such as:
1. Child care;
2. Transportation;
3. Job placement; and
4. Job training.
(e)
“Specialized facility” means an emergency shelter designed solely to
serve the needs of homeless members of an identifiable group including:
(1) Victims of domestic violence;
(2) Persons with mental illness;
(3) Families with children;
(4) Persons with substance abuse problems; and
(5) Other groups of homeless people with similar
therapeutic, rehabilitative, or programmatic needs.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.03 Notice of Rights.
(a)
In clearly understandable language, each emergency shelter shall provide
persons entering the shelter with a verbal summary of their rights and
responsibilities pursuant to He-M 314, notification of how to access the
shelter’s grievance procedures, and, upon request, a written copy of the
grievance procedures.
(b)
A notice of rights and any house rules shall be permanently posted in a
public area of the shelter and be presented in clearly understandable language
and form.
(c)
Each emergency shelter shall have on the premises complete copies of
rules pertaining to guest rights that are available for guest review including,
at a minimum, He-M 204, He-M 314, and He-C 200.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.04 Fundamental Rights.
(a)
No emergency shelter shall deprive a guest receiving emergency shelter
services in New Hampshire of any legal right to which all citizens of the state
and the United States are entitled.
(b)
The legal rights protected shall include, at a minimum:
(1) The right of freedom of religion and religious
preference, including the right to be free from engaging in any religious
activity or practice; and
(2) The right to not be discriminated against in
any manner because of race, color, sex, sexual orientation, religion, national
origin, age, or physical or mental disability, as provided in RSA 354-A:17,
title VII of the civil rights act of 1964, 42 U.S.C. 2000e et. seq.; section
504 of the rehabilitation act of 1973, 29 U.S.C. 791 et. seq.; the age
discrimination act of 1975, 29 U.S.C. 621; the Americans with Disabilities Act
of 1990, 42 U.S.C. 12101, and the Fair Housing Act, 42 U.S.C. Sec. 3601.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.05 Personal Rights.
(a)
Persons who are requesting or receiving emergency shelter services shall
be treated by emergency shelter staff and volunteers with dignity and respect regardless
of the circumstances which brought them to the shelter.
(b)
Staff and volunteers of an emergency shelter shall not abuse, neglect or
exploit guests.
(c)
Guests shall have the right to have information in their records treated
as confidential and disclosed by staff to third parties only as permitted by
the guest, required by law, or allowed in accordance with (e) below.
(d)
Any provisions of He-M 314 that conflict with RSA 173-C:1 shall not
apply.
(e)
A shelter employee may disclose:
(1) To law enforcement personnel that information
necessary to report a crime committed at the shelter; and
(2) To an employee of another shelter:
a. The fact that a guest committed a violent act
or threats of violence within the last 30 days while on shelter premises; and
b. The circumstances of such acts or threats.
(f)
Guests shall have the right to privacy including the following:
(1) The right to courtesies such as knocking on
closed doors before entering;
(2) The right to send and receive unopened and
uncensored correspondence;
(3) The right to have reasonable access to a
telephone with such privacy as shelter arrangements allow, provided that:
a. Guests may be required to pay for long
distance calls; and
b. Calls shall only be made for the following
reasons:
1. Searching for a job;
2. Making medical appointments;
3. Searching for housing; or
4. Other similar matters related to the affairs
of the resident; and
(4) The right to be free from searches of their
persons and possessions, except that:
a. Searches shall be conducted only in
accordance with applicable constitutional and legal standards;
b. Guests may be subjected to routine screening
or scanning for detection of concealed weapons upon entering the shelter; and
c. The policies
and practices regarding such searches shall be uniformly applied to all guests.
(g)
No emergency shelter shall exclude guests for any part of the day, from
October 1 through April 30, unless reasonable arrangements are made for guests
to use an alternative indoor site which is available for guests’ use while the
shelter is closed. From May 1 through
September 30, guests shall not be excluded during severe weather without an
adequate indoor alternative.
