CHAPTER He-C 6300  GENERAL PROGRAM ADMINISTRATION

 

PART He-C 6339  CERTIFICATION FOR PAYMENT STANDARDS FOR COMMUNITY-BASED IN HOME SERVICE PROVIDERS: CHILD HEALTH SUPPORT, HOME BASED THERAPEUTIC, THERAPEUTIC DAY TREATMENT, ADOLESCENT COMMUNITY THERAPEUTIC SERVICES AND INDIVIDUAL SERVICE OPTIONS - IN-HOME

 

Statutory Authority:  RSA 170-G:4 XVIII, RSA 170-G:5

 

REVISION NOTE:

 

          Document #9263, effective 9-20-08, adopted Part He-C 6339 relative to certification for payment standards for community-based in-home service providers.  This part incorporated provisions from the former Part He-C 6352 entitled “Certification for Payment Standards for Community-Based Service Providers” and made extensive changes to the wording, format, structure, and numbering of those provisions.

 

          Document #9263 supersedes all prior filings in the former Part He-C 6352 relative to certification for payment standards for community-based in-home service providers.  The filings affecting the former Part He-C 6352 include the following documents:

 

          #4446, eff 7-1-88

          #5096, eff 3-15-91, EXPIRED 3-15-97

          #7292, eff 5-24-00

          #8009, eff 1-1-04

          #9112, INTERIM, eff 3-24-08, EXPIRED 9-20-08

 

He-C 6339.01  Purpose.

 

(a)  The purpose of this part is to identify the qualifications and performance requirements to become a provider of community-based in-home services for the division for children, youth and families (DCYF) and describe in-home services that assist children and families in remedying abusive, neglectful, delinquent, and children in need of services (CHINS) behaviors.  These services include child health support, home based therapeutic, therapeutic day treatment, adolescent community therapeutic services, and individual service options in-home.

 

(b)  The goals of in-home community based services are to:

 

(1)  Ensure the safety of children, families, and communities;

 

(2)  Improve interpersonal relationships and communication within the family;

 

(3)  Prevent the placement of a child in out-of-home care;

 

(4)  Reduce the recurrence of juvenile delinquent or status offenses;

 

(5)  Improve each child’s well-being in the home and community;

 

(6)  Stabilize the child and family by providing therapeutic support prior to a court-ordered or voluntary placement; and

 

(7)  Assist in preparing the family and the child for reunification if the child is in out-of-home placement by:

 

a.  Supporting the permanency plan of the child; and

 

b.  Supporting and enhancing the child’s positive community connections.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.02  Scope.  This part shall apply to community-based in-home service providers who receive medicaid or financial reimbursement from the department of health and human services (DHHS) for services provided to children and families.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.03  Definitions.

 

(a)  “Adolescent community therapeutic services” means the implementation, coordination, and maintenance of cases involving children in need of services and delinquents, which include intensive monitoring, counseling, and supervision of juveniles.

 

(b)  “Agency” means the board of directors, executive director, and employees of an organization that is incorporated and recognized by the NH secretary of state or another state’s regulatory authority.

 

(c)  “Applicant” means the entity that is requesting certification for payment as an in-home service provider.

 

(d)  “Certification for payment” means the process by which the division for children, youth and families approves the qualifications of and payment to providers of community-based in-home service.

 

(e)  “Child or minor” means an individual from birth through age 20, except as otherwise stated in a specific provision.

 

(f)  “Child health support services” means in-home support services for children and families through the provision of supportive counseling, health assessment, health education, behavioral health management, referral to resources, coordination of services, and other supports for the purpose of improving the health and well-being of children and other family members.

 

(g)  “Child in need of services (CHINS)” means “child in need of services” as defined by RSA 169-D:2.

 

(h)  “Child protective service worker (CPSW)” means an employee of the division for children, youth and families who has expertise in managing cases to ensure families and children achieve safety, permanency and well-being.

 

(i)  “Commissioner” means the commissioner of the department of health and human services or his or her designee.

 

(j) “Community-based in-home services” means child health support, home-based therapeutic, therapeutic day treatment, individual service options in-home, and adolescent community therapeutic services.

 

(k)  “Conflict of interest” means a situation, circumstance, or financial interest, which has the potential to cause a private interest to interfere with the proper exercise of a public duty.

 

(l)  “Corporal punishment” means the deliberate infliction of pain intended to correct behavior or to punish.

 

(m)  “Court-ordered” means a written decree that is issued by a district, family, superior, probate, or Supreme Court.

 

(n)  “Department (DHHS)” means the department of health and human services.

 

(o)  “Direct service staff” means employees, contractors, and volunteers who have access to children or access to client information.

 

(p)  “Director” means the director of the division for children, youth and families, or the director of the division for juvenile justice services, or designee.

 

(q) “Division for children, youth and families (DCYF)” means the organizational unit of the department of health and human services that provides services to children and youth referred by courts pursuant to RSA 169-A, RSA 169-B, RSA 169-C, RSA 169-D, RSA 170-B, RSA 170-C, RSA 170-H and RSA 463.

 

(r)  “DCYF Case plan” means the division for children, youth and families or the division of juvenile justice services written document, pursuant to RSA 170-G:4, III,  that describes the service plan for the child and family, and addresses outcomes, tasks, responsible parties, and timeframes for correcting problems that led to abuse, neglect, delinquency, or child in need of services (CHINS).

 

(s)  “Evidence-informed practice” means the process of treatment, which takes into account client preferences and values, practitioner expertise, best scientific evidence, and clinical characteristics and circumstances.

 

(t)  “Family” means a child(ren) and an adult(s) who reside in the same household and who have a birth, foster, step, adoptive, legal guardianship, or caretaker relative relationship.

 

(u)  “Founded” means a report of abuse or neglect where the department has determined that there is a preponderance of the evidence to believe that a child has been abused or neglected.

 

(v)  “Home-based therapeutic services” means the provision of intensive, short term, therapeutic interventions in the home setting in order to strengthen the family and prevent placement of the child(ren).

 

(w)  “Indicator” means a measure, for which data is available, that helps quantify the achievement of a desired result or outcome.

 

(x)  “Individualized education plan (IEP)” means a child-specific plan that meets educational needs, as defined in RSA 186-C:2, III.

 

(y)  “Individual service options (ISO) In-Home” means a variety of intensive therapeutic, social, and community-based services provided or coordinated to meet the individual needs of a child and his or her family in their residence to prevent placement or to provide post-placement family support, or in a DCYF general foster care setting.

 

(z)  “Juvenile probation and parole officer (JPPO)” means an employee of DCYF who discharges the powers and duties established by RSA 170-G:16, and supervises paroled delinquents pursuant to RSA 170-H.

 

(aa)  “Maltreatment” means the emotional or physical abuse or neglect of a child.

 

(ab)  “Medicaid prior authorization,” means the documentation provided by DCYF indicating the department’s responsibility for payment for medicaid eligible children.

 

(ac)  “NH bridges” means the automated case management, information, tracking, and reimbursement system used by DCYF.

 

(ad)  “NH medicaid mental health authority” means the office of community mental health services administration, under the division of behavioral health within DHHS.

 

(ae)  “Non-court-ordered” means any voluntary agreement between DCYF and a family.

 

(af)  “Outcome” means the intended result or consequence that will occur from carrying out a program or activity.

 

(ag)  “Performance indicators” means the utilization of data measurements to gauge program or activity performance.

 

(ah)  “Prescribing practitioner” means a provider licensed by the New Hampshire Board of Mental Health Practice, Board of Nursing, Board of Psychology or the Board of Medicine that provides services identified on 42 CFR 440:130 to reduce a physical or mental disability and aid in the restoration of a recipient to their best functional level, who demonstrates approval of a medicaid-covered in home support services by signing the child and family’s treatment plan.

 

(ai)  “Primary Caring Adult (PCA)” means someone who:

 

(1)  The child wants to be his or her primary caring adult with whom the child may or may not live upon case closure;

 

(2)  Is fit to serve as the child’s primary caring adult;

 

(3)  Makes a lifelong commitment to be the child’s primary source of guidance and encouragement;

 

(4)  Understands the child’s current and future needs; and

 

(5)  Is an adult other than the child’s parent.

 

(aj)  “Program consultant” means an individual who meets the requirements of the individuals listed in He-C 6339.16(j)(1) or (j)(2).

 

(ak)  “Progress report” means the monthly written notes, specific case reports, and outcome reporting sent by the staff of an agency that documents improvement or lack of improvement made by the child or family toward specific goals, and may also include demographic data and performance indicators, a summary of family contacts, modification to the treatment plan, educational contacts with other professionals, and the disposition of grievances.

 

(al)  “Provider” means the agency that serves a child or family and receives financial reimbursement from DHHS.

 

(am)  “Quality assurance” means the process that DCYF uses to monitor the quality and effectiveness of community-based in-home services.

 

(an)  “Service authorization” means the documentation provided by DCYF indicating the division’s responsibility for payment of community-based services for non-medicaid eligible children.

 

(ao)  “Structured decision making (SDM)” means a case management system utilizing a standardized, systematic approach to manage child protection services.

 

(ap)  “Therapeutic day treatment services” means in-depth, short-term, outcome-oriented, therapeutic services provided to enable a child to reside in the community.

 

(aq)  “Treatment plan” means the written, time-limited, goal-oriented, evidence based plan for the child and family developed by the provider and DCYF, which is in agreement with the DCYF case plan.

 

(ar)  “Voluntary services” means any voluntary, non-court ordered agreement between DCYF and a family.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.04  Application for Enrollment and Certification for Payment Standards for Community-Based In-Home Service.

 

(a)  Applicants who seek initial certification for payment standards for community-based in home service shall contact a DCYF district office supervisor or designee and request to be referred for certification.

 

(b)  Each applicant to be a provider of child health support services shall complete, sign, and submit, a Form 2603 “Application for Certification and Enrollment of Child Health Support Services Providers” (October 2016).

 

(c)  Each applicant shall complete, sign, and submit a “Statement of Affirmation” as part of Form 2603 “Application for Certification and Enrollment of Child Health Support Service Providers” (October 2016), that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the review document is a basis for denial of the continuation of certification. I understand that DCYF has the right to review the information contained in this review document;

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this review of continued certification;

 

By my signature below, I affirm that I have read and agree to adhere to administrative rule He-C 6339, “Certification for Payment Standards for In Home Community Based Service Providers.”

 

(d)  Part C of Form 2603 “Application for Certification and Enrollment of Child Health Support Service Providers” (October 2016) shall be completed, signed, and dated by each direct service staff and include the following:

 

“I declare that all the information contained above is true, correct and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.”

 

(e)  Each submitted and signed Part C of Form 2603 “Application for Certification and Enrollment of Child Health Support Service Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee:

 

“I certify that a criminal record check for this individual is completed and on file at the agency.”

 

(f)  The applicant shall provide the following information with or in addition to Form 2603 “Application for Certification and Enrollment of Child Health Support Service Providers” (October 2016):

 

(1)  A completed, signed, and dated “State of New Hampshire Alternative W-9. (October 2016);

 

(2)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone, and email address;

 

(3)  A copy of the organizational structure of the program;

 

(4)  Prescribing practitioner’s license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure; and

 

(7)  A copy of a current resume or curriculum vitae of the program consultant.

