CHAPTER
He-P 300 DISEASES
Statutory
Authority: RSA 141-C:6
PART
He-P 301 COMMUNICABLE DISEASES
He-P
301.01 Definitions.
(a) "Acceptable immunization" means the
immunizations required in RSA 141-C:20-a and the doses and age requirements in
He-P 301.14.
(b) "Admitting official" means the
principal or his or her designated representative, headmaster or director of
the public or non-public school, state agency, or child care agency.
(c) "Applicant" means the person for
whom application is made to either the AIDS drug assistance or the tuberculosis
patient care financial assistance program, and who becomes a recipient if he or
she is determined to be medically and financially eligible.
(d) "Carrier" means a person or animal
that harbors a specific infectious agent in the absence of discernible clinical
disease and serves as a potential source of infection.
(e) “Case” means any person afflicted with a
communicable disease.
(f) “Chief complaint” means the patient’s set of
symptoms and illnesses when the patient first presents to the emergency
department of a hospital.
(g) "Child care agency" means “child
care agency” as defined in RSA 141-C:2, IV-b.
(h) “Commissioner" means “commissioner” as
defined in RSA 141-C:2, IX.
(i) “Communicable
disease” means “communicable disease” as defined in RSA 141-C:2, VI.
(j) "Common cup" means an open drinking
vessel shared by individuals in public places without disinfection between
uses.
(k) "Conditional enrollment" means the
temporary enrollment of a student who has documentation of at least one dose of
each required vaccine and an appointment date(s) for the next scheduled
dose(s).
(l)
“Congregate setting” means any setting or location where people come together
including, but not limited to, schools, childcare centers, healthcare
facilities, emergency shelters, workplaces, public events, retail outlets, or
other business gathering locations.
(m) "Contact" means a person who has
been in association with an infected person or animal or a contaminated
environment in a manner that provides an opportunity to acquire the infective
agent.
(n) "Date of application" means the
date on which the program receives the signed application for AIDS drug
assistance or for the tuberculosis patient care financial assistance.
(o) "Department" means “department” as
defined in RSA 141-C:2, X.
(p) “Diversion” means the illegal use, tampering,
substitution, or theft of drugs intended for patients by healthcare or
non-healthcare personnel.
(q) “Documentation” means written authenticated
evidence of a laboratory test result or immunization.
(r) “Dose of vaccine” means the amount of vaccine
appropriate to develop or confer immunity as specified in the manufacturer’s
documentation accompanying the vaccine, also known as the package
insert.
(s) “Emergency department visit” means an
encounter where a person is treated, evaluated or both, in the emergency
department of a hospital.
(t)
“Exclude” means to prevent a person from being in a public or communal setting,
such as preventing an employee from reporting to work and from performing any
job responsibilities within the employee’s place of employment.
(u) “Health care facility” means facilities
required to be licensed pursuant to RSA 151:2, I and those facilities exempt
from licensing pursuant to RSA 151:2, II.
(v) "Health care provider" means any
physician or other person self-employed or representing or employed by a
governmental or private agency, department, institution, clinic, laboratory,
hospital, health maintenance organization, pharmacist, association or other
entity who assesses or diagnoses the health status of any person or who treats
any reportable disease or illness.
(w) "Health care setting" means any
governmental or private agency, department, institution, clinic, laboratory,
hospital, health maintenance organization, pharmacist, association, or other
entity which assesses or diagnoses the health status of, or provides medical
care or treatment to any person.
(x) “Hospital” means an institution which is
engaged in providing to patients, under supervision of physicians, diagnostic
and therapeutic services for medical diagnosis, treatment and care of injured,
disabled, or sick persons, or rehabilitation services for the rehabilitation of
such persons, and which is licensed in accordance with RSA 151 and He-P 802.
The term “hospital” also includes psychiatric and substance abuse treatment
hospitals.
(y) "Household" means one or more
adults, with or without children, related by marriage or living together in the
same residence.
(z) "Human Immunodeficiency Virus
(HIV)" means “human immunodeficiency virus” as defined in RSA 141-F:2, V.
(aa) "Institutional setting” means any group
living situation such as in a nursing home, hospital, sheltered care facility,
residential treatment and rehabilitation facility, correctional facility,
transitional housing, long term care facility, or any group care facility.
(ab)
“Invasive” means the organism causing the communicable disease is detected or
isolated from a normally sterile site.
(ac)
"Isolation" means “isolation” as defined in RSA 141-C:2, XII.
(ad)
“Laboratory” means “laboratory” as defined in He-P 808, namely, “any building,
place, or mobile laboratory van, for the biological, microbiological,
serological, chemical, immunohematological,
biophysical, cytological, pathological or other examination of materials
derived from the human body for the purpose of providing information for the
diagnosis, prevention or treatment of disease.”
(ae) “Month” means 28 days, or 4 weeks.
(af) “Outbreak” means
cases of illness or disease occurring in a community, region or specific
population at a rate clearly in excess of what is normally expected.
(ag) "Quarantine" means “quarantine” as
defined in RSA 141-C:2, XIII.
(ah) "Reportable disease" means a communicable
disease, as defined in RSA 141-C:2, VI, required to be reported to the
commissioner pursuant to RSA 141-C:7 and He-P 301.02.
(ai) “Restrict” means to limit activities of a
person in a public or communal setting such as, limiting the activities of an
employee such that the employee is able to report to work and perform certain
job duties as long as that activity poses no threat to the public’s health.
(aj) “Sterile site”
means an area of the body where bacteria are not found growing, and which, when
found, is indicative of infection. These areas of the body include, but are not
limited to, cerebrospinal fluid, blood, joint fluid, pleural fluid, peritoneal
fluid, pericardial fluid, bone, and any other internal body sites and organs in
which bacterial are not normally found.
(ak) “Suspect case”
means any patient who a health care provider has reason to believe is or might
be afflicted with a reportable disease such that diagnostic procedures,
treatments, regimens, or preventive and/or control measures appropriate for the
reportable disease are then instituted by the physician and/or the
commissioner.
Source. #2017, eff 5-10-82; amd
by #2339, eff 4-15-83; amd by #2430, eff 6-30-83; amd by 2545, eff 11-29-83; ss by #3172, eff 1-2-86; ss by
#4230, eff 2-23-87; amd by #4425, eff 5-27-88; ss by
#4946, eff 10-2-90; amd by #6053, eff 6-24-95; ss by
#6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by
#12033, eff 11-3-16
He-P
301.02 Reportable Diseases.
(a) Health care providers shall report to the
department diagnosis, suspicion of diagnosis, or suspected incident involving
the following, in accordance with He-P 301.03, in the following time frames:
(1) Within 24 hours following diagnosis or suspicion
of diagnosis or suspected incident of:
a. Anthrax;
b.
Arboviral infection; including but not limited to West Nile Virus, Eastern
Equine Encephalitis Virus, Dengue, Chikungunya virus, Powassan virus, Zika
virus and St. Louis Encephalitis;
c. Botulism;
d. Brucellosis;
e. Cholera;
f. Creutzfeld-Jacob
disease
g. Diphtheria;
h. Haemophilus
influenzae, invasive disease;
i. Hantavirus Pulmonary Syndrome;
j. Hepatitis, viral: A;
k. Measles;
l. Neisseria meningitidis, invasive disease;
m. Mumps;
n. Pertussis;
o. Psittacosis;
p. Plague;
q. Poliomyelitis;
r. Rabies in Humans or Animals;
s. Rubella, including Congenital Rubella
Syndrome;
t. Tuberculosis Disease;
u. Tularemia;
v. Typhoid Fever;
w. Typhus;
x. Vibrio species including V. cholerae; and
y. Any suspect outbreak, cluster of illness, unusual
occurrence of communicable disease, or other incident that may pose a threat to
the public’s health.
(2) Within 72 hours following diagnosis or
suspicion of diagnosis of:
a. Acquired Immune Deficiency Syndrome (AIDS);
b. Acute flaccid myelitis;
c. Anaplasmosis;
d. Babesiosis;
e. Campylobacteriosis;
f. Chlamydia;
g. Coccidioidomycosis;
h. Cyclospora infection;
i. Cryptosporidiosis;
j. Ehrlichiosis;
k.
Enterobacteriaceae species demonstrating resistance to carbapenem or production
of a carbapenemase;
l. Escherichia coli O157 infection and other shiga toxin producing E. coli;
m. Giardiasis;
n. Gonorrhea;
o. Hepatitis, viral, newly diagnosed infections
only: B, C;
p. Hepatitis, viral: positive B surface antigen
in a pregnant woman;
q.. HIV, including HIV exposure in infants;
r. Legionellosis;
s. Leprosy, Hansen’s Disease;
t. Leptospirosis;
u. Listeriosis;
v. Lyme Disease;
w. Malaria;
x. Pneumococcal disease, invasive;
y. Psittacosis;
z. Rocky Mountain Spotted Fever;
ab. Salmonellosis;
ac. Shigellosis;
ad. Syphilis, including Congenital Syphilis
Syndrome;
ae. Tetanus;
af. Toxic-Shock Syndrome (TSS), Streptococcal or
Staphylococcal;
ag. Trichinosis;
ah. Varicella; and
ai. Yersiniosis.
(b) Laboratories shall report to the department
any laboratory test indicative of or highly correlated with infection of the
following microorganisms in accordance with He-P 301.03(h):
(1) Within 24 hours:
a.
Arboviral infection, including but not limited to West Nile Virus, Eastern Equine
Encephalitis Virus, Dengue, Chikungunya virus, Powassan virus, Zika virus and
St. Louis Encephalitis;
b. Bacillus anthracis;
c. Bordetella pertussis;
d. Clostridium botulinum;
e. Corynebacterium diphtheriae;
f. Francisella
tularensis;
g. Haemophilus
influenzae, sterile site;
h. Hantavirus;
i. Hepatitis, viral: A, E;
j. Mumps;
k. Mycobacterium tuberculosis: isolation of the
organism or detection of its DNA;
l. Neisseria meningitidis, sterile site;
m. Polio;
n. Rabies;
o. Rubella;
p. Rubeola;
q. Salmonella typhii;
r. Vancomycin resistant Staphylococcus aureus
(VRSA);
s. Vibrio species including V. cholerae; and
t. Yersinia pestis.
(2) Within 72 hours:
a. Anaplasmosis phagocytophilum;
b. Babesia microti;
c. Borrelia burgdorferi;
d. Brucella species;
e. Campylobacter species;
f. Chlamidophila
psittaci;
g. Chlamydia trachomatis;
h. Clostridium tetani;
i. Coccidioides immitis;
j. Cryptosporidium parvum;
k. Cyclospora cayetanensis;
l. Ehrlichia species;
m.
Enterobacteriaceae species demonstrating resistance to carbapenem or production
of a carbapenemase;
n. Escherichia coli O157 and other shiga toxin producing E. coli;
o. Giardia species;
p. Hepatitis, viral: positive B surface antigen
in a pregnant woman:
q. HIV, including HIV exposure in infants;
r. Legionella pneumophila;
s. Leptospira species;
t.
Listeria monocytogenes;
u. Mycobacterium leprae;
v. Mycobacterium tuberculosis: blood assays
only;
w. Neisseria gonorrhoeae;
x. Plasmodium species;
y. Rickettsia prowazekii;
z. Rickettsia rickettsii;
aa. Salmonella species other than Salmonella typhii;
ab. Shigella species;
ac. Streptococcus pneumoniae, sterile site;
ad. Treponema pallidum;
ae. Trichinella spiralis; and
af. Yersinia enterocolitica.
(c) Laboratories shall report to the department
within 72 hours the results of all CD4+ lymphocyte laboratory tests.
(d) Laboratories shall report any tests
indicative of HIV infection including antibody, antigen PCR based, and all
viral load tests, including those with no virus detectable.
(e) Laboratories that are owned, operated, and
located on the licensed premises of a hospital shall electronically report the
test results listed in (b)-(d) above.
(f) Each hospital referred to in (d) and (e)
above shall establish an electronic submission process and commence routine
electronic reporting by December 31, 2018; and
(g) Hospitals referred to in (d) and (e) above
shall format electronic submissions in accordance with guidance provided by the
Department in the New Hampshire Local Implementation Guide for Electronic
Laboratory Reporting using HL7 2.5.1, Version 4.0, 5/23/2016, available as
noted in Appendix A.
(h) Laboratories shall submit clinical isolate
material as requested by DHHS for the purpose of public health surveillance and
investigation.
(i) Laboratories that
are owned, operated, and located on the licensed premises of a hospital shall
submit annually a hospital antibiogram report if one exists.
(j) The person in charge, or their designee, of
any healthcare setting shall report to the department any investigation of
suspected or actual incident of diversion of injectable medications in a health
care setting within 72 hours of initiation of such investigation.
Source. #3172, eff 1-2-86; ss by #4230, eff 2-23-87;
ss by #4946, eff 10-2-90; amd by #6053, eff 6-24-95;
ss by #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08;
ss by #12033, eff 11-3-16
He-P
301.03 Reporting of Communicable
Diseases.
(a) Any
physician or other health care provider who assesses, diagnoses, or treats a
person believed to be a case or suspect case of a reportable disease shall
immediately make a report to the department by:
(1) Telephone at one of the following:
1-603-271-4496, from 8:00 a.m. to 4:00 p.m., or after hours and on weekends at:
603-271-5300;
(2) Facsimile at 603-271-0545; or
(3) Electronic transmission by requesting from
the Department during business hours an account in the NH Electronic Disease
Surveillance System (NHEDSS) on forms provided by the commissioner.
(b) Reports provided pursuant to (a) above shall
include:
(1) The full name, age, date of birth, sex, race,
ethnicity, address, telephone number, occupation, and place of occupation of
the patient;
(2) The name of the disease;
(3) The date of onset;
(4) Diagnostic test(s) performed, specimen
type(s), date(s), and result(s);
(5) The name of the person reporting; and
(6) Treatment information including the name and
amount of the medication prescribed.
(c) When no physician or other health care
provider is in attendance, the person in charge of any institution, including
but not limited to a public or non-public school, child care agency, hotel,
restaurant, boarding house, labor camp or other camp, vessel, workplace,
hospital, dispensary, pharmacy, or charitable, penal, or other institution or
place of detention in which there is a case or suspect case of a reportable
disease, shall report the same immediately to the department as provided in
paragraph (a) above.
(d) Reports provided pursuant to (c) above shall
include:
(1) The full name, age, date of birth, sex, race,
ethnicity, address, telephone number, occupation, and place of occupation of
the patient;
(2) The name of the disease or incident;
(3) The date of onset; and
(4) The name, affiliation, and contact
information of the person reporting.
(e) Local boards of health shall report
immediately to the department those cases or suspect cases of reportable
diseases of which they have knowledge.
(f) Reports required pursuant to (e) above shall
include:
(1) The full name, age, date of birth, sex, race,
ethnicity, address, telephone number, occupation, and place of occupation of
the patient;
(2) The name of the disease or incident;
(3) The date of onset;
(4) The name of the original reporting source;
and
(5) The name, affiliation, and contact
information of the person reporting.
(g) The person in charge of any diagnostic
laboratory testing human or animal specimens shall report immediately to the
department as provided in paragraph (a) above, the following except for
laboratories which after December 31, 2018 shall
report to the department pursuant to He-P 301.02(f):
(1) The isolation or identification of causative
agents, positive diagnostic acute immunological responses to causative agents,
or any other positive diagnostic test results for any of the conditions listed
in He-P 301.02(b);
(2) If the laboratory test was conducted on a
human specimen:
a.
The full name, age, date of birth, sex, race, ethnicity, address, telephone
number, occupation, and place of occupation of the person from whom the
specimen was taken;
b. The date the specimen was received;
c. The name of the care provider; and
d. The name of the person reporting; and
(3) If the laboratory test was conducted on an
animal specimen:
a. The full name, address, and telephone number
of the owner of the animal from whom the specimen was taken;
b. The species of animal from which the animal
specimen originated;
c. The date the specimen was received;
d. The name of the veterinarian; and
e. The name of the person reporting.
(h) Every physician or other health care
provider, or the person in charge of any hospital, institution, dispensary,
public or non-public school, child care agency, hotel, restaurant, boarding
house, labor camp or other camp, vessel, workplace or charitable, penal, or
other institution or place of detention having knowledge of the occurrence of
case(s) or suspect case(s) of illness within the workplace or institution
believed to have been due to consumption of food or water shall report the same
immediately to the department as provided in paragraph (a) above.
(i) Hospitals with
emergency departments shall electronically report all emergency department
visits data to the department within 24 hours of the patient encounter, for the
purpose of early detection of reportable diseases and outbreaks, to describe
emerging public health issues, and to identify potential public health threats.
(j) Hospitals shall format electronic submissions
in accordance with guidance provided by the Department in the New Hampshire
Local Implementation Guide for Syndromic Surveillance Reporting, Version 1.07,
2/15/2015, available as noted in Appendix A.
(k) Hospitals with emergency departments shall
commence routine electronic submission of properly formatted data not later
than December 31, 2017.
(l) Investigations by the department of emergency
department encounter reports shall include obtaining other clinical data
necessary for case ascertainment including but not limited to the chief
complaint. The findings of the investigation shall be used to identify
communicable diseases, other health threats, and to institute control measures
to reduce the risk of disease spread or to reduce exposures in a public health
emergency.
Source. #3172, eff 1-2-86; ss by #4230, eff 2-23-87;
ss by #4946, eff 10-2-90; EXPIRED 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.04 Methods of Isolation. Hospitals and other health care facilities
shall institute appropriate precautions consistent with the Healthcare
Infection Control Practices Advisory Committee 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings, June 2007 and the Healthcare Infection Control Practices Advisory
Committee, Management of Multi-drug Resistant Organisms in Healthcare Settings,
HICPAC Advisory Committee. October, 2006, available as
noted in Appendix A.
Source. #2017, eff 5-10-82; amd
by #2339, eff. 4-15-83; amd by $2430 eff. 6-30-83; amd by #2545 eff. 11-29-83; ss by #3172, eff. 1-2-86; ss by
#4230, eff. 2-23-87; ss by #4946, eff 10-2-90; EXPIRED 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.05 Restriction and Control
Measures for Isolation and Quarantine for Specific Diseases.
(a) For a case or suspect case of cutaneous and
inhalation anthrax, hospitals and other institutional settings shall institute
standard precautions according to He-P 301.04 for the duration of the illness.
(b) For a case or suspect case of diphtheria,
isolation precautions shall be instituted as follows:
(1) For a case, suspect case or carrier of
pharyngeal or cutaneous diphtheria, hospitals and other institutional settings
shall maintain appropriate isolation in accordance with He-P 301.04 until 2
cultures from both throat and nose or skin lesions in cutaneous diphtheria
taken not less than 24 hours apart and not less than 24 hours after cessation
of antimicrobial therapy, fail to show diphtheria bacilli;
(2) Where culture is impractical, isolation may be
ended after 14 days of appropriate antibiotic treatment; and
(3) For all close contacts of cases or suspect
cases of pharyngeal or cutaneous diphtheria, employers shall exclude close
contacts of cases or suspect cases from the following job duties until cultures
prove them not to be carriers:
a. Job duties involving the handling of food;
b. Child care job duties; and
c. Direct care of hospitalized and
institutionalized patients.
(c) For a case or suspect case of gonococcal
ophthalmia neonatorum:
(1) Precautions shall be instituted in accordance
with He-P 301.04; and
(2) The health care provider shall institute
isolation of the individual for the first 24 hours after administration of
effective therapy.
(d) For a case or suspect case of invasive Haemophilus influenzae infection, the health care provider
shall institute appropriate isolation in accordance with He-P 301.04 for 24
hours after the start of appropriate antibiotic therapy.
(e) For a case or suspect case of hepatitis,
isolation precautions shall be as follows:
(1) For persons with hepatitis A:
a. Employers shall exclude cases or suspect
cases from the following job duties until one week after onset of jaundice or
until hepatitis A has been ruled out:
1. Job duties involving the handling of food;
2. Child care job duties; and
3. Direct care of hospitalized and
institutionalized patients; and
b. Cases or suspect cases shall be excluded from
attending child care agencies until one week after the onset of jaundice or
until hepatitis A has been ruled out; and
(2) For persons with hepatitis B or C,
precautions shall be instituted in accordance with He-P 301.04.
(g) For a case or suspect case of measles or
rubeola, the following control measures shall be instituted:
(1) The admitting official shall exclude a case
or suspect case from the grounds of public and non-public schools and child care
agencies for at least 4 days after appearance of the rash;
(2) Hospitals and other institutional settings
shall institute appropriate isolation in accordance with He-P 301.04 from
recognition of clinical illness through the fourth day of rash; and
(3) If the case or suspect case occurs in a
health care facility:
a. The facility shall ensure that the following
susceptible personnel receive a dose of measles vaccine:
1. All employees who cannot provide
documentation of:
(i) Two doses of
measles vaccine on or after their first birthday, the second dose
a
minimum of 28 days from the first; or
(ii) Serologic evidence of immunity to measles;
and
b. The facility shall exclude susceptible personnel
who have been exposed from direct patient contact from the 5th to the 21st day
after exposure regardless of whether they received vaccine or immune globulin
after the exposure.