Source. #7405, eff 11-21-001; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.06 Admission.
(a)
No person, regardless of previous place of residence, shall be denied
admission to an emergency shelter if beds or rooms are available, except as
detailed in He-M 314.07 below.
(b)
No person shall be denied emergency shelter because he or she does not
have a valid state driver’s license, non-driver ID, or other form of
government-issued identification.
(c)
An emergency shelter shall have the ability to approve admission of
persons at least 18 hours per day and 7 days per week. A shelter may defer entry to the facility
until the facility opens for the night except as provided in He-M 314.05(g).
(d)
A shelter shall, at a minimum, admit a person to an available bed during
the shelter’s posted evening hours. A
shelter shall admit a person at other hours if staff resources permit.
(e)
No person seeking admission to an emergency shelter shall be denied
access for lack of funds to pay for shelter nor be required to receive approval
of a third party payor or intermediary.
(f)
Shelters may establish a sliding fee scale for admission to the shelter,
provided that the fee scale includes the provision of shelter services at no
cost to guests who are currently unemployed and lack other means of financial
support.
(g)
At the time of admission, shelters shall advise guests of the daily fee,
if any, the guest will be charged.
(h)
Shelter fees paid by guests shall:
(1) Be structured so as not to inhibit transition
into permanent housing; and
(2) Not exceed 30% of a guest’s net income.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.07 Denial of Admission and Termination of
Service.
(a)
A request for admission to a shelter shall be denied if the person
requesting services poses a direct threat to the health or safety of others in
the shelter and the shelter is unable to provide a reasonable accommodation
which would eliminate the risk of direct threat. When a person is denied admission on this
basis, the shelter may contact the local police department.
(b)
A request for admission to a shelter shall be denied if the shelter
lacks space to house the person.
(c)
A request for admission to a shelter may be denied if the shelter is a
specialized facility and the person seeking shelter is not a member of the
special population for which the shelter is designed.
(d)
For any person who is denied admission to a shelter, the shelter shall:
(1)
Inform the person of the reasons for the
denial;
(2) Make every effort to locate alternate emergency
shelter; and
(3) Inform the person of the shelter’s grievance
procedures if the denial is for any reason other than lack of space or failure
to meet the shelter’s admission criteria.
(e)
An emergency shelter may require a guest to leave the shelter under the
following circumstances:
(1) The guest engages in behavior which poses a
direct threat to the health or safety of others in the shelter;
(2)
The guest engages in behavior which
poses a direct threat to his or her own health or safety;
(3) The guest steals or destroys the property of
the shelter or other guests, provided that if the guest denies such allegations
he or she shall not be required to leave unless:
a. The guest is arrested by the police; or
b. Following an investigation by a shelter staff
member, pursuant to (h) below, the staff member conducting the investigation
finds the allegation to be true; or
(4) The shelter director or person in charge of
the shelter at the time of the incident has reason to believe that the guest,
while on the premises, is engaging in behavior that substantially interferes
with the use and enjoyment of the premises by other guests.
(f)
A shelter shall maintain a log of all guests required to leave the
shelter and the reasons therefor. The
information contained in the log shall be forwarded to the bureau of homeless
and housing services upon request.
(g)
Whenever a guest is required to leave a shelter pursuant to (e) above,
the shelter shall:
(1) Provide the guest written documentation of the
reason for being required to leave the shelter and the time frame during which
the guest cannot return to the shelter; and
(2) No later than 24 hours after the guest is
excluded, create a written record which contains the following information:
a. A full description of the guest’s behavior
that resulted in his or her being required to leave the shelter;
b. The names of the persons who were adversely
affected by the behavior; and
c. The signature of the staff member who
witnessed the behavior or conducted the investigation.