 

(g)  Each applicant for home-based therapeutic services shall complete and submit a signed and dated Form 2604 “Application for Certification and Enrollment of Home-based Therapeutic Service Providers” (October 2016).

 

(h)  A Part C of Form 2604 “Application for Certification and Enrollment of Home-based Therapeutic Service Providers” (October 2016) shall be signed and dated by each direct service staff, and include the following:

 

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.”

 

(i)  Each submitted and signed Part C of Form 2604 “Application for Certification and Enrollment of Home-based Therapeutic Service Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee:

 

“I certify that a criminal record check for this individual is completed and on file at the agency.”

 

(j)  The applicant shall submit a signed and dated “Statement of Affirmation” as part of Form 2604 “Application for Certification and Enrollment of Home-based Therapeutic Service Providers” (October 2016), that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of application.  I understand that DCYF has the right to review the information contained in this application.

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this application.

 

By my signature below, I affirm that I have read and agree to adhere to administrative rule He-C 6339, “Certification for Payment Standards in Home Community Based Service Providers.”

 

(k)  The applicant shall provide the following information with, or in addition, to Form 2604 “Application for Certification and Enrollment of Home-based Therapeutic Service Providers” (October 2016) in (f) above:

 

(1)  A copy of a completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016);

 

(2)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone, and email address;

 

(3)  A copy of the program organizational structure;

 

(4)  A copy of the prescribing practitioner’s license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure; and

 

(7) A copy of a current resume or curriculum vitae for the program coordinator and clinical supervisor.

 

(l)  Each applicant for therapeutic day treatment services shall complete and submit a signed and dated Form 2605 “Application for Certification and Enrollment of Therapeutic Day Service Providers” (October 2016).

 

(m)  Part C of Form 2605 “Application for Certification and Enrollment of Therapeutic Day Service Providers” (October 2016) shall be signed and dated by each direct service staff and include the following affirmation:

 

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of my application.”

 

(n)  Each submitted and signed Part C of Form 2605 “Application for Certification and Enrollment of Therapeutic Day Service Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee:

 

“I certify that a criminal record check for this individual is completed and on file at the agency.”

 

(o)  The applicant shall submit a signed and dated “Statement of Affirmation” as part of Form 2605 “Application for Certification and Enrollment of Therapeutic Day Service Providers” (October 2016) that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.  I understand that DCYF has the right to review the information contained in this application.

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this application.

 

By my signature below, I affirm that I have read and agree to adhere to Administrative Rule He-C 6339, “Certification for Payment Standards for In Home Community Based Service Providers.”

 

(p)  The applicant shall provide the following information with, or in addition to, Form 2605 “Application for Certification and Enrollment of Therapeutic Day Service Providers” (October 2016) in (m) above:

 

(1)  A completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016);

 

(2)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone, and email address;

 

(3)  A copy of the program organizational structure;

 

(4)  A copy of the prescribing practitioner license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure; and

 

(7)  A copy of a current resume or curriculum vitae for the program consultant.

 

(q)  Each applicant for adolescent community treatment services shall complete and submit a signed and dated Form 2602 “Application for Certification and Enrollment of Adolescent Community Treatment Service Providers” (October 2016).

 

(r)  Part C of Form 2602 “Application for Certification and Enrollment of Adolescent Community Treatment Service Providers” (October 2016) shall be signed and dated by each direct service staff and include the following affirmation:

 

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.”

 

(s)  Each submitted Part C of Form 2602 “Application for Certification and Enrollment of Adolescent Community Treatment Service Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee:

 

“I certify that a criminal record check for this individual is completed and on file at the agency.”

 

(t)  The applicant shall submit a signed and dated “Statement of Affirmation” as part of Form 2602 “Application for Certification and Enrollment of Adolescent Community Treatment Service Providers” (October 2016) that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.  I understand that DCYF has the right to review the information contained in this application.

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this application.

 

By my signature below, I affirm that I have read and agree to adhere to Administrative Rule He-C 6339, “Certification for Payment Standards for In Home Community Based Service Providers.”

 

(u)  The applicant shall provide the following information with, or in addition to, Form 2602 “Application for Certification and Enrollment of Adolescent Community Treatment Service Providers” (October 2016) in (q) above:

 

(1)  A completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016);

 

(2)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone, and email address;

 

(3)  The organizational structure of the program;

 

(4)  A copy of the prescribing practitioner’s license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure; and

 

(7)  A copy of a current resume or curriculum vitae for the program supervisor.”

 

(v)  Each applicant for individual service option in home provider shall complete and submit a signed and dated Form 2606 “Application for Certification and Enrollment of Individual Service Options (ISO) in Home Providers” (October 2016).

 

(w)  Part C 2606 “Application for Certification and Enrollment of Individual Service Options (ISO) in Home Providers” (October 2016) shall be signed and dated by each direct service staff and affirm, the following:

 

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.”

 

(x)  Each submitted and signed Part C of Form 2606 “Application for Certification and Enrollment of Individual Service Options (ISO) in Home Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee;

 

“I certify that a criminal record check for this individual is completed and on file at the agency.”

 

(y)  The applicant shall submit a signed and dated “Statement of Affirmation” as part of Form 2606 “Application for Certification and Enrollment of Individual Service Options (ISO) in Home Providers” (October 2016) that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.  I understand that DCYF has the right to review the information contained in this application.

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this application.

 

By my signature below, I affirm that I have read and agree to adhere to Administrative Rule He-C 6339, “Certification for Payment Standards for In Home Community Based Service Providers.”

 

(z)  The applicant shall provide the following information with or in addition to Form 2606 “Application for Certification and Enrollment of Individual Service Options (ISO) in Home Providers” (October 2016) in (v) above:

 

(1)  A completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016);

 

(2)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone, and email address;

 

(3)  A copy of the organizational structure of the program;

 

(4)  A copy of the prescribing practitioner’s license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure; and

 

(7)  A copy of a current resume or curriculum vitae for the program.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.05  Review of Continued Certification Compliance.

 

(a)  Community based in-home service providers shall complete and submit a completed, signed and dated Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016), as provided by DCYF, within 30 days of receipt.

 

(b)  Part C of Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) shall be signed and dated by each direct service staff and include the following affirmation:

 

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.”

 

(c)  Each submitted and signed Part C of Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) shall have the following attestation signed and dated by the executive director or designee:

 

“I certify that a criminal record check for this individual is completed an on file at the agency.”

 

(d)  The provider shall submit a signed and dated “Statement of Affirmation” as part of Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) that certifies the following:

 

“I affirm that all the information contained in this application is true, correct, and complete to the best of my knowledge and belief.  I acknowledge that the provision of false information in the application is a basis for denial of the application.  I understand that DCYF has the right to review the information contained in this application.

 

I affirm that I will notify DCYF in writing within 10 days of any change in the information contained in this application.

 

By my signature below, I affirm that I have read and agree to adhere to Administrative Rule He-C 6339, “Certification for Payment Standards for In Home Community Based Service Providers.””

 

(e)  The provider shall provide the following information with, or in addition to Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) in (a) above:

 

(1)  A copy of a resume or curriculum for the program coordinator and the executive director;

 

(2)  The organizational structure of the program;

 

(3)  The resume or curriculum vitae for the prescribing practitioner;

 

(4)  A copy of the prescribing practitioner’s license;

 

(5)  A copy of the professional and general liability insurance certificate(s) for the program;

 

(6)  A copy of the program brochure;

 

(7)  A current list of the board of directors including the following for each member of the board:

 

a.  The full name;

 

b.  The office held;

 

c.  The professional affiliation; and

 

d.  The address, telephone and email address;

 

(8)  A completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016).

 

(f)  Agencies that do not submit a signed and dated Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) within 30 days of receipt shall have their certification revoked in accordance with He-C 6339.22 and denied payment.

 

(g)  Renewal  of certification shall be made by filing a signed and dated Form 2607 “Review of Continued Certification for In-Home Community-Based Service Providers” (October 2016) and shall be based on a review and verification of the provider’s compliance with He-C 6339.14 and specific requirements for the service provided.

 

(h)  Review of continued certification compliance shall occur every 5 years from date of issue.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.06  Notification of Changes.

 

(a)  All providers shall notify DCYF in writing within 10 days of any change in the information contained in the application and provide documentation of the change.

 

(b)  Each agency shall send any new staff information to DCYF.

 

(c)  All providers shall submit a copy of renewed license to DCYF within 10 days of receipt from the New Hampshire licensing authority.

 

(d)  The provider shall notify DCYF of any changes in tax information and complete and submit to DCYF a completed, signed, and dated “State of New Hampshire Alternative W-9” (October 2016) form with its current tax information.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.07  Billing Requirements for Community-Based In-Home Services.

 

(a)  All providers shall be certified and enrolled pursuant to He-C 6339.04 prior to being eligible for reimbursement by DHHS.

 

(b)  The provider shall not bill DHHS for services that are to be reimbursed by another entity.

 

(c)  Providers shall not exceed the rates established by DCYF nor will the rates exceed those charged by the provider for non-DCYF children and in no event shall DCYF be liable for any payments hereunder in excess of such available and appropriate funds.

 

(d)  The provider shall accept reimbursement made by DHHS as payment in full for the services provided.

 

(e)  DCYF shall determine the need for services and the determination shall be binding on the provider.

 

(f)  The provider, if incorporated and if requested, shall submit to DCYF an audited financial statement prepared by an independent licensed public accountant.

 

(g)  The provider shall provide services or care without discrimination as required by Title VI of the Civil Rights Act of 1964, as amended, and without discrimination on the basis of handicap as required by Section 504 of the Rehabilitation Act of 1973, as amended.

 

(h)  The provider’s certification and enrollment shall terminate upon date of sale or transfer of ownership or close of the agency.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

 

He-C 6339.08  Billing Process for Community-Based In-Home Services.

 

(a)  Prior to service delivery, a provider shall obtain an authorization form, which consists of one of the following:

 

(1)  For medicaid eligible recipients, a ”New Hampshire Title XIX Medicaid Program Service Authorization” from the New Hampshire Medicaid fiscal agent or

 

(2)  For non-medicaid eligible recipients, a Form 2110 “Service Authorization”(6/30/2008).

 

(b)  A provider shall bill the NH medicaid fiscal agent for medicaid eligible recipients either via paper claims or electronic claims submission, following the directions outlined by the NH medicaid fiscal agent, as follows:

 

(1)  For a paper claim submission, a provider shall complete a CMS 1500 form and mail it to the NH medicaid fiscal agent; or

 

(2)  For electronic claim submission, a provider shall submit an electronic claim to the NH medicaid fiscal agent.

 

(c)  A provider shall bill the department through NH Bridges for non-medicaid eligible recipients either via paper claims or electronic claims submission, as specified in (d) and (e) below.

