Opening an adult day program in New Hampshire: the He-P 818 license, staffing and the 2026 rewrite

Who needs an Adult Day Program license

New Hampshire licenses adult day care through the same statute that covers hospitals, nursing homes and assisted living, RSA 151. A license is required for “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” ⁠¹. The licensing rule, He-P 818, calls the business an Adult Day Program (ADP) and defines it as a program giving one or more of four services to people 18 or older for fewer than 12 hours a day: supervision, help with activities of daily living, nursing care, or rehabilitation ⁠².

Because the rule’s list is “one or more” of those services, supervision alone is enough: a social day program with no nursing still meets the definition if it supervises 3 or more adults ⁠².

The rule does not apply to programs owned or operated by the State of New Hampshire, or to the facility types RSA 151:2, II(a) to (g) exempts ⁠². Those exemptions include facilities run only for relatives of the owner or manager within the third degree of kinship, physicians’ and other licensed practitioners’ offices, and community health clinics ⁠¹. A program that is not licensed may not advertise itself as an ADP ⁠². If the department tells you a license is needed and you keep operating, the fine is $2,000 ⁠².

Neighboring licenses a founder might confuse with this one:

• Assisted living or residential care. A home or facility offering services beyond room and board to 2 or more people, such as supervision, medical monitoring or help with daily living as a place to live, is a residential care facility under RSA 151:2, I(e), a different license ⁠¹. See the New Hampshire assisted living residence guide.
• Care in the client’s home. Personal care or homemaker staff sent to homes need a home care service provider agency license; nursing and therapy at home need a home health care provider license.
• Adult day inside an existing facility. A senior center, nursing home, assisted living residence (residential care) or supported residential health care facility can host an ADP, but the ADP is still licensed under He-P 818 and must meet the extra space rules in He-P 818.17, covered below ⁠².

Other states’ adult day rules are compared on the adult day license page.

The rule is being rewritten in 2026

He-P 818 took effect on June 2, 2017 ⁠². On September 17, 2026 the Office of Legislative Services published DHHS’s proposal to readopt it with amendments (rulemaking notice 2026-180) ⁠⁸. The public hearing is Thursday, October 22, 2026, at 1:00 PM in the DHHS Brown Building auditorium, 129 Pleasant Street, Concord, and written comments are due Thursday, October 29, 2026, by email or fax to the DHHS Administrative Rules Unit ⁠⁸.

The notice lists these changes, among others ⁠⁸:

• An updated application form and attachment list, and license expiration aligned with RSA 151:5.
• A required written policy on preventing, detecting and resolving controlled substance misuse and diversion.
• A form of identification, showing licensure status where there is one, worn by all staff, volunteers, consulting doctors and students in contact with participants ⁠⁹.
• Checking every staff member’s name against the Bureau of Adult and Aging Services (BAAS) state registry at hire and annually.
• A named person in charge of the infection control program.
• A closure plan when a licensee stops operating, and a new fine for failing to notify DHHS before an administrator change.
• New medication rules on adverse drug reactions and medication-error reporting, and updated nursing and point-of-care testing requirements.
• No changes to the co-location rules in He-P 818.17.

The proposed text keeps the staffing ratios and the four administrator qualification routes described below ⁠⁹. Until DHHS adopts a final rule, the 2017 text applies; this guide cites it and flags where the proposal would change things.

Pick the administrator, nurse and activities coordinator first

He-P 818.15 sets out core services every licensed program must offer, and three of them come with named positions. Hire these people, or at least identify them, before you file: the application must include the administrator’s resume and copies of their licenses or certificates ⁠².

The administrator must name, in writing, an alternate who steps in during absences ⁠². If you later replace the administrator, DHHS needs written notice at least 5 days ahead, with the new person’s resume and licenses, and it decides whether they qualify ⁠².

Social services (social history, psychosocial assessment, family support, advocacy and discharge planning) must be provided by the administrator, the licensed nurse, or a social worker ⁠². The nurse’s role is broad: initial and ongoing assessments, medication administration and wound care, nutritional monitoring, care management or referral, and capillary blood glucose and PT-INR checks with a CLIA-waived system. Those two tests do not require a separate laboratory license under He-P 808 or He-P 817 ⁠².

Staffing ratios and personnel screening

Ratios count everyone on duty, and nursing and activities staff may be counted toward them ⁠²:

So 17 participants need 3 staff, and 25 need 4. The rule adds that ratios must always be enough to meet every participant’s needs, so the table is a floor ⁠². At least one person on duty must hold current adult CPR certification equivalent to basic life support from the American Red Cross or the American Heart Association whenever the program is open ⁠².