(h) For a case or suspect case of
meningococcemia, or infection with invasive Neisseria meningitidis, the health
care provider shall institute appropriate isolation in accordance with He-P
301.04 for 24 hours after start of antibiotic therapy.
(i) For a case or
suspect case of mumps, the following control methods shall be instituted:
(1) The admitting official shall exclude a case
or suspect case from public and non-public schools or child care agencies for 5
days from onset of salivary gland swelling; and
(2) For a case or suspect case in hospitals or
other institutional settings:
a. The health care provider shall institute
appropriate isolation in accordance with He-P 301.04; and
b. The health care provider shall isolate the
confirmed or suspect case in a private room for 5 days from onset of salivary
gland swelling; and
(3) For all close contacts of cases or suspect
cases of mumps, employers shall exclude susceptible close contacts of cases or suspect
cases from the following job duties from days 12-26 post exposure:
a. Job duties involving the handling of food;
b. Child care job duties; and
c. Direct care of hospitalized and
institutionalized patients.
(j) For a case or suspect case of pertussis, the
following control methods shall be instituted:
(1) Confirmed or suspect cases in hospitals or
other institutional settings shall be placed in appropriate isolation in
accordance with He-P 301.04 by the health care provider until they have
received 5 days of antibiotics;
(2) Admitting officials and employers shall
exclude confirmed or suspect cases and symptomatic household contacts from the
following places until they have received at least 5 days of appropriate
antibiotics:
a. Public and non-public schools;
b. Child care agencies; and
c. Work places; and
(3) Health facilities shall exclude health care workers
and other adults with suspect or confirmed pertussis from patient/public
contact until they have received 5 days of a course of antibiotics.
(k) For confirmed or suspect cases of
poliomyelitis, hospitals shall institute isolation in accordance with He-P
301.04.
(l) For confirmed or suspect cases of rabies,
hospitals shall institute appropriate isolation in accordance with He-P 301.04.
(m) For confirmed or suspect rubella, including
congenital rubella syndrome, the following control methods shall be instituted:
(1) In hospitals and institutions, patients
suspected of having rubella shall be managed under appropriate isolation in
accordance with He-P 301.04 and placed in a private room for 7 days after the
onset of rash;
(2) Admitting officials and employers shall
exclude cases or suspect cases from public and non-public schools, child care
agencies and work places for 7 days after onset of rash; and
(3) Hospitals and other health care facilities
shall ensure that both male and female health care personnel who may be exposed
to patients with rubella are immunized unless there is evidence of previous
immunity.
(n) For a case or suspected case of shigellosis,
E. coli 0157, and other shiga toxin producing E.
coli:
(1) Precautions shall be instituted in accordance
with He-P 301.04;
(2) Employers shall exclude cases or suspect
cases from the following job duties until stool cultures are free of the microorganism
on 2 consecutive specimens collected not less than 24 hours apart and at least
48 hours after the last dose of antibiotics, if prescribed:
a. Job duties involving the handling of food;
b. Child care job duties; and
c. Direct care of hospitalized and
institutionalized patients; and
(3) Children who are cases or suspect cases shall
be excluded from child care settings until stool cultures are free of the microorganism
on 2 consecutive specimens collected not less than 24 hours apart and at least
48 hours after the last does of antibiotics, if prescribed.
(o) For a case or suspected case of tuberculosis
(TB), the following control methods shall be instituted:
(1) Employers and admitting officials shall
exclude confirmed or suspect cases of TB from congregate settings, with the
exception of patients being cared for in a healthcare facility under
appropriate precautions, until TB has been ruled out or the confirmed or
suspect case is deemed to be non-infectious by the department; and
(2) Health care providers shall order a drug
susceptibility test on all initial M. tuberculosis cultures performed on the
initial isolate in order to assure proper prescription of treatment.
(p) For a case or suspected case of typhoid
fever:
(1) Precautions shall be instituted in accordance
with He-P 301.04;
(2) Employers and admitting officials shall exclude
cases or suspect cases with the Salmonella typhii
organism from the following job duties until released from supervision by the
local health authority:
a. Job duties involving the handling of food;
b. Child care job duties; and
c. Direct care of hospitalized and
institutionalized patients;
(3) Children who are cases or suspect cases shall
be excluded from child care settings until released from supervision by the
local health authority; and
(4) The local health authority shall supervise
confirmed or suspect cases until:
a. Not less than 3 consecutive cultures of
feces, each taken at least 24 hours apart and at least 48 hours after last dose
of any antibiotic and not earlier than one month after illness onset are
negative; and
b. If any one of the cultures in a. above is
positive, the culture series shall be repeated at intervals of one month during
the 12-month period following illness onset until at least 3 consecutive
negative cultures are obtained.
(q) For a case or suspect case of varicella
disease:
(1) Admitting officials and employers shall
exclude a case, suspect case, or an individual with vesicular eruption related to
varicella disease , from the following places for 5 days after eruption first
appears until vesicles become dry, or in immunized people without crusts, until
no new lesions appear within a 24 hour period:
a. Public and non-public schools;
b. Child care agencies; and
c. Work places; and
(2) Hospitals shall maintain appropriate
isolation in accordance with He-P 301.04 for 5 days after eruption first
appears or until vesicles become dry or until no new onset of lesions appear
within 24 hours if the lesions do not crust, i.e. form macules or papules only
instead of vesicles.
(r) For any communicable disease that poses a
threat to the public’s health and not already described in He-P 301.05, all
cases, suspect cases, and close contacts of cases or suspect cases of a
communicable disease who work in sensitive occupations, such as healthcare,
food service, and child care, or who are otherwise located in a congregate
setting ,shall be excluded or restricted from certain activities until they are
no longer infectious in accordance with RSA 141-C:4 if necessary to protect the
health and safety of the public from a communicable disease, and based on the best available guidance and
recommendations from the Centers for Disease Control and Prevention or other
established sources.
(s) Individuals described in (r) above with
symptoms of acute gastrointestinal illness shall be excluded from duties
involving direct patient care, childcare, or serving of food or the handling of
clean dishware, utensils, or equipment until 48 hours after the resolution of
symptoms or until such time the employee can provide certification from a
physician that the illness is from a non-infectious cause.
Source. #2017, eff 5-10-82; ss by #3172, eff 1-2-86;
ss by #4230, eff 2-23-87; ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.06 Prevention of Gonococcal Ophthalmia
Neonatorum and Perinatal Hepatitis B Infection.
(a) All hospitals and healthcare facilities at
which births are attended shall administer neonatal prophylaxis against
gonococcal ophthalmia.
(b) All hospitals and healthcare facilities at
which births are attended shall administer hepatitis B immune globulin (HBIG)
and the first hepatitis B vaccine dose within 12 hours of birth to all infants
born to hepatitis B surface antigen positive women.
(c) For infants born to women of unknown
hepatitis B surface antigen status, the hospital or healthcare facility at
which the birth was attended shall:
(1) Administer the first hepatitis B vaccine dose
within 12 hours of birth; and
(2) If the mother tests positive for hepatitis B
surface antigen, the hospital or healthcare facility at which the birth was
attended or the health care provider shall administer HBIG to the infant within
7 days of birth.
Source. #4230, eff 2-23-87; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.07 Procedures for Conduct of
Investigation.
(a) In accordance with RSA 141-C:3 the department
shall investigate the incidence of communicable diseases or potential
transmission of communicable diseases posing a threat to the citizens of the
state.
(b) Methods for conducting such investigations
shall include the following:
(1) Surveying pertinent populations, health care
providers and others by use of questionnaires;
(2) Telephone interviews with cases and suspect
cases, contacts, health care providers, employees, and employers of the suspect
source of the disease;
(3) Personal interviews with cases and suspect
cases, contacts, health care providers, employees, and employers of the suspect
source of the disease;
(4) Collection and analysis of samples of food,
body fluids or other clinical specimens of cases, suspect cases and suspect
sources or any other items and individuals suspected in a disease incident; and
(5) Review of individual case medical records,
business records, reports and x-rays of cases, suspect cases and contacts in an
incident.
(c) All tests of biological specimens taken from
New Hampshire residents for the diagnosis of reportable diseases shall be
performed in a laboratory certified under 42 CFR 493. If more extensive laboratory tests will aid
in better awareness of the disease causing agent, the commissioner shall order
tests performed by the New Hampshire public health laboratories (PHL).
(d) Whenever a laboratory submits a specimen,
portion of a specimen, or culture to the PHL for testing, laboratory reporting
requirements shall be deemed to have been fulfilled, provided that the minimum
information specified in RSA 141-C:7 and He-P 301.03 accompanies the specimen
or culture.
(e)
The PHL shall hold negative specimens for 30 day,s
and positive specimens for one year or until the conclusion of the
investigation or study if longer.
Source. #4230, eff 2-23-87; ss by #4271, eff 6-25-87;
ss by #4946, eff 10-2-90; EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.08 Procedures for Disclosure of
Information.
(a) Requests for release of information under RSA
141-C:10, shall be made to the commissioner or his or her designee and shall
describe the type, the purpose, and the ultimate disposition of the requested
information.
(b) In the case where the department receives a
report that a person, who works outside from his or her primary residence, or
who provides child care in his or her primary residence, or who prepares food
in his or her primary residence for sale to the public, is diagnosed with a
reportable disease, or with a condition that can pose a threat to the public
health, the following steps shall be taken:
(1) The department shall disclose to the manager
of the place of employment:
a. The name of the individual employee so
diagnosed;
b. The name of the reportable disease;
c. The laboratory test results associated with
the reportable disease; and
d. What steps the manager shall take to assure
protection of the health of the public from exposure to the risks associated
with the reportable disease; and
(2) The personal identity of the employee shall
be kept confidential by the manager to whom a disclosure is made as described
in (1) above in accordance with RSA 141-C:10, I.
Source. #4230, eff 2-23-87; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.09 Procedures for Decontamination.
(a) The method of decontamination of a commodity,
conveyance, baggage, or cargo shall include one or more of the following:
(1) Washing and rinsing;
(2) Application of pesticides disinfecting agents
or both;
(3) Incineration;
(4) Chemical treatment; and
(5) Other methods proposed by the decontaminator
which the commissioner determines will achieve decontamination equivalent or
superior to that achieved in (1) - (4) above.
(b) The owner or owners of such commodities,
conveyance, baggage, or cargo shall ensure that decontamination is conducted
according to the order of the commissioner.
No commodity, conveyance, baggage, or cargo shall be removed until
decontamination is completed and release has been ordered by the commissioner’s
designee.
Source. #4230, eff 2-23-87; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.10 Distribution of Pharmaceutical
Agents.
(a) Health care providers requesting
pharmaceutical agents from the department shall make such requests via the
online Vaccine Ordering Management System (VOMS) provided by the department at
least 7 days prior to the desired delivery date. The department shall provide VOMS enrollment
information upon request.
(b) Requestors pursuant to (a) above shall
provide the following information via VOMS:
(1) The name of the physician, practice, or
facility;
(2) The provider’s number provided by the
department’s immunization program;
(3) The address of the practice or provider;
(4) The person responsible for ordering
pharmaceutical agents;
(5) The phone number of the person named in (4)
above; and
(6) The type and number of doses of
pharmaceutical agents being ordered.
(c) Health care providers obtaining
pharmaceutical agents from the department shall ensure proper storage and
handling to prevent deterioration, in compliance with the requirements of RSA
318. All pharmaceutical agents shall be
stored in accordance with the manufacturer's instructions that accompany each
shipment of pharmaceutical agents.
Providers shall be responsible for replacement of pharmaceutical agents
if loss occurs due to the facility’s negligent storage or handling procedures.
(d) Health care providers receiving vaccines from
the department shall inform the recipients of such vaccines of their benefits
and risks, in accordance with 42 CFR 110, vaccine information materials.
(e) Health care providers who wish to order
state-supplied vaccines shall complete, on an annual basis, the vaccine
provider’s immunization certification form on which the provider certifies
annually that he or she will comply with the following requirements:
(1) Exercise individualized medical judgment in
the administration of state-supplied vaccines;
(2) Provide the recipient or parent or guardian
of each recipient of such vaccine copies of the current vaccine information
materials;
(3) Retain a written immunization record of the
vaccine administered for a period of at least 3 years following the end of the
calendar year in which the immunization was given and, upon request, furnish
copies of the record to the department or the federal Centers for Disease
Control and Prevention;
(4) Make no charge for vaccines provided by the department
excluding usual or customary office or professional fees charged for vaccine
administration;
(5) For medicaid
federal vaccine eligible children to accept the reimbursement for immunization
administration set by the state medicaid agency or
the contracted medicaid health plans.
(6) Provide state-supplied vaccine to individuals
regardless of their inability to pay vaccine administration fees, and prominently
display a sign that vaccines will be so provided;
(7) To screen children for eligibility if
mandated by state or federal vaccine programs; and
(8) To minimize vaccine wastage;
(9) To manage ordering, storage, and disposal of
vaccine, including:
a. Ordering vaccine and maintaining appropriate
inventories;
b. Not storing vaccine in dormitory-style units
at any time;
c. Storing vaccine under proper storage
conditions at all times, including using:
1. Refrigerator and freezer vaccine storage
units; and
2. Temperature
monitoring equipment and practices that meet NH Immunization Program (NHIP)
storage and handling requirements as provided by the department; and
d. By returning all spoiled or expired public
vaccines to the Center for Disease Control’s (CDC) centralized vaccine
distributor within 6 months of spoilage or expiration date;
(10) Develop policies to avoid fraud and abuse as
defined in 42 CFR 455.2;
(11) Participate in vaccine for children (VFC)
compliance site visits including unannounced visits, and other educational
opportunities associated with VFC program requirements;
(12) All healthcare providers and medical
director’s or equivalent responsible representative shall certify the
following:
a.
That all healthcare provider staff, medical director, or equivalent responsible
representative having access to the VOMS shall comply with all CDC regulations
and guidelines and other applicable federal law related to accessing a CDC
system and ordering publically funded vaccines;
b.
That all healthcare providers or medical director, or equivalent responsible
representative shall identify any individual staff, or representative of the
healthcare provider who is authorized to order vaccines for the healthcare
provider;
c. That a record will kept of any changes in
staff or additions of new healthcare provider staff or representatives, and
will maintain an accurate list of who is
authorized to order vaccines;
d. That the name of anyone no longer authorized
in (12)c. above shall be provided shall
be provided to NH Division of Public Health Services within 24 hours; and
e.
That the identity of the medical director or responsible representative has
been accurately included on the provider enrollment form;
(13) Provide a statement that the healthcare
provider medical director or the equivalent shall replace any vaccine purchased
with state and federal funds that are deemed non-viable due to provider
negligence on a dose-for-dose basis;
(14)
Provide a statement that the healthcare provider medical director or the
equivalent understands that healthcare provider or New Hampshire Immunization
Program (NHIP) may terminate the agreement at any time; and
(15) Provide a statement that if the healthcare
provider terminates the agreement, the unused federal vaccine shall be returned
to NHIP as directed by NHIP.
(f) Vaccine providers shall document the
following minimum information on the vaccine recipient’s medical record:
(1) Type of vaccine;
(2) Date of vaccine administration;
(3) Manufacturer of vaccine administered;
(4) Lot number of vaccine;
(5) Route and site of vaccine administration;
(6) Name and title of the person administering
the vaccine;
(7) Address where the vaccine was administered;
and
(8) Results of eligibility screening of the child
for federal vaccine assistance programs.
(g) When ordering vaccines, health care providers
shall provide the following vaccine utilization information via the online VOMS
provided by the department:
(1) Type, numerical sequence, and number of doses
of vaccine administered for each specified age group;
(2) Current inventory with lot numbers;
(3) Expiration dates;
(4) Wastage in doses;
(5) Number of doses ordered;
(6) Physician or facility’s vaccine provider
number;
(7) Both mailing and street addresses;
(8) Name of provider or facility using vaccine;
(9) Person responsible for ordering vaccine; and
(10) Physician or facility’s phone and fax
numbers.
(h) In the case of an individual experiencing a
vaccine-associated adverse medical event from a state-supplied vaccine, the
health care provider shall immediately report to the national Vaccine Adverse
Event Reporting System at www.vaers.org
or 1-800-822-7967 and notify the department of the report.
Source. #4946, eff 10-2-90; EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P 301.11 HIV/AIDS NH Comprehensive Aids Resource
Emergency (CARE) Program.
(a)
HIV/AIDS financial assistance shall be provided to applicants meeting
the eligibility requirements set forth in this section. Applications for financial assistance shall
be considered in chronological order among all eligible applicants. However, assistance to which these rules
apply shall be subject to the availability of funds and shall not be
financially open-ended.
(b)
Qualified applicants shall be eligible to receive financial assistance
for outpatient health services, insurance services, and drugs that receive Food
and Drug Administration approval for use as therapy for individuals infected
with HIV and infants perinatally exposed to HIV and are authorized for payment
through the program’s current formulary.
(c)
Financial assistance for outpatient health services, insurance services,
and approved drug therapies shall be provided to applicants who meet the
following eligibility requirements:
(1) Are residents of the state of New Hampshire;
(2)
Are infected with HIV or infants perinatally exposed to HIV and have a
physician's prescription for one or more of the drugs covered under this
program;
(3) For drug services only, currently be
prescribed antiretroviral drugs for the treatment of HIV/AIDS or meet one or
more criteria under the US Department of Health and Human Services Guidelines
for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents
available as noted in Appendix A; and
(4) Have an annual gross household income which
is less than 500% of the Federal poverty income guidelines. The program shall
maintain flexibility in implementation of the income limit, up to 10% above or
below the 500% FPL threshold. The
flexibility shall be utilized if changes occur in the federal funding
environment or if access to health insurance and medications becomes
limited.
(d)
The program shall be the payer of last resort and nothing contained in
these rules shall authorize or require the program to provide payment for
drugs, diagnostics, or monitoring services which would otherwise be paid for by
medicaid, medicare, or any
other medical insurance program or policy.
(e)
Each recipient of financial assistance shall notify the program in
writing within 30 days of any change in the recipient’s medical insurance
coverage which results in coverage for drugs which are currently being paid for
by the program.
(f)
An application for financial assistance shall be submitted to the
program before the program provides financial assistance.
(g)
The application referred to in (f) above shall include:
(1) Information about the applicant including:
a. The name and address of the applicant;
b. The first three letters of the applicant’s
mother’s first name;
c. The status of the applicant’s housing and the
applicant’s contact information and mailing address; and
d. Information relating to contacting the
applicant by answering machine, email or mail;
e. Information relating to contacting the
applicant by telephone, voicemail, email, or mail;
(2) Proof of NH residency;
(3) Documentation of HIV positive status;
(4) The name and contact information for the
applicant’s primary and specialty care physician and pharmacy contact
information;
(5) A statement of financial resources, including
any of the following:
a.
The current income tax form of those persons whose income is considered in
determining family income;
b. Recent pay stubs for the individuals referred
to in (4)a. above;
c. A letter from the employer(s) of those
individuals referred to in a. above attesting to present wages; and
d. In the case of zero income, a letter from the
case manager attesting to means of financial support; and
(6) A signed authorization to collect medical
data and prescription coverage information through medicaid,
medicare, or any medical insurance or policy
necessary to determine eligibility as described in He-P 301.11 (c)(2);
(7) A certification that the applicant
understands that the department of health and human services shall not
discriminate against people because of their age, sex race, creed, color,
marital or familial status, physical or mental disability, national origin,
sexual orientation or political affiliation or belief, and shall follow all
federal and state laws and rules prohibiting such discrimination, and including
information about filing a report of any perceived such discrimination;
(8) An acknowledgement by the applicant that he
or she understands and agrees with a client certification, authorizing releases
for a period of one year, and certifies the truthfulness and completeness of
the financial information provided, as follows:
a. That the applicant declares all financial
statements are correct and true to the best of his or her knowledge;
b. That any intentional misrepresentation shall
result in potential legal action on the basis of state or federal laws;
c. That participation in NH CARE program shall
be denied if the applicant withholds information, provides inaccurate or refuse
to provide all necessary information;
d. That the applicant agrees to notify the NH
CARE program within 30days of any change in the applicant’s name, address,
eligibility, financial, or insurance status, or household size, and agrees to
provide evidence of income and medical expenses, medicaid
or medicare status, or health insurance policy, and
agrees to send any refunds to the program which were sent to the applicant but
owed to NH CARE program;
f. That in order to be considered for
participation in the NH CARE program, the applicant authorizes his or her
physician to release information requested by NH CARE program relative to the
content of the applicant’s medical record;
g. That the applicant understands that the
information relative to the medical record shall be maintained under strict
conditions of confidentiality and that the applicant’s identity shall not be
revealed to any person outside of the department (DHHS);
h. The understanding that all information given
to the NH CARE program is strictly confidential and shall not be released to
any other parties unless allowed by law;
i. That the applicant authorizes the staff of
the NH CARE program to communicate with and release information, to administer
and ensure the best possible planning and delivery of services on the
applicant’s behalf, and to authorize NH CARE program to speak with the
applicant’s employer or insurance or consolidated omnibus budget
reconciliation act (COBRA) provider to ensure coverage and
resolve billing issues;
j. That the applicant authorizes the department
and the “City of Boston/Trustees of Health and Hospitals” to access the
applicant records for monitoring purposes and shall not copy, record or remove
anything from the record for a period of two years, notwithstanding the general
release provided in (h)(7) above, and
k. That authorization in (h)(7) and paragraph
(h)(7)j. may be revoked by the applicant at any time in writing; and
(9) A certification by the applicant authorizing
the applicant’s physician as follows: “I
hereby authorize my physician or physician’s representative, to release
information requested by the NH CARE program, relative to the content of my
medical record. I understand that this
information will be maintained under strict confidentiality, will not be
revealed to persons outside the NH department of health and human services, and
will be used solely for my benefit. This
release is valid for one (1) year from date of signature unless revoked by me
in writing.”