(h)
If the circumstances that result in a guest being required to leave a
shelter are not witnessed by a staff member, the incident shall be investigated
by a staff member. Shelter staff shall
document in the written record required in (g) above that the matter was
investigated by a staff member and identify who performed the investigation.
(i) No guest shall be required to leave a shelter
based upon the application of a limit on the length of time that a guest is
allowed to remain in residence.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.08 House Rules.
(a)
Emergency shelters shall adopt house rules determined by the shelter to
be necessary for the safe and effective operation of the shelter provided that
such rules do not conflict with He-M 314 or state or federal law. Whenever house rules are developed or revised,
representative guests and former guests shall be asked for input. A shelter may develop sanctions for rules
violations, except that sanctions shall not include withholding food or medical
attention.
(b)
House rules shall clearly state those rule infractions that could result
in a guest being required to leave the shelter and the corresponding time
frames during which a guest cannot return to a shelter. These rules shall be
based on the categories described in He-M 314.07(e).
(c) House rules shall be:
(1) Posted in a public area; and
(2) Reviewed by staff with each guest upon
admission. A copy of the rules shall be
signed by a staff person and the guest to indicate that they were reviewed and
be kept in each guest’s file.
(d)
Any house rules or revisions of house rules, including any sanctions,
shall be forwarded to the bureau of homeless and housing services for review
and approval prior to implementation.
House rules that the bureau of homeless and housing services determines
to be in conflict with He-M 314.08(a) and (b) shall not be implemented.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
He-M 314.09 Grievance Procedures.
(a)
Each shelter shall establish written grievance procedures by which a
guest’s complaints are addressed.
(b)
A shelter shall provide a guest who files a grievance the opportunity to
have someone assist him or her in filing the grievance. If the guest cannot obtain assistance, the
shelter staff, upon the guest’s request, shall attempt to obtain assistance for
such guest from New Hampshire Legal Assistance or the Legal Advice and Referral
Center (LARC).
(c)
Each shelter shall establish written investigation procedures for allegations
that a guest’s rights as stated in He-M 314.04 through 314.06 have been
violated by shelter staff or volunteers.
(d)
The investigation of a guest’s grievance shall not be conducted by any
person who participated in the action or decision that is the subject of the
grievance.
(e)
Following completion of the investigation, the shelter shall:
(1) Issue a written decision to the complainant
setting forth the disposition of the grievance;
(2) Include information on how the guest can
appeal the decision in accordance with He-M 204; and
(3) Forward a copy of the decision to the bureau
of homeless and housing services.
(f)
A guest may appeal the finding and proposed resolution to his or her
grievance to the department in accordance with He-M 204, rights protection
procedures, and He-C 200, rules of practice and procedure.
(g)
Each shelter shall forward its grievance procedures and any proposed
revisions to its grievance procedures to the bureau of homeless and housing
services for review and approval, prior to implementation. Grievance procedures that the bureau of
homeless and housing services determines to be in conflict with He-M 314.09 shall
not be implemented.
Source. #7405, eff 11-21-00; ss by #9328, eff
11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17
PART He-M 315 RIGHTS OF PERSONS RECEIVING PEER SUPPORT
SERVICES
Statutory
Authority: RSA 126-N:4
He-M 315.01 Purpose. The purpose of this part is to define the
rights of members and participants who are receiving peer support services from
providers that receive funding from the State of New Hampshire and to establish
the responsibilities of peer support agencies (PSA) relative to such rights.
Source. #8445, eff 10-6-05, EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.02 Applicability. Nothing in this part shall affect issues
between members or participants of a PSA that do not arise out of the
operations of the PSA.
Source. #8445, eff 10-6-05, EXPIRED: 10-6-13
New.
#12191, eff 5-26-17
He-M 315.03 Definitions.
(a)
“Abuse” means an act or omission by an employee, consultant, or
volunteer of a PSA which is not accidental and harms or threatens to harm a
member’s or participant’s physical, mental or emotional health or safety and
includes emotional abuse, physical abuse, and sexual abuse.
