CHAPTER He-M 600
PART He-M 601 PAYMENTS TO DISPROPORTIONATE SHARE
PSYCHIATRIC HOSPITALS
Statutory Authority: RSA 135-C:5, I, (d); 135-C: 61, III
He-M 601.01 Definitions.
(a) "Disproportionate share psychiatric
hospital" means a governmental hospital that:
(1) Is primarily engaged in providing, by or under
the supervision of a psychiatrist, psychiatric services for the diagnosis and
treatment of mentally ill persons;
(2) Is located in the state of
(3) Qualifies for a disproportionate share payment
pursuant to He-M 601.02(a) below.
(b) "Disproportionate share payments"
means payments made pursuant to 42 CFR 412.106.
Source. #8432, eff 11-27-05 (formerly He-W 519),
EXPIRED: 11-27-13
He-M
601.02 Requirements for and Amounts
of Payments.
(a) To qualify for a disproportionate share
payment, a disproportionate share psychiatric hospital shall have 50% or more
of service revenue attributable to any combination of the following sources:
(1) Public funds, excluding Medicare or Medicaid;
(2) Bad debts; and
(3) Free care.
(b) Disproportionate share payments shall be made
to a hospital that meets the requirements of (a) above at the rate of 100% of
uncompensated care provided by the hospital during that hospital's current
fiscal year.
Source. #8432, eff 11-27-05 (formerly He-W 519); EXPIRED:
11-27-13
PART He-M
602 VOLUNTARY ADMISSION OF MINORS TO
MENTAL HEALTH FACILITIES OF THE DIVISION OF MENTAL HEALTH AND DEVELOPMENTAL
SERVICES - RESERVED
PARTS
He-M 603 and He-M 604 - RESERVED
PART He-M
605 TRANSPORTATION OF INDIVIDUALS TO
PART
He-M 606
PART He-M
607 ADMISSIONS TO
PART
He-M 608 - RESERVED
PART He-M 609 CONDITIONAL
DISCHARGE
Statutory Authority: RSA l35-C:52; RSA 135-C:61, X and XII
He-M 609.01 Purpose. The purpose of these rules is to define the
criteria and procedures for conditional discharge of a person involuntarily
admitted to a facility and for the revision and revocation of the conditional
discharge.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff
3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; ss by #12014, eff
10-25-16; ss by #13332, eff 1-25-22
He-M 609.02 Definitions.
(a)
“Administrator”
means the superintendent or other chief executive officer of a facility or
THPS.
(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)
“Clinician” means a person who is qualified to provide community mental
health services pursuant to He-M 426.08 (h)-(m).
(d) “Commissioner”
means the commissioner of the department of health and human services.
(e)
“Community mental health program
(CMHP)” means “community mental health program” as defined in RSA 135-C:2,
IV. The term includes the term community mental health provider.
(f) “Conditional discharge”
means the release of a person from a facility during a period of court-ordered
involuntary admission on the condition that
the person comply with specific provisions of community-based treatment or be
subject to readmission to a facility.
(g) “Department”
means the New Hampshire department of health and human services.
(h) “Emergency service staff member”
means a CMHP or THPS clinician who provides short-term clinical or psychiatric
evaluation, treatment, and referral for persons experiencing acute symptoms of
a mental illness and in accordance with He-M 426.08(h)(1).
(i) “Facility”
means New Hampshire hospital or any other treatment program designated as a
receiving facility under RSA 135-C:26 to receive persons for involuntary
admission under RSA 135-C:34-54 and involuntary emergency admission under RSA
135-C:27-33.
(j) “Informed
decision” means a choice made voluntarily by a person 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.
(k) “In need of care” means
a situation where a conditionally discharged person no longer requires
inpatient treatment but where a prescribed
regimen of medical psychiatric or psychiatric care or treatment is required to
prevent the recurrence of the circumstances which led to the person’s dangerous
condition.
(l) “Involuntary
admission” means an order of involuntary commitment made pursuant to RSA
l35-C:34-54 by a probate court.
(m) “Law enforcement
officer” means a person identified in RSA 630:l, II.
(n)
“Physician assistant (PA)” means
a physician assistant licensed to practice in New Hampshire.
(o) “Psychiatrist”
means “psychiatrist” as defined in RSA 135-C:2, XIII, namely, “a physician
licensed to practice in New Hampshire who is either board-certified or
board-eligible according to the most recent regulations of the American Board
of Psychiatry and Neurology, Inc., or its successor organization.”
(p)
“Transitional housing program
services (THPS)” means a residential program that provides housing and support
services to persons with serious and persistent mental illness.
(q)
“Treatment team member” means a mental health clinician who is qualified
pursuant to He-M 426.08 (h)-(m) and who shares ongoing responsibility for the
care and treatment of a CMHP client or THPS client.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93; ss by #5863, eff 7-1-94; ss
by #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08; ss by #12014, eff
10-25-16, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff
7-18-14; ss by 12014, eff 10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21;
ss by #13332, eff 1-25-22
He-M 609.03 Grant of Conditional Discharge.
(a) The administrator of a
facility shall grant a conditional discharge to a person who has been
involuntarily admitted to the facility
pursuant to RSA l35-C:34-54 when the following criteria have been met:
(1) The
person is determined to be in need of care;
(2) A
recommendation for conditional discharge of the person has been made in
accordance with the procedures in He-M 609.03(b); and
(3) The
person or his or her guardian understands and, following an informed decision,
consents to the conditions and term of discharge, including any requirement for
participation in continuing treatment on an outpatient basis.
(b)
A recommendation for conditional discharge of a person shall be made to
the administrator of a facility by a psychiatrist,
APRN, or PA at the facility only after a conference has been held, pursuant to
He-M 401.10 or He-M 401.11, in which:
(1) The
psychiatrist, APRN, or PA participated and concurred in the results thereof;
(2) A
determination has been made that the person is in need of care and the mental
health treatment and supervision needed by the person can be provided in a
CMHP, THPS, or other setting which is less restrictive of the person’s freedom
and ability to make informed decisions;
(3) A
recommendation for conditional discharge has been adopted; and
(4) The
person, community mental health center representative or THPS representative,
and designated receiving facility (DRF) staff have agreed to the term of and
conditions for discharge.
(c) The facility to which
the person to be conditionally discharged has been involuntarily admitted shall
inform the person and his or her guardian, if
any, orally and in writing of the term and conditions of discharge and of the
criterion and process for revocation of conditional discharge.
(d) No conditional
discharge shall be granted by a facility unless the person to be discharged or
his or her guardian, if any, has knowledge of and, following an informed
decision, consents to the term and conditions of discharge and the provisions
of He-M 609. Consent shall be documented in writing.
(e) The term of conditional
discharge granted to a person under He-M 609 shall not exceed the period of
time remaining on the person’s order of involuntary admission made pursuant to
RSA l35-C:34-54.
(f) Information
regarding a person’s conditional discharge shall be shared between the
community mental health center or THPS and the facility serving the person as
necessary to treat him or her and to otherwise carry out the purposes of RSA
135-C and He-M 609.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff
3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff
7-18-14; ss by #12014, eff 10-25-16; amd by #13250,
EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22
He-M 609.04 Grant of Absolute Discharge.
(a) The administrator of a
facility from which a person has been conditionally discharged shall grant to
such person an absolute discharge at the end of the term of the conditional
discharge unless the discharge earlier has been revoked in accordance with RSA
135-C:51, VI or He-M 609.06 or unless another order of involuntary admission of
the person has been made pursuant to RSA l35-C:34-54.
(b) The administrator of a
facility from which a person has been conditionally discharged shall grant to
such person an absolute discharge when, within the previous 3 days, a
psychiatrist, APRN, or PA at the CMHP or THPS providing continuing treatment to
the person on an outpatient basis has:
(1) Examined
the person;
(2) Determined
that the person is no longer in need of care; and
(3) Recommended
that an absolute discharge be granted.
(c) The administrator, in
writing, shall immediately notify the court which made the original order of
involuntary admission pursuant to RSA
l35-C:34-54 and the person’s guardian, if any, that the person has been granted
an absolute discharge.
Source.
#2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90;
ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New.
#7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08;
ss by #9240, eff 8-23-08; amd by #10641, eff 7-18-14; ss by #12014, eff
10-25-16; amd by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22
He-M 609.05 Revision of Conditions. If at
any time the term or conditions of a conditional discharge granted pursuant to
He-M 609.03 are revised, such revision shall be in accordance with the
following procedures:
(a) The revisions shall
be proposed by:
(1) The
CMHP or THPS serving the person conditionally discharged;
(2) The
person conditionally discharged or his or her guardian, if any; or
(3) The
facility from which the person was conditionally discharged;
(b) The proposed revision
shall be forwarded in writing by the proposing party to the other parties;
(c) The administrator, or
designee, of the CMHP or THPS receiving proposed revisions shall review them
and either:
(1) Accept
the proposed revisions and convey the decision in writing to the party making
the proposal; or
(2) Decline
the proposed revisions or propose amended revisions and convene a conference
pursuant to He-M 401.12 to consider the proposed revisions;
(d)
Revisions of the term or
conditions of the conditional discharge shall only be adopted:
(1) As
a result of a conference;
(2) By
a psychiatrist, APRN, or PA at the CMHP or THPS; and
(3)
With the consent, following an informed decision, of the person conditionally
discharged or his or her guardian, if any;
(e) Any revisions
agreed to at the conference shall be in writing and signed by the person
subject to the conditional discharge, his or her guardian, if any, and the
psychiatrist, APRN, or PA; and
(f) The CMHP or THPS shall
file a copy of the revisions in the person’s medical record and provide a copy
to the person, his or her guardian, if any,
and the facility from which the person was conditionally discharged.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New. #7228, eff 3-31-00; ss by #9113, INTERIM, eff
3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; amd by #10641, eff
7-18-14; ss by #12014, eff 10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21;
ss by #13332, eff 1-25-22
He-M 609.06 Revocation
of Conditional Discharge.
(a) Pursuant to RSA
135-C:51, a psychiatrist, APRN, or PA at a CMHP or THPS providing continuing
treatment on an outpatient basis to a person
conditionally discharged pursuant to RSA 135-C:50 may conduct, or cause to be
conducted by a treatment team member or an emergency service staff member, an
examination of the person to determine if the conditional discharge should be
revoked.
(b) An examination
pursuant to (a) above shall only be conducted if the psychiatrist, APRN, or PA
reasonably believes that:
(1) The
person has violated a condition of the discharge by:
a.
Failing or refusing to take medications prescribed by a psychiatrist, APRN, PA,
or emergency physician, PA, or APRN as
defined in RSA 135-C:2, II-a, to treat his or her psychiatric illness, provided
that the psychiatrist, APRN, PA, or emergency physician, PA, or APRN as defined
in RSA 135-C:2, II-a is on the list of physicians, PAs, and APRNs as defined in RSA 135-C:2, II-a,
maintained by the commissioner pursuant to RSA 135-C:28, who are approved by
either a designated receiving facility or a community mental health program
approved by the commissioner, whether on behalf of a CMHP, THPS, NH Hospital,
DRF, or a hospital emergency room receiving a patient who is on a conditional
discharge;
b. Failing or refusing to attend scheduled
appointments, which interferes with the responsibility of the CMHP or THPS to
provide monitoring or treatment. This shall not apply to peer support which
shall be voluntary;
c. Failing or refusing to communicate with the
CMPH or THPS, which interferes with the responsibility of the CMHP or THPS to
provide monitoring or treatment;
d. Failing or refusing to immediately
participate in lab screenings following a documented verbal request or written
request, which interferes with the responsibility of the CMHP or THPS to
provide monitoring or treatment;
e.
Using alcohol or other non-prescription medications/illicit drugs, to the
extent it adversely affects or is likely to adversely affect the person’s
ability to meaningfully participate in treatment; or
f. Failing to comply with a condition
specifically written to address patient-specific behaviors that interfere with
treatment or continued ability to live in the community; or
(2) A
condition or circumstance exists which might create a potentially serious
likelihood of danger to the person or to others established by demonstrating
that:
a. The person has inflicted serious bodily
injury on themselves or has attempted serious self-injury and there is a
likelihood that the act or attempted act will reoccur if the conditional
discharge is not revoked;
b. The person has threatened to inflict serious
bodily injury on themselves and there is a likelihood that an act or attempt of
serious self-injury will occur if the conditional discharge is not revoked;
c. The person’s behavior demonstrates that they
lack the capacity to care for their own welfare;
d. The person is a danger to others, which is
established by demonstrating that the person has inflicted, attempted to
inflict, or threatened to inflict seriously bodily harm on another; or
e. The person’s mental status has deteriorated
from the person’s usual mental status, such that the person is exhibiting an
exacerbation of psychiatric symptoms that potentially endanger self or others,
lead to severe self-neglect, or lead to a failure to function in a less
restrictive environment, and the likelihood of stabilizing and reversing such
deterioration would be substantially improved if treatment were to be given.