(i) The commissioner shall determine whether the
applicant meets the eligibility requirements pursuant to paragraph (c) above.
(j)
The commissioner shall authorize the commencement, duration,
redetermination of eligibility, and reapplication according to the following:
(1) When the commissioner determines that an
applicant is eligible for financial assistance in accordance with He-P
301.11(c), the applicant shall remain eligible for 6 months commencing with the
date of eligibility;
(2) The commissioner shall not reimburse the
applicant or any other person for any payment that was made or debt that was
incurred before the eligibility commencement or after its termination;
(3) The commissioner shall evaluate eligibility
for financial assistance prior to the expiration of the 6 month period
described in (1) above; and
(4) A household or individual who has applied for
financial assistance and has been determined to be ineligible may reapply when
and if the financial, insurance, or medical status changes.
(k)
Notice of determination or other action shall be as follows:
(1) The commissioner shall notify the applicant
within 10 days from the date of receipt of their application that the
commissioner has determined the applicant’s eligibility for assistance; and
(2) The commissioner shall notify a recipient in
writing at least 30 days in advance of any action which affects the recipient’s
eligibility including termination of eligibility.
(l)
An applicant may appeal an eligibility determination as follows:
(1) If an applicant is dissatisfied with any
eligibility determination, the applicant may request, within 30 days of the
date of the commissioner’s notification letter, an informal case review
conference;
(2) The commissioner shall notify the applicant
within 14 days after the case review conference whether the commissioner concurs, modifies, or revokes the
determination; and
(3) If the applicant or applicant’s guardian is dissatisfied
with the result of the case review conference, the applicant or guardian may
request within 30 days of notification of the results of the case review
conference, an adjudicative proceeding held in accordance with RSA 541-A.
(m)
The applicant may contact the office of the ombudsman at any point in
the process for a neutral resolution of the applicant’s complaint.
(n)
The applicant shall contact the NH CARE Program manager if eligibility
is denied; and may
contact
the NH section director if dissatisfied with the response from the NH CARE
program manager.
Source. #4230, eff 2-23-87; ss by #4946, eff 10-2-90;
amd by #5587, eff 2-22-93; ss by #6634, eff 11-25-97;
ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #12586, eff 7-24-18
He-P
301.12 Procedures for Written Orders.
(a) Upon receiving a report that a person has a
communicable disease, is suspected of having a communicable disease or has been
exposed to a communicable disease, the department shall promptly commence an
investigation into the matter in order to confirm the report.
(b) Upon confirming the report, the department shall
make a determination, based on the best available guidance and recommendations
from the Centers for Disease Control and Prevention or other established
sources, as to whether the circumstances of the case require that the affected
person be maintained in isolation or quarantine, undergo a medical examination,
or receive medical treatment.
(c) All orders of isolation, quarantine or
treatment shall be issued in accordance with RSA 141-C:11 and 12, except that
written orders for treatment shall include the reason for and nature of the
medical treatment, where that treatment will be provided, and the duration of
time for which the person will need to undergo the treatment.
(d)
If the person subject to an order of treatment cannot be removed to a health
care provider or to a health care facility for treatment without danger to his
life or to the citizenry, the commissioner shall impose isolation or quarantine
under RSA 141-C:11 and shall arrange for treatment and care as necessary to
mitigate the threat.
(e) The cost of treatment and care, except
treatment provided under RSA 141-C:15, III, shall be in accordance with RSA
141-C:15, IV.
(f) Action taken to enforce an order of
isolation, quarantine or treatment shall be consistent with the provision of
RSA 141- C:13, 14 and 15.
(g) All persons who are subject to orders of
isolation, quarantine or treatment shall be entitled to the due process rights
set for in RSA 141-C:14-a.
Source. #4425, eff 5-27-88; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P 301.13 Documentation of
Immunization.
(a) Every parent or guardian of a child to be admitted
or enrolled in any New Hampshire public or non-public school,
pre-school or child care agency shall, prior to the child’s admittance, provide
documentation, as defined in He-P 301.01(n), to the admitting official of
acceptable immunization of the child as specified in He-P 301.14.
(b) The
admitting official may enroll a child under conditional enrollment when the
parent or guardian provides the following:
(1) Documentation of at least one dose of each
required vaccine; and
(2) The appointment date for the next due dose(s)
of required vaccine.
(c) The appointment date referred to in (b)(2)
above shall serve as the exclusion date if the child fails to keep the scheduled
appointment.
(d) Conditional
enrollment shall not be extended to the next school year for the same dose of
vaccine.
(e) In accordance with RSA 141-C:20-c, the
admitting official shall exempt a child from immunization requirements only if:
(1) The parent or guardian provides a completed
“New Hampshire Childcare/School Immunization Religious
Exemption Form” (March 2023) that states:
“The
administration of immunizing agents conflict with the religious beliefs of the
parent or legal guardian of the student listed above. Pursuant to NH Statute
RSA 141-C:20-d, I understand, in the event of an outbreak of
vaccine-preventable disease, for which immunization is required, an exempt
student shall be excluded from school attendance”; or
(2) A licensed health care provider provides a letter,
on letterhead, certifying that immunization against a particular disease may be
detrimental to the child’s health.
(f) The
admitting official shall require the
following documentation of immunization:
(1) For
measles, mumps, rubella, and hepatitis B:
a. The
month, day, and year of immunization; or
b. Documentation
of immunity by confirming laboratory test results;
(2) For
diphtheria, tetanus, pertussis (DTP/DTaP/DT/Td/Tdap), the month, day, and year
of immunization;
(3) For
poliomyelitis vaccine, the month, day, and year of immunization;
(4) For Haemophilus influenzae type b, (Hib) the month, day,
and year of administration; and
(5) For
varicella, one of the following:
a. The
month, day, and year of immunization;
b. Documentation
of immunity by confirming laboratory test results; or
c. For
students enrolled in kindergarten prior to 2009, parental or medical provider
verification of history of disease.
Source. #4425, eff 5-27-88; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New.
#6634, eff 11-25-97; ss by #7605, eff 12-4-01; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #13460, INTERIM, eff 10-12-22, EXPIRES: 4-10-23; ss
by #13605, eff 3-28-23
He-P
301.14 Immunization Requirements.
(a) The number of immunization doses, dosage,
route of administration, spacing, and age requirements shall be defined by the
Recommended Immunization Schedules for Persons Aged 0-18 years – United States,
2016, as published by the Centers for Disease Control and Prevention (CDC) and
as approved by the Advisory Committee on Immunization Practices (ACIP), the
American Academy of Pediatrics (AAP), and the American Academy of Family
Physicians (AAFP), available as noted in Appendix A.
(b) Unless the child has received an exemption from
the vaccination requirement pursuant to RSA 141-C:20-c, public or private
primary or secondary schools, pre-schools and child care agencies shall not
admit a child without first receiving documentation, as defined in He-P
301.01(n), showing that the child has received the following age-appropriate
and acceptable immunizations:
(1) With regard to diphtheria, tetanus, pertussis
(DPT) or diphtheria, tetanus, accellular pertussis
(DTaP) or tetanus, diphtheria, accelluar pertussis
(Tdap), or if pertussis vaccine is medically contraindicated, then
diphtheria-tetanus toxoid (DT/Td), the following doses:
a. Unless the 4th dose was
administered on or after the fourth birthday, five doses;
b.
For children 6 years and under, 4 or 5 doses, with the last dose administered
on or after the 4th birthday;
c.
For children 7 years of age and older, a minimum of 3 doses with the last dose
administered on or after the 4th birthday;
d.
Children between 7 and 10 years of age who have not completed their primary
immunization schedule or have an unknown vaccine history, a single dose of Tdap, except that if after receiving the dose
of Tdap, they require additional tetanus
and diphtheria toxoid doses, a dose of Td; and
e. Beginning August 1, 2017
a single dose of Tdap prior to entering 7th grade, unless that child
received Tdap at age 7 years or older, in which case no further doses are
required;
(2) Four doses of trivalent polio vaccine, with
the fourth dose administered on or after the 4th birthday and
separated by 6 months from the 3rd dose, unless:
a. The third dose of an all oral polio vaccine
(OPV) or all inactivated polio vaccine (IPV) series was administered on or
after the 4th birthday; with the last two doses separated by 6 months, or;
b.
If the child was enrolled prior to 2011, 3 doses of all oral polio vaccine
(OPV) or all inactivated polio vaccine (IPV) series, with the last dose given
on or after the 4th birthday;
(3) With regard to measles, mumps, rubella (MMR)
vaccine:
a. One dose given on or after 12 months of age;
and
b. For all students in grades kindergarten
through 12th grade 2 valid doses, with the first dose administered
on or after 12 months of age;
(4) Three doses of hepatitis B vaccine;
(5) For varicella vaccines unless laboratory
evidence of immunity for the specific child is provided:
a. One dose given on or after
12 months of age;
b. For all students entering kindergarten after
2009, 2 valid doses of varicella vaccine, with the first dose administered on
or after 12 months of age; and
c. For children enrolled in kindergarten prior
to 2009, parental or medical provider verification that those children have had
varicella disease; and
(6) For Haemophilus
influenza Type b (Hib), with regard to children under the age of 59 months who
are enrolled in child care and pre-school;
a. 4 doses, with the last
dose administered on or after 12 months of age; or
b. One dose on or
after 15 months of age.
Source. #4425, eff 5-27-88; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #7605, eff
12-4-01; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff
11-3-16
He-P
301.15 Procedures for Record Keeping.
(a) Every public or non-public primary and
secondary school, pre-school, and child care agency shall maintain an
immunization record for children enrolled at their public or non-public school,
pre-school, or child care agency. This
record shall include the date of each immunization and shall be separated from
the child’s other medical records and educational records for the purpose of
immunization record audit.
(b) Each admitting official or his or her
designee of all public and non-public primary and secondary schools,
pre-school, and child care agencies shall review the immunization records of
every newly admitted or enrolled child at their public or non-public school or
child care agency.
(c) All record reviews shall determine into which
one of the following categories to place each child:
(1) Children whose immunizations are documented
and acceptable in accordance with He-P 301.13 and He-P 301.14;
(2) Children who are conditionally enrolled;
(3) Children who are exempt from immunization
under RSA 141-C:20-c; and
(4) The total number of children enrolled in the
school.
(d) Each admitting official or his or her
designee shall report the results of this record review to the commissioner by
November 15 of each year.
(e) If the admitting official finds during the
record review that the child’s immunizations are insufficiently documented or
unacceptable, he or she shall notify the child’s parent or guardian stating:
(1) That the child does not have documentary
proof of acceptable immunization; and
(2) That the child shall not be lawfully admitted
or enrolled at the public or non-public school, pre-school, or child care
agency unless:
a. Documentary proof of acceptable immunization
is provided to the admitting official;
b.
The
parent or guardian submits a certificate of medical or religious exemption, as
provided under RSA 141-C:20-c; or
c. The child is
admitted or enrolled conditionally if the child qualifies.
(f) During the conditional enrollment period, the
admitting official or his or her designee shall monitor the records of any
conditionally enrolled child to ensure that the conditionally enrolled child
receives the vaccinations necessary in order to make the child acceptably
immunized. The conditional enrollment
period shall allow for the routine immunization schedule to be followed,
observing appropriate intervals between doses of vaccine(s), and shall not
allow for extension into the following school year for the same dose of
vaccine.
(g) The admitting official of a school,
pre-school, or child care agency shall, at the end of the conditional
enrollment period, exclude from attendance any conditionally enrolled child who
does not have documentary proof of acceptable immunization or immunity as
required in these rules and who has not been exempted under RSA 141-C:20-c.
(h) The admitting official shall readmit or
re-enroll the child exempted as described in (g) above only when the parent or
guardian provides:
(1) Documentary proof of acceptable immunization;
(2) Documentation of immunity by confirming
laboratory test results; or
(3) A certificate of medical or religious
exemption, as provided under RSA 141-C:20-c.
(i) When a transfer
of immunization records is necessary, the admitting official of the child’s
previous school shall provide to the parent or guardian the child’s
immunization record or a copy thereof to present to the admitting official at
the new school on arrival.
(j) Admitting officials or their designees shall
furnish immunization records or copies thereof to each parent or guardian of a
child upon his graduation or final attendance at a secondary school.
Source. #4230, eff 2-23-87; ss by #4946, eff 10-2-90;
EXPIRED: 10-2-96
New. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.16 The Use of the Common Cup.
(a) A common cup used for the purpose of drinking
shall not be utilized in public places.
(b) Paragraph (a) above shall not restrict the
use of a common chalice or similar article during the performance of a
religious ceremony.
Source. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16
He-P
301.17 Tuberculosis Patient Care
Financial Assistance Program.
(a) Tuberculosis (TB) patient care financial assistance
shall be provided for tuberculosis related treatment and services to applicants
meeting the eligibility requirements set forth in this section. Applications
for financial assistance shall be considered in chronological order among all
eligible applicants. However, assistance
to which these rules apply shall be subject to the availability of funds and
shall not be financially open-ended.
(b)
Qualified applicants shall be eligible to receive financial assistance
for the following patient care:
(1) Medications approved by the Federal Food and
Drug Administration for the treatment of tuberculosis, latent tuberculosis
infection, or any medical condition caused by tuberculosis or tuberculosis
medications;
(2) Licensed healthcare provider visits for
active tuberculosis and high risk latent tuberculosis diagnosis, treatment and
follow-up, when indicated;
(3) Diagnostic procedures to diagnose or monitor
the disease;
(4) Laboratory tests related to the diagnosis of
tuberculosis or its treatment; and
(5) Home health agency visits to provide directly
observed therapy.
(c)
Financial assistance for approved TB patient care shall be provided for
applicants who meet the following eligibility requirements:
(1) Are residents of the state of New Hampshire;
(2) Are infected with active tuberculosis or
high-risk Latent Tuberculosis Infection, or those undergoing diagnostic
procedures because of suspected TB;
(3) Are under a physician’s care for TB; and
(4) Have an annual gross household income which
is less than 300% of the Federal poverty income guidelines.
(d) As the payor of last resort, nothing
contained in these rules shall authorize or require the program to provide
payment for drugs, diagnostics or monitoring services which would otherwise be
paid for by medicaid, medicare
or any other medical insurance program or policy.
(e) Each recipient shall notify the program in
writing within 30 days of any change in the recipient’s medical insurance
coverage which results in coverage for patient care costs which are being paid
for by the program.
(f) An application for financial assistance shall
be submitted to the program before the program provides financial
assistance. The application shall
include:
(1) The name and address of the applicant;
(2) Documentation of active tuberculosis or
high-risk latent tuberculosis infection diagnosis, or a statement that the
applicant is undergoing diagnostic procedures because of suspected TB;
(3) Proof of New Hampshire residency;
(4) A statement of financial resources signed by
the applicant, including any of the following:
a. The most recent
income tax form of those persons whose income is considered in determining
family income;
b. A recent pay stub for
each individual in (g)(4)a. above;
c. A letter from the
employer(s) of those individuals in a. above attesting to present wages; and
d. In the case of zero income,
a letter from the healthcare provider or public health nurse case manager
attesting to means of financial support.
(g)
An application for financial assistance shall be submitted to the
program before the program provides financial assistance.
(h)
The application referred to in (g) above shall include:
(1) The name and address of the applicant; and
additional information about the applicant including:
a. Place of birth,
social security number, race, sexual orientation, and ethnicity;
b. The first three
letters of the applicant’s mother’s first name;
c. The status of the applicant’s housing and the
applicant’s contact information and mailing address; and
d. Information relating
to contacting the applicant by answering machine, email or mail;
(2) Proof of NH residency;
(3) Documentation of active tuberculosis or
high-risk latent tuberculosis infection;
(4) The name and contact information for the
applicant’s primary and specialty care physician and pharmacy contact
information;
(5) A statement of financial resources, including
any of the following:
a.
The current
income tax form of those persons whose income is considered in determining
family income;
b. Recent pay
stubs for the individuals referred to in (4)a. above;
c. A letter from the employer(s) of those
individuals referred to in a. above attesting to present wages;
and
d. In the case of zero income,
a letter from the case manager attesting to means of financial support; and
e. Copy of insurance card or proof of insurance,
if applicable;
(i) A signed authorization that:
(1) The applicant understands that DHHS:
a. Shall not discriminate against people because
of their age, sex race, creed, color, marital or familial
status, physical or mental disability, national origin, sexual orientation or
political affiliation or belief;
b. Shall follow all
federal and state laws and rules prohibiting such discrimination; and
c.
Shall
provide the applicant with access to information about filing a report of any
perceived such discrimination;
(2) That financial statements made as part of the
application and eligibility determination are true and correct to the best of
the applicant’s knowledge,
(3) The applicant understands that:
a. Intentional misrepresentations may result
in legal action on the basis of state or federal laws; and
b. That participation
and eligibility shall be denied if information is intentionally withheld,
misrepresented or omitted;
(5) The applicant shall notify NH TB Financial
Assistance Program within 30 days of any change in name, address, eligibility,
financial, insurance status or household size, income or medical expenses and
to provide evidence thereof;
(6) The applicant authorizes his or physician, or
physician’s representative to release information relative to the content of
the applicant’s medical record to NH TB Financial Assistance Program and the
department for the purpose of determining eligibility as described in He-P
301.17(c);
(7) The information from the medical record
including the applicant’s identity shall be maintained in strict confidence and
not revealed to any person outside of the department;
(8) The applicant authorizes the staff at NH TB
Financial Assistance Program to communicate with and release information
including the applicant’s diagnosis to physicians and other health care
professionals including the applicant’s pharmacist, case manager and other
treatment providers to ensure planning and delivery of services to the
applicant; and
(9) The releases in (6) and (8) above are valid
for one year from the date of signature unless revoked by the applicant in
writing.
(j) The commissioner shall determine whether the
applicant meets the eligibility requirements pursuant to paragraph (g) above.
(k) The commissioner shall authorize the
commencement, duration, redetermination of eligibility and reapplication
according to the following:
(1) When the commissioner determines that an
applicant is eligible for financial assistance in accordance with He-P
301.17(c), the applicant shall remain eligible for 12 months commencing with
the date of eligibility;
(2) The commissioner shall not reimburse the
applicant or any other person for any payment that was made before the
eligibility commencement;
(3) The commissioner shall evaluate eligibility
for financial assistance prior to the expiration of the 12 month period
described in (1) above; and
(4) A household or individual who has applied for
financial assistance and has been determined to be ineligible can reapply when
and if the financial or medical status changes.
(l) Notice of determination and notice of other
action shall be as follows:
(1) The commissioner shall notify the applicant
within 10 days from the date of receipt of application that the commissioner
has determined that the applicant is eligible or ineligible for assistance; and
(2) The commissioner shall notify a recipient in writing
at least 30 days in advance of any other action which the commissioner has
decided to take which affects the recipient’s eligibility including termination
of eligibility.
(m) An applicant may appeal an adverse
eligibility determination as follows:
(1) If an applicant is dissatisfied with any
determination, the applicant may request, within 30 days of the date of the
commissioner’s notification letter, an informal case review conference;
(2) The commissioner shall notify the applicant
in writing after the case review conference whether he or she concurs, modifies
or revokes the determination; and
(3) If the applicant is dissatisfied with the
result of the case review conference, he or she may request, within 30 days of
notification of the results of the case review conference, an adjudicative
proceeding held in accordance with RSA 541-A.