 

(d)  For paper claim submissions for all services, a provider shall:

 

(1)  Copy the Form 2110 “Service Authorization” 6/30/2008) for future billings, if the authorized service dates span a date range;

 

(2)  Complete and submit a copy of the Form 2110 “Service Authorization” (6/30/2008) to the department;

 

(e)  For electronic claim submissions, a provider shall:

 

(1)  Request a web billing account from DHHS by completing, signing, and submitting Form 2679 “Provider Web Billing User Account Request Form” (October 2016);

 

(2)  Be issued a log on and personal identification number (PIN) by DHHS for use in accessing the web billing account; and

 

(3)  Neither the provider nor any authorized representative shall transfer his or her log on or PIN, or allow use of his or her log on or PIN by any other person.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.09  Billing Period.

 

(a)  A provider shall bill within one year of the date of provision of a service.

 

(b)  Any bill received after one year of the date of the provision of a service shall be denied pursuant to RSA 126-A:3.

 

(c)  A provider shall submit bills at least on a monthly basis.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.10  Billing Discrepancies.  Questions regarding billing discrepancies shall be directed to the provider relations’ staff of the bureau of administrative operations in DCYF.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.11  Record-Keeping and Record Retention.

 

(a)  A provider shall retain records for a period of no less than 7 years after the completion date of a provided service for each bill submitted to the department, any legally liable county, the medicaid fiscal agent, or a private insurance company.

 

(b)  The provider shall keep records as are necessary to comply with RSA 170-E: 42, when applicable, and to comply with DCYF record-keeping requirements in He-C 6339.

 

(c)  Records shall clearly document the extent of the care and services provided to children and families, including attendance records when those services are charged to the department, and information regarding any payment claimed.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.12  Quality Assurance Activities and Monitoring of Community Based In-home Service Providers.

 

(a)  The provider shall participate in quality assurance activities conducted by DCYF using a variety of activities that may include a combination of record reviews, performance data measurements, and visits to providers.

 

(b)  The provider shall allow an on-site visit by DCYF which may be random or scheduled, for the purposes of:

 

(1)  Interviewing program staff;

 

(2)  Reviewing program documents to determine continued compliance with He-C 6339; and

 

(3)  Examining agency case records for DCYF families.

 

(c)  Providers shall ensure that clinical records, including all progress reports, are available for inspection and review by DCYF staff during any on-site quality assurance or monitoring visit.

 

(d)  Service providers shall be subject to monitoring and evaluation by DCYF through a variety of activities that include:

 

(1)  Queries of data that is stored on NH Bridges case management system and the medicaid management information system (MMIS);

 

(2)  Reviews of case record information;

 

(3)  Data reporting from the service providers; and

 

(4)  Satisfaction surveys from stakeholders, such as families, CPSWs, and JPPOs.

 

(e)  Providers not demonstrating compliance with the provisions of He-C 6339 shall meet with DCYF to develop an approved corrective action plan that includes:

 

(1)  Areas of concern or noncompliance with He-C 6339;

 

(2)  Areas of performance needing improvement;

 

(3)  Recommendations for corrective action or program improvements;

 

(4)  Determinations on corrective action timeframes and any additional responses by the agency; and

 

(5)  Any recommendation regarding continued certification or revocation of certification.

 

(f)  A service provider shall be notified of any problems that are noted on the DCYF staff surveys that include:

 

(1)  Negative responses concerning quality and timeliness of service provision; and

 

(2)  Written comments about agency performance.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.13  Reporting Requirements.

 

(a)  Each service provider shall:

 

(1)  With the assistance of a DCYF representative, if necessary, prepare an annual report of all statistical information used to measure achievement; and

 

(2)  Submit the annual report to DCYF no later than 30 days following the end of the calendar year.

 

(b)  The annual report shall include the following information:

 

(1)  Services provided and changes in strategies that resulted in effective outcomes;

 

(2) Issues with the service utilization and observations about shifts in the targeted service population;

 

(3)  Barriers discovered in the system of care; and

 

(4)  Proposed enhancements to performance indicators.

 

(c)  The provider shall submit monthly reports on outcomes and performance data to DCYF.

 

(d)  Data reports shall be completed and submitted to DCYF no later than 15 days following the end of the month.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.14  Compliance Requirements.

 

(a)  The provider shall comply with:

 

(1)  All applicable licensing and registration requirements prior to applying for certification;

 

(2)  The medical assistance requirements of He-W 500 and He-M 426;

 

(3)  The statutes regarding confidentiality, including RSA 169-B:35, RSA 169-C:25, RSA 169-D:25, RSA 170-B:19, RSA 170-C:14, and RSA 170-G:8-a; and

 

(4)  The child abuse and neglect reporting requirements of RSA 169-C:29-30.

 

(b)  For all direct services staff, prior to beginning their work with children, and thereafter on an annual basis, the provider shall review the sections of RSA 169 on definitions, immunity from liability, and persons required to report.

 

(c)  The provider and his or her employees shall not have a conflict of interest, as defined in He-C 6339.03(k).

 

(d)  The provider shall maintain both professional and general liability insurance.

 

(e)  Whenever transportation services are provided, the agency shall:

 

(1)  Verify that each driver possesses a valid driver’s license;

 

(2)  Verify that each driver has automobile insurance liability coverage;

 

(3) Conduct a motor vehicle record check to verify that each driver has no convictions for impaired driving or multiple motor vehicle violations; and

 

(4) Obtain a criminal records check to verify that each driver has no convictions for crimes against persons.

 

(f)  When domestic violence is identified as an issue for a family, each agency shall follow the “Mental Health Domestic Violence Protocols” (2009), as prepared by the NH governor’s commission on domestic violence and available via the Internet at http://doj.nh.gov/criminal/victim-assistance/protocols from the NH department of justice as listed in Appendix A.

 

(g)  The provider shall:

 

(1)  Be an enrolled NH medicaid provider agency;

 

(2) Employ or contract with a prescribing practitioner who demonstrates approval of the medicaid-covered services by signing the child and family’s treatment plan; and

 

(3)  Accept medicaid payment as payment in full.

 

(h)  The provider shall bill all third party sources of reimbursement, including private health insurance and medicaid, prior to billing DCYF.

 

(i)  As part of the certification requirements, each agency shall provide to each family a written description of their services, including:

 

(1)  Agency staff availability to families;

 

(2)  The services as reflected in the service provision guidelines for each category of service; and

 

(3) The cost of the service, including the parent’s obligation to re-pay a portion of service provision, as applicable.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.15  Treatment Planning and Progress Reports.

 

(a)  The provider shall develop a treatment plan for each child or family receiving their services, with input from individuals described in (b) below.

 

(b)  The following individuals shall be included on the treatment team:

 

(1)  The child, if age and developmentally appropriate;

 

(2)  The child’s parents;

 

(3)  The CPSW or JPPO, or both;

 

(4)  The prescribing practitioner;

 

(5)  Staff members from the agency;

 

(6)  School district personnel as determined by the school districts if applicable; and

 

(7)  Other persons significant to the family, who may include:

 

a.  Teachers;

 

b.  Counselors;

 

c.  Friends;

 

d.  Relatives; and

 

e.  Advocates and primary caring adults assigned by the court.

 

(c)  The treatment plan shall include:

 

(1)  The findings of the assessment as required for the service being provided;

 

(2)  An estimate by the treatment team members of the length of service to be provided to the child and family, based upon referral information and the agency’s assessment;

 

(3)  The child’s permanency plan, identifying one of the following alternatives for the child, as identified by the CPSW or JPPO:

 

a.  Maintain in his or her own home;

 

b.  Reunification with the family;

 

c.  Planned permanent living arrangements;

 

d.  Permanent relative placement;

 

e.  Guardianship by a relative or other person; or

 

f.  Adoption;

 

(4)  A concurrent plan as an alternative to the child’s permanent plan as identified by the CPSW or JPPO; and

 

(5)  The objectives that fall within one or more of the following domains:

 

a.  Safety and behavior of the child;

 

b.  Family;

 

c.  Medical;

 

d.  Education; and

 

e.  Independent living skills training, when applicable.

 

(d)  Each domain identified in (c)(5) above shall address:

 

(1)  The goals and objectives to be achieved by the child and family;

 

(2)  The timeframes for completion of goals and objectives;

 

(3)  An identification of the services that will be provided directly or arranged for, and any measures for ensuring their integration with the child’s activities, including identifying how the child’s family will participate in their care;

 

(4)  The frequency of services; and

 

(5) An identification of the staff responsible for implementing the stated interventions in the treatment plan.

 

(e)  For cases in which reunification is the identified goal, the treatment plan shall include:

 

(1)  A community reintegration and transition plan that identifies the needed supports that would enable the child to return to his or her community; and

 

(2)  The responsibilities of the participants for completing steps necessary to implement the plan.

 

(f)  The treatment plan shall be signed and dated by the following team members, indicating they participated in the process:

 

(1)  The provider’s executive director or treatment coordinator;

 

(2)  The CPSW, JPPO, or both;

 

(3)  When applicable for medicaid funding, the prescribing practitioner;

 

(4)  When age and developmentally appropriate, the child; and

 

(5)  The child’s parents or guardian.

 

(g)  Revisions to the treatment plan shall be explained in writing to any individuals of the team who are unable to participate.

 

(h)  The treatment plan shall be filed in the child’s record and copies sent to:

 

(1)  The CPSW, JPPO, or both;

 

(2)  The child’s parent or guardian; and

 

(3)  The prescribing practitioner.

 

(i)  Once the treatment plan is completed, the agency staff shall receive supervision and instruction by the program supervisors and program consultants, if any, to assure that each child’s treatment plan is consistently implemented.

 

(j)  Each service provider shall provide progress reports and outcomes data for each child in care, in accordance with (k) below.

 

(k)  Progress reports shall include the following:

 

(1)  Monthly written progress reports, which shall be sent to the CPSW or JPPO no later than 15 days following the end of the month; and

 

(2)  Outcome reports, which shall be sent electronically to the DCYF state office on a quarterly basis.

 

(l)  Written progress reports, court reports, and termination reports prepared by the agency shall clearly and accurately reflect the family’s progress and be submitted on time pursuant to RSA 169-B:5-a, RSA 169-C:12-b and RSA 169-D:4-a; as follows:

 

(1)  Specific court reports, which shall be sent to the court with a copy to the CPSW or JPPO no later than 5 days before the scheduled court date, pursuant to RSA 169-B:5-a, RSA 169-C:12-b and RSA 169-D:4-a; and

 

(2)  Service termination reports, which shall be sent to the CPSW or JPPO no later than 15 days following termination.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.16  Requirements for Child Health Support Services.

 

(a) The provider shall comply with sections He-C 6339.01 through He-C 6339.15 for certification compliance.

 

(b)  Authorization for payment for child health support services shall be pursuant to a court order, or a non-court ordered or voluntary agreement between DCYF and the family.

 

(c)  A provider shall not provide services that exceed 90 days per year without prior approval from the CPSW or JPPO.

 

(d)  Service for an additional 90 days per year shall be authorized when the following conditions are met:

 

(1)  The family’s problems have not been resolved and the child remains at risk for out-of-home placement;

 

(2)  The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

 

(3)  The provider submits the following information in writing to the CPSW or JPPO:

 

a.  The reason(s) for continued services;

 

b.  The beginning and ending dates for continued services;

 

c.  The goals for the continued period of services; and

 

d.  The anticipated child and family outcomes.