(c) Before an examination
is conducted, the CMHP or THPS shall prepare a written notice identifying the
belief, and the reasons therefor, that a violation of the conditional discharge
has occurred to include the following:
(1) How the violation interferes with the
responsibility of the CMHP or THPS to provide monitoring or treatment;
(2) Any other circumstances or conditions exist
which might create a potentially serious likelihood of danger to the person or
to others; and
(3) How the person’s mental health status has
deteriorated from the person’s usual mental status, such that the person is
exhibiting an exacerbation of psychiatric symptoms that potentially endanger
self or others, lead to severe self-neglect, or lead to a failure to function
in a less restrictive environment, and the likelihood of stabilizing and
reversing such deterioration would be substantially improved if treatment were
to be given.
(d) Pursuant to
RSA 135-C:51, I(b), a CMHP or THPS representative shall offer and explain the
written notice to the person prior to the examination provided such notice can
be provided safely, without significant possibility of bodily harm.
(e)
If it is unsafe to provide and explain the written notice to the person,
a description of the circumstances indicating such risk shall be placed in the
file.
(f) The CMHP or
THPS shall make a reasonable effort to locate the person, if they are not
immediately available.
(g) If the person cannot be
located or if consent to an examination cannot be obtained, the psychiatrist or
other representative of
the CMHP or THPS may sign a complaint to compel examination.
(h) Upon issuance of such a
complaint, any law enforcement officer shall take custody of the person and
immediately deliver him or her to the place
specified in the complaint.
(i) Following the
examination, the psychiatrist, APRN, or PA may temporarily revoke the
conditional discharge if they find that:
(1) The person has either violated a condition of
the discharge which interferes with the responsibility of the CMHP or THPS to
provide monitoring or treatment;
(2) The person is in such a mental condition as a
result of a mental illness as to create a potentially serious likelihood of
danger to himself or herself or to others; or
(3)
The person’s mental status has deteriorated from their usual mental status,
such that the person is exhibiting an exacerbation of psychiatric symptoms that
potentially endanger self or others, lead to severe self-neglect, or lead to a
failure to function in a less restrictive environment, and the likelihood of
stabilizing and reversing such deterioration would be substantially improved if
treatment were to be given.
(j) If the conditional
discharge is temporarily revoked then:
(1) The
psychiatrist, APRN, or PA, or his or her designee, shall prepare, offer and
explain to the person a written notice giving the reasons for the revocation so
long as is can be done safely, without significant possibility of bodily harm. If
this cannot be done safely, a description of the circumstances indicating such
risk shall be placed in the file; and
(2) The
written notice shall include the name of the receiving facility to which the
person is to be transported upon the facility location being identified. The
person shall not be transported to the facility without having received a
verbal and written notification identifying the facility to which the person is
being transported.
(k) A law enforcement
officer or ambulance personnel shall take custody of the person whose
conditional discharge has been temporarily
revoked and shall deliver him or her, together with a copy of the notice, to
the receiving facility identified by the psychiatrist, APRN, or PA.
(l) The administrator of
the facility to which a person has been returned, or his or her designee,
shall:
(1) Personally
examine such person;
(2) Review
the reasons for temporary revocation of the conditional discharge so long as it
can be done safely, without significant possibility of bodily harm. If this
cannot be done safely, a description of the circumstances indicating such risk
shall be placed in the file; and
(3) Revoke
absolutely the conditional discharge if he or she finds that the person either:
a. Has
violated a condition of the discharge which interferes with the responsibility
of the CMHP or THPS to provide monitoring or treatment; or
b. Is, at the time of examination, in such a
mental condition as a result of mental illness as to create a potentially
serious likelihood of danger to self or to others or the person’s mental status
has deteriorated from the person’s usual mental status, such that the person is
exhibiting an exacerbation of psychiatric symptoms that potentially endanger
self or others, lead to severe self-neglect, or lead to a failure to function
in a less restrictive environment, and the likelihood of stabilizing and
reversing such deterioration would be substantially improved if treatment were
to be given.
(m) The examination,
review, and determination shall be made within 72 hours, excluding Sundays and
state legal holidays, of delivery of a
person to a facility pursuant to (j) above.
(n) If the administrator of
the facility, or his or her designee, determines that an absolute revocation is
warranted, he or she shall immediately prepare, offer, and explain to the
person the information in a written notice of the revocation and
the reasons for the revocation, and notice of the person's right to appeal and
right to legal counsel as set forth in He-M 609.07 so long as it can be done
safely, without significant possibility of bodily harm. If this cannot be done safely, a description
of the circumstances indicating such risk shall be placed in the file.
(o)
Any administrator, of any facility, may absolutely revoke a person’s
conditional discharge, regardless of which facility
initially executed the conditional discharge with the person.
(p) The person shall be
subject to the terms and conditions of the order of involuntary admission made
pursuant to RSA 135-C:34-54 from which conditional discharge was granted as if
such conditional discharge had not been granted.
(q) If the
administrator of the facility, or his or her designee, determines that an
absolute revocation is not warranted, the facility shall return the person to
the location where he or she was taken into custody.
(r) If the person is
returned, he or she shall then be subject to the term and provisions of
conditional discharge that were in effect prior to the temporary revocation of
the conditional discharge.
(s) A person conditionally
discharged may be admitted to a facility through an involuntary emergency
admission (IEA) under RSA 135-C:27-33.
(t) When a person
conditionally discharged has been admitted to a facility by an IEA, the finding
of probable cause for IEA by the district court shall authorize the person’s
admission for not longer than a 10-day period as provided in RSA 135-C:32,
unless during the period of IEA the person’s conditional discharge is
absolutely revoked pursuant to (u) below.
(u) A facility
administrator shall absolutely revoke a person’s conditional discharge when the
person has been admitted to a facility by an IEA, so long as the revocation
occurs within 10 days of the IEA physician’s certification being signed, and
the administrator of the facility, or his or her designee, has personally
examined the individual and found that the person either:
(1) Has
violated a condition of the discharge which interferes with the responsibility
of the CMHP or THPS to provide monitoring or treatment; or
(2) Is,
at the time of examination, in such a mental condition as a result of mental
illness as to create a potentially serious likelihood of danger to self or
others or the person’s mental status has deteriorated from the person’s usual
mental status, such that the person is exhibiting an exacerbation of
psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a
failure to function in a less restrictive environment, and the likelihood of
stabilizing and reversing such deterioration would be substantially improved if
treatment were to be given.
(v) If a conditional
discharge is absolutely revoked pursuant to (u) above, the administrator, or
his or her designee, shall first prepare, offer,
and explain to the person, if it can be done safely without significant
possibility of bodily harm, a written notice of the revocation and the reasons
therefor and notice of the person’s right to appeal and right to legal counsel
as set forth in He-M 609.07.
(w)
If the written notice in (v) above cannot be explained in person safely,
a description of the circumstances indicating such
risk shall be placed in the file within 24 hours of the patient receiving
notice of absolute revocation of his or her conditional discharge and the right
to appeal such revocation, or of the patient requesting an appeal of the
absolute revocation, whichever comes first.
(x)
New Hampshire Hospital (NHH) shall send written notice as required by
(v) above by first-class mail, fax, email, or other written or electronic
methods to the patient’s guardian.
(y)
NHH shall make a good-faith effort to reach the guardian to provide oral
notice of the patient’s absolute revocation,
right to an appeal, and, as applicable, the patient’s decision to request an
appeal.
(z) If a conditional
discharge is absolutely revoked, in addition to the notice given in (v) above,
the department shall:
(1) Provide legal counsel who are not directly
employed by the department, and who contract with the department to
represent persons for involuntary emergency admission proceedings at no cost to
the person;
(2) Provide
patient contact information to the assigned private attorney in order for the
attorney to:
a. Meet with the person, and the person’s
guardian if he or she requests, to discuss the implications of the person’s
initial decision not to appeal the absolute revocation and the avenues of legal
recourse available to the person, including an appeal, and either:
1.. Obtain a written waiver of appeal signed by
the person; or
2. Notify the department of the person's final
decision to appeal the absolute revocation so that the matter may be referred
to the administrative appeals unit and scheduled for a hearing;
(3) Provide legal counsel from a list of private
attorneys, maintained by the department’s bureau of behavioral health who are
not directly employed by the department, and who contract with the department
to represent persons in administrative appeals hearings at no cost to the
person if:
a. The person appeals the absolute revocation;
or
b. The person’s guardian or the guardian’s
attorney appeals the absolute revocation of the conditional discharge; and
(4) Provide
notice to the person’s guardian, if any, of the person’s decision to waive or
exercise his or her option to appeal the absolute revocation of the conditional
discharge and provide the guardian with an opportunity to participate in the
hearing with or without his or her attorney of choice.
(aa) If the written notices of revocation as
referenced in (d), (j), (n), and (v) above cannot be offered to and explained
to the person safely without significant possibility of bodily harm, a
description of the circumstances indicating such risk shall be provided to the
person’s guardian, if any, and placed in the person’s file for each notice.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New. #7228, eff 3-31-00; amd by #7627, eff 2-1-02;
ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08;
ss by #10386, eff 7-24-13; ss by #12014, eff 10-25-16; ss by #12014, eff
10-25-16; ss by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22
He-M 609.07 Appeal
of Revocation.
(a) A person or
his or her guardian, if any, whose conditional discharge has been absolutely
revoked by the administrator of a facility, or his or her designee, pursuant to
He-M 609.06(j) may appeal the decision to the commissioner.
(b) Upon the request of the
person or his or her guardian, a person appealing absolute revocation of
conditional discharge may obtain assistance from the facility in effecting the
appeal.
(c) The appeal shall:
(l) Be
in writing;
(2) State
that a hearing is requested;
(3) State
whether or not assistance of legal counsel is requested at such a hearing; and
(4) Include such information related to the basis
for the appeal as the person or his or her guardian, at the time, may elect to
offer.
(d)
The facility shall submit the appeal to the commissioner, together with
copies of all notices provided to the person
pursuant to He-M 609.06 and any other information relevant to the reasons for
revocation of the conditional discharge.
(e) If a hearing on the
appeal has been requested, the commissioner, or his or her designee, shall:
(l) Obtain
legal counsel for the person; and
(2) Conduct
a hearing on the appeal within 5 working days of the commissioner’s receipt of
the request for a hearing.
(f)
Hearings on appeals filed under
He-M 609.07 shall be conducted in accordance with He-C 203.
(g) Following a
hearing, the commissioner, or his or her designee, shall, within 3 working
days, decide if the person either:
(1) Has violated a condition of the discharge,
which interferes with the responsibility of the CMHP or THPS to provide
monitoring or treatment;
(2) Was in such a mental condition at the time of
examination, as a result of mental illness that has created a potentially
serious likelihood of danger to self or to others; or
(3) The person’s mental status has deteriorated
from the person’s usual mental status, such that the patient is exhibiting an exacerbation
of psychiatric symptoms that potentially endanger self or others, lead to
severe self-neglect, or lead to a failure to function in a less restrictive
environment, and the likelihood of stabilizing and reversing such deterioration
would be substantially improved if treatment were to be given.
(h)
In reaching a decision, only evidence presented at the hearing shall be
considered.
(i)
The burden shall be upon the state to establish that the criterion for
revocation of the conditional discharge is met by clear and convincing
evidence.
(j)
The decision made by the commissioner, or his or her designee, shall:
(1) Be in writing;
(2) State the reasons for the decision; and
(3) Be sent promptly to the person appealing, his
or her guardian, his or her legal counsel, if any, and the facility and CMHP or
THPS that revoked the conditional discharge of the person.
Source. #2748, eff 6-14-84; ss by #4205, eff 1-15-87;
ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93; ss by #5863, eff 7-1-94; ss
by #7228, eff 3-31-00; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss
by #9240, eff 8-23-08; ss by #10641, eff 7-18-14; ss by #12014, eff 10-25-16;
amd by #13250, EMERGENCY RULE, eff 8-6-21; ss by #13332, eff 1-25-22
PART
He-M 610 - RESERVED
PART He-M 611 TRANSFERS TO AND FROM THE SECURE PSYCHIATRIC
UNIT
Statutory
Authority: New Hampshire RSA 171-A:8-a;
135-C:61, IX; 135-C:48; 622:45, II
He-M 611.01 Purpose. The purpose of these rules is to define the
criteria and procedures for the transfer of involuntarily admitted persons with
mental illness or intellectual disability from New Hampshire hospital or any
designated receiving facility in the developmental disabilities services system
to the secure psychiatric unit in the correctional services system and from the
secure psychiatric unit to New Hampshire hospital.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; ss by #13255, eff 8-21-21
He-M 611.02 Definitions.