(n) The applicant may contact the office of the
ombudsman at any point in the process for a neutral resolution of the
applicant’s complaint.
(p) The applicant shall contact the NH CARE
program manager if eligibility is denied; and may contact the NH section
director if dissatisfied with the response from the NH CARE program manager.
(o)
The applicant shall contact the ID Care Services manager if eligibility
is denied, and may contact the NH section director if dissatisfied with the
response from the ID Care Services manager.
(p) Reimbursement shall be made directly to the
provider of the service or to the pharmacy and not directly to the applicant.
Source. #6634, eff 11-25-97; ss by #8242, eff
12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #12586, eff 7-24-18
PART
He-P 302 CRITICAL HEALTH PROBLEMS -
EXPIRED
Source. #3172, eff 1-2-86; ss by #4270, eff 2-23-87,
EXPIRED: 2-23-93
PART
He-P 303 OCCUPATIONAL DISEASE REPORTING
- EXPIRED
Source. #3172, eff 1-2-86, EXPIRED: 1-2-92
PART He-P 304 CANCER REGISTRY RULES
He-P 304.01 Definitions.
(a) “Clinic” means a health
care facility licensed by the state of
(b) “Commissioner” means the
commissioner of the department of health and human services.
(c) “Confidence interval” means
an estimated range of values, which is likely to include an unknown population
parameter, the estimated range being calculated from a given set of sample
data.
(d) “Courier service” means a
mail delivery service that provides guaranteed delivery of documents or
packages by using a reliable tracking system.
(e) “Definitive report” means
information or data in the format of an electronic or paper document, or
report, describing a reportable cancer, including the information described in
He-P 304.02(e), that is submitted to the state cancer registry (SCR) as
follows:
(1) No sooner than 90 days and
no later than 180 days of an initial diagnosis or treatment; or
(2) In cases where the patient
has died, or is transferred to hospice care, within 90 days of death and
transfer.
(f) “Department” means the
(g) “Facility” means “facility”
as defined in RSA 141-B:3, VI, namely, “a governmental or private agency,
department, institution, clinic, laboratory, hospital, health maintenance
organization, association, physician, or other similar unit diagnosing or providing
treatment for cancer.”
(h) “Medical laboratory” means
a facility performing tests or analyses of human samples from patients
suspected to have cancer.
(i)
“Mutual agreement” means an understanding, arrangement, or stipulation
which establishes the responsible reporter to the SCR as made between 2
facilities, clinics, or physicians, which can be confirmed in writing, but for
which written documentation is not required.
(j) “Pathology report” means
electronic or paper report(s) prepared by a pathologist providing a description
of laboratory test results, and an evaluation of cells, tissues, and organs
based on evidence from a sample of body tissue, which is used to diagnose and
characterize disease.
(k) “Protected health
information” means protected health information as defined in 45 CFR 160.103.
(l) “Rapid report” means
information or data in an electronic or paper document or report, describing a
reportable cancer, including the information described in He-P 304.02(d), that
is submitted to the SCR within 45 days of diagnosis.
(m) “Reportable cancer” means
any syndrome, condition, or disease listed in “Table 2 “NAACCR Layout Version
15: Comparison of Reportable Cancers” (Thornton ML, (ed.)) “Standards and Registry Operations/Volume
II/Data Standards and Data Dictionary,” Version 15, 19th ed. (Posted
October 2014, Revised February 27, 2015)/Chapter III, “Standards for Tumor
Inclusion and Reportability” “Table 2 NPCR Requirements”, Springfield, Ill.,
North American Association of Central Cancer Registries. As listed in Appendix A and available as a
free electronic document at http://www.naaccr.org.
(n) “State cancer registry
(SCR)” means the department or, if the department meets its statutory
obligations by contract, an organization, system, or individual contracted by
the department to collect, manage and store information on cases of reportable
cancer pursuant to RSA 141:B:5 and RSA 141-B:10.
Source. #4055, eff 5-27-86; amd
by #4869, eff 7-24-90; ss by #5601, eff 3-24-93; amd
by #6075, eff 8-5-95; ss by #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss
by #11054, eff 3-15-16
He-P 304.02 Reporting
Requirements.
(a) In accordance with RSA
141-B:7, all facilities shall report diagnosis or treatment of a reportable cancer
to the SCR in accordance with the rules specified below, and using the means
described in He-P 304.02(f), (g) and (h).
SCR may be contacted through
http://geiselmed.dartmouth.edu/nhscr/contact.
(b) Pursuant to (a) above, all
facilities shall include information and data in each report describing cancer
diagnosis or treatment according to one of the following standards, as
applicable:
(1) The North American
Association of Central Cancer Registries (NAACCR), “Standards for Cancer
Registries, Volume II/Data Standards and Data Dictionary, 19th Edition, Record
Layout Version 15,” (January 1, 2015)
Edited by Monica Thornton, Revised (February,
27, 2015.), as listed in Appendix A and available as a free document at www.naaccr.org;
(2) The North American
Association of Central Cancer Registries (NAACCR), “Standards for Cancer
Registries/Volume V: “Pathology Laboratory Electronic Reporting, Version 4.0.”
Klein Wt., Havener L (eds.), Springfield (IL); North American Association of
Central Cancer Registries, Inc., April, 2011, as
listed in Appendix A and available as a free electronic document at www.naaccr.org;
or
(3) The National Center for
Chronic Disease Prevention and Health Promotion Division of Cancer Prevention
and Control, “Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries HL7 Clinical Document Architecture (CDA) Release
1.1” (March, 2014), as listed in Appendix A and available as a free electronic
document in PDF format at http://cdc.gov/cancer/npcr/ehrmeaningfuluse/cancer.htm.
(c) Each report shall contain
information or data required by the appropriate standard in (b) above, as
listed in elements (1)-(10) below, and include any supporting information, as
follows:
(1) Item numbers defining
demographics;
(2) Item numbers defining
cancer identification;
(3) Item numbers defining
hospital-specific information;
(4) Item numbers defining stage
prognostic factors;
(5) Item numbers defining the
first course of treatment;
(6) Item numbers defining
follow-up, recurrence, and death;
(7) Item numbers defining
confidential patient information;
(8) Item numbers defining
confidential hospital information;
(9) Item numbers defining other
confidential information; and
(10) Item numbers defining
diagnosis.
(d) Of the item numbers
specified in (b) and (c) above, the following shall require rapid reporting as
defined in He-P 304.01(l) and described in He-P 304.03(b) and (c):
(1) Item numbers defining
demographics;
(2) Item numbers defining
cancer identification;
(3) Item numbers defining
hospital-specific information;
(4) Item numbers defining
confidential patient information; and
(5) Item numbers defining other
confidential information.
(e) The items listed in (c)
above shall require definitive reporting as defined in He-P 304.01(e), and described
in He-P 304.03(a), He-P 304.03(d), He-P 304.04(a), and He-P 304.06(a) and (b).
(f) All facilities making an
electronic report to the SCR in accordance with (a) above, shall submit through
a secure internet-based encrypted mechanism, such as a direct file transfer, or
a web-based reporting form supported by the SCR.
(g) All facilities reporting
electronically shall format reports as specified by one of the following
standards, as applicable:
(1) The North American
Association of Central Cancer Registries (NAACCR), “Standards for Cancer
Registries, Volume II/Data Standards and Data Dictionary, 19th Edition, Record
Layout Version 15.” (January 1, 2015)
Edited by Monica Thornton, Revised (February,
27, 2015), as listed in Appendix A and available as a free document at http://www.naaccr.org;
(2) The North American
Association of Central Cancer Registries (NAACCR), “Standards for Cancer
Registries/Volume V: Pathology Laboratory Electronic Reporting, Version 4.0.”
Klein Wt., Havener L. (eds.) Springfield (IL); North American Association of
Central Cancer Registries, Inc., (April, 2011), as
listed in Appendix a and available as a free
electronic document at http://www.naaccr.org; or
(3) The National Center for
Chronic Disease Prevention and Health Promotion Division of Cancer Prevention
and Control, “Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries HL7 Clinical Document Architecture (CDA) Release
1.1” (March, 2014), as listed in Appendix A and available as a free electronic
document in PDF format at http://cdc.gov/cancer/npcr/ehrmeaningfuluse/cancer.htm.
(h) Where electronic reporting
is not feasible, facilities shall complete and file the New Hampshire State
Cancer Registry (NHSCR) “Cancer Report Form” (July,
2015) provided by the SCR and faxed or mailed by the facilities to the SCR, via
regular mail or a courier service.
Source. #4055, eff 5-27-86, EXPIRED: 5-27-92
New. #5601, eff 3-24-93; amd
by #6075, eff 8-5-95; ss by #7406, eff 11-21-00; ss by #9046, eff 12-5-07; ss
by #11054, eff 3-15-16
He-P 304.03 Reporting of
Information by Hospitals Licensed by the State of
(a) Hospitals licensed by the
state of
(b) Hospitals licensed by the
state of
(c) Hospitals licensed by the
state of
(d) Hospitals licensed by the
state of
(e) Facilities owned by a hospital
licensed by the state of
Source. #4055, eff 5-27-86, EXPIRED: 5-27-92
New. #5601, eff 3-24-93, EXPIRED: 3-24-99
New. #7406, eff 11-21-00; ss by #9046, eff
12-5-07; ss by #11054, eff 3-15-16
He-P 304.04 Reporting of
Information by a Physician Licensed by the State of
(a) A physician, surgeon, or
other licensed health care practitioner who diagnoses or treats cancer patients
shall complete and provide a definitive report in accordance with He-P
304.01(d) for each newly diagnosed cancer case when that patient will not be
immediately referred to a hospital or other treatment center for additional
diagnosis or treatment.
(b) A physician,
surgeon, or other licensed health care practitioner shall provide additional
information to SCR regarding a patient as is considered necessary for
abstraction of required cancer incidence data in accordance with He-P
304.07(a).
(c) A physician, surgeon, or
other licensed health care practitioner may fulfill his or her responsibility
for cancer reporting for a cancer patient through a mutual agreement allowing
cases to be reported by a hospice or other facility that provided medical or
nursing care to that cancer patient.
(d) A physician, surgeon or
other licensed health care practitioner shall make available to the SCR the
medical records of all patients with a reportable cancer for creation of the
definitive report in accordance with He-P 304.01(e).
Source. #4055, eff 5-27-86, EXPIRED: 5-27-92
New. #5601, eff 3-24-93, EXPIRED: 3-24-99
New. #7406, eff 11-21-00; ss by #9046, eff
12-5-07; ss by #11054, eff 3-15-16
He-P 304.05 Reporting of Information
by a Medical Laboratory Licensed by the State of
(a) A medical laboratory
licensed by the state of
(1) Within 180 days after that
pathology report is complete, provide information concerning its findings to
the SCR; and
(2) Fax, mail, or
electronically transmit a copy of the pathology report using procedures
described in this section.
(b) A medical laboratory may
fulfill its responsibility for cancer reporting through a mutual agreement
allowing cases to be submitted by the cancer registrar at an affiliated
hospital or other facility.
(c) The SCR shall be granted
access to pathology reports used to confirm or rule out a diagnosis of cancer
by medical laboratories for the purpose of case finding and quality assurance.
(d) The SCR shall be authorized
to identify cancer cases from the pathology reports and request information
about missing cancer reports from the reporting facility.
Source. #4055, eff 5-27-86; amd
by #4869, eff 7-24-90; ss by #5601, eff 3-24-93, EXPIRED: 3-24-99
New. #7406, eff 11-21-00; ss by #9046, eff
12-5-07; ss by #11054, eff 3-15-16
He-P 304.06 Reporting of
Information by Clinics that Diagnose or Treat Patients With Cancer.
(a) A clinic shall provide a definitive
report for each case in accordance with He-P 304.01(e).
(b) A clinic licensed by the
state of
(1) Be responsible for the
submission of all definitive reports to the SCR; or
(2) Develop a mutual agreement
with a cancer registrar at a hospital or other affiliated facility for the
submission of a definitive report to the SCR.
(c) A clinic shall provide
additional information to SCR regarding a cancer patient as necessary for
abstraction of required cancer incidence data in accordance with He-P
304.07(a).
Source. #4055, eff 5-27-86; ss by #4377, eff 3-1-88;
ss by #5601, eff 3-24-93, EXPIRED: 3-24-99
New. #7406, eff 11-21-00; ss by #9046, eff
12-5-07; ss by #11054, eff 3-15-16
He-P
304.07 Quality Assurance,
Verification, and Confidentiality.
(a) All facilities shall respond
to SCR requests for case information pursuant to He-P 304.02(b) and (c) within
14 working days of receipt of such requests.
(b) All facilities shall
respond to SCR requests to perform a site visit.
(c) SCR shall perform a site
visit at each facility in order to:
(1) Audit pathology reports and
other information to ensure that no cancer cases are overlooked in reporting;
and
(2) Monitor the completeness
and accuracy of the cancer reports.
(d) Each facility shall make available
for reviewing and copying all paper or electronically stored information
including the following:
(1) Laboratory analyses
including tissue, cytology, and pathology reports;
(2) Records regarding radiological
examinations, in relation to cancer diagnoses or treatment;
(3) Reports of diagnoses of
malignant disease, and notations of the reasons for such diagnoses, including
both primary clinicians’ reports and consultants’ reports;
(4) Pharmacy records;
(5) Reports regarding any
operations or an autopsy;
(6) Discharge plans and
abstracts regarding cancer diagnoses; and
(7) A list of the applicable
discharge diagnoses or treatment as identified in the “Casefinding
Lists, Current Lists/Code List,” (October 1, 2015-September 30, 2016), as
listed in Appendix A and available as a free electronic document at http://seer.cancer.gov/tools/casefinding/case2016-icd10cm.html.
(e) Pursuant to 42 USC
280e(c)(2)(D)(viii), individuals complying with the law shall not be held
liable in any civil action with respect to a report of cancer provided to the
SCR, or with respect to access to data or information provided to the SCR.
Source. #4377, eff 3-1-88; ss by #5601, eff 3-24-93,
EXPIRED: 3-24-99
New. #7406, eff 11-21-00; ss by #9046, eff
12-5-07; ss by #11054, eff 3-15-16
He-P 304.08 Procedures for Disclosure
of Protected Health Information.
(a) The SCR shall use and
disclose protected health information in accordance with RSA 141-B:9 and the
provisions of 45 CFR 164 generally, and specifically, 45 CFR 164.502, 164.506
and 164.512.
(b) The department shall
maintain the confidentiality of reports submitted to the SCR pursuant to RSA
141-B:9 except in accordance with (c) below.
(c) A report submitted to the
SCR concerning an individual, and any other information maintained by the SCR,
which, because of a personal identifier, can be readily associated with an
individual, shall only be released:
(1) To the individual upon:
a. Receipt of a written request
which shall be signed by the individual; and
b. Presentation of identification,
such as a driver’s license, by the individual;
(2) If the individual is a
minor, to a parent of the individual upon:
a. Receipt of a written
request, which shall be signed by the parent;
b. Receipt of a certified copy
of the birth certificate of the individual; and
c. Receipt of a copy of the
parent’s identification, such as a driver’s license of the parent;
(3) If the individual has a
court-appointed guardian or if the individual is deceased, to the
court-appointed guardian or to the executor or administrator of the
individual’s estate upon:
a. Receipt of a written
request, which shall be signed by the court-appointed guardian, executor, or
administrator of the estate;
b. Receipt of a certified copy of
the order or decree which appoints the guardian, executor, or administrator;
and
c. Receipt of a copy of
identification, such as a driver’s license, by the guardian, executor, or
administrator;
(4) To an attorney or other
person designated by the individual upon receipt of a written medical release
request which shall be signed by the individual;
(5) To persons conducting
health related research, upon receipt and approval pursuant to He-P 304.09 of a
written application to the department, which shall be signed by the applicant
and includes:
a. The following information
about the principal investigator:
1. Name, address, and phone
number;
2. Organizational affiliation;
3. Professional qualification;
and
4. Name and phone number of
principal investigator’s contact person, if any;
b. The following information
about the data or record copies being requested:
1. Type of event or record
copies;
2. Time period of the data or
record copies;
3. Specific data items required,
if applicable;
4. Medium in which the data or
record copies are to be supplied by the bureau; and
5. Any special format or layout
of data required by the principal investigator;
c. A research protocol which
shall contain:
1. A summary of background and
origin of the research;
2. A statement of the
health-related problem or issue to be addressed by the research;
3. The primary research
hypothesis to be tested;
4. The research design, which
shall include:
(i) Case definition;
(ii) Method of case selection; and
(iii) Method of data analysis;
5. The research methodology,
which shall include:
(i) The way in which
the requested data will be used; and
(ii) The procedures for follow-back to any persons
or facilities named in records, if applicable;
6.
Procedures to obtain informed consent from the research participants, if
applicable;
7. The procedures that shall be
followed to maintain the confidentiality of any data or copies of records
provided to the requester; and
8. The intended completion
date;
d. A statement signed by the
principal investigator agreeing to the following:
1. The investigator shall
acknowledge the department as the source of the data in any and all public
reports, publications, or presentations generated by the requester from these
data;
2. The investigator shall
specify that the analyses, conclusions, and recommendations drawn from such
data are solely those of the requester and are not necessarily those of the
department;
3. Any data or record copies
provided shall not be used for any purpose other than that described in the
application;
4. The principal investigator and
the research staff shall not disclose the identity of individuals revealed in
the data or record copies to any persons except as is necessary to perform the
research described in the application;
5. The data record shall not be
further released to any other person or organization without the written
consent of the commissioner or his designee; and
6. No form of information
derived from the data or record copies that identify any individuals shall be
made public;
e. A written statement ensuring
that the investigator shall hold all information confidential; and
f. When contact with patients
will occur, submission of an Institutional Review Board (IRB) approval for the
study by an IRB formed in accordance with the requirements of the U.S.
Department of Health and Human Services Code of Federal Regulations for
Protection of Human Subjects, 45 CFR 46, June 23, 2005; or
(6) In association with an
audit as required under Title III of Public Health Services Act, 42 U.S.C. 241
et seq.
(d) Persons fraudulently
requesting data or information shall be subject to penalty for unsworn
falsification pursuant to RSA 641:3.
Source. #9046, eff 12-5-07; ss by #11054, eff 3-15-16
He-P
304.09 Approval Criteria for Release
of Confidential Data for Research Purposes.
(a) The commissioner shall
review applications for the use of confidential SCR data, based on the
following criteria:
(1) Completeness of
application, pursuant to He-P 304.08(b)(5);
(2) Documentation of adequate
measures to insure confidentiality of patients, pursuant to He-P 304.08(b)(5);
(3) Determination of whether
the study, if carried out according to the application submitted pursuant to
He-P 304.08(b)(5), will be able to answer the research hypothesis as stated in
this application; and
(4) Qualifications of
investigator(s) and research staff, as indicated by:
a. Documentation of training and
previous research, such as peer reviewed publications, in the proposed or
related area; and
b. Affiliation with a university, medical center or other institution,
which will provide sufficient research resources.
(b) The commissioner shall deny
an application in accordance with RSA 541-A: 29, II (a) when it has been
determined that one or more of the requirements of He-P 304.08(b)(5) or He-P
304.09(a) have not been met.
Source. #9046, eff 12-5-07; ss by #11054, eff 3-15-16
He-P 304.10 Aggregate Data. The number of cancer cases shall not be
released in any document where the numbers of cancer cases are between 1 and 4.
Source. #9046, eff 12-5-07; ss by #11054, eff 3-15-16
PART
He-P 305 HIV - EXPIRED
He-P 305.01 Definitions.
(a)
"Anatomical parts" mean "anatomical parts" as
defined in RSA 291-A.I.V.
(b)
"Autologous donor" means an individual who provides a blood
product or anatomical part for self-use.
(c)
"Blood transfusion centers" mean those facilities referenced
in RSA 141-F:5, I which receive for distribution or use, donated whole blood or
blood components.
(d)
"Blood components" mean whole blood constituents or
derivatives.
(e)
"Clinical laboratory improvement amendments of 1988 (CLIA)"
means the revision of Section 353 of the Public Health Service Act (42 U.S.C.
263(a)), compliance with which certifies that laboratories may accept human
specimens for the purposes of performing laboratory examinations or procedures.
(f)
"Confirmatory test" means a test that utilizes a different
methodology than the screening test and has equal or greater specificity than
the screening test.
(g)
"Human immunodeficiency virus" or HIV means "human
immunodeficiency virus" as defined in RSA 141-F:2, V.
(h)
"Indeterminate" test result means that a test result does not meet
the criteria for either a reactive or nonreactive test. The term includes "equivocal".
(i) "Initial test" means the first HIV
test performed on the specimen.
(j)
"Laboratory" means any building or place for the biological,
microbiological, serological, chemical, immunohematological,
hematological, biophysical, cytological, pathological, or other examination of
materials derived from the human body.