(b)
“Culturally competent” means having attained the knowledge, skills, and
attitudes necessary to provide effective supports, services, education, and technical
assistance to populations in the geographic area served by the agency.
(c)
“Department” means the New Hampshire department of health and human
services.
(d)
“Discrimination” means an action or a failure to act that has the effect
of excluding a consumer from participation, subjecting a member to unequal
treatment, or harassing a member because of and on the basis of:
(1) Race;
(2) Color;
(3) Sex;
(4) Sexual orientation;
(5) Marital status;
(6) Religion;
(7) National origin;
(8) Age;
(9) Disability;
(10) Socio-economic class;
(11) Political ideology;
(12) Veterans status; or
(13) Gender identity.
(e)
“Emotional abuse” means:
(1) The misuse of power, authority, or both;
(2) Verbal harassment; or
(3) Unreasonable confinement that results or
could result in mental anguish or emotional distress of a member.
(f)
“Exploitation” means the use of a member’s or participant’s person or
property for another’s profit or advantage or breach of a fiduciary
relationship through improper use of a member’s person or property including
situations where a person obtains money, property. or services from a member or
participant through undue influence, harassment, deception, or fraud.
(g)
“Guest” means any person who is invited to visit the PSA by a member, a
participant, or the PSA.
(h)
“Member” means any peer, who has made an informed decision to join, and
agrees to support the goals, objectives, rights, and responsibilities of, the
PSA.
(i) “Neglect” means an act or omission which
results or could result in the deprivation of essential services necessary to
maintain the minimum mental, emotional, or physical health of a member or
participant.
(j)
“Participant” means a peer, whether or not he or she is a member, who
participates in any aspect of the PSA.
(k)
“Peer” means any individual, 18 years of age or older, who self
identifies as having lived experience as a former recipient, or as at
significant risk of becoming a recipient of publicly funded mental health services.
(l)
“Peer support agency (PSA)” means an organization whose primary purpose
is to provide culturally competent peer support to peers 18 years of age or
older.
(m)
“Physical abuse” means the use of physical force which results or could
result in physical injury to a member or participant.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New.
#12191, eff 5-26-17
He-M 315.04 Membership.
(a) All peers shall be granted access to services
provided by a PSA except as provided in He-M 315.08.
(b)
All peers seeking membership in a PSA shall be granted membership at no
charge.
(c)
Membership meetings shall be convened for the purpose of seeking
membership input and feedback into planning and delivery of services.
(d)
Board of director meetings shall be open to members except upon majority
vote to enter an executive session limited to board members.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.05 Notice of Rights.
(a)
Each PSA shall provide members and participants with a verbal and
written summary, in clearly understandable language and form, of their rights
and responsibilities pursuant to He-M 315 and notification of the complaint
procedures.
(b)
A notice including member and participant personal and fundamental
rights, membership rules, and reasons for suspension of membership or participation,
pursuant to He-M 315 shall be permanently posted in a public area and be
presented in clearly understandable language and form.
(c)
Each PSA shall have on the premises and available for review a complete
set of rules pertaining to:
(1) Member and participant rights;
(2) Member and participant rules;
(3) Complaint procedures; and
(4) Appeal procedures.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.06 Fundamental Rights.
(a)
No PSA shall deprive a member or participant of any legal right to which
all citizens of New Hampshire and the United States are entitled.
(b)
The legal rights protected shall include:
(1) The right of freedom of religion and religious
preference, including the right to be free from engaging in any religious
activity or practice; and
(2) The right not to be discriminated against in
any manner as defined 315.03 (c)
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New.
#12191, eff 5-26-17
He-M 315.07 Personal Rights.
(a)
Persons receiving services from a PSA shall have the right to be treated
by PSA staff, volunteers, and consultants with dignity and respect at all
times.
(b)
Staff, volunteers, and consultants of a PSA shall not abuse, neglect, or
exploit agency members or participants.