(a)
“Administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or that person’s designee.
(b)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(c)
“Corrections commissioner” means the commissioner of the department of
corrections or his or her designee.
(d) “Designated receiving facility
(DRF)” means New Hampshire hospital or a developmental services program
designated as a receiving facility under RSA 171-A:20 and He-M 526.
(e)
“Hearing” means “adjudicative proceeding” as defined by RSA 541-A:1, I,
namely “the procedure to be followed in contested cases, as set forth in RSA
541-A:31 through RSA 541-A:36.”
(f)
“Medical unit director” means the person responsible for the provision,
supervision and administration of medical and psychiatric services for the
department of corrections and the unit pursuant to RSA 622:43, I, (a).
(g)
“Unit” means the secure psychiatric unit established by RSA 622:41.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17
He-M 611.03 Categories of Admission or Transfer to the
Unit. Persons shall be admitted or
transferred to the unit from the jurisdiction of the mental health or
developmental services system under the following circumstances:
(a)
Upon order of a probate court pursuant to RSA 622:45 or 171-B:12; or
(b)
Upon an order by the chief executive officer of New Hampshire hospital,
or designee, to which the person has been involuntarily admitted pursuant to
RSA 135-C:27-33 or RSA 135-C:34-54, or by the administrator of a DRF to which
the person has been committed pursuant to RSA 171-B:12 when:
(1) The transfer has been approved by the
commissioner and the corrections commissioner; or
(2) An emergency has been determined to exist
pursuant to He-M 611.06(b).
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17
He-M 611.04 Admissions by Probate Court. Pursuant to RSA 622:45, I (a) and (c), a
probate court may order a person to be involuntarily admitted to the unit.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17
He-M 611.05 Transfers to the Unit.
(a)
The chief executive officer of New Hampshire hospital, or designee, or
the administrator of a developmental services DRF shall transfer a person from
the DRF to the unit under the following circumstances:
(1) The person was admitted either to New
Hampshire hospital or the developmental services DRF by:
a. An involuntary emergency admission pursuant
to RSA 135-C:27-33;
b. An involuntary admission pursuant to RSA
135-C:34-54;
c. An involuntary admission pursuant to RSA
171-B; or
d. The administrator of a state DRF;
(2) The chief executive officer, or designee, or
administrator has determined that the person would present a serious likelihood
of danger to self or others if retained at either New Hampshire hospital or the
developmental services DRF;
(3) Such determination of serious likelihood of
danger is based upon the behavior(s) of the person to be transferred or other
circumstances which create a strong probability that New Hampshire hospital or
the developmental services DRF cannot reasonably provide the degree of safety
and security necessary to prevent the harm;
(4) The person has been informed verbally and in
writing of the proposed transfer and the reasons therefor, and has been given
the opportunity to consent or object to the transfer in accordance with the
requirements in He-M 611.07; and
(5) The commissioner and the corrections
commissioner, or a third party who is mutually acceptable to the commissioner
and corrections commissioner, determine that the criteria in (1)-(4) above have
been met.
(b)
In approving or objecting to a transfer pursuant to (c)-(g) below, the
commissioner, corrections commissioner, or third party shall determine whether
the criteria in He-M 611.05(a)(1)-(4) have been met. Any transfer that meets such criteria shall
be approved.
(c)
An order for transfer shall be signed by the chief executive officer of
New Hampshire hospital, or designee, or by the administrator of the
developmental services DRF and sent to the commissioner for approval. If the commissioner objects to the transfer,
the transfer shall not be made. If the
commissioner approves the transfer, the order for transfer shall be sent to the
corrections commissioner.
(d)
If the corrections commissioner, or his or her designee, objects to the
transfer, the transfer shall not be made.
However, the commissioner and the corrections commissioner may agree to
have the disagreement resolved by a mutually acceptable third party. The decision of the third party shall be
binding upon the commissioner and the corrections commissioner.
(e)
If the third party objects to the transfer, the transfer shall not be
made.
(f)
If the commissioner and the corrections commissioner, or the third
party, approve the transfer and the person to be transferred has consented to
the proposed transfer, the administrator ordering the transfer shall be
notified and shall make arrangements for the transfer in accordance with He-M
611.08.
(g)
A transfer shall be suspended to the unit until a bed is available. If a transfer is accepted pending bed
availability, the unit administrator shall inform the referring DRF within 24
hours of a bed becoming available. . The person shall not be transferred unless
the chief executive officer, designee, or other DRF staff familiar with the
circumstances necessitating the transfer, or administrator who ordered the
transfer determines that the person continues to meet the criteria in He-M
611.05(a)(1)-(4).
(h)
If the commissioner and the corrections commissioner, or the third
party, approve the transfer and the person to be transferred objects to the
proposed transfer and requests an appeal of the proposed transfer, the person
shall not be transferred. A hearing on
the proposed transfer shall be held in accordance with He-M 611.07 and He-C 200
within 5 days, excluding Saturdays, Sundays, and holidays after the transfer
has been approved or suspended pending bed availability.
Source. #7299, eff 5-25-00; amd by #7504, eff 6-16-01;
ss by #9229, EMERGENCY,
eff 8-5-08, EXPIRES: 2-1-09; ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; ss by #13255, eff 8-21-21
He-M 611.06 Emergency Transfers to the Unit.
(a)
In the event of an emergency as specified by (b) below, a person who has
been admitted to New Hampshire hospital by an involuntary emergency admission
pursuant to RSA 135-C:27-33 or an involuntary admission pursuant to RSA
135-C:34-54 or to a developmental services DRF pursuant to RSA 171-B:12 shall
be transferred to the unit without the prior approval of the commissioner and
the corrections commissioner.
(b)
The chief executive officer of New Hampshire hospital, or designee, or
administrator of the developmental services DRF shall determine that an
emergency exists when:
(1) There is a serious likelihood of danger to
the person or to others if the transfer is not made; and
(2) An immediate transfer is necessary in order
to protect the person or others.
(c)
The determination of a serious likelihood of danger shall be based upon
the behavior(s) of the person to be transferred or other circumstances which
create a strong probability that the person will cause or attempt to cause harm
to self or others and New Hampshire hospital or the developmental services DRF
cannot reasonably provide the degree of safety and security necessary to
prevent the harm.
(d)
Prior to the emergency transfer of the person, the person and his or her
guardian, if one has been appointed, shall be informed verbally and in writing
of the transfer and reasons therefor, and shall be given an opportunity to
consent or object to the transfer in accordance with the requirements in He-M
611.07.
(e)
Within 24 hours, excluding Saturdays, Sundays and holidays, of an
emergency transfer, the chief executive officer of New Hampshire hospital, or
designee, or the administrator of the developmental services DRF shall obtain
the approval of the commissioner and the corrections commissioner for the
transfer of the person. In approving or
objecting to an emergency transfer, the commissioner, corrections commissioner,
or third party shall determine whether the criteria in He-M 611.05(a)(1) and
He-M 611.06(b)-(d) have been met.
(f)
Exceptions to (e) above shall be as follows:
(1) If the commissioner approves an emergency
transfer and the corrections commissioner objects to the transfer, they may
agree to have the disagreement resolved by a mutually acceptable third party;
(2) Except as provided for in (1) above, if the
approvals of the commissioner and the corrections commissioner are not obtained
within 24 hours after the transfer, excluding Saturdays, Sundays and holidays,
the person shall be immediately returned to the DRF from which he or she was
transferred;
(3) The decision of the third party shall be made
no later than 72 hours, excluding Saturdays, Sundays, and holidays, following
the emergency transfer and shall be binding upon the commissioner and the
corrections commissioner; and
(4) If the third party objects to the transfer,
the person shall be immediately returned to the DRF from which he or she was
transferred.
(g)
If the commissioner and the corrections commissioner, or the third
party, approve the emergency transfer, the person transferred to the unit shall
be under the care and custody of the corrections commissioner and the medical
unit director.
(h)
If the person transferred to the unit objects to the transfer, he or she
may appeal the decision to the commissioner and be afforded a hearing in accordance with
the procedures set forth in He-M 611.07 and He-C 200 within 5 working days,
excluding Saturdays, Sundays and holidays, after the transfer has been approved
or suspended pending bed availability.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17
He-M 611.07 Transfer from the Unit to New Hampshire
Hospital.
(a) A person
shall have the right to request a transfer to the least restrictive environment
necessary to achieve the purposes of treatment.
(b) Transfers from the unit to New Hampshire hospital
shall be made pursuant to Cor 504.11.
(c) If the
commissioner denies a transfer, the denial shall be communicated to the person and his or her guardian, if
applicable, and include notice of the person’s rights and the procedures to
appeal the transfer decision.
(d) If the person is denied a requested
transfer to the New Hampshire hospital, the person may appeal the decision to
the commissioner and be
afforded a hearing in accordance with the procedures set forth in He-M
611.08 and He-C 200 within 5 business days after the transfer has been denied
or suspended, pending bed availability.
Source. #13255,
eff 8-21-22
He-M 611.08 Notices and Hearings.
(a)
If a person objects to a proposed or actual transfer in accordance with
He-M 611.05(g) or He-M 611.06(h), or a denial of transfer from the unit to New
Hampshire hospital in accordance with He-M 611.07 (c), he or she may request a
hearing, on the decision to transfer or the decision to deny a transfer from
the unit to New Hampshire hospital, by the commissioner. A person being
transferred or denied a transfer from the unit to New Hampshire hospital, and
his or her guardian if applicable, shall be provided verbal and written notice
of his or her rights including his or her right to appeal. Such notice shall specify that the person has
the right to a hearing in which the person may explain why he or she objects,
in which witnesses may be called and asked questions, and in which he or she
may be represented by a lawyer provided free of charge if he or she chooses.
(b)
A hearing on the decision to transfer or a denial of transfer from the
unit to New Hampshire hospital shall be held in accordance with He-C 200.
(c)
The hearing shall be scheduled by the commissioner within 5 days of receipt
of the request for a hearing by the administrative appeals unit (AAU) excluding
Saturdays, Sundays, and holidays. Any
request received after close of business shall be considered received on the
next business day.
(d)
If a person objects to a transfer or denial of a transfer from the unit
to New Hampshire hospital, requests a hearing, and requests legal counsel, he
or she shall be provided with legal counsel at no cost.
(e)
If the person does not object to the transfer or denial of a transfer from
the unit to New Hampshire hospital, does not request a hearing, or does not
request legal counsel, within 72 hours of the transfer, excluding Saturdays,
Sundays, and holidays, there shall be provided, at no cost to the person, a
private attorney not employed by the department of health and human services,
department of corrections, or a designated receiving facility. The attorney shall be authorized to schedule
a meeting with the person to discuss the person’s procedural rights and either,
obtain an informed waiver of one or more of those rights signed by the person,
or revoke the person’s initial waiver of any such rights so that a hearing may
be scheduled by the department on the person’s objection to the transfer. A waiver revocation shall effectively
invalidate the initial waiver.
(f)
In the case of a proposed transfer, within 15 days following a hearing
the commissioner shall issue a written decision and:
(1) If the evidence presented is clear and
convincing that the criteria set forth in He-M 611.05(a)(1)-(4) are met, the
transfer shall be made in accordance with He-M 611.08; or
(2) If the evidence presented is not clear and
convincing that the criteria set forth in He-M 611.05(a)(1)-(4) are met, the
transfer shall not be made.
(g)
In the case of an emergency transfer, within 10 days following a hearing
the commissioner shall issue a written decision and, if the evidence presented
does not support a conclusion that the criteria set forth in He-M 611.06(a)-(d)
are met, the objection to transfer shall be upheld and the person shall be
returned within 72 hours to either New Hampshire hospital or the developmental
services DRF from which he or she was transferred.
(h) In the case of a denial of transfer from the
unit to New Hampshire hospital, the
commissioner shall issue a written decision within 15 days following a hearing
and:
(1) If the criteria set forth in Cor 504.11 are
met, the denial of transfer from the unit to the New Hampshire hospital shall
be overturned; or
(2) If the criteria set forth in Cor 504.11 are
not met, the denial of transfer from the unit to the New Hampshire hospital
shall be upheld.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; ss by #13255, eff
8-21-21 (formerly He-M 611.07)
He-M 611.09 Transfer Procedures.
(a)
The DRF administrator who has ordered the transfer of a person under the
emergency procedures in He-M 611.06 or who has received approval to transfer a
person under He-M 611.05 shall promptly inform the unit of the transfer.
(b)
Persons to be transferred to the unit or returned by the unit to New
Hampshire hospital or the developmental services DRF shall be transported by
DRF staff, unit staff, or any law enforcement officer empowered to act under
RSA 135-C:62 or 171-A:27. The
administrator ordering the transfer shall inform the unit, by telephone, of the
transfer arrangements at least 2 hours in advance of the transfer.