(k)
"Proficiency testing" means a form of external quality control
in which specimens are received from outside the laboratory, analyzed as
routine specimens, and the results returned to a central location for
comparison with other participating laboratories.
(l)
“Reactive” means that a component of the patient’s specimen has formed
detectable complexes with the HIV antigen or antibody supplied by the
laboratory scientist during the analysis as defined by the procedure used.
(m)
"Researcher" means an individual who conducts HIV tests, for
the purpose of increasing the scientific knowledge of HIV, in accordance with
RSA 141-F:5, III.
(n)
"Screening test" means any test which requires further testing
by a different methodology in order to definitively report the presence of a
condition.
(o)
"Specimen" means a portion of tissue or body fluid material
from a human body.
(p) "Test
kit" means all components of a test procedure that are packaged together
by the manufacturer.
(q) "Tissue procurer" means a physician
licensed or registered to practice in New Hampshire, or person authorized by
such physician, who obtains, processes, distributes, or uses anatomical parts.
Source. #4637, eff 6-19-89; EXPIRED 6-19-95
New. #6563, eff 8-21-97; ss by #8355, eff 5-24-05,
EXPIRED:5-24-13
He-P 305.02 Licensing and Certification Requirements.
The following shall apply:
(a)
Any laboratory, business or other organization either testing or
collecting specimens shall be licensed in accordance with RSA 151; and
(b)
Any laboratory, business or other organization either testing or collecting
specimens shall be in compliance with the Clinical Laboratory Improvement Act
(CLIA)as implemented in 42CFR 493.
Source. #4637, eff 6-19-89; EXPIRED: 6-19-95
New. #6563, eff 8-21-97; ss by #8355, eff 5-24-05,
EXPIRED: 5-24-13
He-P 305.03 Procedures for HIV Testing of Whole Blood
or Blood Components by Blood Transfusion Centers and of Donors of Anatomical
Parts by Tissue Procurers.
(a)
Pursuant to RSA 141-F:5, I, and II, any New Hampshire blood transfusion
center which receives, for distribution or use, whole blood or a blood
component not previously tested for the presence of an antibody to, or antigen
of, HIV, or New Hampshire tissue procurer who obtains, for distribution or use,
anatomical parts, the donors of which were not previously tested for the
presence of an antibody to, or antigen of, HIV, shall:
(1) Have the whole blood, blood component, or the
donor of anatomical parts tested by the New Hampshire department of health and
human services, public health laboratories or other laboratories, businesses or
organizations which test human blood, tissue or other samples as part of their
operations;
(2) Maintain for at least 4 years
a record of the number of tests performed on specimens collected; and
(3) Maintain for at least 4 years a record on the
number of tests described in He-P 305.02 (b) that were positive or
indeterminate for each type of test performed;
(b)
Notwithstanding He-P 305.02 (a), HIV testing for autologous donors shall
be pursuant to 21 CFR 610.45.
Source. #4637, eff 6-19-89; EXPIRED: 6-19-95
New. #6563, eff 8-21-97; ss and moved by #8355, eff
5-24-05 (from He-P 305.02) , EXPIRED: 5-24-13
He-P 305.04 Procedures for Confidentially Testing HIV
Specimens for Medical Research.
(a)
Any New Hampshire facility engaged in medical research which tests
specimens for the presence of an antibody to, or antigen of, HIV pursuant to
RSA 141-F:5, III shall assign a principal investigator.
(b)
The principal investigator shall:
(1) Be a licensed physician;
(2) Be responsible for ensuring that the specimen
being tested is free of any personal identifiers prior to its release to a
researcher;
(3) Be responsible for ensuring that any personal
identifiers can not be retrieved;
(4) Be responsible for ensuring that an
alphanumeric identifier is assigned to the specimen which shall be used in all
future reference to the specimen; and
(5) Be responsible for review of all completed
research data and reports to ensure that no personal identifiers can be
recognized by anyone reading the completed data or report.
Source. #4637, eff 6-19-89; EXPIRED: 6-19-95
New. #6563, eff 8-21-97; ss and moved by #8355,
eff 5-24-05 (from He-P 305.03), EXPIRED: 5-24-13
He-P 305.05 Procedures for Conducting HIV Tests in
Correctional Facilities and the
(a)
The facility shall maintain a confidential record kept in accordance
with RSA 141-F:8 for the collection of specimens;
(b)
The confidential record shall include the following:
(1) The name of the person from whom the specimen
was taken;
(2) The name and address of the licensed
physician, or person authorized by the physician who collected the specimen;
and
(3) The date the specimen was collected;
(c)
All specimens shall be tested by the New Hampshire department of health
and human services, public health laboratories or other laboratories,
businesses or organizations which test human blood, tissue, or other samples as
part of their operations;
(d)
A record of the number of tests performed on specimens received shall be
maintained for at least 4 years; and
(e)
A record of the number of tests that were positive or indeterminate
shall be maintained for at least 4 years.
Source. #4637, eff 6-19-89; EXPIRED: 6-19-95
New. #6563, eff 8-21-97; ss and moved by #8355;
eff 5-24-05 (from He-P 305.04), EXPIRED: 5-24-13
He-P 305.06 Standards for Performing HIV Testing.
(a)
This section shall apply to any
(b)
A laboratory or other such business or organization which offers to
test, or engages in testing, to detect or quantify antibody to, or antigen of,
HIV shall comply with the provisions for consent in RSA 141-F:5 and the
exceptions thereunder.
(c)
Any purposeful violation of the requirements set forth in these rules
shall be subject to enforcement under RSA 141-F:11.
(d)
All laboratories, public or private, or other such businesses or
organizations shall use only analytic procedures that are FDA approved and in
compliance with CLIA, as found in 42CFR Part 493, and which include but are not
limited to the following:
(1) The manufacturer’s testing insert kit for all
initial and confirmatory testing; and
(2) The performance of external controls.
(e)
No laboratories or other such businesses or organizations shall report
any reactive or indeterminate screening test result prior to the performance of
a confirmatory test as defined by the manufacturer’s testing kit package
insert, except:
(1) When the test is being conducted by a blood
transfusion center or tissue procurer for the purpose of determining the
medical acceptability of a blood, organ or tissue donor;
(2) When the physician who ordered the test
specifically attests that he/she needs the initial test result to provide
optimal emergency diagnosis and/or emergency treatment to the individual; or
(3) When the reactive or indeterminate screening
test result is obtained using a FDA-approved rapid
testing technology and such test result is reported as a screening test result
that must be subjected to a confirmatory test.
(f)
Reports of tests on all HIV specimens shall be kept confidential in
accordance with RSA 141-F: 7 and RSA 141-F: 8;
(g)
Laboratories or other such businesses or organizations shall use the
following record protocol:
(1) A record of the number of tests performed on
specimens received shall be maintained for at least 4 years;
(2) A record of the number of tests that were
positive or indeterminate shall be maintained for at least 4 years; and
(3) Records of tests on all HIV specimens shall
be kept confidential in accordance with RSA 141-F:7 and RSA 141-F:8.
Source. #8355; eff 5-24-05 (from He-P 305.05),
EXPIRED: 5-24-13
PART He-P 306
NOTIFICATION OF FIREFIGHTERS, EMERGENCY CARE PROVIDERS AND POLICE
OFFICERS AFTER EXPOSURE TO INFECTIOUS DISEASE - EXPIRED
Source. #4742, eff 1-23-90, EXPIRED: 1-23-96
PART
He-P 307 IMMUNIZATION REGISTRY
He-P 307.01 Purpose. These
rules implement the procedures of the department pursuant to RSA 141-C:20-f relative to
the establishment and maintenance of a New Hampshire immunization registry
(registry) for children and adults to aid, coordinate, and promote effective
and cost-efficient disease prevention and control efforts. The
information contained in the registry shall be used for the following purposes:
(a) To
remind registrants to receive all required immunizations in a timely manner by
providing access to the registrant’s immunization record and to provide
registrants with information about recommended immunizations;
(b) To
ensure appropriate management and use of immunizations distributed by the
department; and
(c) To
control communicable diseases by
assisting in the identification of individuals who require immediate
immunization in the event of a disease outbreak.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by 14010, eff 6-27-24
He-P 307.02 Definitions.
(a) “Administering
health care provider” means a health care provider whose medical focus is limited
to completing a screening checklist for contraindications and administering an
immunization.
(b) “Authorized user”
means a person or entity which is authorized to enter information into or
access certain information contained in the registry, including:
(1) Administering,
current, and former health care providers;
(2) Health
care providers;
(3) Schools;
(4) Licensed child
care agencies;
(5) The
department’s division of public health
services; and
(6) Designated individuals
of (1)-(5) above.
(c) “Commissioner”
means the commissioner of the New Hampshire department of health and human
services, or their designee.
(d) “Current
health care provider” means a health care provider who the patient has chosen
for ongoing health care and who maintains a complete medical history of the
patient.
(e) “Department”
means the New Hampshire department of health and human services.
(f) “Former
health care provider” means a health care provider that is no longer a
patient’s current health care provider.
(g) “Health
care provider” means “health care provider” as defined in RSA 141-C:2, X-a.
namely, “any licensed person who or entity which provides health care services,
including but not limited to, hospitals, medical clinics and offices, clinical
laboratories, physicians, naturopaths, chiropractors, pharmacists, dentists,
registered or other nurses, and nurse practitioners, paramedics, and emergency
medical technicians.” This term also includes other immunization providers.
(h) “Immunization”
means “immunization” as defined in RSA 141-C:2, XI-a,
namely, “inoculation with a specific antigen to promote antibody formation in
the body” or “immunizing agent” as defined in RSA 141-C:2, XI-b namely, “a
vaccine, antitoxin, or other substance used to increase a person's immunity to
a disease.”
(i) “Immunization event” means an immunization or
immunoglobulin administration, exemption, refusal as defined in (s) below, or
adverse reaction.
(j) “Managed
care organization” means an entity which offers a managed care plan, as defined
in RSA 420-J:3, XXV, namely, “a health benefit plan that either requires a
covered person to use, or creates incentives, including financial incentives,
for a covered person to use health care providers managed, owned, under
contract with, or employed by the health carrier.”
(k) “New
Hampshire immunization registry (registry)” means a single repository of
accurate, complete, and current immunization records to aid, coordinate, and
promote effective and cost-efficient disease prevention and control efforts for
New Hampshire residents.
(l) “Opt-in” means the process an individual
follows to elect to participate in the registry and, after which, one’s
personal data will be provided to the registry.
(m) “Opt-out”
means the process an individual follows to elect not to participate in the
registry and, after which, one’s personal data
will not be provided to the registry.
(n) “Patient”
means an adult individual or minor child who receives an immunization or other
health care services in New Hampshire.
(o) “Personal data” means a registrant’s name,
date of birth, race, ethnicity, gender, address, contact information,
immunization information, and immunization events.
(p) “Public
health purpose” means a population-based activity or individual effort primarily
aimed at the prevention of injury, disease, or premature mortality, or the
promotion of health in the community.
(q) “Read-only
rights” means the ability of the data to be accessed but not entered or
modified.
(r) “Read/write
rights” means the ability of the data to be accessed, entered, or modified.
(s) “Refusal”
means the act of not receiving an immunization on a
particular day or at a particular medical appointment, for such
reasons as, wanting to delay the immunization to another time, not wanting a
particular immunization at that time, behavioral or medical issues at the time
of immunization, or a religious exemption from a particular immunization. This
term does not include refusal to participate in the registry.
(t)
“Registrant” means the patient who did not opt-out of the registry prior to the
statutory change, effective July 1, 2023, who has opted-in to the registry, or
who has not withdrawn from the registry.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.03 Establishment and
Maintenance of the Immunization Registry. The department shall implement
and maintain a computerized immunization
registry as established in RSA 141-C:20-f in compliance with all applicable
state statutes and federal laws and regulations.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.04
Authorized User Access to the Registry.
(a) The following
authorized users, and their designated individuals, shall have read/write
rights to the registry:
(1) Administering,
current, and former health care providers; and
(2) The department’s division
of public health services.
(b) The
following authorized users, and their designated individuals, shall have
read-only rights to the registry:
(1) Health
care providers who are not listed in (a)(1) above;
(2) Schools, only
for named individuals in their care;
(3) Licensed child
care agencies, only for named individuals in their care; and
(4) Local public health entities, which are
administered by the cities of Manchester and Nashua, New Hampshire.
(c) Access to
the registry for all entities in (a) and (b) above, except (a)(2) and (b)(4)
shall be limited to patients in their care.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.05 Content and
Submission of Immunization Event Reports.
(a) For
each patient who, after being given the opportunity to opt-in or opt-out of
participating in the registry in accordance with He-P 307.06, and who has
explicitly provided written or electronic consent to opt-in, shall have all immunization
events reported, unless exempted under He-P 307.05(c)(3), to the registry
within 7 business days of the event through an electronic interface or manual
data entry at https://nhiis-prod.dhhs.nh.gov/nhiis/Login.aspx by a
participating administering or current health care provider when a state or
federally supplied immunization is administered.
(b) For
each immunization event where a state or federal supplied immunization was
administered to a registrant, administering or current health care providers
who are participating in the registry shall report to the registry such data
listed in the Centers for Disease Control and Prevention’s (CDC), “Core Data
Elements for an Immunization Information History”, listed in the functional
standards document at https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html and in Appendix B in HL7
Version 2.5.1: Implementation Guide for Immunization Messaging Release 1.5
(October 2018) found at https://repository.immregistries.org/files/resources/5bef530428317/hl7_2_5_1_release_1_5__2018_update.pdf ,
available as noted in Appendix A.
(c) For
each immunization event, administering or current health care providers who are
participating in the registry shall also report to the
registry the following types of registrant information:
(1) The
registrant’s insurer information as held by the administering or current health
care provider;
(2) Any doses of immunization(s)
previously administered to the registrant by the health care provider that may
not have been previously reported to the registry for which there is
documentation;
(3) Any doses of immunization previously
administered to the registrant by another health care provider that may not have
been previously reported to the registry for which there is documentation
provided unless the administering or current health care provider cannot
manually or electronically transmit this information to the New Hampshire
Immunization Information System (NHIIS); and
(4) Date
of death, if applicable and if known.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.06 Procedures for
Patients to Opt-In or Opt-Out of the Registry.
(a) No
patient, or the patient’s parent or guardian
if the patient is a minor, shall be required to participate in the immunization
registry.
(b) No
patient’s personal data shall be entered into the registry without that
patient, or the patient’s parent or guardian if the patient is a minor, being
given the opportunity to opt-in or opt-out of the registry and providing
written or electronic consent.
(c) No
health care provider shall provide to the registry the name of, or any
immunization information relating to, any patient who opts out of participating
in the registry.
(d) A
health care provider shall not provide information relating to immunizations
contained in a former patient’s medical record without that patient, or the
patient’s parent or guardian if the patient is a minor, first requesting that
such information be reported to the registry.
(e) A
patient, or the patient’s parent or guardian if the
patient is a minor, shall be provided an opportunity to opt-in or opt out
of the registry as follows:
(1) At
the time of immunization by an administering health care provider who is
participating in the registry,
unless the provider is able to confirm documentation of prior opt-in or opt-out
in the patient’s medical record; or
(2) Prior
to or at a face-to-face encounter with a current health care provider by the
current health care provider who
is participating in the registry, unless the provider is able to confirm
documentation of prior opt-in or opt-out in the patient’s medical record.
(f) In
all cases described in (e) above, the opportunity to opt-in or opt-out of the
registry shall be provided in writing in a clear, succinct, and conspicuous
manner, in simple language, and in a form, style, and size easily readable by
the average adult.
(g) The provider shall maintain documentation, in
the patient’s medical record, of providing the opportunity to opt-in or opt-out
of the registry as well as the written or electronic consent given by any
patient, or the patient’s parent or guardian, if the patient is a minor, who
has elected to opt-in to the registry.
(h) In all cases described in (e) above, the
provider shall inform and educate the patient about the registry and ensure
patient understanding of the following:
(1) Participation in
the New Hampshire immunization registry is voluntary;
(2) Immunization information for registrants may
be consolidated and used by authorized NHIIS users such as their health care
provider, school nurse, licensed child care provider, or NH division of public
health to provide notice about upcoming immunizations, overdue immunizations or
identification of recommended immunization
in the event of a disease outbreak;
(3) The decision to
opt-in or opt-out of the New Hampshire immunization registry shall not prevent
them from receiving immunizations;
(4) Individuals may
reverse their decision at any time by notifying their current health care
provider(s);
(5) Individuals may remove all existing
information from NHIIS by submitting a “New Hampshire Immunization Information
System (NHIIS) Withdrawal Form” to their health care provider or by mailing or
faxing a notarized “New Hampshire Immunization Information (NHIIS) Withdrawal
Form” to:
Department
of Health and Human Services
Division
of Public Health Services
NH
Immunization Program
29
Hazen Drive
Concord,
NH 03301-6504
Attn:
Registry Admin
Fax:
(603) 696-3226
(6) An individual’s immunization information will
not be released to the New Hampshire immunization registry unless they have
provided explicit electronic or written consent; and
(7) The NHIIS may exchange immunization
information with other state or territory Immunization Information Systems
(IIS). In the event that an immunization
record exists for individuals who participates in another state’s or
territory’s registry, by choosing to participate they allow the transfer of
their immunization record from another state or territory into the NHIIS. In the event that the registrant receives
medical treatment that would have prompted retrieval of the registrant’s
immunization record or immunization in another state or territory or there is a
change of residence to another state or territory, by
choosing to participate, they allow the transfer of their immunization record
from the NHIIS to be exchanged with that other state’s or territory’s IIS.
(i) If the opportunity to opt-in or opt-out of
the registry is provided by a current health care provider prior to a
face-to-face encounter with the current health care provider, as described in
(e)(2) above, that provider shall send a written communication to the patient,
or the patient’s parent or guardian if the patient is a minor, which meets the
requirements in (f) above in form and substance, which is individually
directed, and in which opting-in or opting out is the focus of the communication.
(j) In the event a patient or the patient’s
parent or guardian if the patient is a minor, changes their decision from
opt-in to opt-out or vice versa, the registrant, or the registrant’s parent or
guardian if the registrant is a minor, shall follow the process as described in
He-P 307.09.
(k) An
administering or current health care provider who is participating in the
registry, including the physicians and nurses in the administering or current
health care provider’s professional practice or medical group, shall not be
required to provide notice of the opportunity to opt-in or opt-out of the
registry to the same patient, or the patient’s parent or guardian if the
patient is a minor, more than once unless evidence of prior opt-in or opt-out
cannot be confirmed via patient medical records.
(l) An administering or current health care
provider who is participating in the registry, including the physicians and
nurses in the administering or current health care provider’s professional
practice or medical group, shall not be required to obtain explicit written or
electronic consent to send personal data to the registry for any patient, or
the patient’s parent or guardian if the patient is a minor, if the healthcare
provider has documentation in the medical record of an opportunity to opt-out
prior to July 1, 2023 and did not elect to opt-out unless there is a change to
the registrant’s decision to opt-in or opt-out to the registry.
(m) Nothing
in this rule shall relieve the patient, or the patient’s parent or guardian if the
patient is a minor, who chooses to opt-out of participation in the registry,
from the obligation to comply with current immunization requirements set forth
in RSA 141-C:20-a or He-P 301.14.
(n) Nothing in this rule shall relieve the
provider from the obligation to maintain a record of immunization within the
practice’s patient’s medical record in accordance with Med 501.02(f)(8) and
other state or federal regulations.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.07 Procedures for
Patients to Withdraw from Participation in the Registry.
(a) A
patient, or the patient’s parent or guardian if the patient is a minor, may
withdraw from participation in the registry at any time,
including the removal of information contained in the registry, as follows:
(1) The
patient, or the patient’s parent or guardian if the patient is a minor, shall
complete the vaccine recipient
information section of the “New Hampshire Immunization Information System
(NHIIS) Withdrawal Form” (March 2023) and acknowledge that:
“I
understand that this withdrawal from participation in the registry will not
prevent me or my child from receiving
immunizations/vaccinations.
I
understand withdrawing will delete all existing vaccine information within the
NHIIS for myself or for my child. This is a permanent deletion that cannot be
undone.
I
understand that I may reverse my decision by completing a “Reverse Previous
Decision not to Participate in the New Hampshire Immunization/Vaccination
Registry” (3/2016) form with my current healthcare provider.
I
understand that it is my responsibility to inform my other health care
providers of my decision to withdraw from the registry so that no future
immunization/vaccination information is reported to the NHIIS.