(c)
Staff, volunteers, and consultants of a PSA shall respect the privacy of
members and participants.
(d)
A PSA shall maintain the confidentiality of membership records except as
in (e) below.
(e)
A PSA may disclose to law enforcement personnel that information
necessary to report a crime committed at the agency.
(f)
The PSA shall disclose the information specified in (e) above:
(1) To the department of health and human
services;
(2) When required to report abuse or neglect of a
child pursuant to RSA 169-C;
(3) When required to report abuse, neglect or
exploitation of an adult pursuant to RSA 161-F; and
(4) As otherwise required by law.
(g)
Members and participants of a PSA shall have the right to privacy
including the following:
(1) The right to courtesies such as knocking on
closed doors before entering; and
(2) The right to have reasonable access to a
telephone and a computer, if one is available for use, with such privacy as
agency facilities allow, provided that members and participants may be required
to pay for long distance calls.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.08 Suspension of Membership or Participation.
(a)
A PSA shall suspend a member or participant for the day and require him
or her to immediately leave the agency premises under the following
circumstances:
(1) The member or participant engages in behavior
that poses an imminent risk of harm to the health and safety of others in the
agency;
(2) The member or participant engages in behavior
which poses an imminent risk of harm to his or her own health or safety; or
(3) The member or participant is verbally abusive
of others in the agency.
(b) A PSA may suspend a member or
participant for up to 12 months under the following circumstances:
(1) The member or participant steals or destroys
the property of the PSA or any person while on the premises of the PSA;
(2) The member or participant engages in behavior
that substantially interferes with the use and enjoyment of the premises by
others; or
(3) The member or participant violates a rule of
the PSA for which the rules of the PSA impose such a suspension.
(c)
If the member or participant denies allegations made pursuant to a
suspension and files a complaint pursuant to He-M 315.10, a proposed suspension
under He-M 315 shall not be effective unless:
(1) The member or participant is arrested by the
police; or
(2) The allegation is founded following a review
pursuant to the PSA’s internal complaint procedures.
(d)
Whenever a member or participant is directed to leave a PSA pursuant to
He-M 315, the agency shall, no later than 24 hours after the person is
excluded, create a written record which contains the following information:
(1) A full description of the member’s or
participant’s behavior that resulted in him or her being directed to leave the
PSA; and
(2) The PSA shall make good faith effort to
obtain the signature(s) of the individual(s) who witnessed the behavior.
(e)
Any member or participant suspended from services available on-site at a
PSA shall be eligible for off-site services offered by the PSA, such as
warm-line services, provided that he or she agrees to comply with all rules of
the PSA.
(f)
Any member or participant suspended from services available off-site
shall be eligible for on-site services offered by the PSA, provided that he or
she agrees to comply with all rules of the PSA.
(g)
Providers shall ensure that all guests follow the same rules as members and
participants, and shall ask guests to leave the premises of the PSA if they
refuse to comply.
(h)
Any member or participant suspended pursuant to He-M 315 for a period of
more than 5 days shall be reinstated following the suspension period at such time
as a reentry plan developed by the member or participant which addresses the
circumstances that led to the suspension is accepted by the PSA director or his
or her designee.
(i) Any member or participant subject to suspension
may exercise his or her rights as provided in He-M 315.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.09 Member and Participant Rules.
(a)
A PSA shall adopt rules for members and participants as determined by
the board of directors to be necessary for the safe and effective operation of
the PSA provided that such rules do not conflict with state or federal law or
rule.
(b)
When PSA rules are developed or revised, staff shall solicit comments
from members.
(c)
A PSA shall grant members the right to vote on PSA business at member
meetings and vote at annual meetings to elect a board of directors.
(d) A PSA may develop sanctions for rules
violation. Sanctions shall not include permanent expulsion.