(c)
The administrator ordering a transfer shall cause a copy of the
emergency order or other approved order of transfer to be delivered with the
person to the unit and notify the commissioner and the corrections commissioner
when a transfer is made.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.08)
He-M 611.10 Readmissions to the Secure Psychiatric
Unit. Persons transferred to a
mental health or developmental services DRF from the unit pursuant to RSA
622:48 who are transferred back to the unit shall be transferred under the
provisions of He-M 611.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.09)
He-M 611.11 Jurisdiction. Pursuant to RSA 622:45, IV, persons admitted
or transferred to the unit shall be under the care and custody of the
corrections commissioner and the medical unit director and shall be subject to
the rules of the corrections commissioner.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES:
8-13-17; ss by #12341, eff 7-25-17; renumbered by #13255 (formerly He-M 611.11)
He-M 611.12 Commitment Limitations.
(a)
Pursuant to RSA 622:45, IV, no person shall be retained in the unit
longer than the period of the order of involuntary admission to the mental
health or developmental services system to which he or she was subject at the
time of transfer except upon further order of a court.
(b)
New Hampshire hospital or a developmental services DRF, as applicable,
shall collaborate with the unit in order to review each person’s treatment plan
and the best location for ongoing care during the period of commitment. When a person ceases to meet criteria for
admission to the unit, the DRF that transferred the person to the unit shall
facilitate the person’s transfer back to the DRF. If the DRF does not have an available bed,
the person shall be placed on the waiting list for the next available bed.
Source. #7299, eff 5-25-00, EXPIRED: 5-25-08
New. #9229, EMERGENCY, eff 8-5-08, EXPIRES: 2-1-09;
ss by #9371, eff 2-1-09, EXPIRED: 2-1-17
New. #12104, INTERIM, eff 2-14-17, EXPIRES: 8-13-17;
ss by #12341, eff 7-25-17; renumbered by #13255 (formerly
He-M 611.11)
PART He-M 612 TRANSFERS BETWEEN RECEIVING FACILITIES
Statutory
Authority: RSA 135-C:31, V; 135-C:48
He-M 612.01 Purpose. The purpose of these rules is to establish
the criteria and procedures for transfers of civilly committed persons between
receiving facilities in the mental health services system.
Source. #3178, eff 1-21-86; ss by #5483, eff
10-23-92, EXPIRED: 10-23-98
New. #6982, eff 4-22-99, EXPIRED: 4-22-07
New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16
He-M 612.02 Definitions.
(a)
"Administrator" means the chief executive officer of the
facility or, in the absence of the administrator, the executive person in
charge of the facility.
(b)
"Attorney" means a lawyer retained by, employed by, or
appointed by a court to represent a client.
(c)
"Commissioner" means the commissioner of the department of
health and human services.
(d)
“Department” means the department of health and human services.
(e)
"Guardian" means a person who is appointed by the court to
care for the person, property, or both, or property of another person pursuant
to RSA 464-A.
(f)
"Involuntary admission" means admission of a person to a
receiving facility on an involuntary basis by an order of the probate court
pursuant to RSA 135-C:34-54.
(g)
"Involuntary emergency admission" means admission to a
facility on an involuntary, emergency basis, pursuant to RSA 135-C:27-33, of an
individual who is in such mental condition as a result of a mental illness as
to pose a likelihood of danger to self or others.
(h)
"Receiving facility," as defined in RSA 135-C:2, XIV, means “a
treatment facility which is designated by the commissioner to accept for care,
custody and treatment persons involuntarily admitted to the state mental health
services system.”
Source. #3178, eff 1-21-86; ss by #5483, eff
10-23-92, EXPIRED: 10-23-98
New. #6982, eff 4-22-99, EXPIRED: 4-22-07
New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16
He-M 612.03 Status Transfers.
(a)
Receiving facilities shall be designated under RSA 135-C:26 and He-M
405.04 for any one or more of the following purposes:
(1) To receive persons for involuntary emergency
admission beginning with initial custody and continuing through the day
following the probable cause hearing;
(2) To receive persons for the period of
involuntary emergency admission after the probable cause hearing; and
(3) To receive persons for involuntary admission
pursuant to RSA 135-C:34-54.
(b)
Whenever a receiving facility has custody of a person for a period of an
involuntary emergency admission or an involuntary admission and the facility
has not been designated by the commissioner as a receiving facility for that
purpose, the administrator of the receiving facility shall transfer the person
to New Hampshire hospital, or another facility which has been designated for
that purpose, for any remaining period of involuntary emergency admission or
involuntary admission.
(c)
When a receiving facility is aware that it has custody of a person who
requires a transfer under this section, the facility shall immediately notify
New Hampshire hospital, or another facility which has been designated for that
purpose, of the need to transfer the person;
(d)
Notification pursuant to (c) above shall be in the form of a transfer
order which shall:
(1) State the reason for the transfer;
(2) Identify the facility to which the person is
being transferred;
(3) Be signed by the facility administrator or
the administrator's designee; and
(4) If the person to be transferred is a child,
comply with the requirements of RSA 126-U:12.
(e)
A copy of the transfer order shall be given to the person being
transferred and the person's guardian and attorney, if any.
(f)
Within 24 hours of receipt of a transfer order, the facility from which
a person is being transferred shall arrange for transportation of the person
from the facility to New Hampshire hospital or another facility receiving the
person. The person shall be transported by facility staff, New Hampshire
hospital staff, or any law enforcement officer empowered to transport under RSA
135-C:62.
(g)
If, prior to taking custody of a person under RSA 135-C:27-33 or RSA
135-C:34-54, a receiving facility determines that it has not been designated
for the purpose for which the person is being placed at the facility, the
administrator of the facility or the administrator's designee shall:
(1) Refuse to accept custody of the person and
direct the law enforcement officer transporting the person to deliver the
person to a receiving facility which has the requisite designation; or
(2) Admit the person to the facility and arrange
a transfer pursuant to (c) and (d) above if the administrator or the
administrator's designee determines that the refusal to accept custody likely
will result in harm to the person or to others.
(h)
Once transferred, a person shall be subject to RSA 135-C, and RSA 126-U
if applicable, as if originally placed in the custody of New Hampshire hospital
or another facility to which the person was transferred.
(i)
If a person being transferred under He-M 612.03 objects to the transfer,
the challenge shall be treated as a client complaint in accordance with He-M
204.
Source. #3178, eff 1-21-86; ss by #5483, eff
10-23-92, EXPIRED: 10-23-98
New. #6982, eff 4-22-99, EXPIRED: 4-22-07
New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16
He-M 612.04 Treatment and Security Transfers. Whenever a facility has custody of a person
for a period of involuntary emergency admission or involuntary admission, the
administrator of the facility or the administrator's designee shall order the
transfer of the person to another receiving facility under the following
circumstances and procedures:
(a)
Transfers for treatment purposes shall be ordered if:
(1) A person's condition is such that the
facility which has custody cannot reasonably provide the treatment required to
stabilize or ameliorate the person's condition; and
(2) The administrator or the administrator's
designee has determined that the facility to which the person is to be
transferred can provide the treatment the person requires;
(b)
Transfers for security purposes shall be ordered if:
(1) A person's behavior is such that the facility
which has custody cannot reasonably provide the supervision and control
necessary to prevent the person from causing bodily harm to self or others, or
significant damage to property; and
(2) The administrator or the administrator's
designee has determined that the facility to which the person is to be
transferred can provide the supervision and control the person requires;
(c)
All transfers under He-M 612.04 shall only occur following the prior
approval of the commissioner or the commissioner's designee;
(d)
The commissioner or the commissioner's designee shall grant prior
approval for transfer verbally or in writing after:
(1) Consideration of the facts upon which the
transfer order was based; and
(2) Determination that the transfer complies with
He-M 612;
(e)
When a transfer is to be made for treatment or security purposes, the
administrator or the administrator's designee shall sign a transfer order which
shall state the reasons for the transfer and the facility to which the person
is to be transferred;
(f)
The administrator or the administrator's designee shall give:
(1) The person to be transferred:
a. A copy of the transfer order; and
b. A verbal explanation of:
1. The transfer order;
2. The transfer procedures; and
3. The right to object to the transfer; and
(2) The person's guardian and attorney, if any, a
copy of the order;
(g)
The administrator of a facility shall order an emergency transfer of a
person without securing the prior approval of the commissioner if:
(1) There is serious likelihood that the person
or others will be in danger if the transfer is not made; and
(2) An immediate transfer is necessary in order
to protect the person or others;
(h)
Immediately following an emergency transfer of a person, the administrator
of a facility shall provide to the commissioner or the commissioner's designee
a copy of the transfer order required by He-M 612.04 (d);
(i)
Within 48 hours of receipt of a transfer order, the commissioner or the
commissioner's designee shall either approve the transfer or disapprove the
transfer based upon the criteria listed in (g) (1) and (2), and, if the-
transfer is disapproved, the person shall be promptly returned to the facility
from which the person was transferred;
(j)
Objections to transfers under this section shall require emergency
action pursuant to He-M 204;
(k)
Once transferred, a person shall be subject to RSA 135-C as if
originally placed in the custody of the facility to which the person was
transferred;
(l)
Transportation of a person under this section shall be arranged by the
facility making the transfer;
(m)
The person shall be transported by staff of the facility from which or
to which the person is being transferred or by any law enforcement officer
empowered to transport under RSA 135-C:62; and
(n)
If the person to be transferred is a child, any transportation, notice
and documentation shall comply with the requirements of RSA 126-U:12.
Source. #3178, eff 1-21-86; ss by #5483, eff
10-23-92, EXPIRED: 10-23-98
New. #6982, eff 4-22-99, EXPIRED: 4-22-07
New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16
He-M 612.05 Transfers to Less Restrictive Settings.
(a)
Whenever a receiving facility has custody of a person for a period of
involuntary emergency admission or involuntary admission, the administrator of
the facility or the administrator's designee shall order the transfer of the
person to another receiving facility if:
(1) That facility can provide an environment
which is less restrictive of the person's freedom of movement than the
receiving facility having custody of the person; and
(2) That facility can provide the care,
treatment, and security required for the person.
(b)
When a transfer is being made to a facility with a less restrictive
setting, the administrator or the administrator's designee shall sign an order
of transfer. The transfer order shall state the reason for the transfer and the
facility to which the person is to be transferred.
(c)
The administrator or the administrator's designee shall give:
(1) The person to be transferred:
a. A copy of the transfer order; and
b. A verbal explanation of:
1. The transfer order;
2. The transfer procedures; and
3. The right to object to the transfer; and
(2) The person's guardian and attorney, if any, a
copy of the order; and
(3) If the person to be transferred is a child,
the required notice and documentation required by RSA 126-U:12.
(d)
No transfer shall take place under He-M 612.05 without the prior
approval, based on the criteria listed in (a) above, of the commissioner and
the administrator of the facility to which the person is being transferred.
(e)
If a person being transferred under He-M 612.05 objects to the transfer,
the challenge shall be treated as a client complaint in accordance with He-M
204.
(f)
Once transferred, a person shall be subject to RSA 135-C as if
originally placed in the custody of the facility to which the person was
transferred.
(g)
Transportation of a person under this section shall be arranged by the
facility making the transfer.
(h)
The person shall be transported by staff of the facility from which or
to which the person is being transferred or by any law enforcement officer
empowered to transport under RSA 135-C:62.
Source. #3178, eff 1-21-86; ss by #5483, eff
10-23-92, EXPIRED: 10-23-98
New. #6982, eff 4-22-99, EXPIRED: 4-22-07
New. #9192, eff 6-26-08; ss by #11168, eff 8-26-16
PART He-M 613 ADMISSION TO AND DISCHARGE FROM NEW HAMPSHIRE
HOSPITAL
Statutory
Authority: New Hampshire RSA 135-C:4,
III; 16; 61, II, IV
He-M 613.01 Purpose. The purpose of this rule is to define
standards and procedures for placement at New Hampshire hospital (NHH).
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.02 Definitions.
(a)
“Absolute discharge” means the complete and unconditional discharge of
an individual from NHH.
(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)
“Certificate” means the certificate of a physician or an APRN pursuant
to RSA 135-C:28, I, stating that the person to be admitted meets the criteria
for IEA specified in RSA 135-C:27.
(d)
“Certifying practitioner” means a physician or an APRN who issues a
certificate of involuntary emergency admission in accordance with RSA 135-C:28,
I.
(e)
"Commissioner" means the commissioner of the department of
health and human services.
(f)
"Community mental health program" (CMHP) means “community mental
health program” as defined in RSA 135-C:2, IV, namely, “a program established
and administered by the state, city, town, or county, or a nonprofit
corporation for the purpose of providing mental health services to the
residents of the area and which minimally provides emergency, medical or
psychiatric screening and evaluation, case management, and psychotherapy
services.”