Patients
who choose to withdraw from participation in the registry are not relieved from
the obligation to comply with current immunization requirements set forth in
RSA 141-C:20-a and He-P 301.14.” ;
(2) The
patient, or the patient’s parent or guardian if the patient is a minor, shall
obtain signature of a health care provider or a public notary on the “New
Hampshire Immunization Information System (NHIIS) Withdrawal Form” (March 2023)
;
(3) The
patient, or the patient’s parent or guardian if the patient is a minor, or
health care provider in (2) above shall fax or mail the completed “New
Hampshire Immunization Information System (NHIIS) Withdrawal Form” (March 2023)
to the department; and
(4) The
department shall remove all patient information from the registry.
(b) If a patient, or the
patient’s parent or guardian if the patient is a minor, requests withdrawal
from participation in accordance with (a) or (b) above, then no information
relating to the patient shall remain in the registry, and no record of the
transaction, including the request itself, shall be kept by either the
department or the health care provider.
(c) It shall be the
responsibility of the patient, or the patient’s parent or guardian if the
patient is a minor, to inform his or her other health care
providers of his or her decision to withdraw from participation in the
registry. In order to ensure that no future
immunization/vaccination information is reported to the registry, such patient,
or the patient’s parent or guardian if the patient is a minor, shall complete a
“Choose not to Participate in the New Hampshire Immunization/Vaccination
Registry” form (3/16 edition) with each of the patient’s current and
administering health care providers who are participating in the registry.
(d) Nothing in this rule
shall relieve the patient, or the patient’s parent or guardian if the patient
is a minor, who chooses to remove his or her
information from the registry, from the obligation to comply with current
immunization/vaccination requirements set forth in RSA 141-C:20-a or He-P
301.14.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99, EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.08 Procedures
for Patients to Review and Correct Information Contained in the Registry.
(a) A patient, or the patient’s parent or
guardian if the patient is a minor, may review and correct information contained in the registry by making a request through
their health care provider who is participating in the registry or through the
department in accordance with this section.
(b) A request under (a) above for a registry
record review to the department shall be via the completion and submission of a
“New Hampshire Immunization Information System (NHIIS) Request for Immunization
Record” (June 2024) that includes the signature of the patient or the patient’s
parent or guardian if the patient is a minor.
(c) If the above
signature is that of a guardian or if there has been a legal name change, a
copy of the appropriate legal documentation shall be submitted before the
records are released.
(d) Upon receipt of a complete request in (b)
above, the department shall provide the patient, or the patient’s parent or guardian if the patient is a minor, a copy of the
requested record or statement that there is no associated record by mail.
(e) A request under (a) above for a registry record review to a health
care provider who is participating in the registry shall be by a method to be
determined by the health care provider.
(f) A record of the transaction described in (b) and (e) above, including
the request itself, shall be maintained by the department or the health care
provider to ensure that the department or the health care provider are in
compliance with federal HIPAA record retention requirements.
(g) A request to correct information contained in the registry shall be
as follows:
(1) A patient, or a patient’s parent or guardian if the patient is a
minor, shall:
a. Complete the “New Hampshire Immunization Information
System Correction to NHIIS Immunization Record” form (June 2024), available on the department’s web site
at https://www.dhhs.nh.gov/programs-services/disease-prevention/immunizations/nh-immunization-information-system/nhiis-1 or at the office of the current health care
provider who is participating in the registry;
b. Return the completed form to the current
health care provider who is participating in the registry or to the department via fax or mail listed in He-P
307.06(h)(5);
c. If the completed form is being returned to the department, include a copy
of the following supporting documentation for the information requested to be
corrected:
1. For verification of requestor identity, the form signed by a notary public or a copy of
a valid state issued photo ID or passport;
2. For proof of
parent, a copy of the minors birth certificate;
3. Documentation of
immunization
received, if a dose needs to be corrected, added, or deleted;
4. A copy of legal court documentation, if there has been a legal name
change or as proof of guardianship for minors or medial proxy; and
5. A copy of other
legal documents, if applicable;
(2) If the completed form is being returned to
a current health care provider who is participating in the registry, the provider
shall confirm validity of identification and any correction(s) being requested
prior to performing any NHIIS correction;
(3) Upon receipt of the
materials in (1) above, and upon verification of information requested to be
corrected, the entity who received the “New
Hampshire Immunization Information System Correction
to NHIIS Immunization Record” form (June 2024) shall
make any such corrections or updates to the patient’s record within 7
business days;
(4) Only the corrected information shall remain
in the registry; and
(5) A record of the transaction in described in
(1) through (3) above, including the request itself, shall be maintained by the
entity who received the “New Hampshire Immunization Information System
Correction to NHIIS Immunization Record” form (June 2024), in accordance with
HIPAA record retention requirements.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99,
EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.09 Procedures for
Patients to Reverse Decision to Opt-in or Opt Out of
the Registry.
(a) A
patient, or the patient’s parent or guardian if the patient is a minor, may
reverse the decision to opt-in or opt-out of participation in the registry at
any time by informing each of their administering health care providers who
participate in the registry of their decision to reverse their opt-in or
opt-out status.
(b)
The provider shall document the patient’s, or the patient’s parent or guardian
if the patient is a minor, reversal of decision and explicit consent to opt-in,
if applicable, in the patient’s medical record.
(c) The provider shall ensure that past, current,
and future immunization information is or is not further reported to the
registry in accordance with the patient’s change in opt-in or opt-out
status.
(d) If a patient, or the
patient’s parent or guardian if the patient is a minor, reverses their decision
and opts-out of the registry, they may withdraw their information from the
registry, pursuant to He-P 307.07.
Source. #6830, INTERIM, eff 8-14-98, EXPIRED:
12-12-98
New. #6941, eff 1-30-99,
EXPIRED: 1-30-07
New. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P 307.10 Requests
for Registry Data for Research or Other Purposes.
(a) Only de-identified data from the registry
shall be released by the department for research
purposes.
(b) Release of aggregated statistical data shall
not include direct-identifiers, as defined by HIPAA and in accordance with RSA
91-A:10, that would allow constructive identification of individuals. The cell
size shall not be released in any document where the numbers of counts are
between 1 and 4.
(c) A “New Hampshire Immunization Program Request for Non-Confidential Data” form
(June 2024) shall be completed by the researcher, submitted to the
division’s immunization section, and approved before any data shall be
released.
(d) The
completed “New Hampshire Immunization Program Request for Non-Confidential
Data” form shall be mailed or faxed to:
Department
of Health and Human Services
Division
of Public Health Services
Immunization
Section – Data Request
29
Hazen Drive
Concord,
NH 03301-6504
Fax:
(603) 271-3850
(e) If
the request is not complete, the department shall notify the applicant in
writing within 10 business days of receiving the request specifying any
information or supporting documentation required to be submitted before the
request can be processed.
(f) If
after written notice in (e) above the applicant fails to provide the missing
information or supporting documentation, within 30 days of such notice, the
application shall be considered incomplete and shall not be processed.
(g) Persons
fraudulently requesting data shall be subject to penalty for unsworn
falsifications in accordance with RSA 641:3.
(h) The
department shall approve applications for the use of registry data if:
(1) The
application is complete; and
(2) It
is determined that the study, if carried out according to the request
submitted, will serve a public health purpose as defined in He-P 307.02(p).
(i) The department shall deny an application when
it has been determined that one or more of the requirements of (h) above have
not been met.
Source. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
He-P
307.11 Exchange of Registrant
Immunization Records.
(a) The department may enter, pursuant to (b)
below, into data sharing agreements with other jurisdiction’s immunization
information systems (IIS) in order to ensure a complete immunization record for
all registrants for the purposes as outlined in RSA 141-C:20-f, I and V and
He-P 307.01, and for other purposes as allowable under HIPAA and state and
federal laws.
(b) Registrant immunization information may be
exchanged with another jurisdiction’s IIS in order to create a complete
vaccination record for the following purposes:
(1) To create a single repository of accurate,
complete, and current immunization records to aid, coordinate, and promote
effective and cost-efficient disease prevention and control efforts;
(2) To ensure that registrants receive all
recommended immunizations in a timely manner by providing access to the
registrant’s immunization record and to provide registrants with information
about recommended immunizations;
(3) To improve immunization rates by facilitating
notice to registrants of overdue or upcoming immunizations; and
(4) To control communicable diseases by assisting
in the identification of individuals who require immediate immunization in the
event of a disease outbreak.
Source. #14010, eff 6-27-24
He-P 307.12 Procedures for
Managed Care Organizations to Obtain Summary Statistics of Immunization
Information on Members. The department shall provide annual summary
statistics of immunization information to managed care organizations.
Source. #12163, eff 5-1-17; ss by #14010, eff 6-27-24
(from He-P 307.11)
PART
He-P 308 FINANCIAL ASSISTANCE TO
PARTIALLY FUND TOWNS OR CITIES FOR MOSQUITO CONTROL ACTIVITIES - EXPIRED
Statutory
Authority: RSA 141-C:6, XXII, RSA 141-C:24
He-P 308.01 Purpose. The purpose of this part is to set forth the procedures
for administration and distribution of funds directed toward mosquito control
activities as established in RSA 141-C:25 and establishment of mosquito control
districts.
Source. #8683, EMERGENCY
RULE, eff 7-17-06, EXPIRED: 1-13-07
New. #8799, eff 1-19-07; ss by #9173, eff 6-7-08,
EXPIRED: 6-7-16
He-P
308.02 Definitions.
(a)
“Commissioner” means the commissioner of the
(b)
“Department” means the
(c)
“Eligible costs” means costs incurred by a town, city, or mosquito
control district:
(1) During the same calendar year, prior to or
following the declaration of a public health threat; and
(2) For mosquito control activities aimed at
reducing the public health threat.
(d)
“Mosquito control” means activities targeting the abatement of mosquitoes
through the application of pesticides aimed at mosquito larvae (larvicide) and
adult mosquitoes (adulticide).
(e)
“Mosquito control district (MCD)” means contiguous municipalities that
work together for the purpose of applying for a special permit and/or partial
funding pursuant to RSA 141-C:24.
(f)
“Mosquito control fund” means a fund, established pursuant to RSA
141-C:25, to assist cities, towns, and MCDs by providing funding for the
purpose of offsetting the costs of mosquito control activities including, but
not limited to, the purchase and application of chemical pesticides.
(g)
“Mosquito control plan” means a written document prepared by a town,
city, or MCD that describes preventive and response actions for reducing human
mosquito-borne disease.
(h)
“Special permit” means a special permit obtained in accordance with Pes
505, Pes 506, and/or Pes 604.
(i) “Public health threat” means a condition
declared by the commissioner, in consultation with the Centers for Disease
Control and Prevention and with concurrence of the governor, that warrants
expedited mosquito control activities within a city, town, or MCD, and which is
based on local factors per RSA 141-C:25, III(a).
Source. #8683, EMERGENCY
RULE, eff 7-17-06, EXPIRED: 1-13-07
New. #8799, eff 1-19-07; ss by #9173, eff 6-7-08; amd by #9303, eff 10-25-08, EXPIRED: 6-7-16
He-P 308.03 Mosquito Control Districts: Contiguous municipalities that establish
mosquito control districts for the purposes of applying for moneys from the mosquito
control fund shall be eligible for financial assistance if the district is
established pursuant to RSA 430:13 and meets the requirements set forth in He-P
308.05.
Source. #8683, EMERGENCY
RULE, eff 7-17-06, EXPIRED: 1-13-07
New. #8799, eff 1-19-07; ss by #9173, eff 6-7-08,
EXPIRED: 6-7-16
He-P 308.04 Application for Financial Assistance to
Partially
(a)
A town, city, or MCD desiring to apply for financial assistance for
mosquito control activities shall submit the following documents to the
department:
(1) The completed application form, “Application
for Financial Assistance to Partially Fund Towns, Cities, or MCD’s Activities”;
and
(2) A copy of the town, city, or MCD’s mosquito
control plan, which shall include at a minimum:
a. A list of pesticides, including their active
ingredient(s), to be applied and methods by which these pesticides will be
applied to ensure the application is performed in a safe and proper manner, if
the town is requesting financial assistance for the treatment of mosquitoes
with pesticides;
b. A description of the safeguards in place to protect
the health of the public, wildlife, and resources within the state;
c. A description of a comprehensive public
awareness campaign geared toward prevention and designed to educate the public
about the health risks associated with mosquitoes;
d.
A description of surveillance activities
employed to detect a mosquito-borne public health threat; and
e. A description of appropriate mosquito control
methods.
(b)
The public awareness campaign described in (a)(2)c. above shall address,
at a minimum:
(1) The potential severe human illness associated
with bites from infected mosquitoes;
(2) Measures the public can take to reduce
mosquito-breeding locations on their property and in their community; and
(3) Measures to prevent mosquito bites through
the use of effective repellant, types of clothing, and altered activity
schedules during times of peak mosquito biting.
(c)
The “Application for Financial Assistance to Partially Fund Towns,
Cities, or MCD’s Activities” shall be signed by the individual filing the
application, or, for MCDs, by a representative from each incorporated town or
city belonging to that particular MCD.
(d)
The “Application for Financial Assistance to Partially Fund Towns,
Cities, or MCD’s Activities” may be obtained by contacting:
The
Arboviral Surveillance Program
The
Department of Health and Human Services
Division
of Public Health Services
(603)
271-4496
(e)
The applicant shall mail or hand-deliver the above-listed documents to:
Arboviral
Surveillance Coordinator
The
Department of Health and Human Services
Division
of Public Health Services
Source. #8683, EMERGENCY
RULE, eff 7-17-06, EXPIRED: 1-13-07
New. #8799, eff 1-19-07; ss by #9173, eff 6-7-08
(from He-P 308.03), EXPIRED: 6-7-16
He-P 308.05 Eligibility.
(a)
The town, city, or MCD shall be eligible to receive funds for mosquito
control activities if the following criteria have been met:
(1) The commissioner, in consultation with the
Centers for Disease Control and Prevention and with concurrence of the
governor, has declared a public health threat within a given city, town, or MCD
based on local factors per RSA 141-C:25, III(a);
(2) The commissioner, after consultation with the
Centers for Disease Control and Prevention, has determined mosquito control
activities are appropriate to mitigate the public health threat based on local
factors per RSA 141-C:25, III(a); and
(3) The town, city, or MCD that is requesting
financial assistance:
a. Holds a current special permit, approved in
accordance with Pes 505, Pes 506, and/or Pes 604;
b. Completes and submits an application no later than December 1st of the
calendar year in which expenses were incurred, along with other required
documentation, to the department, as described in He-P 308.04; and
c. Requests funding for mosquito control
activities aimed to address a public health threat of a mosquito-borne disease
and not for nuisance mosquito control activities.
(b)
“Nuisance mosquito control” means mosquito control activities which are
not aimed at a declared public health threat.
(c) The amount of funding requested through the
application shall be no more than 25% of the total eligible costs of mosquito
control activities directed at a public threat.
Source. #8683, EMERGENCY
RULE, eff 7-17-06, EXPIRED: 1-13-07
New. #8799, eff 1-19-07; ss by #9173, eff 6-7-08
(from He-P 308.04), EXPIRED: 6-7-16
He-P 308.06 Approval for Towns, Cities, or MCDs to
Receive Funds for Mosquito Control Activities.
(a)
The commissioner shall base the decision as to whether to grant the
funding request, and, if the request is granted, the amount of funding to be
provided, on the following criteria:
(1) The nature and degree of the declared threat
to the public health;
(2) The mosquito control activities proposed by
the city, town, or MCD;
(3)
Funding from the mosquito control fund shall not exceed 25% of the total
eligible costs of mosquito control activities; and
(4) Funding is available through the
appropriation under RSA 141-C:25.
(b)
If an application is approved, the department shall notify the applicant
in writing of the approval, and the amount of funding approved, within 30
working days of December 1st.
(c)
If an application is denied, the department shall notify the applicant in
writing of the reason for the denial within 30 working days of December 1st.
(d)
Applications shall be received by the department by December 1st
of the calendar year for which expenses were incurred.
Source. #9173, eff 6-7-08 (from He-P 308.05),
EXPIRED: 6-7-16
PART He-P 309
Healthcare associated Infections reporting
Revision Note:
Document #13282, effective 10-23-21,
was an interim rule that amended He-P 309.01 titled “Definitions” and He-P
309.02 titled “Reporting Requirements”.
Document #13282 also repealed He-P
309.05 titled “Central Line Insertion Practices (CLIP)” and
renumbered, but did not readopt, He-P 309.06 through He-P 309.13 as He-P 309.05
through He-P 309.12 as indicated in the source notes. The interim rule was scheduled to expire
4-21-22 except for the repeal of He-P 309.05, which was permanent. The prior filings affecting He-P 309.05
included the following documents:
#9851, eff 1-14-11
#10079, eff 1-26-12
#12943, eff 12-11-19
Before the interim
rule expired, Document #13351, effective 3-19-22, readopted with amendments
He-P 309.01, He-P 309.02, and He-P 309.10, which was formerly titled “Surgical
Antimicrobial Prophylaxis and Intravenous Antimicrobial Administration” and was
now re-titled as “Intravenous Antimicrobial Administration”.
He-P 309.01 Definitions.
(a) “Ambulatory
surgical center” means “ambulatory surgical center” as defined in He-P 812.03(i) and licensed in accordance with RSA 151 and He-P
812. The term “ambulatory surgical center” includes “ambulatory
surgical facility” as used in RSA 151:33.
(b) “Assisted living residence”
means “assisted living residence” as defined in RSA 161-J:2, II.
(c) “Catheter-associated urinary tract
infections (CAUTI)” means urinary tract infections that are associated with
having a catheter as defined by the National Healthcare Safety Network (NHSN)
in the material incorporated by reference in He-P 309.03(a).
(d) “Central line” means one of
the following types of intravascular catheter that terminates at or close to
the heart, or in one of the great vessels that is used for infusion, withdrawal
of blood, or hemodynamic monitoring:
(1) A
permanent central line, including:
a. Tunneled catheters;
b. Tunneled dialysis
catheters; and
c. Implanted catheters;
(2) A
temporary central line or a non-tunneled, non-implanted catheter; and
(3) An
umbilical catheter, which is a vascular catheter inserted through the umbilical
artery or vein in a neonate.
(e) “Centers for Medicare and
Medicaid Services (CMS)” means the federal agency within the U.S. Department of
Health and Human Services that administers the Medicare and Medicaid programs.
(f) “Central line related bloodstream infections
(CLABSI)” means central line-associated blood stream infections, or a
bloodstream infection that is associated with having a central line as defined
by NHSN in He-P 309.04(a).
(g) “Department” means the New Hampshire
department of health and human services.
(h) “End stage renal disease dialysis center
(ESRDDC)” means “end stage renal disease dialysis center” as defined in He-P
811.03(r) and licensed in accordance with RSA 151 and He-P 811. The term includes “end-stage renal dialysis
center” as used in RSA 151:33.
(i) “Healthcare associated infection (HAI)” means
an infection that a patient acquires during the course of receiving treatment
for another condition within a healthcare setting.
(j) “Healthcare personnel (HCP)” means all
facility personnel, including but not limited to, physicians, nurses, nursing
assistants, therapists, technicians, emergency medical service personnel,
dental personnel, pharmacists, laboratory personnel, autopsy personnel,
students, trainees, volunteers, and contractual staff not employed by the
healthcare facility, such as clerical, dietary, housekeeping, and maintenance
staff regardless of clinical responsibility or patient contact.
(k) “Hospital” means “hospital” as defined in RSA
151:2, I(a).
(l) “Influenza vaccination rates” means the
proportion of persons that received influenza vaccine.
(m) “Inpatient census” means the average number
of inpatients per year for each hospital, which shall be determined by the
total number of admissions per year.
(n) “Intravenous (IV)
antimicrobial start” means administration starts of all intravenous antibiotics
or antifungals.
(o) “LabID event” means a positive laboratory
test result for Clostridioides difficile toxin
A, toxin B, or both, or any detection of toxin-producing Clostridioides
difficile organisms by culture or other laboratory means on an unformed
stool specimen that conforms to the container, when tested through methods such
as molecular assays, include polymerase chain reaction (PCR), toxin assays,
including enzyme immunoassay (EIA), or both.
(p) “Measure” means any infection or process
measure reported by a hospital pursuant to RSA 151:33, II and III and as
described in He-P 309.02(a) and (b), and any infection or process measure
reported by an ambulatory surgical center pursuant to RSA 151:33, II-a and III
and as described in He-P 309.02(c) and (d).
(q) “National Healthcare Safety Network (NHSN)”
means the web-based surveillance system for healthcare-associated infection
surveillance maintained by the Centers for Disease Control and Prevention.
(r) “New Hampshire veterans’ home” means “home”
as defined in Ve-H 102.03 and licensed in accordance with RSA 119:1 and Ve-H
100-400. This term includes “veterans’ home” as used in RSA 151:33.
(s) “Nursing home” means “nursing home” as
defined in He-P 803.03(az) and licensed in accordance
with RSA 151 and He-P 803.
(t) “Residential care facility” means
“residential health care facility” as defined in He-P 805.03(bj) and licensed in accordance with RSA 151 and He-P 805.