 

(e)  Child health support services shall be provided for the following:

 

(1)  Families at risk of having a child removed from the home due to maltreatment;

 

(2)  Young parents, including teen parents and others who are inexperienced and struggling with their parental responsibilities;

 

(3)  Socially isolated families who lack appropriate parenting role models and access to supportive services;

 

(4)  Families in which ineffective child management techniques are being employed and children who may be withdrawn or depressed, aggressive, delinquent, anxious, or display self-destructive behaviors;

 

(5)  Families where the parents are in the home, but temporarily are unable to effectively carry out parenting functions because of physical or mental illness, disabilities, convalescence, substance abuse, or complications of pregnancy;

 

(6)  Families in which the parents’ ability to effectively parent their children is diminished due to a preoccupation with the care of other family members, such as a spouse, child, or a grandparent who is chronically ill, convalescing, or permanently disabled, or when a parent has a prolonged grief reaction over the death of a spouse, child, or other person;

 

(7)  Families in need of help to learn how to care for children due to lack of knowledge, emotional immaturity, or overwhelming responsibility for many children;

 

(8)  Families headed by grandparents or other relatives who are overwhelmed with the responsibilities of parenting, thereby placing the child at risk of placement in another home;

 

(9)  Families in which the child has been placed out of the home on a temporary basis and the parents need therapeutic intervention to prepare for the return of the child, including help with issues such as appropriate parenting, child management techniques, discipline, communication skills, and anger management, as well as safety of the physical home environment;

 

(10)  Families who need therapeutic intervention to avert future neglect, abuse, delinquency, status offenses, emotional disturbances, and out-of-home placement of a child;

 

(11)  Families who provide foster care who require additional assistance in order to preserve the placement; and

 

(12)  Adoptive families to preserve the family unit.

 

(f)  Child health support services shall include:

 

(1)  An initial health and behavioral health assessment, including the following;

 

a.  The health status of each family member;

 

b.  A behavioral health diagnosis and treatment received;

 

c.  The prescription medications of each family member; and

 

d.  The needs of the children and parents;

 

(2)  Addiction recovery support  that includes ongoing risk assessment and referral for substance abuse treatment, as well as supportive counseling for those in addiction treatment programs to reduce the effects these addictions have on parenting abilities;

 

(3)  Family-based support that includes education, consultation, and follow-up activities that develop and maintain family support systems to enhance and encourage parental coping and nurturing skills, assessment of parent and child interaction, family counseling and skill building for parents and their children who are in an out-of-home placement, and parenting skills instruction, including role modeling;

 

(4)  Behavior management that includes:

 

a.  An initial behavioral health assessment of the family;

 

b.  Assistance with the development and implementation of behavior strategies for the children and parents in conjunction with child development, including managing the child’s behavior through appropriate discipline;

 

c.  Education and parenting skills to inform and prepare parents for a child’s behaviors and needs, including age appropriate socialization skills of the child;

 

d.  Family support focused on coping skills, stress management, conflict resolution, and impulse control; and

 

e.  Support family and modeling behavioral strategies;

 

(5)  An assessment of the family’s home health care management and education of physical or behavioral illnesses, as well as providing assistance to parents in implementing medical regimes as they relate to their tasks of daily living as prescribed by their medical and behavioral health provider;

 

(6)  Family support with household management that includes safety instruction to eliminate, reduce, or avoid hazards in the home;

 

(7)  Family support with nutritional education that includes safe food handling procedures and dietary needs of children and family;

 

(8) Connections and facility referrals to community resources and supports that includes instruction, and assistance with accessing community agencies and services; and

 

(9)  Parent education about age appropriate activities, discipline and behavior modification including supervised visitation between parent(s) and children, as ordered by the court.

 

(g)  A provider for child health support services shall:

 

(1)  Review the DCYF case plan;

 

(2)  Complete an initial behavioral health needs assessment for the family and using information from the DCYF case plan develop a treatment plan within 30 days of the referral;

 

(3)  Provide a completed treatment plan to the CPSW or JPPO within 30 days of referral;

 

(4)  The agency shall document each family visit, including:

 

a.  The type of service;

 

b.  The date of service;

 

c  The names of the family members and other individuals who participated;

 

d.  The name of the agency staff who assisted the family;

 

e.  A brief summary of the in-home session;

 

f.  The length of time spent with the family; and

 

g.  The provider’s signature and the signature of a family member and child, as is age appropriate;

 

(5)  Retain a copy of the log of visits and contacts in the family’s file for review during the onsite visits;

 

(6)  Attend case planning or treatment-planning meetings with the family as requested by the CPSW or JPPO;

 

(7)  Discuss discharge planning needs with the family members and the CPSW or JPPO;

 

(8)  Discuss the reason for service termination with the family and CPSW or JPPO;

 

(9)  Immediately notify the CPSW or JPPO of any significant changes in or affecting the family, such as:

 

a.  Changes in  employment or income;

 

b.  Housing changes including eviction notice;

 

c.  Death or serious injury or illness of a family member;

 

d.  Separation of the caregivers;

 

e.  Unplanned pregnancy;

 

f.  Changes in patterns of school attendance;

 

g.  Arrests;

 

h.  Police contacts; or

 

i.  Probation or parole violations;

 

(10)  Provide each family with a written description of services, as described in He-C 6339.14 including the cost of the service and potential reimbursement by the family to the DHHS for the services provided;

 

(11)  Employ staff that provides evening, weekend, and holiday coverage to meet the needs of the family;

 

(12)  Employ child health support aides in sufficient number to maintain a 1:6 average aide-to-family caseload ratio; not to exceed 1:9;

 

(13)  Provide child health support aides with agency identification; and

 

(14)  Have an agency policy in place regarding missed appointments by client families.

 

(h)  The agency shall employ or contract with a prescribing practitioner.

 

(i)  The agency shall employ or contract with a program consultant who is available for consultation with child health support aides.

 

(j)  The program consultant referenced in (i) above shall meet one of the following:

 

(1)  For cases when the primary issue is physical health, a physician, physician assistant, advanced registered nurse practitioner (ARNP), registered nurse (RN), or licensed practical nurse (LPN); and

 

(2)  For cases when the primary issue is behavioral health, licensed psychologist, licensed pastoral psychotherapist, licensed clinical social worker, licensed clinical mental health counselor, or licensed marriage and family therapist.

 

(k)  The prescribing practitioner servicing as the program consultant shall:

 

(1)   Sign each treatment plan separately as both the prescribing practitioner and program consultant; and

 

(2)  Meet the definition of prescribing practitioner.

 

(l)  The program consultant shall review the treatment plan no less than quarterly and document the review by signing and dating the treatment plan.

 

(m)  The agency shall employ child health support aides who:

 

(1)  Are at least 22 years of age; and

 

(2)  Possess:

 

a.  A bachelor’s degree from an accredited college or university with a major study in nursing, health, psychology, social work, sociology, education, guidance, or a related field emphasizing human relations, physical, or behavioral health;

 

b.  An associate’s degree from an accredited college or university with a major study in nursing, health, psychology, social work, sociology, education, guidance, or a related field emphasizing human relations, physical, or behavioral health and have 2 years’ experience working with families or other relevant human services experience; or

 

c.  A high school diploma or general equivalency diploma and have 4 years experience working with families or other relevant human services experience.

 

(n)  In addition to the requirements in (m) above, all child health support aides shall:

 

(1)  Complete a minimum of 20 hours per year of in-service training, as follows:

 

a.  At least 8 of the 20 hours shall be family systems training; and

 

b.  12 hours of the overall training hours may be provided in supervision and staff meetings that relate to general therapeutic topics such as:

 

1.  Substance use disorders:

 

2.  Child abuse and neglect;

 

3.  Labor and sex trafficking;

 

4.  Sexual abuse;

 

5.  Domestic and family violence;

 

6.  Behavioral health needs of children and families;

 

7.  Safety planning for family members;

 

8.  Crisis intervention techniques;

 

9.  Early childhood screening and child development;

 

10.  Trauma informed practice, including screening and evidence-based practices;

 

11.  Treatment of any co-occurring disorders;

 

12.  Restorative practices and delinquency prevention;

 

13.  Behavioral management techniques; and

 

14.  Infant safe sleeping practices.

 

(o)  The agency shall maintain documentation of training that includes:

 

a.  The dates of training;

 

b.  The names of  training sessions attended; and

 

c.  The number of hours per training.

 

(p)  Child health support aides shall:

 

(1)  Be available for immediate contact so appointments may be scheduled or canceled; and

 

(2)  Carry and present agency identification to the child’s caregiver as necessary.

 

(q)  The program supervisor shall provide a minimum of one hour per week of individual clinical supervision for a the child health support aide working full time and pro-rated for part time staff to review the progress and barriers of each case, for which one session per month may be substituted with group supervision.

 

(r)  The agency shall complete annual staff evaluations.

 

(s)  Within 15 days after service termination, the agency shall forward a report to the CPSW, JPPO or his or her supervisor, that includes:

 

(1)  A summary of visits and contacts with the family, including dates, duration, and locations;

 

(2)  A summary of the progress or lack of progress in meeting the treatment plan, including the tasks accomplished, timeframes, and measurable outcomes achieved;

 

(3)  New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation, or court report;

 

(4)  The community resources and supports available to the family that might be accessed in the future;

 

(5)  Recommendation for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child as specified in the treatment plan and how the provider has worked with the family to assist them in accessing recommended services; and

 

(6)  The dated and signature of the child health support aide and prescribing practitioner;

 

(t)  If services are terminated prior to the 15th day of the month, no monthly progress report shall be required for the month.  The information for the month in which services are terminated shall be included in a discharge report.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.17  Requirements for Home-Based Therapeutic Services.

 

(a) The provider shall comply with sections He-C 6339.01 through He-C 6339.15 for certification compliance.

 

(b)  Authorization for payment for home-based therapeutic services shall be pursuant to a court order, or a non-court-ordered or voluntary agreement between DCYF and the family.

 

(c)  A provider shall not provide services that exceed 90 days per year without prior approval from the CPSW or JPPO.

 

(d)  Service for an additional 90 days per year shall be authorized when the following conditions are met:

 

(1)  The family’s problems have not been resolved and the child remains at risk for out-of home placement;

 

(2)  The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

 

(3)  The provider submits the following documentation to the CPSW or JPPO:

 

a.  The therapeutic need(s) for continued services;

 

b.  The beginning and anticipated ending dates for the continued services request;

 

c.  The goals for the continued period of services; and

 

d.  The anticipated child and family outcomes.