(g)
“Conditional discharge” means “conditional discharge” as defined in RSA
135-C:2, V, namely, “the release of an involuntarily admitted person from a
receiving facility on the condition that the person accept treatment in the
community or be subject to readmission.”
(h)
“Director” means the director of the bureau of behavioral health of the
department of health and human services.
(i)
“District court” means the state court that has the authority pursuant
to RSA 135-C:20 to conduct probable cause hearings for involuntary emergency
admissions and order an evaluation of a minor pursuant to RSA 169-B:20, RSA
169-B:21, I, RSA 169-C:16, III, and RSA 169-D:14, III. The term also includes the term “circuit
court – district court division” which is a state court located in each county
of New Hampshire with a district, probate, and family court division.
(j)
"Informed decision" means a choice made voluntarily by a
patient or person for whom admission is sought 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.
(k)
“Involuntary admission” means admission of a person to a receiving facility
on an involuntary basis by order of the probate court pursuant to RSA
135-C:34-54.
(l)
“Involuntary emergency admission” (IEA) means admission to a receiving
facility on an involuntary, emergency basis, pursuant to RSA 135-C:27-33, of an
individual who is in such mental condition as a result of a mental illness as
to pose a likelihood of harm to self or others.
(m)
“Least restrictive alternative” means the program or service which least
inhibits a person’s freedom of movement, participation in the community, and
informed decision-making while achieving the purposes of treatment.
(n)
“Medical director” means the person responsible for providing oversight
and advice regarding the clinical services and treatment within the state
mental health services system.
(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:
(1) Epilepsy;
(2) Intellectual disability;
(3) Continuous or noncontinuous periods of
intoxication caused by substances such as alcohol or drugs; or
(4) Dependence upon or addiction to any substance
such as alcohol or drugs.”
(p)
“Minor” means any person under the age of 18 years.
(q)
“Parent” means a biological or adoptive parent who has legal custody of
a minor, including either parent if custody is shared, or a person or agency
appointed as a guardian of the person of a minor.
(r)
“Petition” means a request for the involuntary admission of a person
completed in accordance with RSA 135-C:36.
(s)
“Physician” means “physician” as defined in RSA 135-C:2, XII, namely, “a
medical doctor licensed to practice in New Hampshire.”
(t)
"Preadmission screening" means a review of a nursing home
applicant conducted prior to admission pursuant to He-M 1302 that allows the
department to confirm the applicant’s diagnosis, identify the necessary level
of care, and determine the need for specialized services.
(u) “Probate court” means the state circuit court
– probate division which has authority to preside over civil commitment and
guardianship proceedings.
(v)
“Psychiatric disorder” means a mental disorder classified in the Diagnostic
and Statistical Manual of Mental Disorders, fifth edition, (DSM-5), published by the American Psychiatric
Association, with the exception of
intellectual disability, organic mental disorders, substance abuse
disorders, adjustment disorders, and Z codes.
(w)
“Psychiatrist” means “psychiatrist” as defined in RSA 135-C:2, XIII,
namely, “a physician licensed to practice in New Hampshire who is either
board-certified or board-eligible according to the most recent regulations of
the American Board of Psychiatry and Neurology, Inc., or its successor
organization.”
(x)
“Receiving facility” means “receiving facility” as defined in RSA
135-C:2, XIV, namely, “a treatment facility which is designated by the
commissioner to accept for care, custody and treatment persons involuntarily
admitted to the state mental health services system.”
(y)
“Severe personality disorder” means a mental disorder classified in the
DSM-V and characterized by personality traits which are inflexible,
maladaptive, and cause a severe degree of either functional impairment or
subjective distress.
(z)
“Skilled nursing facility” means a medical facility which provides
skilled nursing and rehabilitation services for a limited period of time
following inpatient hospital care.
(aa)
“Superintendent” means the chief administrative officer of NHH.
(ab)
"Transitional housing services" (THS) means a residential and
rehabilitative program that assists
people with mental illness who have been discharged from NHH to adjust to
living in a non-institutional, community-based setting.
(ac)
“Voluntary admission” means admission to NHH subsequent to the
documented consent of the person being admitted or his or her legal guardian.
(ad)
“Z codes” means DSM-5 categories that describe clinically-related
conditions of a person that are not directly attributable to a mental illness
but might interfere with treatment of that illness or otherwise have an effect
on the person’s ability to carry out functions of daily living.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.03 Voluntary Admission of Adults to NHH.
(a)
To be eligible for voluntary admission to NHH, an applicant shall meet
the following criteria:
(1) The applicant shall be referred by his or her
regional CMHP;
(2) The applicant shall be certified by the CMHP
as eligible for community mental health services pursuant to He-M 401.04
through 401.07;
(3) Pursuant to RSA 464-A:25, I (a), if a guardian
of the person has been appointed for the applicant:
a. The guardian may consent to admission to NHH
with prior approval of the probate court; or
b. If there is no prior probate court approval,
the guardian may consent to admission to NHH provided a psychiatrist or APRN
licensed to practice in New Hampshire has certified in writing that placement
at NHH is in the ward’s best interests and is the least restrictive placement
available; and
(4) If the applicant does not have a guardian of
the person, the applicant shall make an informed decision to consent to the
voluntary admission.
(b)
A person who refers himself, herself, or another person for admission to
NHH shall do so in writing or by telephone to the medical director of NHH or
his or her designee.
(c)
Each referral shall include:
(1) A description of the person’s recent clinical
history relative to the conditions and events which led to the request for
admission;
(2) A description of less restrictive
alternatives considered by the referring party;
(3) A statement which demonstrates why less
restrictive alternatives are inappropriately suited to the patient’s needs or
are otherwise not available; and
(4) A statement why NHH is the least restrictive
treatment alternative.
(d)
An applicant for voluntary admission to NHH shall only be eligible for
admission if, as determined by the medical director or his or her designee:
(1) NHH is the least restrictive alternative
among the available treatment options; and
(2) NHH has the
capacity, programs, and services to address the applicant’s presenting
complaints and symptoms.
(e)
No voluntary admission shall occur without the written prior approval of
the medical director or his or her designee.
(f)
Pursuant to RSA 135-C:12, III, NHH shall notify an applicant of his or
her eligibility for admission within 15 days after receipt of the application.
(g)
Referring parties shall make every effort to refer applicants for
voluntary admission between the hours of 8:00 a.m. and 4:00 p.m., Monday
through Friday, excluding holidays.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.04 Involuntary Admission of Adults to NHH.
(a)
Involuntary Emergency Admission (IEA) shall be made according to the
following criteria:
(1) If the official current Judicial Branch form
(NHJB-2826-D) including the petitioner’s statement, the physical examination,
mental examination, and certificate of examining physician or APRN requesting
admission are complete as to form and content, the admission:
a. Shall be made if the person being referred
meets the criteria for admission specified in RSA 135-C:27, as judged by the
NHH admitting practitioner; or
b. Shall be denied if, in the opinion of the
admitting practitioner, with the verbal concurrence of the medical director or
his or her designee, the person being referred fails to meet the criteria
specified in RSA 135-C:27;
(2) If an IEA is denied, the denial shall result
in the admitting practitioner immediately notifying the certifying practitioner
and the CMHP of the reason(s) for the denial;
(3) Except as allowed by (4) below, if a
practitioner’s certificate or petition requesting admission is not complete as
to form and content:
a. The person being referred shall not be
admitted;
b. The person being referred shall be returned
to the place where he or she was taken into custody; and
c. The admitting practitioner shall notify the
certifying practitioner and the community mental health program approving that
practitioner of the reasons for the denial of the admission; and
(4) Minor deficiencies in the form and content of
the petition and practitioner’s certificate including a misplaced or omitted
signature, or the failure to transmit to the court the original petition or
original practitioner’s certificate, or any other detail that on its own would
not result in a denial of admission, shall:
a. Not be the cause for denial of an admission
pursuant to He-M 613.04 (a) (2) above; and
b. Be remedied within 24 hours of admission.
(b)
Non-emergency involuntary admissions shall be made according to the
following criteria:
(1) Pursuant to RSA 135-C:34, the person being
admitted shall be in such mental condition as a result of mental illness as to
create a potentially serious likelihood of danger to self or others; and
(2) Admissions shall not occur unless ordered by a
probate court pursuant to RSA 135-C:45.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.05 Medical Transfer of Involuntarily Admitted
Patients.
(a)
The superintendent or his or her designee shall order the medical
transfer of an involuntarily admitted patient to an acute care hospital if the
following conditions apply:
(1) The patient has acute medical needs requiring
treatment which cannot be provided at NHH;
(2) The hospital to which the patient is to be
transferred can provide the treatment that the patient requires; and
(3) One of the following applies:
a. The patient has consented to the transfer;
b. The patient’s legal guardian, if the guardian
has been granted decision-making authority regarding medical care, has
consented to the transfer; or
c. The patient:
1. Is legally competent;
2. Is unable to consent to the transfer; and
3. Has acute medical needs that require
emergency treatment.
(b)
A patient who is transferred from NHH for medical treatment shall remain
under the protective custody of NHH pursuant to the authority under which the
patient was involuntarily admitted.
(c)
If the patient being transferred under He-M 613.05 or his or her
guardian objects to the transfer, the challenge shall be treated as a complaint
in accordance with He-M 204.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.06 Discharge from NHH Pursuant to Voluntary
Admission.
(a)
Pursuant to RSA 135-C:16, if a person is a patient on a voluntary basis,
he or she may withdraw from the receiving facility, whether or not such
withdrawal is made against medical advice.
(b)
A patient who has requested to withdraw shall:
(1) Be released upon request if an examination
conducted in accordance with RSA 135-C:17 is not ordered;
(2) Be released if an examination is ordered but
does not occur within the 24-hour period;
(3) Be released if an examination determines that
the criteria specified in RSA 135-C:27 are not met; or
(4) Be held and treated in accordance with the
provisions of RSA 135-C:27-33 if an examination determines that the criteria
are met.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.07 Discharge Pursuant to IEA.
(a)
Pursuant to RSA 135-C:32, if a person is admitted on an involuntary,
emergency basis, such involuntary confinement shall be limited to a 10-day
period, not including Saturdays and Sundays, unless a petition requesting the
probate court to issue an order of involuntary admission is filed within the
10-day period. Subsequent to the filing
of such petition, confinement shall continue only until issuance of the probate
court order or until such time as is specified in that order.
(b)
Pursuant to RSA 135-C:33, any person involuntarily admitted on an
emergency basis shall be granted absolute discharge by the superintendent or
his or her designee if the superintendent determines that the person no longer
meets the criteria for admission identified in RSA 135-C:27.
(c)
Absolute discharge shall be made according to the following:
(1) NHH shall notify the CMHP in the region from
which the person was admitted and the region to which the person was
discharged, unless the discharge was pursuant to a finding in court of no
probable cause;
(2) NHH shall issue written notice to the person
discharged and his or her legal guardian, if applicable, that notification
pursuant to (1) above was made; and
(3) NHH shall arrange or provide transportation
of the person to his or her in-state destination of choice unless the person
chooses to provide his or her own transportation.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.08 Discharge Pursuant to Non-emergency
Involuntary Admission.
(a)
Pursuant to RSA 135-C:39, if a person is admitted on an involuntary,
non-emergency basis, such involuntary confinement shall not continue beyond the
time allowed by the probate court order unless a petition requesting the court
to issue another order of involuntary admission is filed within the initial
period of involuntary admission. Subsequent to the filing of such petition,
confinement shall only continue until issuance of the probate court order or
until such time as is specified in that order.
(b)
Any person involuntarily admitted on a non-emergency basis shall be
granted absolute discharge by the superintendent or his or her designee if:
(1) The person has been examined within 3 days
prior to the discharge by the superintendent or his or her designee; and
(2) Following such examination, the
superintendent or his or her designee has determined and documented that, in
his or her professional opinion, the person does not meet the criteria
identified in RSA 135-C:34.
(c)
Upon the discharge of any person pursuant to (a) and (b) above, the
superintendent shall immediately, and in writing, notify the probate court
entering the original order of commitment that an absolute discharge has been
granted to the person.
(d)
Conditional discharge of any person who has been involuntarily admitted
on a non-emergency basis shall take place in accordance with He-M 609.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.09 Admission to Transitional Housing Service.
(a)
To be eligible for admission to the transitional housing service (THS),
an applicant shall meet the following criteria:
(1) The applicant shall have been referred from
NHH or have been discharged from the THS within the 30 days immediately
preceding application;
(2) The applicant shall be 18 years of age or
older and have a primary diagnosis of:
a. Psychiatric disorder or severe personality
disorder; or
b. Intellectual disability or pervasive
developmental disorder as defined in
DSM-5 with a secondary diagnosis of psychiatric disorder or severe
personality disorder; and
(3) The applicant’s individual service plan shall
specify that he or she:
a. No longer needs the level of care provided by
NHH;
b. Requires the degree of care and supervision
available from the THS; and
c. Has an identified goal of community
placement.