This term also includes “assisted living residence-residential care (ALR-RC)”.
(u) “Specialty hospital” means a psychiatric or
rehabilitation hospital as defined in He-P 802.
(v) “Supported residential health care facility
(SRHCF)” means “supported residential health care facility” as defined in He-P
805.03(bu).
(w) “Surgical antimicrobial prophylaxis” means
administration of antibiotics in relation to a surgical procedure as defined by
CMS in He-P 309.07(a).
(x) “Surgical wound infections” means surgical
site infections (SSI), or an infection that is associated with a surgical
procedure, as defined by NHSN in He-P 309.06(a).
(y) “Vascular access
site infection” means an infection that is associated with having a dialysis
access site.
Source. #9851, eff 1-14-11; ss by #10079, eff
1-26-12; amd by #10344, eff 5-22-13; ss by #12943, eff 12-11-19; amd
by #13282, INTERIM, eff 10-23-21; ss by #13351, eff 3-19-22 (see Revision Note
at part heading for He-P 309)
He-P 309.02 Reporting Requirements.
(a) In
accordance with RSA 151:33, II, all hospitals shall identify, track, and report
infections, including:
(1) Catheter-associated
urinary tract infections;
(2) Central
line related bloodstream infections; and
(3) Surgical
wound infections.
(b) All
hospitals shall provide to the department Clostridioides difficile infection
(CDI) labID event data, if available.
(c) Hospitals
shall also identify, track, and report process measures including:
(1)
Coverage rates of influenza vaccination for health care personnel and
patients or residents; and
(2) Antimicrobial use data, if available.
(d) In
accordance with RSA 151:33, II-a, all ambulatory surgical centers shall
identify, track, and report surgical wound infections.
(e) Ambulatory surgical
centers shall also identify, track, and report on the following:
(1) Surgical
antimicrobial prophylaxis administered intravenously; and
(2) Coverage
rates of influenza vaccination for health care personnel.
(f) In
accordance with RSA 151:33, II-b, all end-stage renal dialysis centers shall
identify, track, and report dialysis events, including:
(1) Positive
blood cultures; and
(2) Vascular
access site infections.
(g) End
stage renal dialysis centers shall also identify, track, and report on the
following:
(1) Intravenous
antimicrobial start time; and
(2) Coverage
rates of influenza vaccination of health care personnel.
(h)
In accordance with RSA 151:33, II-c, the New Hampshire veterans’ home and all
nursing homes, residential care facilities, and assisted living facilities
shall identify, track, and report coverage rates of influenza vaccination of
health care personnel.
Source. #9851, eff 1-14-11; ss by #10079, eff
1-26-12; ss by #12943, eff 12-11-19; amd by #13282,
INTERIM, eff 10-23-21; ss by #13351, eff 3-19-22 (see Revision Note at part
heading for He-P 309)
He-P 309.03 Catheter-Associated Urinary Tract
Infections (CAUTI).
(a)
Hospitals shall comply with the United States Centers for Disease
Control and Prevention, National Healthcare Safety Network,
“Catheter-Associated Urinary Tract Infection (CAUTI) Event” (January 2019
edition), available as noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf,
when submitting CAUTI data.
(b)
Hospitals shall monitor all adult and pediatric intensive care units for
CAUTI events all 12 calendar months, and shall report data on CAUTI events
quarterly via NHSN.
(c)
Hospitals shall provide data within 60 days of the close of each quarter
to NHSN, as follows:
(1) Quarter 1 data, from January
1st to March 31st, shall be reported on or before May 30th;
(2) Quarter 2 data, from April 1st
to June 30th, shall be reported on or before August 29th;
(3) Quarter 3 data, from July 1st
to September 30th, shall be reported on or before November 29th; and
(4) Quarter 4 data, from October
1st to December 31st, shall be reported on or before March 1st of the following
calendar year.
(d) Specialty hospitals, ESRD centers,
residential care facilities, assisted living residences, nursing homes, and
veterans’ homes shall not be required to report CAUTI.
Source. #10079, eff 1-26-12; ss by #12943, eff
12-11-19
He-P 309.04 Central Line-Associated Blood Stream
Infections (CLABSI).
(a)
Hospitals shall comply with the United States Centers for Disease
Control and Prevention National Healthcare Safety Network, “Central Line
Bloodstream Infection (CLABSI) Event”, (January 2019 Edition), available as
noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf,
when submitting CLABSI data.
(b)
Hospitals shall monitor all adult, pediatric, and neonatal intensive
care units for CLABSI events all 12 calendar months, and shall report data on
CLABSI events quarterly via NHSN.
(c)
Hospitals shall provide data within 60 days of the close of each quarter
to NHSN, as follows:
(1) Quarter 1 data, from January
1st to March 31st, shall be reported on or before May 30th;
(2) Quarter 2 data, from April 1st
to June 30th, shall be reported on or before August 29th;
(3) Quarter 3 data, from July 1st
to September 30th, shall be reported on or before November 29th; and
(4) Quarter 4 data, from October
1st to December 31st, shall be reported on or before March 1st of the following
calendar year.
(d)
Specialty hospitals, ESRD centers, residential care facilities, assisted
living residences, nursing homes, and veterans’ homes shall not be required to
report CLABSI.
Source. #9851, eff 1-14-11; amd
by #10079, eff 1-26-12 (from He-P 309.03); ss by #12943, eff 12-11-19
He-P 309.05 Surgical Site Infections (SSI).
(a)
Hospitals and ambulatory surgical centers shall comply with the United
States Centers for Disease Control and Prevention, National Healthcare Safety
Network, “Surgical Site Infection (SSI) Event” (January 2019 edition),
available as noted in Appendix A at http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf,
when submitting SSI data.
(b)
Hospitals shall report on the following NHSN operative procedures:
(1) Abdominal
hysterectomy;
(2) Coronary
artery bypass graft surgery for chest incision and donor site;
(3) Colon
surgery for incision, resection, or anastomosis of the large intestine; and
(4) Knee
arthroplasty.
(c)
Ambulatory surgical centers shall report on the following NHSN operative
procedures:
(1) Breast
surgery;
(2) Hernia
repair surgery; and
(3) Open
reduction of fracture surgery.
(d)
Hospitals and ambulatory surgical centers shall monitor for the
specified SSI events above all 12 calendar months, and shall report data on SSI
events quarterly via NHSN.
(e)
Hospitals and ambulatory surgical centers shall provide data within 60
days of the close of each quarter to NHSN, as follows:
(1) Quarter 1 data, from January
1st to March 31st, shall be reported on or before May 30th;
(2) Quarter 2 data, from April 1st
to June 30th, shall be reported on or before August 29th;
(3) Quarter 3 data, from July 1st
to September 30th, shall be reported on or before November 29th; and
(4) Quarter 4 data, from October
1st to December 31st, shall be reported on or before March 1st of the following
calendar year.
Source. #9851, eff 1-14-11; ss by #10079, eff 1-26-12
(from He-P 309.05); ss by #12943, eff 12-11-19; renumbered
by #13282, INTERIM (formerly He-P
309.06) (see Revision Note at part heading for He-P 309)
He-P 309.06 Clostridioides
Difficile Infections (CDI).
(a)
Hospitals shall comply with the United States Centers for Disease
Control and Prevention, National Healthcare Safety Network,
“Multidrug-Resistant Organism & Clostridioides difficile
Infection (MDRO/CDI) Module” (January 2019 edition), available as noted in
Appendix A at https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf,
when submitting CDI labID event data, if such data is
available.
(b) Hospitals shall monitor for CDI events all 12
calendar months and shall report data on CDI events quarterly via NHSN.
(c) Hospitals shall provide data within 60 days
of the close of each quarter to NSHN, as follows:
(1) Quarter 1 data, from January 1st to March
31st, shall be reported on or before May 30th;
(2) Quarter 2 data, from April 1st to June 30th,
shall be reported on or before August 29th;
(3) Quarter 3 data, from July 1st to September
30th, shall be reported on or before November 29th; and
(4) Quarter 4 data, from October 1st to December
31st, shall be reported on or before March 1st of the following calendar year.
Source. #12943, eff 12-11-19; renumbered by #13282,
INTERIM (formerly He-P 309.07) (see Revision Note at part heading for He-P 309)
He-P 309.07 Antimicrobial Use Data.
(a) Hospitals shall report antimicrobial use data
annually on April 30th or earlier for the previous year if such data is
available.
(b) If such data is available, hospitals with
antimicrobial use data shall report by either or both of the following:
(1) Sending antimicrobial use data by complying
with United States Centers for Disease Control and Prevention, National
Healthcare Safety Network, “Antimicrobial Use and Resistance (AUR) Module”
(January 2019 edition), available as noted in Appendix A at https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf;
or
(2) Completing the “Days of Therapy (DOT)
Reporting Sheet” and returning it to the department via:
a. Email, as an attachment, to haiprogram@dhhs.nh.gov;
b. Fax to
(603) 271-0545; or
c. Mail to:
Healthcare
Associated Infections Surveillance Program
Bureau of Disease
Control
Division of Public
Health Services
Department of
Health and Human Services
29 Hazen Drive
Concord, NH 03301
(c) Hospitals reporting antimicrobial use data
through the “Days of Therapy (DOT) Reporting Sheet” form shall include the
following information on the form:
(1) Name of person completing the form;
(2) Name of facility;
(3) Email address of person completing the form;
(4) Telephone number of person completing the
form;
(5) Total number of patient days during the
reporting period;
(6) Class of antibiotic administered, specified
as intravenous or oral;
(7) Days of therapy by each antibiotic
administered; and
(8) Any other desired comments.
Source. #12943, eff 12-11-19; renumbered by #13282,
INTERIM (formerly He-P 309.09) (see Revision Note at part heading for He-P 309)
He-P 309.08 Vascular Access Site Infections (VASI).
(a) End stage renal dialysis centers shall comply
with the United States Centers for Disease Control and Prevention, National
Healthcare Safety Network, “End Stage Renal Dialysis (ESRD) Event” protocol
(January 2019 edition), available as noted in Appendix A at
http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf, when
submitting ESRD data.
(b) End
stage renal dialysis centers shall
report on the following NHSN vascular access site infections:
(1) Bloodstream infection (BSI);
(2) Local access site infection (LASI);
(3) Access-related bloodstream infection (ARBSI); and
(4) Vascular access infection (VAI);
(c)
End stage renal dialysis centers shall
monitor for VASI events all 12 calendar months and shall report on VASI events
quarterly via NHSN.
(d) End stage renal dialysis centers shall provide data within 60 days of the
close of each quarter to NHSN, as follows:
(1) Quarter 1 data, from January 1st to March 31st, shall be reported on or before
May 30th;
(2) Quarter 2 data, from April 1st to June 30th, shall be reported on or before
August 29th;
(3) Quarter 3 data, from July 1st to September 30th, shall be reported on or before
November 29th; and
(4) Quarter 4 data, from October 1st to December 31st, shall be reported on or
before March 1st of the following calendar year.
Source. #12943, eff 12-11-19; renumbered by #13282,
INTERIM (formerly He-P 309.09) (see Revision Note at part heading for He-P 309)
He-P 309.09 Positive Blood Cultures.
(a) End stage renal dialysis centers shall comply
with the United States Centers for Disease Control and Prevention, National
Healthcare Safety Network, “End Stage Renal Dialysis (ESRD) Event” protocol,
(January 2019 edition), available as noted in Appendix A at
http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf, when
submitting ESRD data.
(b) End stage renal dialysis centers shall report
positive blood cultures.
(c) End stage renal dialysis centers shall
monitor for positive blood cultures all 12 calendar months and shall report
data on positive blood cultures quarterly via NHSN.
(d)
End stage renal dialysis centers shall provide data within 60 days of
the close of each quarter to NHSN, as follows:
(1) Quarter 1 data, from January 1st to March
31st, shall be reported on or before May 30th;
(2) Quarter 2 data, from April 1st to June 30th,
shall be reported on or before August 29th;
(3) Quarter 3 data, from July 1st to September
30th, shall be reported on or before November 29th; and
(4) Quarter 4 data, from October 1st to December
31st, shall be reported on or before March 1st of the following calendar year.
Source. #12943, eff 12-11-19; renumbered by #13282,
INTERIM (formerly He-P 309.10) (see Revision Note at part heading for He-P 309)
He-P 309.10 Intravenous
Antimicrobial Administration.
(a) End
stage renal dialysis centers shall, when submitting ESRD data, report
intravenous antimicrobial administration by complying with the United States
Centers for Disease Control and Prevention, National Healthcare Safety Network,
“End Stage Renal Dialysis (ESRD) Event” protocol (January 2022 edition),
available as noted in Appendix A at
http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf.
(b)
In addition to the reporting requirements identified in (a) above, end stage
renal dialysis centers shall submit ESRD data within 60 days of the close of
each quarter, as follows:
(1) Quarter
1 data, from January 1st to March 31st, shall be reported on or before
May 30th;
(2) Quarter
2 data, from April 1st to June 30th, shall be reported on or before
August 29th;
(3) Quarter
3 data, from July 1st to September 30th, shall be reported on or before
November 29th; and
(4) Quarter
4 data, from October 1st to December 31st, shall be reported on or before March
1st of the following calendar year.
(c) Ambulatory
surgical centers shall report the list of procedures during which the patient
received intravenous prophylactic antibiotic to the department on the
“Intravenous Antibiotic Reporting Form” (November 2019) within 60 days of the
close of each quarter, as follows:
(1) Quarter
1 data, from January 1st to March 31st, shall be reported on or before
May 30th;
(2) Quarter
2 data, from April 1st to June 30th, shall be reported on or before
August 29th;
(3) Quarter
3 data, from July 1st to September 30th, shall be reported on or before
November 29th; and
(4) Quarter
4 data, from October 1st to December 31st, shall be reported on or before March
1st of the following calendar year.
(d) The
department shall contact all ambulatory surgery centers via email no later than
March 15 of each year, and provide the survey, as well as a pdf copy.
(e) Ambulatory
surgery centers shall either:
(1) Complete
the survey; or
(2) Complete the
pdf version of the survey and return to the department via:
a. Email,
as an email attachment, to haiprogram@dhhs.nh.gov;
b. Fax,
at (603) 271-0545; or
c. Mail,
to:
Healthcare
Associated Infections Surveillance Program
Bureau
of Disease Control
Division
of Public Health Services
Department
of Health and Human Services
29
Hazen Drive
Concord,
NH 03301
(f) Ambulatory
surgery centers shall report the following measures on the “Intravenous
Antibiotic Reporting Form” (November 2019):
(1) Facility name;
(2) Unique patient
identification number;
(3) Date
of the surgery or procedure;
(4) Type
of procedure using codes as defined by the World Health Organization’s
“International Classification of Diseases (ICD)” (11th Revision),
available as noted in Appendix B;
(5) Type
of prophylactic antibiotic;
(6) Time of the
start of the intravenous antibiotic was included; and
(7) Time
of the start of the incision.
(g) Specialty
hospitals shall not be required to report surgical antimicrobial prophylaxis
data and intravenous antimicrobial administration.
(h) Residential
care facilities, assisted living residences, nursing homes, and the veterans’
home shall not be required to report surgical antimicrobial prophylaxis data
and intravenous antimicrobial administration.
Source. #9851, eff 1-14-11; amd
by #10079, eff 1-26-12 (from He-P 309.06); ss by #12943, eff 12-11-19 (formerly
He-P 309.07); renumbered by #13282, INTERIM (formerly He-P 309.11); ss by
#13351, eff 3-19-22 (see Revision Note at part heading for He-P 309)
He-P 309.11 Influenza Vaccination Rates.
(a)
Hospitals and specialty hospitals shall report staff and patient
vaccination rates annually on or before April 30th for the previous influenza
season via the “Flu Survey- Hospital” as described in (g) below.
(b)
Assisted living residences and residential care facilities shall report
staff and resident vaccination rates annually on or before April 30th for the
previous influenza season via the “Flu Survey- Assisted Living” as described in
(h) below.
(c)
Nursing homes and the New Hampshire veterans’ home shall report staff
and resident vaccination rates annually on or before April 30th for the
previous influenza season via the “Flu Survey-LTC &VA” as described in (h)
below.
(d)
Ambulatory surgical centers and end stage renal dialysis centers shall
report staff vaccinations rates annually on or before April 30th for the
previous flu season via the “Flu Survey for ASC and End Stage Rental Dialysis
Centers” as described in (i) below.
(e)
The department shall contact hospitals, specialty hospitals, residential
care facilities, assisted living facilities, nursing homes, the New Hampshire
veterans’ home, ambulatory surgical centers, and end stage renal dialysis
centers each year on or before April 1st, and provide an online link to the
survey, as well as a pdf copy.
(f)
Hospitals, specialty hospitals, residential care facilities, assisted
living residences, nursing homes, the New Hampshire veterans’ home, ambulatory
surgical centers and end stage renal dialysis centers shall either:
(1) Complete the survey via the survey link; or
(2) Complete the pdf version of the survey and
return to the department via:
a. Email,
as an email attachment to haiprogram@dhhs.nh.gov;
b. Fax, to (603) 271-0545; or
c. Mail,
to:
Healthcare Associated Infections Program
Bureau of Disease Control
Division of Public Health Services
Department of Health and Human Services
29 Hazen Drive
Concord, NH 03301
(g) Hospitals and specialty hospitals shall
report the following information:
(1) Hospital contact information,
to include the following:
a. Facility name;
b. Name of person completing the
survey;
c. Professional title of person
completing the survey;
d. Email address of person
completing the survey; and
e. Telephone number of the person
completing the survey;
(2) Number of patients admitted to
the hospital during the reporting season, separated by:
a. Total number of patient
admissions; and
b. Total number of patient
admissions excluding readmissions;
(3) Number of patients immunized
against seasonal influenza;
(4) Number of patients not
immunized against seasonal influenza;
(5) Number of patients admitted
that have been immunized against pneumococcal disease;
(6) Number of healthcare personnel
who worked or volunteered at the facility during the reporting period;
(7) Number of staff immunized
against seasonal influenza during the reporting season;
(8) Number of staff not immunized
against seasonal influenza during the reporting season;
(9) Of the staff not immunized, the number who did not receive influenza
vaccine for the following reasons:
a. Medical contraindications;
b. Religious;
c. Personal or philosophical; or
d. Unknown;
(10) The extent to which the
facility has a seasonal influenza vaccination policy, indicated as:
a. A policy is in place;
b. A policy is not in place but
being considered;
c. A policy is not in place and is
not being considered; or
d. Other;
(11) For facilities that have a
seasonal influenza vaccination policy, the reasons for exemption, indicated as:
a. Medical;
b. Religious;
c. Personal or philosophical; or
d. Other;
(12) For facilities that have a
seasonal influenza vaccination policy, the requirements for staff with an
acceptable reason for exemption, indicated as:
a. The wearing of a mask;
b. Receiving verbal or written
education, or both; or
c. Other;
(13) For facilities that have a
seasonal influenza vaccination policy, the potential consequences for
unvaccinated staff without an acceptable reason for exemption, indicated as:
a. The wearing of a mask;
b. Progressive discipline, up to
and including termination;
c. Receiving verbal or written
education, or both; or
d. Other;
(14) For facilities that have a
season influenza vaccination policy, the number of noncompliant staff that were
that were:
a. Temporarily suspended;
b. Resigned; or
c. Terminated;
(15) Whether or not the facility
offers high-dose influenza vaccine; and
(16) Any other comments the
facility would like to share.
(h) Assisted living residences,
residential care facilities, nursing homes, and the New Hampshire veterans’
home shall report the following information:
(1) Facility contact information:
a. Facility name;
b. The name of the person
completing the survey;
c. The professional title of the
person completing the survey;
d. The email address of the person
completing the survey;
e. The telephone number of the
person completing the survey;
f. The facility’s license number;
and
g. The facility’s street address
and city name;
(2) The total number of residents
or attendees of the facility during the reporting season;
(3) Number of residents or
attendees immunized against influenza;
(4) Number of residents or
attendees not immunized against influenza;
(5) Number of residents or
attendees that have ever received a pneumococcal disease vaccination;
(6) The number of healthcare
personnel who worked or volunteered at the facility during the reporting
season;
(7) The number of facility staff
immunized against influenza for the reporting season;
(8) The number of facility staff
not immunized against influenza for the reporting season;
(9) Of the staff not immunized,
the number who did not receive influenza vaccine for the following reasons:
a. Medical contraindications;
b. Religious;
c. Personal or philosophical; or
d. Unknown;
(10) The extent to which the
facility has a seasonal influenza policy, indicated as:
a. A policy is currently in place;
b. A policy is not in place but is
being considered;
c. A policy is not in place and is
not being considered; or
d. Other;
(11) For those facilities that have an influenza vaccination policy, the
acceptable reasons for exemption, indicated as:
a. Medical;
b. Religious;
c. Personal or philosophical; or
d. Other;
(12) For those facilities that
have an influenza vaccination policy, the requirements for staff with an
acceptable reason for exemption, indicated as:
a. The wearing of a mask;
b. Receiving verbal or written
education, or both; or
c. Other;
(13) For those facilities that
have an influenza vaccination policy, the potential consequences for
unvaccinated staff without an acceptable reason for exemption, indicated as:
a. The wearing of a mask;
b. Progressive discipline, up to
and including termination;
c. Receive verbal or written
education, or both; or
d. Other;
(14) For those facilities that
have an influenza policy, the number of noncompliant staff that were:
a. Temporarily suspended;
b. Resigned; or
c. Terminated;
(15) Whether or not the facility
offered high-dose influenza vaccine; and
(16) Any other comments the
facility would like to share.