Screening rules, all from He-P 818.19 ⁠²:

• Criminal records checks from the NH Department of Safety for every applicant for employment (except people licensed by the NH Board of Nursing), every volunteer and independent contractor with participant contact, and every household member.
• Registry checks against the BAAS state registry and the Board of Nursing’s nursing assistant registry before hire or before any participant contact. A listed person cannot be hired without a waiver from BAAS or the Board of Nursing. (The 2017 rule still calls BAAS the Bureau of Elderly and Adult Services.)
• Disqualifiers: any felony; a conviction for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation; or an agency finding of abuse, neglect, exploitation, assault, fraud or theft. DHHS grants a waiver if it finds the person is not a threat.
• Age: direct care staff must be 18 or older unless they are licensed nursing assistants or students working under a nurse’s supervision.
• Health: a physical exam or health screening and a 2-step TB test (Mantoux or another CDC-approved method) done within 12 months before employment, before contact with participants or food.
• Training: orientation within the first 3 days of work, covering participant rights, complaint procedures, infection control, fire and emergency plans and mandatory reporting; the same topics again as annual continuing education.
• Medication: unlicensed staff who help participants with medication need at least a 4-hour medication supervision course taught by a nurse, practitioner, pharmacist, or someone they trained. A nurse may delegate medication administration to unlicensed staff only for oral medications ⁠².

Keep a separate personnel file for each staff member at the licensed premises ⁠². DHHS’s guidance says that if records are held off-site, they must reach the surveyor within two hours of arrival ⁠⁶.

The building: local sign-offs, fire code and space

New Hampshire puts much of the building review in the hands of town officials. For an existing building you need written approval from four local officials, each dated no more than 90 days before you file ⁠²:

1. Health officer

   Local health rules, drinking water and wastewater.

2. Building official

   State building code and local building ordinances.

3. Zoning officer

   Local zoning.

4. Fire chief

   The state fire code, Saf-C 6000, including the day-care occupancies chapter of NFPA 101, and local fire ordinances.

If your town has no such official, the board of selectmen or the mayor signs instead ⁠². DHHS publishes a local approval form, but its FAQ says the form is only suggested: a town can use its own form, a certificate of occupancy, or an email ⁠⁶. For a building under construction, submit approvals based on the officials’ plan review with the application and again when construction is finished ⁠².

New construction, additions and alterations that affect fire, health or building code compliance trigger more steps ⁠²:

• Send DHHS notice and architectural plans showing each room’s use and exact measurements, including window and door sizes, at least 60 days before work starts. DHHS approval is not required before you start, but proceeding without it is at your own risk.
• Send architectural, sprinkler and fire alarm plans to the State Fire Marshal’s office under RSA 153:10-b, V. Only the Fire Marshal can grant fire code variances.
• ADPs newly built after the 2017 rule must meet the Facility Guidelines Institute’s Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, Adult Day Care chapter, 2014 edition.
• The finished building must pass a DHHS inspection before use.

He-P 818.23 and 818.24 then set the standing physical requirements ⁠²:

• Heat of at least 70°F during the day when participants are present, with fuel-fired heating equipment serviced yearly and records kept 4 years. No unvented fuel-fired heaters; portable heaters only in staff areas.
• At least one toilet and hand sink, more as needs require, with grab bars, soap dispensers and hot and cold water. Programs newly licensed after March 18, 2008 also need at least one shower or bathing facility.
• Dining space and a seat at a table for every participant, a telephone participants can use, and a recliner, cot or bed in a rest area for anyone who needs to rest.
• Interconnected smoke detectors and a carbon monoxide monitor on every level, and a 2A-10BC fire extinguisher on every level within 50 feet of travel, checked monthly.
• Monthly evacuation drills at varying times, with every staff member taking part at least quarterly.

He-P 818 sets no square-foot-per-participant figure for a freestanding program. Your capacity is limited by the occupant load NFPA 101 allows, which is printed on the license certificate, and by the rule’s general requirement of enough space and equipment for the services you provide ⁠².

If you run a private well, the application needs water test results under Env-Dw 702.02 and 704.02; on a public system, a copy of a water bill is enough ⁠². Bacteria and nitrate testing must be repeated every 3 years and submitted with renewals ⁠².