(b) Application for admission to the THS shall be
made through the administrator of THS.
(c)
The administrator of the THS shall accept an applicant for admission to
the THS if:
(1) The criteria identified in (a) above are met;
(2) The THS has the capacity to provide services
to the applicant; and
(3) The applicant’s CMHP has been informed of the
proposed placement of the applicant in the THS.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.10 Voluntary Admission of Minors to NHH.
(a)
To be eligible for voluntary admission to NHH, an applicant shall:
(1) Be a minor;
(2) Be referred by his or her regional CMHP
subsequent to a review by a professional team not employed by NHH which shall
include at least the following:
a. A doctor of psychology, a master’s level
social worker, or a registered nurse certified in mental health by the American
Nursing Association; and
b. A psychiatrist licensed to practice in NH;
and
(3) Have a determination by the medical director
or designee that:
a. The applicant has a mental illness;
b. Ambulatory care resources available in the
community do not meet the treatment needs of the recipient;
c. Proper treatment of the recipient’s
psychiatric condition requires services on an inpatient basis under the direction
of a practitioner;
d. The services can reasonably be expected to
improve the recipient’s condition or prevent further regression so that the
services will no longer be necessary; and
e. NHH is the least restrictive alternative
among the available treatment options.
(b)
An application for voluntary admission shall be made by, or with the
written consent of, a parent or legal guardian of the minor requesting to be
admitted.
(c)
An application for voluntary admission shall be made in writing and
include:
(1) The name, address, and telephone number of
the parent or legal guardian requesting the admission;
(2) The name and birth date of the minor whose
admission is requested;
(3) A request for the admission signed by the
minor’s parent(s) or legal guardian and witnessed in writing; and
(4) If applicable, a copy of the court order
granting the legal guardian authority to place the ward.
(d)
An applicant for voluntary admission shall be reviewed by a professional
team not employed by NHH that includes, at a minimum:
(1) A doctor of psychology, a master’s level
social worker, or a registered nurse certified in mental health by the American
Nursing Association; and
(2) A psychiatrist licensed to practice in New
Hampshire.
(e) Following a review pursuant to (d) above, a
written report shall be issued that includes:
(1) The name, address, telephone number, and
professional qualifications of the persons conducting the review;
(2) The name, birth date, and address of the
minor;
(3) The name, relationship to the minor, address,
and telephone number of the parent(s) or legal guardian;
(4) The following information regarding the minor
being reviewed:
a. A developmental and social history;
b. An evaluation of the family situation;
c. A psychiatric history and the results of a
mental status examination conducted personally by the team psychiatrist;
d. An evaluation of school functioning;
e. Any appropriate medical evaluations; and
f. A preliminary diagnosis of the type of mental
illness from which the minor suffers;
(5) A statement regarding the purpose for the
admission and any recommendations for treatment that have been developed;
(6) A copy of form “Certification of Need for
Inpatient Services under 21” MR #109 (8/31/2016) completed with:
a. The minor’s name; and
b. A statement signed and dated by the team
psychiatrist:
1. Certifying that the minor requires inpatient
care; and
2. Estimating whether the minor will require
such care for either 30 days or more or 29 days or less; and
(7) A statement by the professional team
performing the review that the admission criteria identified pursuant to He-M
613.03 (d) have been met.
(f)
The medical director or his or her designee shall:
(1) Review each application for voluntary
admission within one business day;
(2) Attempt to obtain the required information by
telephone if the application materials are not complete;
(3) Approve the application if:
a. The application is complete or the required
information has been obtained; and
b. The information received demonstrates that
the criteria in He-M 613.10 (a) have been met; and
(4) Deny the application if the criteria have not
been met.
(g)
If an application for voluntary admission is denied, the medical director
or designee shall refer the minor as follows:
(1) If denial is based on a reasonable belief
that the minor would not benefit from inpatient treatment at NHH, then referral
shall be made to a program or services that would most likely benefit the minor;
or
(2) If denial is based on a reasonable belief
that NHH is not the inpatient facility best suited to providing treatment to
the minor or is not the least restrictive alternative, then referral shall be
made to another mental health program.
(h)
Following admission, NHH shall conduct periodic reviews of each
voluntarily admitted minor to determine if the admission criteria continue to
be met. The reviews shall be conducted:
(1) In a manner approved by the medical director;
(2) In consultation with the treatment staff
assigned to the minor; and
(3) No later than the first business day
following admission and at least every 30 days thereafter until discharge.
(i)
If a determination is made pursuant to (h) above that a voluntarily
admitted minor no longer meets the admission criteria, the medical director
shall discharge the minor to the custody of the legally responsible party.
Source. #4838, eff 6-15-90, EXPIRED: 6-15-96
New. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.11 Involuntary Admission of Minors to NHH.
(a)
The IEA of minors to NHH shall be made according to (b)-(e) below.
(b)
If a practitioner’s certificate and a petition requesting the IEA of a
minor to NHH are complete as to form and content, the admission shall:
(1) Be made if, in the judgment of the admitting
practitioner, the criteria specified in RSA 135-C:27 are met; or
(2) Be denied if, in the judgment of the admitting
practitioner, with the verbal concurrence of the medical director of his or her
designee, the minor being referred fails to meet the criteria specified in RSA
135 C:27.
(c)
If an IEA is denied, the admitting practitioner shall promptly notify
the following of the reason(s) for the denial:
(1) The certifying practitioner;
(2) The legally responsible party; and
(3) The CMHP responsible for the applicant, if
the certifying practitioner is approved or employed by a CMHP.
(d)
Except as allowed by (e) below, if a certificate or petition requesting
admission is not complete as to form and content:
(1) The person being referred shall not be
admitted;
(2) Arrangements
shall be made, in consultation with the parent or guardian and the CMHP, to
return the applicant to the sending community; and
(3) The admitting practitioner shall promptly
notify the certifying practitioner and the CMHP approving or employing that
practitioner of the reasons for the denial of admission.
(e)
Minor deficiencies in the form and content of the petition and the
certificate including a misplaced or omitted signature, or the failure to
transmit the original petition or original certificate, or any other detail
that on its own would not result in a denial of admission, shall:
(1) Not be cause for denial of an admission; and
(2) Be remedied within 24 hours of admission.
(f)
Non-emergency involuntary admissions of minors to NHH shall be made
according to the following criteria:
(1) The minor being admitted shall be in such
mental condition as a result of mental illness as to create a potentially
serious likelihood of danger to self or others; and
(2) Admissions shall not occur unless ordered by
a probate court pursuant to RSA 135-C:45.
(g)
Personal and medical information and identifying documents regarding the
involuntarily admitted minor shall be released as soon as possible, but within
5 business days, by the CMHP to NHH providing such release has been authorized
in writing by the minor’s parent(s) or legal guardian.
(h)
The information and documents referred to in (d) above shall include, at
a minimum, the minor’s:
(1) Birth certificate, or photocopy thereof;
(2) Medical insurance information;
(3) Social security number;
(4) Previous psychiatric and psychological
evaluations;
(5) Previous treatment summaries;
(6) Educational records, reports and evaluations;
(7) Immunization records;
(8) Most recent physical exam; and
(9) Psychosocial history.
(i)
Following involuntary admission of a minor pursuant to (b) or (f) above,
NHH shall conduct periodic reviews to determine if the criteria for such
admission continue to be met. The reviews shall be conducted:
(1) In a manner approved by the medical director;
(2) In consultation with the treatment staff
assigned to the minor; and
(3) No later than the first business day
following admission and at least every 30 days thereafter until the admission
becomes voluntary or until discharge.
Source. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.12 Court Ordered Evaluations of Minors.
(a)
When admission of a minor to NHH for mental health evaluation is ordered
by a district court pursuant to RSA 169-B:20, 169-B:21, I, 169-C:16, III or
169-D:14, III, the admission shall be conducted according to the following
criteria:
(1) Prior to admission, the minor shall be
reviewed by a professional team as required by He-M 613.10 (d); and
(2) Upon review of the minor by a professional
team, the appropriate CMHP shall review the team’s report and forward the
report to NHH if the criteria identified pursuant to He-M 613.10 (a) have been
met.
(b)
Pursuant to RSA 135-C:65, admission for an inpatient evaluation at NHH
shall only occur following prior approval for such evaluation by the
commissioner or his or her designee.
(c)
The commissioner or his or her designee shall approve admission of a
minor if:
(1) He or she is in receipt of a copy of the
court order and a written report of the professional team pursuant to (a)(1)
above; and
(2) He or she determines that:
a. The criteria identified pursuant to He-M
613.10 (a) have been met; and
b. Proper evaluation of the minor’s psychiatric
condition requires services on an inpatient basis under the direction of a
psychiatrist.
(d) Minors admitted for mental health evaluations
pursuant to RSA 169-B:20, 169-C:16, III and 169-D:14, III shall be discharged
within 60 days of admission or at the time of the dispositional hearing,
whichever comes first.
Source. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.13 Medical Transfer of Involuntarily Admitted
Minors.
(a)
The medical director or his or her designee shall order the medical
transfer of an involuntarily admitted minor to an acute care hospital if the
following conditions apply:
(1) The minor has acute medical needs requiring
treatment which cannot be provided at NHH;
(2) The hospital to which the minor is to be
transferred can provide the treatment that the minor requires; and
(3) The minor’s parent or legal guardian, or the
department of health and human services, if that agency has custody of the
minor, has approved the transfer.
(b) A minor who is transferred from
NHH for medical treatment shall remain under the protective custody of NHH
pursuant to the authority under which the minor was involuntarily admitted.
(c)
If the parent or legal guardian of the minor being transferred or the
department of health and human services, if that agency has custody of the
minor, objects to the transfer, the challenge shall be treated as a client
complaint in accordance with He-M 204.
Source. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.14 Discharge of Minors from NHH Following An
IEA.
(a)
If a minor is admitted to NHH on an involuntary, emergency basis, such
involuntary confinement shall be limited to a 10-day period unless a petition
requesting probate court to issue an order of involuntary admission is filed
within the 10-day period, or unless the minor becomes a voluntary patient
pursuant to He-M 613.10. Subsequent to the filing of such petition, confinement
may continue only until issuance of the probate court order or until such time
as is specified in that order.
(b)
Any minor involuntarily admitted to NHH on an emergency basis shall be
granted discharge by the superintendent or his or her designee if the
superintendent determines that the minor no longer meets the criteria for
admission identified in RSA 135-C:27.
(c)
Such discharge from NHH shall be made according to the following:
(1) NHH shall notify the CMHP in the region from
which the minor was admitted and the region to which the minor was discharged;
(2) NHH shall issue written notice to the minor
discharged and his or her parent(s) or legal guardian, or the department of
health and human services, if that agency has custody of the minor, that
notification pursuant to He-M 613.14 (c) (1) was made; and
(3) In consultation with the minor’s parent(s) or
legal guardian, or the department of health and human services, if that agency
has custody of the minor, NHH shall arrange or provide transportation of the
minor to the in-state destination designated by the parent(s) or legal
guardian.
Source. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
He-M 613.15 Discharge of Minors from NHH Following
Non-emergency Involuntary Admission.
(a)
If a minor is admitted involuntarily to NHH , such involuntary
confinement shall not continue beyond the time allowed by the probate court
order unless a petition requesting the court to issue another order of
involuntary admission is filed within the period of involuntary admission, or
unless the minor becomes a voluntary patient pursuant to He-M 613.11.
Subsequent to the filing of such petition, confinement shall continue only until
issuance of the probate court order or until such time as is specified in that
order.
(b)
Any minor involuntarily admitted to NHH on a non-emergency basis shall
be granted discharge by the superintendent upon the approval of the
commissioner or his or her designee, if:
(1) The minor has been examined within 3 days
prior to the discharge by the superintendent or his or her designee; and
(2) Following such examination, the
superintendent or his or her designee has clinically determined and documented that,
in his or her opinion, the minor does not currently meet the criteria
identified in RSA 135-C:34.
(c)
Upon the discharge of any minor from NHH pursuant to(b) above, the
superintendent or his or her designee shall immediately, and in writing, notify
the minor’s parent(s), legal guardian, department of health and human services
and the probate court entering the original order of commitment that an
absolute discharge has been granted to the minor.
(d)
Any minor who has been involuntarily admitted to NHH on a non-emergency
basis shall be conditionally discharged if the conditions specified in He-M
609.03 are met.