 

(e)  Home-based therapeutic services shall be provided for:

 

(1)  Families with a child who is at imminent risk for placement;

 

(2)  A family with a child who has returned home or is at risk of returning to placement;

 

(3) Families where the parents are temporarily unable to deal with their child-rearing responsibilities because of a family member’s physical or mental illness, disability, convalescence, substance use disorder, or pregnancy;

 

(4)  Families temporarily under stress with the care of a parent, child, or another member of the family;

 

(5)  Families for whom child placement has been determined necessary to ensure safety and the parents need assistance preparing for the placement or return of the child to a safe environment;

 

(6)  Parents who request voluntary services, including voluntary children in need of services (CHINS) and the requested service is not available to the family through a community service agency;

 

(7)  Families, including those who provide foster care services, needing assistance to strengthen and support the child’s current placement in a foster home or a relative’s home;

 

(8)  Families who are experiencing a crisis that might require the removal of a child due to physical abuse or neglect by the parent or caregiver or unlawful behaviors by the child such as school truancy, running away, or delinquency; or

 

(9)  Families in crisis whose child is immediately placed in emergency care for safety reasons after the initial DCYF assessment or due to legal or judicial intervention because of juvenile offenses, and the family’s goal is for the child to return home with this service provided.

 

(f)  Home-based therapeutic services shall include:

 

(1)  On-call 24-hour availability to families;

 

(2)  Assessment and service planning based on the DCYF case plan or pre-dispositional investigation report or treatment and ongoing assessment for each child enrolled in the program;

 

(3)  Substance use disorder recovery support that includes ongoing risk assessment and referral for substance abuse treatment, as well as supportive counseling for those in addiction treatment programs to reduce the effects these addictions have on the child and parent;

 

(4)  Family and individual counseling with family members and persons in their immediate support system to develop or maintain family growth and assistance necessary for independent family functioning;

 

(5)  Assistance to parents in  compliance with court orders;

 

(6)  Crisis assistance and safety planning with families by responding immediately to a family’s needs;

 

(7)  Referrals and coordination to other services and supports made with JPPO and CPSW;

 

(8)  A written description of services, as described in He-C 6339.14 including the cost of the service and potential reimbursement by the family to the state for services provided;

 

(9)  For families who need crisis assistance:

 

a. A face-to-face meeting initiated within 24 hours of referral to complete an initial assessment and develop an immediate safety plan that includes strategies for diffusing the crisis and maintaining the safety of all family members;

 

b.  Submit the safety plan in writing to the JPPO or CPSW within 72 hours; and

 

c. If safety cannot be assured at the face-to-face meeting, immediately develop and coordinate an alternative safety plan with the JPPO or CPSW,  the program administrator, or DCYF field administrator or supervisor during weekends and holidays; and

 

(10)  For families not in need of crisis assistance:

 

a.  Contact the family within 48 hours of referral, excluding weekends and holidays; and

 

b.  Have a face-to-face meeting with the family within 5 working days of the date of the referral to conduct an initial assessment and develop the treatment plan; and

 

(11)  An assessment of the needs of each child and the parents that is based upon:

 

a.  The information included from one of the following:

 

1.  The DCYF case plan, pursuant to RSA 170-G:4 III and court reports pursuant to RSA 169-B:5-a, RSA 169-C:12-b or RSA 169-D:4-a; or

 

2.  The investigation report, pursuant to RSA 170-G:16, I or III, RSA 169-B:16, III-IV, or RSA 169-D:14, III-IV; and

 

b.  Identification of substance use disorders, domestic and family violence, sexual abuse, or other situations that impact the child’s safety.

 

(g)  When available, the CPSW or JPPO shall be present for the initial assessment and development of the treatment plan.

 

(h)  Face-to-face meetings with families shall include parents or other caregivers, the child or children, and other family members as necessary to develop and implement the treatment plan.

 

(i)  The therapist shall maintain an on-going log of contacts and visits with family members and with school, health, and other service providers including the following:

 

(1)  The type of service;

 

(2)  The date of service;

 

(3)  The names of the family members and other individuals who participated;

 

(4)  The name of the therapist who assisted the family;

 

(5)  A brief summary of the in-home session;

 

(6)  The length of time spent with the family; and

 

(7)  The provider’s signature and the signature of the family member and child.

 

(j)  The agency shall immediately notify the JPPO or CPSW of any significant changes in or affecting the family, such as:

 

(1)  Change of employment or income;

 

(2)  Housing changes including an eviction notice;

 

(3)  Death or serious injury or illness of a family member;

 

(4)  Separation of the caregivers;

 

(5)  Unplanned pregnancy;

 

(6)  Changes in patterns of school attendance;

 

(7)  Arrests;

 

(8)  Police contacts; or

 

(9)  Violations of probation or parole.

 

(k)  The agency shall have a policy in place regarding missed appointments by client families.

 

(l)  The home-based therapeutic agency shall:

 

(1)  Employ or contract with a prescribing practitioner;

 

(2)  Employ a program coordinator who meets the following:

 

a.  A master’s degree in social work, psychology, education, or a related field with an emphasis in human services;

 

b.  Two years clinical experience working with families, and

 

c.  Two years supervisory or management experience;

 

(3)  Employ therapists who have:

 

a.  A master’s degree with a major in social work, counseling, psychology, or a related field and at least 2 years of direct work experience in assisting children and families; or

 

b.  A bachelor’s degree with a major in social work, counseling, psychology, or a related field and at least 5 years of direct work experience in assisting children and families; and

 

(4)  Employ case managers who meet the following minimum qualifications:

 

a.  A bachelor’s degree in social work, psychology, education or a related field with an emphasis in human services; and

 

b.  Experience of 2 years with children and families.

 

(m)  The prescribing practitioner serving as the program consultant shall:

 

(1) Sign each treatment plan separately as both the prescribing practitioner and program consultant; and

 

(2)  Meet the definition of prescribing practitioner.

 

(n)  Therapists and case managers shall participate in weekly supervision that includes a discussion of each case and a review of the progress made by each family towards the goals of the treatment plan.

 

(o)  The agency shall have at least one full-time program coordinator for every 6 therapists.

 

(p)  Program coordinators shall be available to the therapists and case managers 24 hours a day, 7 days a week.

 

(q)  Each therapist and case manager shall have an annual evaluation with a copy maintained in his or her file.

 

(r)  Each therapist and shall complete a minimum of 20 hours of training per year that includes topics related to:

 

(1)  Family systems;

 

(2)  Substance use disorders;

 

(3)  Child abuse and neglect;

 

(4)  Labor or sex trafficking;

 

(5)  Sexual abuse;

 

(6)  Domestic and family violence;

 

(7)  Behavioral health;

 

(8)  Safety planning for family members;

 

(9)  Crisis intervention techniques;

 

(10)  Early childhood and screening and child development;

 

(11)  Trauma informed practice, including evidence-based practices;

 

(12)  Treatment of any co-occurring disorders;

 

(13)  Behavioral management techniques; and

 

(14)  Infant safe sleeping practices.

 

(s)  For each therapist and case manager, the agency shall maintain on file copies of training certificates, signed by the trainer, that document:

 

(1)  The names of training sessions attended;

 

(2)  The number of hours per training; and

 

(3)  The dates of training.

 

(t)  The therapist’s and case manager’s caseload shall not exceed an average of 6 families per month.

 

(u)  The therapist and case manager shall participate in weekly supervision that includes a discussion of the progress made by each family.

 

(v)  Within 15 days after service termination, the agency shall forward to the CPSW, JPPO, or  the supervisor a report that includes:

 

(1)  A summary of visits and contacts with the family, including dates, duration, and locations;

 

(2)  A summary of the progress or lack of progress in meeting the treatment plan, including the tasks accomplished, timeframes, and measurable outcomes achieved;

 

(3) New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation report, or court report;

 

(4)  The community resources and supports available to the family that might be accessed in the future, if needed;

 

(5)  Recommendations for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child, as specified in the treatment plan, and how the provider has worked with the family to assist them in accessing recommended services; and

 

(6)  The date and signature of the prescribing practitioner and therapist;

 

(w)  If services are terminated prior to the 15th day of the month, no monthly progress report shall not be required for the month.  The information for the month in which services are terminated shall be included in a discharge report.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.18  Therapeutic Day Treatment Services Programs.

 

(a) The provider shall comply with sections He-C 6339.01 through 6339.15 for certification compliance.

 

(b)  Authorization for payment for therapeutic day treatment services shall be pursuant to a court order, or a non-court ordered or voluntary agreement between DCYF and the family.

 

(c)  Services shall be limited to a period of time not to exceed 180 days. 

 

(d)  Service for an additional 90 days per year shall be authorized when the following conditions are met:

 

(1)  The family’s problems have not been resolved and the child remains at risk for out-of-home placement;

 

(2)  The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

 

(3)  The provider submits the following documentation to the CPSW or JPPO;

 

a.  The reason(s) for continued services;

 

b.  The beginning and ending dates for continued services;

 

c.  The goals for the continued period of services; and

 

d.  The anticipated child and family outcomes.

 

(e)  Therapeutic day treatment services shall be provided for children who are:

 

(1)  Experiencing challenging conditions in one or more of the following domains:

 

a.  Developmental;

 

b.  Psychological;

 

b.  Social;

 

c.  Family;

 

d.  Cognitive;

 

e.  Educational;

 

f.  Behavioral; or

 

g.  Substance use;

 

(2)  At imminent risk for out-of-home placement or actively engaged in reuniting with family and community; or

 

(3)  In families who provide foster care who require additional support in order to preserve the placement.

 

(f)  Therapeutic day treatment services shall not be a substitute for special education or other federally required educational services.

 

(g)  A provider for therapeutic day treatment services shall offer the following:

 

(1)  Assessment and service planning based on the DCYF case plan or pre-dispositional investigation report or treatment and ongoing assessment for each child enrolled in the program;

 

(2)  Crisis intervention and stabilization;

 

(3)  Evidence-based practice or best practice; and

 

(4) Evidence-based psychotherapies, including individual, group, and family counseling that might occur in a community or in-home setting;

 

(h)  In addition to the requirements in (g) above, programs shall offer any combination of the following, as necessary:

 

(1)  Vocational assessment, when specifically requested by the CPSW or JPPO;

 

(2)  Health education, including substance use disorder prevention, sexual health, nutrition counseling, and physical fitness;

 

(3)  Parent education, parent skills training, and parent support groups;

 

(4)  Therapeutic recreation, such as adventure-based and experiential activities; and

 

(5)  After school, weekend, and school vacation therapeutic programming.

 

(i)  Interagency referral, coordination, and collaboration between DCYF, education, behavioral health, developmental disabilities, medical, and any other involved discipline shall be a component of therapeutic day treatment services.

