§ 151:2 — License or Registration Required

I. The following facilities shall not be established, conducted, or maintained without acquiring a license under this chapter:
(a) Hospitals, and infirmaries or health services maintained by an educational institution. For the purposes of this subparagraph "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. The term "hospital" includes psychiatric and substance abuse treatment hospitals.
(b) Home health care providers, as defined in RSA 151:2-b.
(c) Laboratories performing tests or analyses of human samples, collection stations, or laboratories performing testing on therapeutic cannabis pursuant to RSA 126-X:6, III(a)(16).
(d) Facilities or portions of a facility operating as an outpatient rehabilitation clinic, ambulatory surgical center, hospice, emergency medical care center, drop-in or walk-in care center, dialysis center, birthing center, or other entity where health care associated with illness, injury, deformity, infirmity, or other physical disability is provided, whether operated for profit or for free or at a reduced cost, however named, and whether owned by a hospital or hospital holding corporation or operated as part of a hospital's services.
(e) Residential care facilities, whether or not they are private homes or other structures built or adapted for the purpose of providing residential care, offering services beyond room and board to 2 or more individuals who may or may not be elderly or suffering from illness, injury, deformity, infirmity or other permanent or temporary physical or mental disability. Such facilities shall include those:
(1) Offering residents home-like living arrangements and social or health services including, but not limited to, providing supervision, medical monitoring, assistance in daily living, protective care or monitoring and supervision of medications; or
(2) Offering residents social, health, or medical services including, but not limited to, medical or nursing supervision, medical care or treatment, in addition to any services included under subparagraph (1).
Such homes or facilities shall include, but not be limited to, nursing homes, sheltered care facilities, rest homes, residential care facilities, board and care homes, or any other location, however named, whether owned publicly or privately or operated for profit or not.
(f) Adult day care services offering medical supervision, care or treatment, or providing assistance in daily living activities, to 3 or more individuals, whether operated for profit or not.
II. This chapter shall not be construed to require licensing of the following:
(a) Facilities which are operated for the continuing care of one person or 3 or fewer persons in a facility certified by the commissioner of health and human services under RSA 126-A:19 and RSA 126-A:20. This exemption also applies to buildings that provide residences to both independent individuals and individuals receiving services pursuant to RSA 126-A:19 and RSA 126-A:20. This exemption also applies to any entity that provides housing to 3 or more individuals receiving services pursuant to RSA 126-A:19 and RSA 126-A:20, provided that individuals are not required to use the entity to obtain personal assistance or any health-related or supportive services beyond room and board.
(b) Facilities maintained or operated for the sole benefit of persons related to the owner or manager by blood or marriage within the third degree of consanguinity.
(c) Facilities maintained and operated by any church or religious denomination solely for those ordained clergy or members of religious orders.
(d) Facilities providing only room and board.
(e) Physicians' offices and related facilities.
(f) Offices and related facilities of other persons licensed in this state to practice a health care profession.
(g) Facilities operating as community health clinics.
(h) Acute care centers established, operated, or designated by the department pursuant to RSA 141-C:26.
(i) Any other facility exempted by rules adopted under this chapter.
III. Facilities licensed under this chapter shall not claim to promote or advertise themselves, in any form or manner, as providing, or being able to provide services other than those for which they are licensed.
IV. Rules for residential care facilities and supported residential care facilities, as defined in rules adopted by the department pursuant to RSA 541-A, which are licensed pursuant to RSA 151:2, I(e) or certified in accordance with RSA 151:9, VIII, shall permit such facilities to admit residents who have been determined eligible for nursing facility services under a medicaid home and community-based care waiver for the elderly and chronically ill and who have been referred to such a facility as an alternative to placement in a nursing facility, provided that the clinical services and supports required by the person can be provided or obtained in the facility. No bed may be licensed in both the nursing facility and residential care facility categories at the same time.
V. No person shall operate as, or represent himself or herself as, an individual home care service provider as defined in RSA 151:2-b, V unless that person is registered in accordance with this chapter.
VI. (a)(1) No new license shall be issued for, and there shall be no increase in licensed capacity of, any nursing home, skilled nursing facility, intermediate care facility, or rehabilitation facility, including rehabilitation hospitals and facilities offering comprehensive rehabilitation services. This moratorium shall not apply to any rehabilitation facility whose sole purpose is to treat individuals for substance use disorder or mental health issues or to any continuing care facility for which a certificate of authority has been issued by the insurance commissioner pursuant to RSA 420-D:2.
(2) Provided however, effective July 1, 2023, any pediatric intermediate care facility, established before the effective date of this subparagraph is authorized to house 2 additional pediatric residents beyond its licensed capacity prior to that date, with this authorization to expire June 30, 2026. Notwithstanding the moratorium established in subparagraph (a)(1), the commissioner of health and human services may assess the capacity of any pediatric intermediate care facility and report any need for additional beds to the standing policy committees of the house and senate with jurisdiction over health and human services and the fiscal committee of the general court. If the commissioner determines additional beds are necessary, the commissioner may increase a pediatric intermediate care facility's number of licensed beds upon approval of the fiscal committee of the general court.
(b) This moratorium shall not prohibit the relocation or transfer of beds to a nursing home, skilled nursing facility, or intermediate care facility; provided that the beds to be transferred or relocated were in existence as of July 1, 2016, that the receiving facility is located in the same county as the facility where those beds were located as of July 1, 2016, and that the action shall not reduce the number of Medicaid beds located in that county. This restriction on transfers shall not apply to any beds transferred from one entity to another before the effective date of this paragraph.
(c) This moratorium shall not prohibit the relocation or transfer of beds to a rehabilitation facility, including rehabilitation hospitals and facilities offering comprehensive rehabilitation services; provided that the beds to be transferred or relocated were licensed on July 1, 2016. This restriction on transfers shall not apply to any beds transferred from one entity to another before the effective date of this paragraph.

Legislative History

1947, 216:1, par. 2. RSA 151:2. 1959, 236:1. 1969, 379:1. 1975, 265:1. 1976, 11:1. 1979, 95:1; 399:2. 1985, 302:1. 1988, 156:1. 1990, 140:2, XI. 1991, 365:2. 1995, 310:8. 1996, 146:1, 2. 1998, 388:4. 2002, 101:2, eff. Jan. 1, 2003. 2008, 271:6, eff. June 26, 2008. 2012, 41:1, 2, eff. July 1, 2012; 282:8, eff. June 30, 2015. 2015, 143:9, eff. Aug. 11, 2015; 276:203, eff. June 30, 2016. 2018, 298:3, eff. June 25, 2018. 2019, 287:1, eff. Sept. 17, 2019; 326:13, eff. Aug. 16, 2019. 2023, 79:566, eff. July 1, 2023. 2024, 158:1, eff. June 30, 2024. 2025, 95:1, eff. Aug. 16, 2025; 153:1, eff. Sept. 5, 2025.