(e)
Each PSA shall have rules that address:
(1) Use of telephone, fax, computers and other
PSA resources available for use by members and participants;
(2) Substance use on agency property by members
and participants;
(3) Code of conduct of members and participants;
(4) Suspension and reentry procedures;
(5) Privacy and confidentiality; and
(6) Criminal
activity.
(f)
PSA rules shall be posted in a public area and reviewed by staff with
each member at the time the member joins.
(g)
Any PSA rules or revisions of those rules, including any sanctions,
shall be forwarded to the department for review 30 days prior to adoption by
the board. PSA rules that conflict with
state or federal law or rule, shall not be adopted.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
He-M 315.10 Complaint Procedures.
(a)
Every member, participant, and applicant for membership shall have the
right to file a complaint, which may be made either orally or in writing. A complainant may request to keep his or her
identity confidential throughout the complaint process. If the complainant
requests to have his or her identity kept confidential, he or she shall be
notified that it may interfere with the investigation, the resolution of the complaint, or both.
(b)
Each PSA shall establish complaint procedures that include:
(1) Informal means by which a member’s or
participant’s complaints can be addressed;
(2) A formal process to investigate allegations
that a member’s or participant’s rights have been violated by agency staff,
volunteers, consultants, or peers; and
(3) An immediate review by the PSA director or
his or her designee when a member or participant is suspended.
(c)
Each PSA shall investigate and attempt to resolve every complaint for
which a formal investigation is requested.
(d)
A PSA shall provide a member or participant who files a complaint the
opportunity to have someone assist him or her in presenting the complaint. If the member or participant cannot obtain
assistance, the agency staff, upon the member’s or participant’s request, shall
attempt to obtain assistance for such person from available advocacy services.
(e)
The investigation of a member’s or participant’s complaint shall not be
conducted by any person who participated in the action or decision that is the
subject of the grievance.
(f)
Following completion of a formal investigation, the board of directors
of the PSA shall issue a written decision to the member or participant within
20 business days setting forth the disposition of the complaint. The PSA shall immediately forward a copy of
the decision to the office of client and legal services (OCLS).
(g)
A member or participant may appeal the finding and proposed resolution
to his or her complaint in accordance with He-M 202, rights protection
procedures, and He-C 200, rules of practice and procedure.
(h)
He-M 315, He-M 402, He-M 202, and He-C 200 shall be available at every
PSA in a public location for review.
(i) Each PSA shall forward its complaint
procedure and any proposed revisions to the complaint procedure to the OCLS for
review and consultation 30 days prior to implementation. PSA procedures that conflict with He-M 315,
as determined by the OLCS shall not be implemented.
Source. #8445, eff 10-6-05,
EXPIRED: 10-6-13
New. #12191, eff 5-26-17
PART He-M 316 COMMITTEE FOR THE PROTECTION OF HUMAN
SUBJECTS
Statutory
Authority: RSA 171-A:19-a, IX; RSA
171-A:19-b.
He-M 316.01 Purpose. The purpose of this rule is to establish fees
in order to offset departmental costs of providing assistance to the committee
for the protection of human subjects (CPHS).
Source. #9588, eff 11-4-09; ss by #12408, INTERIM,
eff 10-24-17, EXPIRES: 4-22-18
He-M 316.02 Definitions.
(a)
“Committee for the protection of human subjects (CPHS, committee)” means
a department-sponsored institutional review board (IRB) charged with overseeing
all research projects involving human subjects that are conducted in institutions
and community programs funded in whole or in part by the bureau of behavioral
health (BBH), the bureau of developmental services (BDS), or the
bureau of drug and alcohol services (BDAS) of the New Hampshire department of
health and human services.
(b)
“Continuing review” means an annual review of the progress of the
research.
(c)
“Department” means the New Hampshire department of health and human
services.
(d)
“Expedited review” means a review carried out by the CPHS chairperson or
by one of more experienced reviewers designated by the chairperson from among
the members of the CPHS.