(i) Ambulatory
surgery centers and end-stage renal dialysis centers shall report the following
information:
(1) Facility contact information:
a. Facility name;
b. The name of the person
completing the survey;
c. The professional title of the
person completing the survey;
d. The email address of the person
completing the survey; and
e. The telephone number of the
person completing the survey;
(2) Number of healthcare personnel
who worked or volunteered at the facility during the reporting period;
(3) The number of healthcare
personnel immunized against influenza for the reporting season;
(4) The number of healthcare
personnel not immunized against influenza for the reporting season;
(5) Of the staff not immunized,
the number who did not receive influenza vaccine for the following reasons:
a. Medical contraindications;
b. Religious;
c. Personal or philosophical; or
d. Unknown;
(6) The extent to which the
facility has a seasonal influenza policy, indicated as:
a. A policy is currently in place;
b. A policy is not in place but is
being considered;
c. A policy is not in place and is
not being considered; or
d. Other;
(7) For those facilities that have
an influenza vaccination policy, the acceptable reasons for exemption,
indicated as:
a. Medical;
b. Religious;
c. Personal or philosophical; or
d. Other;
(8) For those facilities that have
an influenza vaccination policy, the requirements for staff with an acceptable
reason for exemption, indicated as:
a. The wearing of a mask;
b. Receiving verbal or written
education, or both; or
c. Other;
(9) For those facilities that have
an influenza vaccination policy, the potential consequences for unvaccinated
staff without an acceptable reason for exemption, indicated as:
a. The wearing of a mask;
b. Progressive discipline, up to
and including termination;
c. Receiving verbal or written
education, or both; or
d. Other;
(10) For those facilities that
have an influenza policy, the number of noncompliant staff that were:
a. Temporarily suspended;
b. Resigned; or
c. Terminated;
(11) Total number of procedures
performed at the facility within the past calendar year; and
(12) Any other desired comments
the facility would like to share.
Source. #9851, eff 1-14-11; amd
by #10079, eff 1-26-12 (from He-P 309.07); ss by #12943, eff 12-11-19 (formerly
He-P 309.08); renumbered by #13282, INTERIM (formerly He-P 309.12) (see
Revision Note at part heading for He-P 309)
He-P 309.12 Fees.
Pursuant to RSA 151:36, the department shall assess a fee to hospitals,
ambulatory surgical centers, and end stage renal dialysis centers that are
required to report under RSA 151:33 to support the program’s approved annual
operating budget and which shall be proportional to the total number of
measures reported by all hospitals, ambulatory surgical centers, and end stage
renal dialysis, as follows:
(a)
The base amount for the hospitals’ portion of the annual operating
budget shall be proportional to the total number of measures reported, as
described by the reporting categories in He-P 309.02(a) through (c), by all hospitals in the state;
(b)
Of that base amount stated in (a) above, each hospital shall pay a fee
based on the appropriate fee category for that hospital;
(c)
There shall be 5 proportional fee categories based on the hospital’s
number of beds, which shall total the base amount of payment that is required
by hospitals;
(d)
The fee categories and the proportional rates of the budgeted amounts
for hospitals shall be as follows:
(1) Specialty hospitals at 0.900%;
(2) Less than 25 beds at 2.500%;
(3) 25-199 beds at 4.500%;
(4) 200-299 beds at 5.240%; and
(5) 300 beds or more at 5.880%;
(e)
The number of beds attributed to each hospital shall be the number of
beds for which the hospital is licensed by the department’s bureau of health
facilities administration, in accordance with He-P 802, at the time the fees
are assessed;
(f)
All ambulatory surgical centers shall report the number of procedures
for the previous calendar year to the department by email to HAIprogram@dhhs.nh.gov on or before
March 1st of the following year;
(g)
The base amount for the ambulatory surgical centers’ portion of the
annual operating budget shall be proportional to the total number of measures
reported, as described by the reporting categories in He-P 309.02(c) and (d), by all ambulatory surgical centers in the state;
(h)
Of that base amount stated in (g) above, each ambulatory surgical center
shall pay a fee based on the appropriate category for that ambulatory surgical
center;
(i) There shall be 3 proportional fee categories
based on the range of procedures performed annually at an ambulatory surgical
center, which shall total the base amount of payment that is required by
ambulatory surgical centers;
(j)
The proportional fee categories and the total percentage of the budget
for that category shall be:
(1) No operative procedures at 20%;
(2) 1–1,499 operative procedures annually at 35%;
and
(3) More than 1,500 operative procedures annually
at 45%;
(k)
The total proportion of the budget for that procedure fee category shall
be split equally among all facilities that fall within that category;
(l)
The base amount for the end stage renal dialysis center portion of the
annual operating budget shall be proportional to the total number of measures
reported, as described by the reporting categories in He-P 309.02(a) and (b),
by all end stage regnal dialysis centers in the state;
(m)
Of that base amount stated in (l) above, each end stage renal dialysis
center fee is based on a flat fee for all end stage renal dialysis;
(n)
The department shall notify hospitals, ambulatory surgical centers, and
end stage renal dialysis centers the fee assessed to them upon passage of the
program’s operating budget and then annually each year of the biennium;
(o)
A hospital or ambulatory surgical center that is not licensed during the
entire base year but is licensed at the time the fees are assessed shall pay
the lowest fee category for that year; and
(p)
Hospitals, ambulatory surgical centers, and end stage renal dialysis
center shall send the fee for the annual amount to the department within 30
days after notification.
Source. #9851, eff 1-14-11; ss by #10344, eff
5-22-13); ss by #12943, eff 12-11-19 (formerly He-P 309.09); renumbered by
#13282, INTERIM (formerly He-P 309.13) (see Revision Note at part heading for
He-P 309)
PART He-P 310 - RESERVED
PART He-P 311 RULES FOR TEMPORARY ACUTE CARE CENTERS LOCATED WITHIN A
HOSPITAL
He-P 311.01 Purpose. The purpose of these rules is to set forth
the requirements to establish and operate
temporary acute care centers located within a hospital pursuant to RSA
141-C:26, and thereby ensure, through basic standards, the health and safety of
individuals in a temporary acute care center located within a hospital
.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
He-P 311.02 Scope.
This part shall apply to any person, agency, partnership, corporation,
government entity, association, or other legal entity operating a temporary
acute care center. Any facility established under this section shall be exempt
from the provisions of RSA 151, except as otherwise required herein.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
He-P 311.03 Definitions. As used
in this part, unless the context indicates otherwise, the following terms have
the following meanings:
(a) “Centers for
Medicare and Medicaid Services (CMS)” means the United States Department of
Health and Human Services Centers for Medicare and Medicaid Services;
(b) “Commissioner” means
the commissioner of the New Hampshire department of health and human services;
(c) “Department”
means the New Hampshire department of health and human services; and
(d) “Temporary acute care center” means a facility
established for the purpose of the delivery of acute medical services to persons who would normally require admission to an acute care
hospital, when there is a public health incident as defined in RSA 508:17-a,
II(c) and when the acute care hospitals in the area do not have the physical
and human resources necessary to meet the demand or anticipated demand for
medical care.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
He-P 311.04 Establishment. A temporary acute care
center shall only be established with the authorization of the commissioner,
following the written approval of the governor, for a temporary duration when
there is a public health incident as defined in RSA 508:17-a, II(c) and when the acute care hospitals
in the area do not have the physical and human resources necessary to meet the
demand or anticipated demand for medical care to persons who would normally
require admission to an acute care hospital.
Source. #13304, EMERGENCY RULE, eff 12-10-21,
EXPIRED: 6-8-22
New. #13380-A, eff 5-25-22
He-P 311.05 Duties and Responsibilities.
(a) The temporary acute care center shall comply with
these rules and all applicable CMS regulations, in consideration of any waivers
or flexibilities allowable and approved by CMS, under 42 CFR 482 and 42 CFR 485
in effect throughout the duration of the operation of the temporary acute care
center, including, but not limited to:
(1) Facility and staffing requirements;
(2) Screening and admission criteria;
(3) Payment and reimbursements;
(4) Clinical standards;
(5) Recordkeeping;
(6) Patient rights; and
(7) Discharge criteria.
(b) The temporary acute care center shall comply
with all provisions of RSA 151:21, except when the health or safety of the
individual or other patients would be endangered.
(c) If notified by CMS that the temporary acute
care center is out of compliance with (a) above to the extent that the health or safety of individuals are in jeopardy, the department shall
withdraw the temporary acute care center’s designation.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
He-P 311.06 Payment and Reimbursement. The temporary acute care center shall follow
its established procedures for the billing of services
rendered.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
He-P 311.07 Immunity. For the purposes of immunity, actions taken
pursuant to this section shall be considered an emergency management function
under RSA 21-P:41, I.
Source. #13304, EMERGENCY RULE, eff 12-10-21; ss by
#13380-A, eff 5-25-22
Appendix A
Documents
Incorporated by Reference
|
Rule |
Title |
Publisher, How to
Obtain, Cost |
|
He-P
301.02(e)(2) |
NH
Local Implementation Guide for Electronic Laboratory Reporting using HL7,
2.5.1, 7/31/2014. |
Available as an
on-line document free of charge at www.dhhs.nh.gov/dphs/bphsi/documents/elrguide |
|
He-P
301.03(i)(1) |
NH
Local Implementation Guide for Syndromic Surveillance Reporting, Version
1.07, 2/15/15. |
Available as an
on-line document free of charge at www.nh.gov/dphs. |
|
He-P
301.04 |
Healthcare
Infection Control Practices Advisory Committee 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings, June 2007. |
Available as an
on-line document free of charge at www.cdc.gov/hicpac. |
|
He-P
301.04 |
Healthcare
Infection Control Practices Advisory Committee, Management of Multi-drug
Resistant Organisms in Healthcare Settings, HICPAC Advisory Committee. October 2006. |
Available as an
on-line document free of charge at www.cdc.gov/hicpac/mdroGuidelines2006. |
|
He-P
301.11(c)(5) |
US
Department of Health and Human Services Guidelines for the Use of
Antiretroviral Agents in HIV-1 Infected Adults and Adolescents. |
Available free
of charge at: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. |
|
He-P
301.14 |
Recommended
Immunization Schedules for Persons Aged 0-18 years- US 2016 by Centers for
Disease Control and Prevention (CDC) and as approved by the Advisory
Committee on Immunization Practices (ACIP), the American Academy of
Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). |
Available on
line free of charge at www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. |
|
He-P 304.01(m) |
“Chapter III, Standards for Tumor Inclusion and Reportability” Table
2. “NAACCR Layout Version 15:
“Comparison of Reportable Cancers” “NPCR Requirements.” (Thornton ML,
(ed)). “Standards for Cancer Registry
Operations”/Volume II: “Data Standards
and Data Dictionary, Record Layout” Version 15, 19th ed. (Posted
October 2014, Revised February 27, 2015), |
Available online at no cost at www.naaccr.org. |
|
He-M 304.02(b) and (g) |
North American Association of Central Cancer Registries (NAACCR),
“Standard for Cancer Registries, Volume II”/“Data Standard and Data
Dictionary”, 19th (ed.), “Record Layout Version 15”,
Implementation: January 1, 2015, Edited by Monica Thornton, Revised February
2015. |
Available online at no cost at www.naaccr.org. |
|
He-M 304.02(b) and (g) |
“Standards for Cancer Registries” Volume V: “Pathology Laboratory
Electronic Reporting, Version 4.0.”Klein Wt., Havener L. (eds.) |
Available online at no cost at www.naaccr.org. |
|
He-M 304.02(b) and (g) |
|
Available online at no cost at http://cdc.gov/cancer/npcr/meaningful_use.html. |
|
He-M 304.07(d)(7) |
Surveillance, Epidemiology and End Results
Program (SEER) “Case Finding List, Current List”, ICD-10-CM-(FY 2015-October
1, 2015-September 30, 2016. |
Available online at no cost at http://seer.cancer.gov/tools/casefinding. |
|
He-P 307.05(b) |
Centers for Disease Control and Prevention’s, “Core
Data Elements for Immunization Information Systems, listed in the functional
standards document and in Appendix B in HL7 Version 2.5.1: Implementation
Guide for Immunization Messaging Release 1.5” (October 2018) |
Publisher:
Centers for Disease Control and Prevention Cost: Free of
Charge The
incorporated document is available at: https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html;
or |
|
He-P 309.03(a) |
United States Centers for Disease Control and
Prevention, National Healthcare Safety Network’s, “Catheter-Associated
Urinary Tract Infection (CAUTI) Event” (January 2019 Edition) |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: |
|
He-P 309.04(a) |
United States Centers for Disease Control and
Prevention, National Healthcare Safety Network’s, “Central Line Bloodstream
Infection (CLABSI) Event” (January 2019 Edition) |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf |
|
He-P 309.05(b) |
United States Centers for Disease Control and
Prevention, National Healthcare Safety Network’s, “Central Line Insertion
Practices (CLIP) Adherence Monitoring” (January 2019 Edition) |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: http://www.cdc.gov/nhsn/PDFs/pscManual/5psc_CLIPcurrent.pdf |
|
He-P 309.06(a) |
United States Center for Disease Control and
Prevention, National Healthcare Safety Network’s, “Surgical Site Infection
(SSI) Event” (January 2019 Edition). |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf |
|
He-P 309.07(a) |
United States Center for Disease Control and
Prevention, National Healthcare Safety Network’s, “Multidrug-Resistant
Organism and Clostridiodes difficile Infection (MDRO/CDI)
Module” (January 2019 Edition). |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf |
|
He-P 309.08(b)(1) |
United States Center for Disease Control and
Prevention, National Healthcare Safety Network’s, “Antimicrobial Use and
Resistance (AUR) Module” (January 2019 Edition) |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: |
|
He-P 309.09(a); He-P 309.10(a); and He-P 309.11(e) |
United States Center for Disease Control and
Prevention, National Healthcare Safety Network’s, “End Stage Renal Dialysis
(ESRD) Event” (February 2018 Edition) |
Publisher:
United States Center for Disease Control and Prevention Cost:
Free to the Public The
incorporated document is available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf |
|
He-P 309.11(j) |
World Health Organization’s “International
Classification of Diseases” (11th Revision) |
Publisher:
World Health Organization Cost:
Free to the Public The
incorporated document is available at: https://icd.who.int/en |
APPENDIX B
|
RULE |
RSA/FEDERAL CITATION |
|
He-P
301.01 |
RSA
141-C:2 |
|
He-P
301.02 |
RSA
141-C:6, I , RSA 141-C:7; RSA 141-C:8 |
|
He-P
301.03 |
RSA
141-C:6, I; RSA 141-C:7 |
|
He-P
301.04 |
RSA
141-C:11-15 |
|
He-P
301.05 |
RSA
141-C:11-15 |
|
He-P
301.06 |
RSA
132:6; RSA 132:10-b |
|
He-P
301.07 |
RSA
141-C:3, RSA 141-C:9 |
|
He-P
301.08 |
RSA
141-C:10 |
|
He-P
301.09 |
RSA
141-C:16-a |
|
He-P
301.10 |
RSA
141-C:17; RSA 141-C:17-a |
|
He-P
301.11 |
RSA
141-C:2, IV, RSA 141-C:3, III |
|
He-P 301.11(b),
(c) intro., (c)(3), (c)(4), (g) intro., (g)(1) intro., and (g)(1)d. |
RSA 141-C:2, VI,
RSA 141-C:3, III, RSA 141-C:4, X., RSA 141-C:15, IV |
|
He-P
301.12 |
RSA
141-C:11, RSA 141-C:12 |
|
He-P
301.13 |
RSA
141-C:20-a through RSA 141-C:20-e |
|
He-P
301.14 |
RSA
141C:20-a thru e |
|
He-P
301.15 |
RSA
141C:20-a thru e |
|
He-P
301.16 |
RSA
141-C:6, XI |
|
He-P 301.17(c) intro.,
(c)(4), (e), (h) intro., (h)(3), (h)(5) intro., (h)(5)e., and (o) |
RSA 141-C:15,
III |
|
|
|
|
He-P 304.01 |
RSA 141-B:2 |
|
He-P 304.02 |
RSA 141-B:7; RSA
141-B:8, II, RSA 141-B:10 |
|
He-P 304.03 |
RSA 141-B:7; RSA
141-B:8, II, RSA 141-B:10 |
|
He-P 304.04 |
RSA 141-B:7; RSA
141-B:8, II, RSA 141-B:10 |
|
He-P 304.05 |
RSA 141-B:7; RSA
141-B:8, II, RSA 141-B:10 |
|
He-P 304.06 |
RSA 141-B:7; RSA
141-B:8, II, RSA 141-B:10 |
|
He-P 304.07 |
RSA 141-B:8,
III; RSA 141-B:8, IV; RSA 141-B:9, 42 USC
280e(c)(2)(D)(viii) |
|
He-P 304.08 |
RSA-141-B:8,
III; RSA 141-B:9; 45 CFR 164, 45 CFR164.502,
45 CFR 164.506, 45 CFR 164.512 |
|
He-P 304.09 |
RSA 141-B:8,
III, RSA 141-B:9 |
|
He-P 304.10 |
RSA 141-B:8,
III, RSA 141-B:9 |
|
He-P-305.01 |
RSA 541-A:7 |
|
He-P 305.02 |
RSA 151:2 |
|
He-P 305.03 |
RSA 141-F:6 |
|
He-P 305.04 |
RSA 141-F:5 through F:7 |
|
He-P 305.05 |
RSA 141-F:5, IV |
|
He-P 305.06 |
RSA 141-F:7 |
|
He-P 307.01 –
H-P 307.06 |
RSA 141-C:20-f |
|
He-P 307.07 |
RSA 141-C:20-f,
III; RSA 141-C:20-f, IIII-a |
|
He-P
307.08 -307.11 |
He-P
307.01 – 307.06; RSA 141-C:20-f |
|
He-P
308.01 |
RSA
141-C:25, I, RSA 430:13 |
|
He-P
308.02 |
RSA
141-C:24, RSA 141-C:25, IV, as amended by Chapter Law 73 of the 2008 Session |
|
He-P
308.03 |
RSA
141-C:24, RSA 430:13 |
|
He-P
308.04 |
RSA
141-C:25, III, RSA 141-C:25, IV |
|
He-P
308.05 |
RSA
141-C:25, III, RSA 141-C:25, IV, RSA 141-C:25, V |
|
He-P
308.06 |
RSA
141-C:25, III, (b) |
|
He-P 309.01 |
RSA 151:32 |
|
He-P 309.02 |
RSA 151:33; RSA 151:35 |
|
He-P 309.03 |
RSA 151:33: I, II(a)(2), III, IV, V; RSA
151:35 |
|
He-P 309.04 |
RSA 151:33: I, II(a)(1), IV, V; RSA
151:35 |
|
He-P 309.05 |
RSA 151:33: I, II(b)(1), IV, V; RSA
151:35 |
|
He-P 309.06 |
RSA 151:33: I, II(a)(3), II-a(a), IV, V;
RSA 151:35 |
|
He-P 309.07 |
RSA 151:33: I, III, IV; RSA 151:35 |
|
He-P 309.08 |
RSA 151:33:I, III, IV; RSA 151:35 |
|
He-P 309.09 |
RSA 151:33, II-b (b), IV, RSA 151:35 |
|
He-P 309.10 |
RSA 151:33, I, II-a (b), IV and, V, RSA
151:35 |
|
He-P 309.11 |
RSA 151:33, I, II-a (b), IV, V, RSA
151:35 |
|
He-P 309.12 |
RSA 151-:33, I, II-a (c) IV, V, RSA
151:35 |
|
He-P 309.13 |
RSA 151:36 |
|
He-P 311.01 |
RSA 141-C:26 |
|
He-P 311.02 |
RSA 141-C:26 |
|
He-P 311.03 |
RSA 141-C:26 |
|
He-P 311.04 |
RSA 141-C:26 |
|
He-P 311.05 |
RSA 141-C:26 |
|
He-P 311.06 |
RSA 141-C:26 |
|
He-P 311.07 |
RSA 141-C:26 |