 

(j)  A provider for therapeutic day treatment services shall:

 

(1)  Review each child and family referral, including pertinent documentation and previous evaluations to determine appropriateness for therapeutic day treatment;

 

(2)  Conduct a clinical assessment within 7 working days of referral that includes an individual and family needs assessment and a mental status examination for each child, as appropriate to the program offering, unless current assessments or mental status examinations have been completed within the past year and identification of the strengths and resources of the family;

 

(3)  Within 30 days of referral, develop and implement an individually designed treatment plan, in conjunction with the CPSW or JPPO and the child and parents;

 

(4)  Provide each family with a written description of services as described in He C 6339.14, including the cost of the service and potential reimbursement by the family to the state for services provided;

 

(5)  Provide 24-hour emergency coverage, 7 days per week for the child and family; and

 

(6)  Maintain a record for each child and family that includes:

 

a. Child and family names, medicaid and other third party identification numbers, addresses, and birth dates;

 

b.  Child’s medical, social, developmental, educational, and family history;

 

c.  Child’s diagnosis and the name of attending physician, psychiatrist, or psychologist;

 

d.  DCYF case plan;

 

e.  Child’s individual education plan, if applicable;

 

f.  A description of any tests ordered and performed and their results;

 

g.  A description of treatment, including measurable goals and timeframes;

 

h.  A list of any medications prescribed;

 

i.  Plan for coordinating services with other providers;

 

j.  Daily progress notes indicating the services provided to the child;

 

k.  Monthly progress summary which identifies the services provided and progress toward achievement of treatment goals;

 

l.  An attendance sheet or contact log that supports the dates and times that are billed; and

 

m.  Discharge plan or summary that identifies the after care plan and summarizes the case in relationship to the treatment and plan of care.

 

(k)  The agency shall:

 

(1)  Employ or contract with a prescribing practitioner;

 

(2)  Employ or contract with a program consultant who meets the following:

 

a.  A master’s degree in social work, psychology, education, or a related field with an emphasis in human services;

 

b.  Clinical experience of 2 years working with families; and

 

c.  Supervisory or management experience of 2 years.

 

(3)  Therapists who have:

 

a.  A master’s degree with a major in social work, counseling, psychology, or a related field and at least 2 years of direct work experience assisting children and families; or

 

b.  A bachelor’s degree with a major in social work, counseling, psychology or a related field and at least 5 years of direct work experience in assisting children and families; and

 

(4)  Employ case managers who meet the following minimum qualifications:

 

a.  A bachelor’s degree in social work, psychology, education, or a related field with an emphasis in human services; and

 

b.  Two years of experience with children and families.

 

(l)  The prescribing practitioner serving as the program consultant shall sign each treatment plan separately as both the prescribing practitioner and program consultant.

 

(m)  Therapists and case managers shall participate in weekly supervision that includes a discussion of each case and a review of the progress made by each family towards the goals of the treatment plan.

 

(n)  In addition to the requirements in (k) above, the agency shall:

 

(1)  Provide weekly clinical supervision to staff, including a review of the treatment plan for each family;

 

(2)  Complete annual staff evaluations;

 

(3)  Provide 20 hours per year of mandatory in-service training for staff that includes topics related to:

 

a.  Family systems;

 

b.  Substance use disorders;

 

c.  Child abuse and neglect;

 

d.  Labor and sex trafficking:

 

e.  Sexual abuse;

 

f.  Domestic and family violence;

 

g.  Safety planning for family members;

 

h.  Crisis intervention techniques;

 

i.  Early childhood screening and child development;

 

j.  Trauma informed practice, including evidence-based practices;

 

k.  Treatment of any co-occurring disorders;

 

l.  Behavioral management techniques; and

 

m.  Infant safe sleeping practices;

 

(4)  For each therapist and case manager, the agency shall maintain on file copies of training certificates, signed by the trainer that document:

 

a.  The names of training sessions attended;

 

b.  The number of hours per training; and

 

c.  The dates of training.

 

(o)  The agency shall discharge the child and family from the program when:

 

(1)  The child and family make progress in achieving the goals as identified in the treatment plan;

 

(2)  The child’s behavior while in the program requires removal and referral to more intensive residential treatment; or

 

(3)  The child and family are unable to utilize treatment and are referred to other services.

 

(p)  Within 15 days after service termination, the agency shall forward to the CPSW, JPPO, or the supervisor a report that includes:

 

(1)  A summary of visits and contacts with the family including dates, duration, and locations;

 

(2)  A summary of the progress or lack of progress in meeting the treatment plan including the tasks accomplished, timeframes, and measurable outcomes achieved;

 

(3)  New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation report, or court report;

 

(4)  The community resources and supports available to the family that might be accessed in the future;

 

(5)  Recommendations for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child as specified in the treatment plan and how the provider has worked with the family to assist them in accessing recommended services; and

 

(6)  The dated signature of the prescribing practitioner and therapist. 

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.19  Requirements for Adolescent Community Therapeutic Services.

 

(a) The provider shall comply with sections He-C 6339.01 through He-C 6339.15 for certification compliance.

 

(b)  Authority for payment for adolescent community therapeutic services shall be pursuant to a court order or any voluntary agreement between the family and DCYF.

 

(c)  A provider shall not provide services that exceed 90 days per year, without prior approval from the CPSW or JPPO.

 

(d)  Service for an additional 90 days per year shall be authorized when the following conditions are met:

 

(1)  The family’s problems have not been resolved and the child remains at risk for out-of-home placement;

 

(2)  The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

 

(3)  The provider submits the following documentation to the CPSW or JPPO:

 

a.  The reason(s) for continued services;

 

b.  The beginning and ending dates for continued services;

 

c.  The goals for the continued period of services; and

 

d.  The anticipated child and family outcomes.

 

(e)  Adolescent community therapeutic services shall be provided to:

 

(1)  Children who are exhibiting inappropriate behaviors in the home, school, or community; and

 

(2)  Children living in their own home, a relative’s home, a guardian’s home, or foster home.

 

(f)  Adolescent community therapeutic services shall provide:

 

(1) Assessment and service planning based on the DCYF case plan, pre-dispositional investigation report or treatment, and ongoing assessment for each child enrolled in the program;

 

(2)  Strength based counseling and support that includes multiple contacts with the child and family, school, and work sites to monitor behavior and activities and provide instruction on job search and maintaining employment, as specified by the treatment plan;

 

(3)  Crisis intervention available to the child and family to intervene, assess the safety of the environment, and prevent out of home placement;

 

(4)  Family intervention, including supportive based counseling with the family to improve relationships and ease tension in the household;

 

(5)  Ongoing assessments for health and safety, including drug screenings, curfew checks, school attendance, and intensive supervision;

 

(6)  Health and safety education, to provide counseling and information on independent living and substance use, and encourage the child to make positive choices;

 

(7)  Behavior management skills training to assist in developing and implementing behavior modification plans for the youth and family regarding discipline, stress, and conflict issues;

 

(8)  Information regarding community resources and support that includes advocacy and outreach to assist children and families in learning how to access community resources and to develop the skills to use these services within the community and comply with court orders by:

 

a.  Assisting the family and CPSW or JPPO in advocating for special education services when necessary to meet the conditions of the DCYF case plan, attending school meetings, team evaluations, and IEP meetings regarding the child’s school performance, and role modeling how to effectively communicate;

 

b.  Providing information about community resources and services, and making referrals for needed services;

 

c.  Coordinating transportation services for child and the family to enable participation in program activities; and

 

d.  Consulting with attorneys as requested by the CPSW or JPPO and attending court hearings with the child; and

 

(9)  Therapeutic recreational services, including individual or group activities appropriate to the age and needs of the child and designed to:

 

a.  Develop healthy interests;

 

b.  Enable the program staff to assess the child in a natural environment;

 

c.  Teach adaptive ways to spend unstructured time;

 

d.  Develop social skills and peer interaction skills;

 

e.  Provide a positive outlet for aggressive energy; and

 

f.  Build self-esteem.

 

(g)  A provider of adolescent community therapeutic services shall:

 

(1)  Schedule an intake meeting with the child, family, CPSW or JPPO, caseworker, and program supervisor within 24 hours for emergency referrals and within 5 working days of referral for non-emergency cases;

 

(2)  Provide each family with a written description of services, as described in He-C 6339.14 including the cost of the service and potential reimbursement by the family to the state for services provided;

 

(3)  Complete an initial assessment within 15 calendar days of the intake meeting, in conjunction with the child, family, and CPSW or JPPO, that includes:

 

a.  An identification of the child’s strengths;

 

b.  The child’s responsibilities for his or her behavior;

 

c.  The supervision to be provided by the family;

 

d.  The adolescent community therapeutic services to be provided; and

 

(4)  Complete a written treatment plan at the end of 30 calendar days;

 

(5)  Reassess the treatment plan and progress toward identified goals on a monthly basis, in consultation with the child, family, agency worker, and CPSW or JPPO to determine whether to continue services, the duration of services, and the purposes and goals;

 

(6)  Provide multiple contacts, by telephone and a minimum of a one-hour face-to-face meeting each week with the child and family as prescribed by the DCYF case plan, which may include:

 

a.  A weekend contact with the child;

 

b.  School attendance checks in person or by telephone;

 

c.  Job attendance checks in person or by telephone; and

 

d.  Curfew checks;

 

(7)  Provide assistance to the family in locating the youth in instances of failure to meet curfew or attend school or job;

 

(8)  Provide assistance to the family with school suspension, supervision through frequent daily telephone contacts, additional face-to-face contacts, or in-office supervision if available;

 

(9)  Submit copies of monthly progress reports to the CPSW or JPPO, the youth, and family; and

 

(10)  Maintain records for each child to include:

 

a.  Name of family, address, and telephone number;

 

b.  Reasons for referral;

 

c.  Initial assessment, which shall be completed following the intake meeting;

 

d.  DCYF case plan, updated at monthly progress reviews;

 

e.  Daily log of contacts and services to the child and family;

 

f.  Incident reports that describe behaviors by the youth, with a copy submitted to the CPSW or JPPO;

 

g.  Progress reports that contain a summary of contacts with the youth, family and others, any mutually agreed upon changes to the treatment plan, goals and objectives achieved by the child and family, and specific plans for next month; and

 

h.  Other information, such as behavioral health and medical records.

 

(h)  When a child or family is visited, the child and parent, if present, shall be required to sign the contact log, and the agency staff shall retain a copy of the log in the family’s file for review during the on-site visits.

 

(i)  The agency shall document each family visit including;

 

(1)  The type of service;

 

(2)  The date of service;

 

(3)  The names of the family members and other individuals who participated;

 

(4)  The name of the staff who assisted the family;

 

(5)  A brief summary of the in-home session;

 

(6)  The length of time spent with the family; and

 

(7)  The provision of the provider’s signature and the signature of a family member and the child, if age appropriate.

 

(j)  A provider for adolescent community therapeutic services shall:

 

(1)  Employ or contract with a prescribing practitioner;

 

(2)  Employ a program supervisor who:

 

a.  Possesses a master’s degree in social work or a related field and 2 years experience in social services; or

 

b.  A bachelor’s degree in social sciences or a related field and 5 years experience including at least 2 years of previous supervisory experience;

 

(3)  Employ adolescent therapeutic caseworkers who possess a bachelor’s degree in social sciences or a related field;

 

(4)  Provide 20 hours per year of mandatory in-service training for adolescent therapeutic caseworkers including topics related to:

 

a.  Family systems;

 

b.  Substance use disorders;

 

c. Child abuse and neglect;

 

d.  Labor and sex trafficking;

 

e.  Sexual abuse;

 

f.  Domestic and family violence;

 

g.  Behavioral health

 

h.  Safety planning for family members;

 

i.  Crisis intervention techniques;

 

j.  Early child hood screening and child development;

 

k.  Trauma informed practice including evidence-based practices;

 

l.  Treatment of any co-occurring disorders;

 

m.  Behavioral management techniques; and

 

n.  Infant safe sleeping practices;

 

(5)  Maintain documentation of training, which includes:

 

a.  The dates of training;

 

b.  The titles of training topics; and

 

c.  The number of hours per training;

 

(6)  Have an adolescent therapeutic caseworker to child ratio of an average of no more than 1 to 7 with a maximum caseload not exceeding 1:9;

 

(7)  Employ staff that provide evening, weekend, and holiday coverage to meet the needs of the family;

 

(8)  Have on-call 24-hour availability for families;

 

(9)  Provide a minimum of one hour per week of individual clinical supervision by the program supervisor with the adolescent therapeutic caseworker to review each case progress and barriers, for which one session per month may be substituted with group supervision; and

 

(10)  Complete annual staff evaluations, with copies maintained in staff files.