(e)
“Full committee review” means a review of the research submission at a
meeting at which a quorum is convened by the committee established pursuant to
RSA 171-A:19-a, II.
(f)
“Principal investigator (PI)” means the individual with primary
responsibility for the design, conduct, and funding of a research project.
(g)
“Quorum” means a majority of the members of the CPHS are present,
including at least one member whose primary expertise is scientific and one
member whose primary expertise is nonscientific.
(h)
“Research” means a systematic investigation, including research
development, testing and evaluation, designed to develop or contribute to generalizable
knowledge, and for the purposes of this rule does not include:
(1) Activities that are
solely for the purpose of clinical intervention;
(2) The collection of information for quality
improvement activities; or
(3) Client satisfaction surveys.
Source. #9588, eff 11-4-09; ss by #12408, INTERIM,
eff 10-24-17, EXPIRES: 4-22-18
He-M 316.03 Fees.
(a)
The fee for the review of each research
submission shall be as follows:
(1) $2000 for full committee review; and
(2) $750 for expedited review.
(b) The fees in (a) above shall include the
continuing review.
(c)
The following shall be exempt from fees:
(1) Unfunded research studies;
(2) Studies that utilize department funds; and
(3) Request for review to determine exemption
from CPHS oversight per 45 CFR 46.101(b).
Source. #9588, eff 11-4-09; ss by #12408, INTERIM, eff
10-24-17, EXPIRES: 4-22-18
APPENDIX A: Incorporation by Reference Information
Rule |
Title |
Publisher; How to Obtain; and Cost |
He-M 311.06(a)(4)-(5) |
“The Joint Commission Comprehensive Accreditation
Manual for Hospitals” (January 2015) |
Joint Commission Resources, Inc. One Renaissance
Boulevard, |
APPENDIX B
RULE |
STATUTE |
He-M
305.01-305.02 |
RSA
135-C:57, IV, RSA 126-U:1 |
He-M
305.03(a) |
RSA
135:21-b, RSA 126-U:3 |
He-M
305.03(b) |
42
CFR 482.13(e)(3)(ii); (f)(3)(ii) |
He-M
305.03(b)-(d) |
RSA
135-C:57, IV |
He-M
305.03(d) |
42
CFR 482.13(e)(2), (3)(ii)(A); (f)(2), (3)(ii)(A) |
He-M
305.03(e)(2) |
42
CFR 482.13(e)(3)(iv); (f)(3)(iv) |
He-M
305.03(e)-(f) |
RSA 135:21-b |
He-M
305.03(e)-(h) |
RSA
135:21-b |
He-M
305.04(a) |
RSA
135-C:57, V, RSA 126-U:4, :5, :5-a, :5-b, and :11 |
He-M
305.04(b)(1) |
42
CFR 482.13(e)(1)(9) |
He-M
305.04(b)-(d) |
RSA
135:21-b |
He-M
305.04(c), (d) |
42
CFR 482.13(e)(3)(i); (f)(3)(i),
RSA 126-U:4, :5, :5-a, :5-b |
He-M
305.04(e)-(i) |
RSA
135-C:57, IV, RSA 126-U:4, 5, :5-a, :5-b |