Source. #7050, eff 6-29-99, EXPIRED: 6-29-07
New. #9191, eff 6-26-08; ss by #11183, eff 9-20-16
PART He-M 614 PROCESS FOR
INVOLUNTARY EMERGENCY ADMISSION
Statutory Authority: New Hampshire RSA 135-C:4, III; 135-C:61, II
He-M 614.01 Purpose. The purpose of this rule is to define the
process for involuntary emergency admission (IEA) to a designated receiving
facility or New Hampshire Hospital (NHH).
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.02 Definitions.
(a) “Certificate” means the document completed by
a certifying practitioner pursuant to RSA 135-C:28, I, stating that the person
to be admitted meets the criteria for IEA specified in RSA 135-C:27.
(b) “Certifying practitioner” means a licensed
practitioner who has been approved by either a DRF or a CMHP to have the
expertise and qualifications to complete an IEA certificate in accordance with
RSA 135-C:28, I, and placed on a list of certifying practitioners by the
commissioner.
(c) “Commissioner” means the commissioner of the
department of health and human services.
(d) “Community mental health program” (CMHP)
means “community mental health program” as defined in RSA 135-C:2, IV. The term
includes the term “community mental health provider”.
(e) “Designated receiving facility” (DRF) means a
“receiving facility” as defined in RSA 135-C:2, XIV and includes NHH pursuant
to RSA 135-C:26.
(f) “Incapacitated” means that a person, as a
result of the use of alcohol or substances, is in a state of intoxication, or
mental confusion resulting from withdrawal, such that:
(1) The person appears to need
medical care or supervision to assure his or her safety; or
(2) The person appears to
present a direct active or passive threat to the safety of others.
(g) “Informed decision” means an “informed
decision” as defined by RSA 135-C:2, IX.
(h) “Intoxicated” means a condition in which the
mental or physical functioning of an individual is substantially impaired as a
result of the presence of alcohol or substances in his or her system.
(i) “Involuntary admission” means an order of
involuntary commitment made pursuant to RSA 135-C:34-54 by a probate court.
(j) “Involuntary emergency admission (IEA)” means
admission to the state mental health system on an involuntary, emergency basis,
pursuant to RSA 135-C:27-33, of a person who is in such mental condition as a
result of a mental illness as to pose a likelihood of harm to self or others.
(k) “Licensed practitioner” means a physician,
physician’s assistant (PA), or advance practice registered nurse (APRN)
licensed to practice in this state.
(l) “Mental health program” means any program in
which mental health services are performed to treat someone with a mental
health concern.
(m) “Mental illness” means “mental illness” as
defined in RSA 135-C:2, X.
(n) “Minor” means any person under the age of 18
years.
(o) “Parent” means a biological or adoptive legal
custodian of a minor, or a person or agency appointed as a guardian of the
person of a minor.
(p) “Petition” means a written document that
requests the IEA of a person and that is completed in accordance with the
requirements in RSA 135-C:27-28.
(q) “Petition and certificate” means the entire
document entitled “Petition and Certificate for Involuntary Emergency Admission
(IEA)” created by the State of New Hampshire, Judiciary Branch, Form
NHJB-2826-D, (03/17/2022).
(r) “Petitioner” means any individual who has
petitioned for an examination of a person for the purpose of an IEA, which may
include a certifying practitioner who has conducted or caused to be conducted
an examination or completed a certificate for purposes of IEA.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.03 Criteria for Involuntary Emergency
Admission.
(a) A person shall be eligible for an IEA if the
person is in such mental condition as a result of mental illness to pose a
likelihood of danger to themselves or others. A mental condition that is a
result of a mental illness requires that the mental condition be directly
linked to mental illness and not the result of any other ailment.
(b) A person shall be considered a danger to
themselves if any one of the following sets of circumstances exists:
(1) Within 40 days of the
completion of a petition, the person has inflicted serious bodily injury on
himself or has attempted suicide or serious self-injury and there is a
likelihood the act or attempted act will recur if admission is not ordered;
(2) Within 40 days of the
completion of a petition, the person has threatened to inflict serious bodily
injury on himself and there is likelihood that an act or attempt of serious
self-injury will occur if admission is not ordered;
(3) The person's behavior
demonstrates that he or she so lacks the capacity to care for his or her own
welfare that there is a likelihood of death, serious bodily injury, or serious
debilitation if admission is not ordered; or
(4) The person meets the
following criteria:
a. The person has been
determined to be severely mentally disabled as determined by their medical
practitioner in accordance with the standard of practice that the licensed
practitioner must follow for a period of at least one year;
b. The person has had at least
one involuntary admission, within the last 2 years, pursuant to RSA
135-C:34-54;
c. The person has no guardian
of the person appointed pursuant to RSA 464-A;
d. The person is not subject to
a conditional discharge granted pursuant to RSA 135-C:49, II;
e. The person has refused the
treatment determined necessary by a mental health program, as defined in He-M
614.02(l), approved by the department; and
f. A psychiatrist at a CMHP has
determined, based upon the person's clinical history, that there is a
substantial probability that the person's refusal to accept necessary treatment
will lead to death, serious bodily injury, or serious debilitation if admission
is not ordered.
(c) A person shall be considered a danger to
others if, within 40 days of the completion of the petition, the person has
inflicted, attempted to inflict, or threatened to inflict serious bodily harm on
another.
(d) For persons on a conditional discharge from
NHH, when a condition or circumstance exists which may create a potentially
serious likelihood of danger to the person or to others, a psychiatrist,
psychiatrist-supervised PA, or APRN at the CMHP providing the person’s
outpatient care shall be authorized to revoke the conditional discharge in
accordance with RSA 135-C:51 and He-M 609.06.
(e) The CMHP providing
outpatient care to a person on a conditional discharge shall be authorized to
disclose protected health information as necessary, consistent with the
treatment exception in the Health Insurance Portability and Accountability Act
(HIPAA), 45 CFR §164.502(a)(1)(ii), to a CMHP, hospital emergency department,
or DRF providing treatment to the person.
(f) When it is not known
whether a person is on a conditional discharge, a petition and certificate
shall be authorized.
(g) If, prior to the completion
of a petition and certificate, it is discovered that a conditional discharge
exists and the CMHP providing outpatient care is available, the CMHP shall be
authorized to proceed with a revocation of the conditional discharge.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.04 Procedure for Involuntary Emergency
Admission.
(a) A petitioner may petition for the IEA of a
person if the petitioner reasonably believes the criteria in He-M 614.03 are
satisfied.
(b) The petition and
certificate for IEA shall be completed in its entirety by using the State of
New Hampshire, Judiciary Branch, Form NHJB-2826-D, (03/17/2022).
(c) The petitioner and certifying practitioner
may be the same person.
(d) The petitioner shall attend the hearing,
in-person, or by telephone or video, and shall be available to testify.
(e) If a witness is available to testify, the
witness’s statement shall be completed by a witness who has observed dangerous
acts or behaviors by the person sought to be admitted and the witness shall
provide the following information on page 5 of the petition and certificate:
(1) Information identifying the
witness; and
(2) A statement or statements
as to specific dangerous acts or behaviors within the last 40 days by the
person sought to be admitted observed by the witness.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.05 Completing the Petition and Certificate.
(a) The petition shall
be completed by the petitioner and consists of the petitioner’s statement.
(b) The petitioner’s
statement in (a) above shall be completed as follows:
(1) The petitioner shall review
the instructions to petitioner on page 2, and provide the following information
on pages 3 and 4 of the petition and certificate:
a. The name of the person
sought to be admitted and the date;
b. Information identifying the
person sought to be admitted and whether the petitioner believes the person is
or has been a danger to self or others; and
c. Information identifying the
petitioner and a description of specific dangerous acts or behaviors within the
last 40 days by the person sought to be admitted; and
(2) The petitioner shall sign
the petition.
(c) A statement by a witness, witness’ statement,
shall be completed if a witness is necessary and available to testify.
(d) If a witness is available to testify, the
witness’s statement in (c) above shall be completed by a witness who has
observed dangerous acts or behaviors by the person sought to be admitted and
the witness shall provide the following information on page 5 of the petition
and certificate:
(1) Information identifying the
witness; and
(2) A statement or statements
as to specific dangerous acts or behaviors within the last 40 days by the
person sought to be admitted observed by the witness.
(e) The physical
examination shall be conducted within 3 days of the date of the completion of
the petition in (a) above, as follows:
(1) A licensed practitioner or
their designee shall conduct a physical examination of the person sought to be
admitted and provide the following information on page 6 of the petition and
certificate:
a. The name of the person
sought to be admitted;
b. Information identifying the
licensed practitioner or designee such
as name, title, phone number, and address;
c. A detailed description of
the nature of the physical examination, including a list of known past or
present medical conditions, positive physical findings, and other pertinent
medical information that the mental health facility may need to know; and
d. A signed statement that the
person sought to be admitted is medically approved for admission to a DRF; and
(2) The licensed practitioner
or designee shall perform such physical examination in accordance with the
standard of practice applicable to the practitioner pursuant to RSA 326-B, RSA
328-D, or RSA 329, and any other applicable laws or rules to ensure that:
a. The person sought to be
admitted is medically stable for the level of medical care that the DRF is able
to provide; and
b. The individual’s medical
problems are not impacting their mental status in a way that interferes with diagnosing
the mental illness.
(f) The mental examination shall be conducted
within 3 days of the completion of the petition in (a) above, as follows:
(1) A licensed practitioner or
designee shall conduct a mental examination of the person sought to be admitted
and provide the following information on page 7 of the petition and
certificate:
a. The name of the person
sought to be admitted;
b. Information identifying the
licensed practitioner or designee such as name, title, phone number, and
address;
c. A detailed description of
the nature of the examination, including a list of any past or present mental
condition, hospitalizations for psychiatric reasons, psychotropic medications,
current mental status, orientation, memory, judgment, speech productiveness,
coherence, emotional tone, insight, activity level, appearance, and any other
pertinent information on the person’s mental state; and
d. The signature of the
licensed practitioner or designee; and
(2) The licensed practitioner
or designee shall perform such mental examination in accordance with their
standard of practice pursuant to RSA 326-B, RSA 328-D or RSA 329, and any other
applicable laws or rules.
(g) Upon request for IEA by a petitioner, if the
person sought to be admitted refuses to consent to a mental examination, a
petitioner or a law enforcement officer may request a justice of the peace to
order the examination as follows:
(1) The request shall be in the
form of a complaint and prayer for compulsory mental examination pursuant to
RSA 135-C:28, II and NHJB-2826-D
(03/17/2022), which shall be signed and sworn to before a justice of the peace;
and
(2) The complaint shall be
submitted to the justice of the peace along with the petition.
(h) The certifying practitioner shall not sign
the certificate if:
(1) The person has untreated
medical ailments that may be the cause of the person’s mental health
concerns;
(2) The person has medical ailments that cannot be safely treated by
the medical services available at the DRF; or
(3) The person is incapacitated
from alcohol or substance use.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.06 List of Licensed Practitioners Approved to
Certify Involuntary Emergency Admissions.
(a) The commissioner or designee shall maintain a
list of certifying practitioners who are approved by either a DRF or a CMHP to
certify an IEA.
(b) To be approved as a certifying practitioner,
the practitioner shall attend an initial and annual training thereafter on
involuntary emergency admissions, non-emergency involuntary admissions, and
voluntary admissions.
(c) Certifying practitioners approved in
accordance with (a) and (b) above who are on the list shall be authorized to
certify individuals under both RSA 135-C:27-33 and RSA 135-C:36.
(d) DRFs and CMHPs in each mental health region
of the state shall provide the names of all certifying practitioners they have
approved to the department.
(e) When a DRF or CMHP accepts or removes
approval for a certifying practitioner, it shall provide the name of the new or
removed certifying practitioner to the commissioner.
(f) The department may remove a certifying practitioner
from the list if the certifying practitioner fails to comply with these rules
in accordance with the following process:
(1) Prior to removing a
certifying practitioner from the list, the commissioner shall provide a warning
to the certifying practitioner that specifies the non-compliance with this rule
and gives the certifying practitioner an opportunity to come into compliance;
(2) After receiving the
warning, if the certifying practitioner continues to not comply with the rules,
the department shall remove the certifying practitioner from the list; and
(3) Upon removal of a
certifying practitioner, the department or designee shall inform the DRF or
CMHP that approved the certifying practitioner that the certifying practitioner
has been removed.
(g) The DRF or CMHP may reapprove the certifying
practitioner after the certifying practitioner receives additional training on
involuntary emergency admissions, non-emergency admissions, and voluntary
admissions and the DRF or CMHP determines that the certifying practitioner
understands how to perform IEAs in accordance with the requirements of this
rule.
(h) If the DRF or CMHP reapproves a certifying
practitioner, it shall inform the department of the new approval.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.07 Completion of Certificate by Certifying
Practitioner.