 

(k)  The prescribing practitioner serving as the program supervisor shall sign each treatment plan separately as both the prescribing practitioner and program consultant.

 

(l)  The agency shall:

 

(1)  Terminate services only after consultation and a mutual decision is reached with the child, family, and CPSW or JPPO, based on previously determined criteria in the treatment plan;

 

(2)  Forward a termination notification to the CPSW or JPPO within one working day of any unplanned terminations;

 

(3)  Abide by the following timeframes for planned terminations:

 

a.  Continue services for no more than 5 days to allow for transition work if the child is placed with a family who provides foster care, a residential facility, or secure placement facility;

 

b.  Continue services for no more than 2 business days, with CPSW or JPPO approval, when the child enters an emergency foster home, respite care, relative home, or shelter care;

 

c.  Continue services for no more than 7 days for a child who has run away if the program continues to be actively involved with the family and the plan is for the youth to continue to live at home;

 

d.  Suspend services if the child and family are on vacation or for other reasons are to be away for more than 7 days; and

 

e.  If services continue for 7 days or less, services shall at a minimum include daily telephone contact with the child or family;

 

(4)  Within 15 days after service termination, the agency shall forward to the CPSW, JPPO, or his or her supervisor a report that includes:

 

a.  A summary of visits and contacts with the family including dates, duration, and locations;

 

b.  A summary of the progress or lack of progress in meeting the treatment plan including the tasks accomplished, time frames, and measurable outcomes achieved;

 

c.  New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation report or court report;

 

d.  The community resources and supports available to the family that might be accessed in the future;

 

e.  Recommendations for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child as specified in the treatment plan and how the provider has worked with the family to assist them in accessing recommended services;

 

f. The date and signature of the prescribing practitioner and adolescent therapeutic caseworker;

 

(5)  If services are terminated prior to the 15th day of the month, no monthly progress report shall not be required for the month.  The information for the month in which services are terminated shall be included in a discharge report.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.20  Requirements for Individual Service Options (ISO) In-Home.

 

(a)  The provider shall comply with sections He-C 6339.01 through He-C 6339.15 for certification compliance.

 

(b)  Authorization for payment for individual service options in-home shall be pursuant to a court order, or a non-court ordered or voluntary agreement between DCYF and the family.

 

(c)  Services shall be limited to a period of time not to exceed 180 days, without DCYF approval.

 

(d)  Services for an additional 90 days per year shall be authorized when the following conditions are met:

 

(1)  The family’s problems have not been resolved and the child remains at risk for out-of-home placement;

 

(2)  The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

 

(3)  The provider submits the following information in writing to the CPSW or JPPO:

 

a.  The reason(s) for continued services;

 

b.  The beginning and ending dates for continued services;

 

c.  The goals for the continued period of services; and

 

d.  The anticipated child and family outcomes.

 

(e)  The individual service option (ISO) in-home agencies shall:

 

(1)  Promote family self-sufficiency and to connect families to supports in the community;

 

(2)  Promote collaboration and communication with DCYF staff and other local service providers;

 

(3)  Serve children in their home, foster or relative care provider, or home community;

 

(4)  Provide or coordinate all of the services needed for the treatment of the child and family;

 

(5)  Receive approval from DCYF prior to placing a child in a residential care facility for crisis stabilization; and

 

(6)  Provide each family with a written description of services, as described in He-C 6339.14 including the cost of the service and potential reimbursement by the family to the state for services provided.

 

(f)  Crisis stabilization in a residential care facility shall not exceed 10 days per year per child.

 

(g) Requests for waivers pursuant to He-C 6339.21 to the 10-day limit for residential crisis stabilization shall be submitted to the DCYF.

 

(h)  ISO in-home services shall be provided to families with:

 

(1)  Abused and neglected children, CHINS, and delinquent children; and

 

(2)  Children between the age of birth to age 21, who might be experiencing one or more of the following:

 

a.  Chronic mental, emotional, physical, or behavioral challenges;

 

b.  Post-traumatic stress symptoms;

 

c.  Mental health diagnosis(e);

 

d.  Sexually reactive behaviors;

 

e.  A history of traumatic experiences;

 

f.  Unable to participate in local education program;

 

g.  Require intensive supervision and consistent structure and might benefit from remaining home; or

 

h.  Might need short-term, intensive residential care.

 

(i)  A provider of ISO in-home services shall provide, purchase, or connect a family to services that include:

 

(1)  Case management, treatment planning, and service coordination;

 

(2)  Assessment and service planning based on the DCYF case plan or pre-dispositional investigation report and ongoing assessment for each child enrolled in the program;

 

(3)  Individual, group, family, and substance use disorder counseling;

 

(4) In-Home services, including:

 

a.  Home-base therapeutic services; and

 

b.  Child health support;

 

(5)  Support for children who are transitioning to a family setting;

 

(6)  Emergency on-call 24-hour response to crises;

 

(7)  Respite care in a licensed foster home;

 

(8)  Crisis stabilization in a residential care facility with prior DCYF approval;

 

(9)  Transportation;

 

(10)  Assisting older children to transition to adult living situations;

 

(11)  Identification of relatives, mentors, and others who will support or assist the child and family;

 

(12)  Transitional assistance from DCYF to adult services;

 

(13)  Coordination of medical, community mental health, and dental care;

 

(14)  Coordination of public or private school education;

 

(15)  Coordination of recreational activities;

 

(16)  Coordination of substance use disorder evaluations and random drug testing; and

 

(17)  Coordination of vocational services.

 

(j)  The ISO in-home agency shall obtain a referral for services and its attachments.

 

(k)  The ISO in-home agency shall assess each family member’s needs in the home within 30 days of referral based on:

 

(1)  The DCYF case plan, pursuant to RSA 170-G:4 III and court report, pursuant to RSA 169-B:5-a, RSA 169-C:12-b, or RSA 169-D:4-a; or

 

(2)  The investigation report pursuant to RSA 170-G:16, I or III, RSA 169-B:16, III-IV, or RSA 169-D:14, III-IV.

 

(l)  The agency’s assessment shall include:

 

(1)  Identification of the strengths and resources of the family;

 

(2)  Identification of alcohol or substance use disorders, domestic or family violence, sexual abuse, or other situations that might impact the child’s safety;

 

(3)  A review of previously completed evaluations and assessments, medical records, and psychological tests;

 

(4)  A determination of immediate services needed by the family;

 

(5)  Identification of community or relative resources available to the family; and

 

(6)  A summary of treatment and service needs.

 

(m)  The ISO in-home agency shall provide DCYF with monthly progress reports that include:

 

(1)  The family’s name;

 

(2)  The name of the person completing the report;

 

(3)  The date of the report;

 

(4)  Improvements that are being made towards specific goals;

 

(5)  Summary of family contacts and progress made towards specific goals;

 

(6)  Changes to the treatment plan;

 

(7)  Educational updates; and

 

(8)  Contacts with other professionals.

 

(n)  Progress reports shall include the following about each child’s medical, dental, and behavioral health care:

 

(1)  Prescriptions and current dosages;

 

(2)  Over-the-counter medication;

 

(3)  Dates of visits during the month being reported;

 

(4)  New health care issues and diagnosis;

 

(5)  Next scheduled visits; and

 

(6)  Name of health care practitioner and office address.

 

(o)  Progress reports shall be provided to the parents or guardians, unless contraindicated by a court order, or a request from DCYF. 

 

(p)  The ISO in-home agency shall keep records that include a case record on each child and his or her family that contains:

 

(1)  The assessment used to develop the treatment plan;

 

(2)  The signed ISO in-home treatment plan and its revisions;

 

(3)  Weekly child and family progress notes;

 

(4)  Documentation of therapeutic work with the family; and

 

(5)  Monthly progress reports.

 

(q)  When a child or family is visited, the child and parent, if present, shall be required to sign the contact log and the agency staff shall retain a copy of the log in the family’s file for review during the onsite visits.

 

(r)  The agency shall document each family visit including:

 

(1)  The type of service;

 

(2)  The date of service;

 

(3)  The names of the family members and other individuals who participated;

 

(4)  The name of the therapist who assisted the family;

 

(5)  A brief summary of the in-home session;

 

(6)  The length of time spent with the family; and

 

(7)  The provision of the provider’s signature and the signature of a family member and child.

 

(s)  The ISO in-home agency shall:

 

(1)  Employ or contract with a prescribing practitioner;

 

(2)  Employ a program coordinator who meets the following:

 

a.  A master’s degree in social work, psychology, education, or a related field with an emphasis in human services;

 

b.  Two years clinical experience working with families, and

 

c.  Two years supervisory or management experience;

 

(3)  Therapists who have:

 

a.  A master’s degree with a major in social work, counseling, psychology, or a related field and at least 2 years of direct work experience in assisting children and families; or

 

b.  A bachelor’s degree with a major in social work, counseling, psychology or a related field and at least 5 years of direct work experience in assisting children and families; and

 

(4)  Employ case managers who meet the following minimum qualifications:

 

a.  A bachelor’s degree in social work, psychology, education or a related field with an emphasis in human services; and

 

b.  Two years of experience with children and families.

 

(t)  The prescribing practitioner may also serve as the program consultant as long as they sign each treatment plan separately as both the prescribing practitioner and program consultant.

 

(u) Therapist and case managers shall participate in weekly supervision that includes a discussion of each case and a review of the progress made by each family towards the goals of the treatment plan.

 

(v)  Therapists and case managers shall complete a minimum of 20 hours of training per year that includes topics related to:

 

(1)  Family systems;

 

(2)  Substance use disorders;

 

(3) Child abuse and neglect;

 

(4)  Labor and sex trafficking;

 

(5)  Sexual abuse;

 

(6)  Domestic and family violence;

 

(7)  Behavioral health

 

(8)  Safety planning for family members;

 

(9)  Crisis intervention techniques; and

 

(10)  Early child hood screening and child development;

 

(11)  Trauma informed practice including evidence-based practices;

 

(12)  Treatment of any co-occurring disorders;

 

(13)  Behavioral management techniques; and

 

(14)  Infant safe sleeping practices.

 

(w)  The agency shall maintain documentation of training for therapist and case managers, which includes:

 

(1)  The dates of training;

 

(2)  The titles of training topics; and

 

(3)  The number of hours per training.