He-M
305.04(f) |
42
CFR 482.13(c)(1), RSA 126:5 and :5-a |
He-M
305.04(g) |
42
CFR 482.13(e)(5), RSA 126-U:2 and :11 |
He-M 305.04(h) |
42 CFR 482.13(e)(8) |
He-M
305.04(i), (k) |
42
CFR 482.13(e)(1) |
He-M
305.04(j) |
RSA
135-C:61, XI |
He-M
305.04(k)-(l) |
RSA
135-C:57, IV |
He-M
305.04(l) |
42
CFR 482.13e(1) |
He-M
305.04(l)(4) |
42
CFR 482.13(e)(1) |
He-M
305.04(m)-(o) |
RSA
135:21-b |
He-M
305.05(a)-(b) |
RSA
135-C:57, IV; 42 CFR 482.13(e)(1)(B); RSA 126-U:1 |
He-M 305.05(c)-(e) |
RSA 135:21-b |
He-M
305.06(a)-(b) |
RSA
135-C:57, I, RSA 126-U:7 and :10 |
He-M
305.06(c) |
RSA
135-C:61, XI; 42 CFR 482.13(e)(3)(ii)(B); RSA
126-U:7 and :10 |
He-M
305.06(d)-(f) |
RSA 135-C:61,
XII, RSA 126-U:7 and :10 |
He-M
305.06(d)-(g) |
RSA
135-C:61, XII, RSA 126-U:7 and :10 |
He-M
305.07 |
RSA
135-C:5, (b) |
He-M
305.07(a) |
42
CFR 482.13(e); |
He-M
305.08 |
RSA
135-C:61, XII |
He-M
305.09 |
42
CFR 482.13(g)(1)(iii), RSA 126-U: 7 and :10 |
He-M 306.01 - 306.06 |
RSA 135-C:57, III, V |
He-M 306.07 |
RSA 135-C:60 |
He-M 306.08 |
RSA 135-C:57, III, V |
He-M
309.01 |
RSA
135-C:13, 18, 56, 57, 59 |
He-M
309.02 |
RSA
135-C:13, 18, 56, 57, 59 |
He-M
309.03 |
RSA
135-C:59 |
He-M
309.04 |
RSA
135-C:56 |
He-M
309.05 |
RSA
135-C:56, 57; RSA 135-C: 19-a; RSA 329, 330-A, 329-B, 326-B |
He-M
309.06 |
RSA
135-C:57 |
He-M
309.07 |
RSA
135-C:18 |
He-M
309.08 |
RSA
135-C:18 |
He-M
309.09 |
RSA
135-C:58 |
He M 310.01 |
RSA 171-A:8; 11,
12, 13; 14; 15; 29; 137-K-3, IV |
He M 310.02 |
RSA 171-A:8; 11,
12, 13; 14; 15; 29 |
He M 310.03 |
RSA 171-A:15;
137-K-3, IV |
He M 310.04 |
RSA 171-A:14, I;
137-K-3, IV |
He M 310.05 |
RSA 171-A:14;
29; 137-K-3, IV |
He M 310.06 |
RSA 171-A:11,
12, 13; 137-K-3, IV, ;42 CFR 441.301(c)(1) |
He M 310.07 |
RSA 171-A:8;
137-K-3, IV |
He M 310.08 |
RSA 171-A:8;
137-K-3, IV |
He M 310.09 |
RSA 171-A:14,
II, III, IV; 29; 137-K-3, IV; 42 CFR
441.301(c)(4)(vi)(F) |
He M 310.10 |
42 CFR
441.301(c)(4)(vi)(A) |
He-M 310.11 |
RSA 171-A:17 |
He-M 310.12 |
42 CFR
441.301(c)(4)(vi)(A) |
He
M 311.01 |
RSA
135-C:2, 8, 11, 12, 13, 14, 15 29 |
He
M 311.02 |
RSA
135-C:8, 11, 12, 13, 14, 15, 29 |
He
M 311.03 |
RSA
135-C:59 |
He
M 311.04 |
RSA
135-C:13 and RSA 135-C:56 |
He
M 311.05 |
RSA
135-C:56, 63-a, II; RSA 135-C: 19-a; RSA
326, 330-A, 329-B, 326-B |
He
M 311.06 |
RSA
135-C:57 |
He
M 311.07 |
RSA
135-C:18 |
He-M
314.01 - 314.09 |
RSA
126-A:26 |
He-M
315 |
RSA
126-N:3; RSA 135-C:1 |
He-M
316.01 - 316.02 |
RSA
171-A:19-a |
He-M
316.03 |
RSA
171-A:19-a, IX |