(a) The certificate portion of the petition and
certificate form shall be completed in accordance with the following:
(1) Within 3 days of completion
of the petition, a certifying practitioner shall state the following on page 8
of the petition and certificate:
a. He or she is a licensed practitioner
who is on the list identified in He-M 614.06 as approved to certify IEAs;
b. He or she is not a relative
of the person named in the petition who is alleged to be mentally ill;
c. He or she has conducted or
has designated a licensed practitioner to conduct a physical examination of the
individual;
d. He or she has conducted or
has designated a licensed practitioner to conduct a mental examination of the
individual;
e. The time and date that he or
she personally examined the person sought to be admitted and that this time and
date are within 3 days of completion of the attached petition;
f. Certify that as a result of
the physical and mental examinations that the certifying practitioner has
completed and/or reviewed, and the acts or behaviors the licensed practitioner
has observed or which were reported by the petitioner and/or witness, the
criteria of RSA 135-C:27 are satisfied, as the person is in such mental
condition as a result of mental illness as defined in He-M 614.02(m), that he or
she poses a serious likelihood of danger to self or others as described in He-M
614.03(b);
g. He or she understands they
may be required to appear in court for a hearing;
h. The DRF which can best
provide the degree of security and treatment required by the person sought to
be admitted;
i. That the certifying
practitioner informed the person of the DRF to which the person will be or will
likely be transported;
j. All statements are true; and
k. The certifying
practitioner’s signature, printed name, address, and phone number;
(2) A certifying practitioner
shall not complete a certificate for a person who consents to voluntary mental
health treatment at any time the individual is under the care of the certifying
practitioner, unless the individual withdraws that consent and the practitioner
subsequently determines that an IEA is necessary; and
(3) A certifying practitioner
shall only complete a certificate for a person:
a. When the certifying
practitioner has determined that the dangerous behavior(s) is not caused by an
untreated physical ailment;
b. When the certifying
practitioner has determined that the dangerous behavior(s) is not caused by the
influence or acute withdrawal from alcohol or other substances;
c. When the certifying practitioner
has determined that the dangerous behavior(s) is not caused by an intellectual
disability as defined in RSA 135-C:2, X;
d. When the certifying
practitioner has determined that the dangerous behavior(s) is not caused by a
neurocognitive disorder, such as Alzheimer’s disease or dementia; and
e. When the certifying
practitioner has reviewed and considered a less restrictive voluntary option
for treatment in accordance with He-M 614.10(a).
(b) The petition and certificate are not complete
until:
(1) All requirements of He-M
614.04 through 614.07 are met;
(2) The DRF to which the
individual is transferring is identified on the petition and certificate. If a
DRF bed is not available, the certifying practitioner shall identify on the
petition and certificate the DRF which best meets the needs of the patient; and
(3) Be signed and dated by the
certifying practitioner.
(c) The individual shall be admitted to the state
mental health system as soon as the petition and certificate are complete.
(d) Treatment of individuals within the state
mental health system shall be administered in accordance with all applicable
federal and state laws and rules, such as:
(1) All practitioner or
clinical standards of practice such as RSA 329, RSA 328-D, and RSA 326-B and
the rules promulgated thereunder;
(2) All health facility
standards such as RSA 151, He-P 802, and Center for Medicare and Medicaid
Services (CMS) conditions of participation;
(3) The Emergency Medical
Treatment and Labor Act (EMTALA); and
(4) Any other federal and state
laws and rules that govern the treatment of individuals seeking and receiving
mental health treatment from a medical provider.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.08 Filing of Completed Petition and
Certificate for Involuntary Emergency Admission.
(a) Immediately upon completion of the
certificate, the certifying practitioner or designee shall transmit the
petition and certificate in its entirety to the DRF identified on the
certificate.
(b) If NHH is identified as the DRF on the
petition and certificate, the completed petition and certificate shall be sent
directly to NHH.
(c) If another DRF is identified on the petition
and certificate, the completed petition and certificate shall be sent to that
DRF with a copy of the petition and certificate sent to NHH.
(d) If NHH determines prior to filing with the court
that the petition and certificate is not completed in accordance with the
requirements of this rule, the petition and certificate shall be considered
invalid.
(e) If a certificate is determined invalid, the
individual subject to the certificate shall not be considered in the state
mental health services system until a certificate is complete.
(f) The certifying practitioner shall be
responsible for completing the certificate fully prior to resubmitting to NHH.
(g) NHH shall contact the certifying practitioner
to notify them that the certificate is invalid and that the individual is not
in the custody of the state mental health system.
(h) The completed petition and certificate shall
be filed with the circuit court that shall schedule a probable cause hearing,
even if the individual has yet to be transferred to the DRF.
(i) If the person is transferred to a different
DRF than the one originally identified on the certificate, or discharged to
another non-DRF location, the hospital shall notify the original DRF of the
transfer immediately upon knowledge of the change.
(j) The DRF shall then notify the court in which
the petition was filed and inform the court of the disposition and location, if
known, of the individual.
(k) Only the DRF originally identified on the
petition and certificate shall be responsible for filing the completed petition
and certificate with the court but any DRF shall consider for admission any
completed petition and certificate received by any DRF.
(l) The transmission of the petition and
certificate to other medical providers as well as the court system shall be
done in accordance with HIPAA and any other applicable privacy and
confidentiality laws.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.09 Delivery to Receiving Facility. Delivery to a DRF shall be in accordance with
RSA 135-C:29.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.10 Rescission of Involuntary Emergency
Admission.
(a) Following completion of a certificate
pursuant to RSA 135-C:28 and before custody of the person is accepted by a law
enforcement officer pursuant to RSA 135-C:29, the certificate shall be
rescinded if the individual no longer meets the criteria of RSA 135-C:27.
(b) Following completion of a certificate
pursuant to RSA 135-C:28 and before custody of the person is accepted by a law
enforcement officer pursuant to RSA 135-C:29, the certificate may be rescinded
and the person who is the subject of the certificate released in any of the
following circumstances:
(1) A mobile crisis team under
contract with the department accepts transfer of the person's care;
(2) An assertive community
treatment team operated by a CMHP accepts transfer of the person's care;
(3) A community-based provider
accepts transfer of the person's care;
(4) Clinical reasons preclude
the continuation of an IEA; or
(5) Any other circumstance
exists that the certifying practitioner believes addresses the individual’s
needs and the individual’s care can be conducted safely outside of inpatient
treatment.
(c) A rescission shall be completed on form
“Involuntary Emergency Admission Invalidation Form” (September 2022) and sent
to the DRF identified on the completed petition and certificate, the court, and
to NHH.
(d) Upon the rescission of the certificate in
accordance with (a) or (b) above, the hospital emergency department shall
immediately notify the patient that the certificate has been rescinded and that
the patient is no longer in custody.
(e) Pursuant to RSA 135-C:29-a, no civil action
shall be maintained against a person who rescinds an involuntary admission in
accordance with (a) or (b) above, provided that the practitioner is acting in
good faith within the limits of their authority.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.11 Notice Pursuant to RSA 135-C:30.
(a) Upon completion of the certificate, the
certifying practitioner or designee shall provide the patient the notice of
rights of person sought to be admitted, included in the IEA Form NHJB-2826-D
(03/17/2022) to the individual in custody.
(b) The notice identified in (a) above does not
replace the notice required to be given by the DRF in accordance with RSA
135-C:30.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.12 IEA Probable Cause Hearings.
(a) Within 3 days after completion of the
certificate, not including Sundays and holidays, and subject to the notice
requirements of RSA 135-C:24, there shall be a probable cause hearing in the
circuit court having jurisdiction over the matter to determine if there is
probable cause for involuntary emergency admission in accordance with RSA
135-C.
(b) For 48 hours prior to the hearing, the person
sought to be admitted shall not be given medication or treatment that would
adversely affect their judgment or limit their ability to prepare for the
hearing unless the person sought to be admitted makes an informed decision to
consent to treatment or unless a medical or psychiatric emergency exists in
accordance with the following:
(1) A person’s judgment is
adversely affected or their ability to prepare is limited if they are unable to
work with their counsel and unable to understand the reasons why an involuntary
emergency admission is sought; and
(2) If medication or treatment
is given to the person sought to be admitted prior to the probable cause
hearing, the physician prescribing the medication shall advise the district
court of the nature of the medication, the reason for it, and its probable
effect upon the person in writing, prior to the hearing or if at the hearing,
presented by the physician.
(c) If an individual has received medications
within the 48 hour period prior to the hearing, the certifying provider or
designee shall complete “48 Hour Rule-MEDICATION LISTING FORM” (September
2022).
(d) The medication form identified in (c) above
shall be sent to NHH or DRF identified on the certificate so that it can be
sent to the court for its review.
(e) For good cause, the person or the person’s
attorney may file a motion requesting a change of venue or transfer.
(f) The hospital or DRF having custody of the
person at the time the probable cause hearing is scheduled shall be responsible
for ensuring the person has virtual or telephonic access so that the individual
may participate in their hearing.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
He-M 614.13 Ten-Day Limitation Period for Involuntary Emergency
Admission.
(a) The 10-day limitation period for IEAs shall
be in accordance with RSA 135-C:32, which states that the 10-day period
excludes Saturdays and Sundays.
(b) The 10-day period shall begin at the time the
petition and certificate are complete.
(c) A subsequent petition for IEA containing
allegation of specific facts or actions which occurred subsequent to the
initial IEA may be completed and certified if necessary in accordance with RSA
135-C:32.
Source. #13350, EMERGENCY RULE, eff 3-16-22, EXPIRED:
9-12-22
New. #13456, eff 10-6-22
APPENDIX
RULE |
SPECIFIC
STATE STATUTE THE RULE IMPLEMENTS |
He-M
601.01 |
RSA
135-C:5, I, (d) |
He-M
601.02 |
RSA
135-C:5, I, (d) |
|
|
He-M
609.01 |
RSA
135-C:13, 18, 56, 57 & 59 |
He-M
609.02 |
RSA
135-C:13, 18, 56, 57 & 59 |
He-M
609.03 |
RSA
135-C:59 |
He-M
609.04 |
RSA
135-C:56 |
He-M
609.05 |
RSA
135-C:56 & 57; RSA 135-C: 19-a; RSA 329, 330-A; RSA
329-B; & RSA 326-B |
He-M
609.06 |
RSA
135-C:57 |
He-M
609.07 |
RSA
135-C:18 |
|
|
He-M 611.01 -
611.02 |
RSA 135-C:61,
IX, RSA 171-A:8-a |
He-M 611.03 |
RSA 171-B:15;
RSA 135-C:61, IX; RSA 171-A:8-a |
He-M 611.04 |
RSA 622:45 |
He-M 611.05 |
RSA 135-C:31, V;
48; RSA 171-A:8-a; RSA 171-B:15; RSA 622:45 |
He-M 611.06 |
RSA 135-C:31, V;
48; RSA 171-A:8-a |
He-M 611.07 |
RSA 135-C:31, V;
48; RSA 171-A:8-a; RSA 171-B:15; RSA 622:45 |
He-M 611.08 |
RSA 135-C:61,
IX; RSA 171-A:8-a |
He-M 611.09 |
RSA 622:45, IV |
He-M 611.10 |
RSA 622:45, IV |
He-M 611.11 |
RSA 622:45, IV |
|
|
He-M
612.01 - 612.02, 612.03(c) - 612.05 |
RSA
135-C:31, V; 48 |
He-M
612.03(a)-(b) |
RSA
135-C:26 |
He-M
612.04 |
RSA
135-C:28 |
|
|
He-M
613.01-613.02 |
RSA
135-C:4, III |
He-M
613.03 |
RSA
135-C:12; 13 |
He-M
613.04(a) |
RSA
135-C:27; 28 |
He-M
613.04(b) |
RSA
135-C:34; 35 |
He-M
613.05 |
RSA
135-C:31, V |
He-M
613.06 |
RSA
135-C:16; 17 |
He-M
613.07 |
RSA
135-C:32; 33 |
He-M
613.08(a) |
RSA
135-C:39 |
He-M
613.08(b)-(d) |
RSA
135-C:49 |
He-M
613.09 |
RSA
135-C:4, III |
He-M
613.10 |
RSA
135-C:12, 13 |
He-M
613.11 |
RSA
135-C:12; 13 |
He-M
613.11(a)(3), (g)-(h) |
RSA
135-C:27; 28 |
He-M
613.11(f) |
RSA
135-C:34; 45 |
He-M
613.12 |
RSA
135-C:64, II; 65 |
He-M
613.13 |
RSA
135-C:31, V |
He-M
613.14 |
RSA
135-C:32; 33 |
He-M
613.15(a) |
RSA
135-C:39 |
He-M
613.15(b)-(d) |
RSA
135-C:49 |
He-M
614 |
RSA
135-C:4, III; 135-C:61, II |