 

(x)  Up to 5 hours of documented supervision by a therapist may be applied towards the 20 hours of annual training requirement for therapists and case managers.

 

(y)  The case manager’s average caseload shall not exceed an average of 6 families per month.

 

(z)  The therapist’s maximum caseload shall not exceed an average of 10 families per month.

 

(aa)  Within 15 days after service termination, the agency shall forward to the CPSW, JPPO, or his or her supervisor a report that includes:

 

(1)  A summary of visits and contacts with the family including dates, duration, and locations;

 

(2)  A summary of the progress or lack of progress in meeting the treatment plan including the tasks accomplished, timeframes, and measurable outcomes achieved;

 

(3)  New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation, or court report;

 

(4)  The community resources and supports available to the family that might be accessed in the future;

 

(5)  Recommendation for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child as specified in the treatment plan and how the provider has worked with the family to assist them in accessing recommended services; and

 

(6)  The date and signature of the prescribing practitioner and therapist.

 

(ab)  If the services are terminated prior to the 15th day of the month, no monthly progress report shall not be required for the month.  The information for the month in which services are terminated shall be included in the discharge report.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

          He-C 6339.21  Waivers.

 

(a)  Applicants or providers who request a waiver of a requirement in He-C 6339 shall submit a written request to the commissioner or his or her designee that includes the following information:

 

(1)  The anticipated length of time the requested waiver will be needed;

 

(2)  The reason for requesting the waiver;

 

(3)  Assurance that if the waiver is granted the quality of service and care to children and families will not be affected;

 

(4)  A written plan to achieve compliance with the rule or explaining how the provider will satisfy the intent of the rule, if the waiver is granted;

 

(5)  How the service will be affected if the waiver is not granted;

 

(6)  Evidence that the agency's board of directors has approved the waiver request, such as, minutes of the board meeting documenting that the request was approved or a signature of the board's president or chairman; and

 

(7)  A statement that the rule for which a waiver is being requested is not related to compliance with the life safety code or environmental health and safety issues, unless approved in writing by the fire inspector, local health officer, or public health services.

 

(b)  A waiver shall be granted if:

 

(1)  The department concludes that authorizing deviation from compliance with the rule from which waiver is sought does not contradict the intent of the rule; and

 

(2)  The alternative proposed ensures that the object or intent of the rule will be accomplished.

 

(c)  When a waiver is approved, the applicant’s or provider’s subsequent compliance with the alternative approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.22  Denial of Application and Revocation of Provider Certification.  An application shall be denied or provider certification revoked if:

 

(a)  DCYF determines that the state does not have a need for the service;

 

(b)  The applicant or provider, or the individual acting on the applicant’s or provider’s behalf, submits materially false information to DCYF;

 

(c)  There has been a conviction for a felony or any crime against a child that has not been annulled or overturned;

 

(d)  There has been disciplinary action taken by a licensing body or professional society, a finding of civil liability made for professional misconduct, or a finding of an ethical violation made by a state or national professional association or any other state’s regulatory board;

 

(e)  There has been revocation of membership on any hospital, medical, or allied health provider staff;

 

(f)  There has been revocation of provider status with any group or health maintenance organization;

 

(g)  There has been revocation of clinical privileges;

 

(h)  There has been termination of academic appointment by an institution;

 

(i)  There has been cancellation of professional or general liability insurance by the insurance company;

 

(j)  There has been abusive or neglectful treatment of a child as determined by any state statute;

 

(k)  There has been a failure to submit a completed, signed, and dated Form 2607 “Review of Continued Certification for In-home Community based Service Providers” (October 2016) within 30 days, pursuant to He-C 6339.05; or

 

(l)  There has been failure to comply with He-C 6339.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.23  Notification of Denial or Revocation.  If DCYF denies an application or revokes certification, a letter shall be sent to the applicant or provider by registered mail, which sets forth the reasons for the determination.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.24  Request for Certification Reconsideration.

 

(a)  A request for certification reconsideration shall:

 

(1)  Be filed within 30 days of the date of receipt of the letter sent by DCYF;

 

(2)  Be submitted in writing; and

 

(3)  Be filed with the director of DCYF.

 

(b)  The DCYF director shall uphold or overturn the request.

 

(c)  The applicant or provider shall be notified of the decision, in writing by the director.

 

(d)  The applicant or provider may appeal the DCYF director’s decision pursuant to He-C 6339.25.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

He-C 6339.25  Appeals.

 

(a)  Applicants or providers who wish to appeal a decision to deny an application or revoke or suspend certification shall file an appeal with the commissioner, pursuant to RSA 170-G:4-a.

 

(b)  In accordance with RSA 170-G:4-a, the appeal shall:

 

(1)  Be made in writing;

 

(2)  Be signed and dated;

 

(3)  State the reasons for the appeal pursuant to RSA 170-G:4-a; and

 

(4)  Be filed within 14 working days of the date of receipt of written notification.

 

(c)  Pursuant to RSA 170-G:4-a and He-C 200, the commissioner or designee and 2 members of the DCYF advisory board shall hear the appeal.

 

Source.  (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17

 

PART He-C 6340  CERTIFICATION PAYMENT STANDARDS FOR ADOPTIVE REPORT WRITING SERVICE PROVIDERS

 

Statutory Authority:  RSA 170-G:4 XVIII, RSA 170-G:5

 

REVISION NOTE:

 

            Document #9264, effective 9-20-08, adopted Part He-C 6340 relative to certification for payment standards for adoptive report writing service providers.  This part incorporated provisions from the former Part He-C 6352 entitled “Certification for Payment Standards for Community-Based Service Providers” and made extensive changes to the wording, format, structure, and numbering of those provisions.

 

            Document #9264 supersedes all prior filings in the former Part He-C 6352 relative to certification for payment standards for adoptive report writing service providers.  The filings affecting the former Part He-C 6352 include the following documents:

 

            #4446, eff 7-1-88

            #5096, eff 3-15-91, EXPIRED 3-15-97

            #7292, eff 5-24-00

            #8009, eff 1-1-04

            #9112, INTERIM, eff 3-24-08, EXPIRED 9-20-08

 

He-C 6340.01  Purpose.  The purpose of this part is to identify the qualifications and performance requirements to become a provider of adoptive report writing services, which includes adoptive history reports and adoptive home study reports, for the division for children, youth and families (DCYF) as required by RSA 170-G:4 XVIII and RSA 170-B:18.

 

Source.  (See Revision Note at part heading for He-C 6340) #9264, eff 9-20-08; ss by #12059, eff 12-6-16

 

He-C 6340.02  Scope.  This part shall apply to individuals or agencies that seek certification to receive financial reimbursement from the department of health and human services (DHHS) for the provision of adoptive report writing services.

 

Source.  (See Revision Note at part heading for He-C 6340) #9264, eff 9-20-08; ss by #12059, eff 12-6-16

 

He-C 6340.03  Definitions.

 

(a)  “Adoptive report writing” means adoptive history reports and adoptive home study reports.

 

(b)  “Adoptive history report” means the completion of a written case history, which includes social, medical, psychological and educational information about a child who might be adopted and the birth family.

 

(c) “Adoptive home study report” means the written report of an assessment into the conditions of the adoption petitioner as described in RSA 170-B:18, I for the purpose of ascertaining whether the adoptive home is a suitable home for the minor child and whether the proposed adoption is in the best interest of the minor child.

 

(d)  “Applicant” means the person or entity that is requesting certification for payment as an adoptive report writing service provider.

 

(e)  “Case plan” means the division for children, youth and families’ (DCYF) written plan for the child and the family which outlines how services will be provided, pursuant to RSA 170-G: 4 III, and 42 U.S.C. 671, PART E-Federal Payments for Foster Care and Adoption Assistance Section 471(a)(16), 475(1) and (5)(A) and (D) State Plan For Foster Care and Adoption Assistance. This term includes “placement plan.”

 

(f)  “Certification for payment” means the process by which DCYF approves the qualifications of and reimbursement to providers of adoptive report writing services.

 

(g)  “Child” means “child” as defined in RSA 170-E:25:I or “child” as defined in RSA 169-C:3 or “child” as defined by RSA 169-D:2.

 

(h)  “Child protective service worker (CPSW)” means an employee of DCYF who is specially trained to work with families referred to the DCYF pursuant to RSA 169-C, RSA 170-B, RSA 170-C, and RSA 463.

 

(i)  “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

 

(j)  “Conflict of interest” means any circumstance, situation, or financial interest which has the potential to cause a private interest to directly or indirectly affect, influence, or interfere with the performance of the duties of a provider or his or her employee as a provider for the Division for Children, Youth and Families.

 

(k)  “Department” means the New Hampshire department of health and human services (DHHS).

 

(l)  “Director” means the director of the division for children, youth, and families, or his or her designee.

 

(m)  “Division for children, youth, and families (DCYF)” means the organizational unit of the department of health and human services that provides services to children and youth referred by courts pursuant to RSA 169-B, RSA 169-C, RSA 169-D,  RSA 170-B, RSA 170-C, and RSA 463.

 

(n)  “Juvenile probation and parole officer (JPPO)” means an employee of DCYF who exercises the powers and duties as provided for in RSA 170-G: 16, and supervises paroled delinquents pursuant to RSA 170-H.

 

(o)  “NH bridges” means the automated case management, information, tracking, and reimbursement system used by DCYF.

 

(p)  “Provider” means the individual or agency that receives financial reimbursement from the department for adoptive report writing services.

 

(q)  “Structured analysis family evaluation (SAFE)” means the copyrighted structured home study methodology and evidence based forms obtained through the Consortium for Children by providers who have been trained and certified in their use.

 

(r)  “Service authorization” means the documentation provided by DCYF indicating the division’s responsibility for payment of community based services.

 

Source.  (See Revision Note at part heading for He-C 6340) #9264, eff 9-20-08; ss by #12059, eff 12-6-16

 

He-C 6340.04  Compliance Requirements.

 

(a)  Providers shall comply with:

 

(1)  The confidentiality statutes of RSA 169-B:35, RSA 169-C:25, RSA 169-D:25, RSA 170-B:23, RSA 170-C:14, and RSA 170-G:8-a; and

 

(2)  The child abuse and neglect reporting requirements of RSA 169-C:29-30.

 

(b)  Providers and his or her employees shall not have a conflict of interest as defined in He-C 6340.03(i).

 

(c)  Failure to comply with the rules of this chapter shall result in:

 

(1)  Denial of an applicant pursuant to He-C 6340.16;

 

(2)  Revocation of certification for payment of a provider pursuant to He-C 6340.16; or

 

(3)  Denial of reimbursement.

 

Source.  (See Revision Note at part heading for He-C 6340) #9264, eff 9-20-08; ss by #12059, eff 12-6-16

 

He-C 6340.05  Application Process For Payment Standards For Adoptive Report Writing Services.

 

(a)  Applicants who seek initial certification for payment for adoptive report writing services shall contact DCYF and request certification.

 

(b)  The DCYF shall assess the need for services based on the following criteria:

 

(1)  The number of children and families who require services exceeds the available community resources;