Programs inside a senior center, nursing home or assisted living residence

An ADP located in a senior center, nursing home, assisted living residence (residential care) or supported residential health care facility must have at least one room designated as the licensed ADP that is at least 200 square feet, used only by ADP participants and staff, with its own medication storage and medical supply storage ⁠². It also needs an accessible bathroom on the same floor with a toilet, sink and shower, plus a recliner or bed reserved for ADP participants who need rest ⁠². All required ADP services must be delivered in the designated room ⁠². The 2026 proposal leaves these requirements unchanged ⁠⁸.

Policies and plans the inspectors will look for

Before the clinical inspection, have these in writing ⁠²:

• The scope and type of services you offer, including all He-P 818.15 core services, and policies and procedures for every service, reviewed yearly.
• A written chain of command.
• Admission paperwork: rights and responsibilities, complaint procedure, and a list of all charges. Core services must be in the basic rate, not billed separately, and you must give 30 days’ written notice before raising fees.
• A quality improvement program with a committee that tracks reportable incidents, complaints, falls, participant and staff conflicts, and medication delivery.
• An infection control program and the CDC isolation-precaution procedures if you accept participants with reportable or infectious diseases.
• Restraint policies limiting who can authorize emergency restraints.
• If you serve people with dementia, Alzheimer’s disease or mental illness, dementia and mental-illness training for direct care staff, and a security system that stops a participant leaving unnoticed if they have wandered in the last 60 days, their wandering has changed, or they are a danger to themselves or others.
• An emergency management program run by a committee that includes the administrator. The written plan must be approved by your local emergency management director, reviewed by the fire department as appropriate, and modeled on the Incident Command System. A program within 10 miles of a nuclear power plant that is part of the NH Radiological Emergency Response Plan must add those elements. You must also take part in a community disaster drill each year, which can be a tabletop exercise.

The care process is also fixed by rule. Each participant needs a physical exam done within the year before admission or within 72 hours after; a nursing assessment by an RN, or by an LPN supervised by an RN, within 7 days; and a care plan within 30 days, which the nurse reviews at least every 6 months ⁠². Progress notes are due every 30 days for the first 90 days, then quarterly ⁠². You must serve at least one meal a day providing a third of an adult’s recommended dietary allowances, with no more than 3 hours between meals and offered snacks ⁠². Keep participant records for 4 years after discharge ⁠².

Filing the application, in order

1. Form the business and register the name

   If you operate as a corporation, LLC or trade name, the application needs your Certificate of Authority, Certificate of Formation or Certificate of Trade Name from the NH Secretary of State ⁠².

2. Secure the site and get the four local approvals

   described above, timed so none is more than 90 days old when you file ⁠².

3. Run criminal records checks

   on the applicant, the licensee if different, the administrator and household members ⁠². The August 2025 form asks for checks on the owner and the business entity and on household members 17 or older who live at the facility; it lets you use any vendor as long as New Hampshire results are included, and it asks for the administrator’s BAAS registry result and a signed non-conviction attestation ⁠⁵.

4. Complete the application form

   The 2017 rule names the May 2017 “Application for Residential or Health Care License,” but the form DHHS posts is the August 2025 “Application for Residential, Health Care, or Special Health Care Services,” which lists Adult Day Care as classification 18 ⁠²⁠⁵. Sole owners sign it themselves; a corporation needs two officers’ signatures ⁠³⁠⁵. The form also asks you to describe your services, the health care you will provide, and who will provide it ⁠⁵.

5. Attach the rest

   : a floor plan, the administrator’s resume and licenses, the water documentation, and the fee ⁠².

6. Mail or hand-deliver the package

   to DHHS, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 ⁠². The licensing unit’s phone is (603) 271-9039 and its email is [email protected] ⁠⁶.

7. Answer any deficiency letter within 90 days

   If DHHS lists missing items and you do not send them within 90 days, the application is closed and you must start over with a new fee ⁠².

8. Pass the clinical and life safety code inspections

   DHHS issues the license only after both inspections find full compliance. If you are still out of compliance after a second on-site inspection, the application is denied ⁠².

Your initial application is not confidential. RSA 151:4 makes it open to public inspection as soon as it is filed, and DHHS posts initial applications on its website ⁠³⁠⁵.

The 2017 rule also asks new applicants to certify that they published notice of the application in a local newspaper in 2 separate issues at least 10 business days before filing, and, within 15 miles of a critical access hospital, that they gave the hospital’s chief executive registered-mail notice ⁠². The statute paragraph on public notice, RSA 151:4, VII, now reads “[Repealed.]” (2020), and the August 2025 form keeps its critical access hospital statement only for hospital (He-P 802) applicants ⁠³⁠⁵. The adult day rule has not been amended since 2017, and the 2026 proposal’s notice does not say whether the certifications stay. Ask the licensing unit at (603) 271-9039 whether it still expects the newspaper and hospital notices from an adult day applicant, and allow 10 business days before filing if it does.

Fees

RSA 151:5, XX sets the annual license fee for adult day care centers at $200, and the August 2025 application lists the same amount for He-P 818 programs (as published on October 12, 2026) ⁠⁴⁠⁵. Pay by check or money order to “Treasurer, State of New Hampshire,” or in cash in the exact amount ⁠²⁠⁵. Facilities run by federal, state or local government do not pay the fee, and the fee is refunded if the license is denied ⁠³. Fees cannot be moved to another application, and a closed or denied application needs a new fee ⁠².

Renewal, inspections and changes

A license runs one year ⁠⁴. Under He-P 818 it expires on the last day of the month before the month it was issued, one year later ⁠²; the 2026 proposal would align this with RSA 151:5 ⁠⁸. Submit the renewal application at least 120 days before expiration; late filing carries a $100 fine, and a license that lapses without a complete renewal application means filing as a new applicant ⁠². DHHS inspects before each renewal, and its staff may inspect the premises, services and records at any time ⁠². When an inspection finds deficiencies, a plan of correction is due within 21 days of the date on the letter sending the report ⁠².

Give DHHS 30 days’ written notice before a change of ownership, location, address, name or capacity ⁠². A new owner, a new location, or more participants than the license allows each require a new application and license before you operate ⁠². Give 30 days’ notice before closing ⁠². Post the license certificate, the previous 12 months of clinical inspection reports, the patients’ bill of rights, your complaint procedure and your evacuation floor plan in a public area ⁠². Reportable incidents go to DHHS within 48 hours, with a written follow-up within 5 days ⁠².

How New Hampshire programs are paid through Medicaid

Public funding runs mainly through the Choices for Independence (CFI) waiver, New Hampshire’s Medicaid home and community-based services program for adults who would otherwise qualify for nursing facility care. He-E 801.15 covers adult day services for non-acute needs when they are delivered by a program licensed under RSA 151:2 and He-P 818 ⁠⁷. Covered services include supervision, personal care, condition monitoring, referrals, and the He-P 818 health and safety, dietary, nursing, social, rehabilitative and recreational services ⁠⁷. CFI does not pay for adult day services for a participant who also receives residential care facility or adult family care services ⁠⁷. CFI providers must also meet He-E 801.33 and the provider and documentation rules in He-E 803 ⁠⁷.

He-E 803 covers Medicaid “adult medical day” services. It requires the program to be licensed under He-P 818 and enrolled as a NH Medicaid provider, to have at least one full-time RN or LPN on site whenever participants are present, and to arrange or provide transportation ⁠⁷. Eligible participants are Medicaid recipients 18 or older who live independently, have been referred by a practitioner after an exam within 60 days, and need the service for at least 4 hours a day on a regular basis ⁠⁷. The official text of He-E 803 carries a source note reading “EXPIRED: 10-28-19,” even though He-E 801.15(d) still tells adult day providers to follow it ⁠⁷. The published rules do not say whether NH Medicaid still enrolls providers under He-E 803 as written. Before you build your staffing around the full-time nurse requirement, ask NH Medicaid Provider Enrollment ([email protected] or 866-291-1674, the contacts on the licensing application) which He-E 803 requirements it applies to a new adult day provider ⁠⁵.

Sources

1. 1
   New Hampshire General Court, RSA 151:2, Licensing Required Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Hampshire Department of Health and Human Services, He-P 818, Adult Day Programs (eff. June 2, 2017) Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Hampshire General Court, RSA 151:4, Application for License Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Hampshire General Court, RSA 151:5, Issuance of License; Fees Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Hampshire Department of Health and Human Services, Health Facilities Administration, Application for Residential, Health Care, or Special Health Care Services (August 2025) Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Hampshire Department of Health and Human Services, Health Facilities Administration (FAQs, contacts and fees) Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Hampshire General Court, Office of Legislative Services, He-E 800, Medical Assistance (He-E 801 Choices for Independence; He-E 803 Adult Medical Day Care Services) Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Hampshire Office of Legislative Services, Administrative Rules, Rulemaking Notice 2026-180: He-P 818 Adult Day Programs, readopt with amendment Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Hampshire Department of Health and Human Services, He-P 818 Initial Proposal (July 17, 2026) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF