CHAPTER He-A 300
CERTIFICATION AND OPERATION OF ALCOHOL AND OTHER DRUG DISORDER TREATMENT PROGRAMS
PART He-A 301 CERTIFICATION OF ALCOHOL AND OTHER
DRUG ABUSE DISORDER TREATMENT PROVIDERS
Statutory Authority:
RSA 172:8-b
He-A
301.01 – 301.10
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A
301.11
Source. #7496, eff 5-23-01; amd by #7596, eff 11-20-01; ss by # 9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A
301.12 – 301.21
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. # 9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
PART He-A 302 OPERATIONAL REQUIREMENTS FOR ALL
ALCOHOL AND OTHER DRUG ABUSE DISORDER TREATMENT PROVIDERS
Statutory Authority:
RSA 172:8-b
He-A
302.01 -302.01
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. # 9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 302.03
Source. #7496, eff 5-23-01;
ss by #7597, eff 11-20-01; ss by #9497, INTERIM, eff 6-26-09, EXPIRED: 12-23-09
He-A 302.04
Source. #7496, eff 5-23-01; amd by #7597, eff 11-20-01; ss by #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 302.05 – 302.07
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 302.08 – 302.09
Source. #7496, eff 5-23-01; amd by #7597, eff
11-20-01, ss by #9497, INTERIM, eff 6-26-09, EXPIRED: 12-23-09
He-A 302.10
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497,
INTERIM, eff 6-26-09, EXPIRED: 12-23-09
He-A
302.11
Source. #7496, eff 5-23-01; amd by #7597, eff 11-20-01, ss by #9497, INTERIM, eff 6-26-09, EXPIRED: 12-23-09
He-A 302.12
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
PART He-A 303 RIGHTS OF PERSONS RECEIVING TREATMENT
FOR ALCOHOL AND OTHER DRUG ABUSE DISORDERS IN THE COMMUNITY
Statutory Authority:
RSA 172:8-b
He-A
303.01 – 303.03
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 303.04
Source. #7496, eff 5-23-01; amd by #7598, eff 11-20-01, ss by #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A
303.05
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 303.06
Source. #7496, eff 5-23-01; amd by 7598, eff 11-20-01; ss by #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
He-A 303.07 – 303.09
Source. #7496, eff 5-23-01,
EXPIRED: 5-23-09
New. #9497, INTERIM, eff
6-26-09, EXPIRED: 12-23-09
PART He-A 304 CERTIFICATION AND OPERATIONAL REQUIREMENTS FOR OPIOID TREATMENT
PROGRAMS
Statutory Authority:
RSA 318-B:10, VII(b) and VIII(b)
He-A 304.01 Purpose and Scope.
(a)
The purpose of these rules is to describe the requirements necessary to
be certified by the New Hampshire bureau of drug and alcohol services as an
approved opioid treatment program.
(b)
These rules shall not apply to licensed practitioners who prescribed
buprenorphine to their patients in a setting other than an opioid treatment
program certified under these rules.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.02 Definitions.
(a) “Buprenorphine” means a synthetic
opiate with partial agonist actions used in the treatment of opioid use
disorder.
(b) “Bureau” means the New Hampshire
bureau of drug and alcohol services or successor program area within the
department of health and human services.
(c) “Client” means a person who is
enrolled in and receiving services from an opioid treatment program certified
under these rules. This term does not include patients who are prescribed
buprenorphine by a licensed practitioner practicing within a certified opioid
treatment program.
(d) “Critical incident” means any actual
or alleged event or situation that creates a significant risk of substantial or
serious harm to physical or mental health, safety, or well
being, including but not limited to:
(1) Abuse;
(2) Neglect;
(3) Exploitation;
(4) Rights violation;
(5) Missing person;
(6) Medical emergency;
(7) Restraint; or
(8) Medical error.
(e) “Heroin” means an illegal
semi-synthetic drug produced from the morphine contained in sap of the opium
poppy, and known to have the potential for devastating addictive properties in
vulnerable individuals.
(f) “Licensed counselor” means a master
licensed alcohol and drug counselor (MLADC), a licensed alcohol and drug
counselor (LADC), or a licensed mental health professional who has demonstrated
competency in the treatment of substance use disorders.
(g) “Licensed practitioner” means a
medical professional legally practicing within their scope in the State of New
Hampshire, is authorized to dispense synthetic opioids for the treatment of
substance use disorders, and who is employed by or under contract with the
opioid treatment program and practicing under the supervision of the program’s
medical director.
(h) “Licensed supervisor” means an MLADC,
a LADC who is also a licensed clinical supervisor (LCS), or a licensed mental
health professional who has demonstrated competency in the treatment of
substance use disorders.
(i) “Methadone” means a legal drug,
methadone hydrochloride, which is a synthetic opioid that has been demonstrated
to be an effective treatment agent for opioid use disorders.
(j) “Methadone/buprenorphine maintenance
services” means treatment services which substitute methadone, or any of its
derivatives, or buprenorphine, over time, to relieve withdrawal symptoms of
opioid use disorder, to reduce craving, and to permit normal functioning and
engagement in rehabilitative services.
(k) “Methadone/buprenorphine
withdrawal management” means the dispensing of methadone, buprenorphine, or a
similar substance in decreasing doses to a client in order to
reduce or eliminate adverse physiological or psychological effects incident to
the withdrawal from the sustained use of opioids.
(l) “Opioid treatment program (OTP)” means
a substance use disorder program which dispenses methadone/buprenorphine for
the purpose of opioid withdrawal management, maintenance, treatment, and
rehabilitation services.
(m) “Opioids” means a group of
morphine-like substances that are:
(1) One of the following:
a. Directly derived from the opium poppy, such
as morphine and codeine;
b. Semi-synthetic substances partially derived
from the opium poppy, such as heroin; or
c. Purely synthetic substances, such as
hydromorphone and meperidine; and
(2) Active through specific receptors in the
human body.
(n) “Plan of
correction (POC)” means a plan developed and written by the certificate holder,
which specifies the actions that will be taken to correct non-compliance with
applicable rules or codes identified at the time of an inspection or during the
course of a complaint investigation.
(o) “Sentinel event”
means:
(1) An unanticipated death, not including
homicide or suicide;
(2) Permanent loss of function, or risk thereof,
not related to the natural course of an individual’s illness or underlying condition;
(3) The person is the victim or alleged
perpetrator of a homicide;
(4) Suicide;
(5) Suicide attempt;
(6) Rape or any other sexual assault;
(7) Serious physical injury, or risk thereof to
or by a client that jeopardizes a person’s health; or
(8) Serious psychological injury, or risk
thereof, that jeopardizes a person’s health that is associated with the
planning and delivery of care.
(p) “Split dose”
means the division of the client’s daily dose of methadone or buprenorphine
into 2 separate doses. This term also
includes “split dosing.”
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.03 Application Submission.
(a)
Each applicant for certification as an OTP shall submit the following to
the department:
(1) A completed
application form entitled “Application
for Substance Use Disorder
Program Certification” (January 2018 edition), signed by the applicant
or, if not a sole proprietorship, 2 of the corporate officers and affirming the
following:
“I swear or affirm that the information provided is
accurate to the best of my knowledge and belief. I believe that my facility is
in full compliance with RSA 172:8-6 and RSA 318:B and
the rules promulgated there under. I understand that providing false
information shall be grounds for denial, suspension, or revocation of
certification.”
(2) If
applicable, proof of authorization from the New Hampshire secretary of state to
do business in the State of New Hampshire in the form of one of the following:
a. “Certificate
of Authority,” if a corporation;
b. “Certificate
of Formation,” if a limited liability corporation; or
c. “Certificate
of Trade Name,” where applicable;
(3) Resumes
identifying the qualifications of the administrator and medical director;
(4) Copies of
applicable licenses for the administrator and medical director;
(5) Written
local approvals as follows:
a. For an
existing building, the following written local approvals shall be obtained no
more than 90 days prior to submission of the application, from the following
local officials or, if there is no such official(s), from the board of
selectmen or mayor:
1. The health
officer verifying that the applicant complies with all applicable local health
requirements and drinking water and wastewater requirements;
2. The building official verifying that the
applicant complies with all applicable state building codes and local building ordinances;
3. The zoning
officer verifying that the applicant complies with all applicable local zoning
ordinances; and
4. The fire
chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the
department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by
the state fire marshal with the board of fire control, and local fire
ordinances applicable for the facility’s type of business; and
b. For a
building under construction, the written approvals required by a. above shall
be submitted at the time of the application based on the local official’s
review of the building plans and upon completion of the construction project;
(6) A written
disclosure from the applicant, certificate holder, and administrator(s),
containing a list of any:
a. Convictions
in this or any other state;
b. Permanent
restraining or protective orders;
c. Findings by
the department or any administrative agency in this or any other state for
assault, fraud, theft, abuse, neglect, or exploitation; and
d. An
explanation of the circumstances surrounding disclosure of matters described in
a. through c. above; and
(7) The results
of a criminal records check from the NH department of safety for the applicant,
certificate holder, and administrator.
(b)
The applicant shall submit the documents in (a) above to:
Department of Health and Human Services
Bureau of Drug and Alcohol Services
105 Pleasant Street
Concord, NH 03301
Fax: 603-271-6105
Email:
BDAS@dhhs.nh.gov
Source. #7496, eff 5-23-01; amd by #7599, eff 11-20-01; ss by #9476, eff 5-22-09; ss by
#12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.04 Processing
of Initial Applications and Issuance of Certifications.
(a) An application for an initial certification
shall be complete when the department determines that all items required by He-A 304.03(a) have been received.
(b) If an application does not contain all of the
items required by He-A 304.03(a), the department shall
notify the applicant in writing of the items required before the application
can be processed.
(c)
Unless a waiver has been granted, the department shall deny a certification
application in accordance with He-A 304.10(b) after reviewing the information
in He-A 304.03(a)(6)-(7) if, after review, it determines that the applicant,
certificate holder, or administrator:
(1) Has been
convicted of any felony in this or any other state;
(2) Has been
convicted of a sexual assault, other violent crime, assault, fraud, theft,
abuse, neglect, or exploitation in this or any other state;
(3) Has had a
finding by the department or any administrative agency in this or any other
state for assault, fraud, theft, abuse, neglect, or exploitation of any person;
or
(4) Otherwise
poses a threat to the health, safety, or well-being of clients.
(d) All certifications issued in accordance with
He-A 304 shall be non-transferable by person or location.
(e) Following an inspection, a certification
shall be issued if the department determines that an applicant requesting an
initial certification is in full compliance with He-A
304, including (f) below.
(f) To be certified under He-A 304, an applicant
shall have:
(1) Either:
a. Both of the following:
1. A current certification as an OTP from the U.S.
Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration (SAMHSA); and
2. A current accreditation as an OTP from a
SAMHSA-approved OTP accrediting body; or
b. A provisional certification as an OTP from SAMHSA;
(2) A current
registration with the U.S. Drug Enforcement Administration in accordance with
21 CFR 1301-1307; and
(3) A pharmacy
in compliance with RSA 318:51-b and licensed in accordance with Ph 600 as a
limited retail drug distributor as defined in RSA 318:1, VII-a.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.05 Certification
Expirations and Procedures for Renewals.
(a) When an OTP is not currently certified under He-A 304, certification shall be valid on the date of
issuance and expire one year later, on the last day of the month it was issued,
unless a completed application for renewal has been received.
(b) Except as in (a) above, a certification shall
be valid on the date of issuance and expire 3 years later, on the last day of
the month it was issued, unless a completed application for renewal has been
received.
(c) Each certificate holder shall complete and
submit to the department an application pursuant to He-A 304.03(a)(1) at least
120 days prior to the expiration of the current certification.
(d) The certificate holder shall submit with the
renewal application:
(1) A request
for renewal of any existing non-permanent waivers previously granted by the
department, in accordance with He-A 304.08, if applicable. If such a request is
not received, the rule(s) for which the waiver was previously requested shall
not continue to be waived beyond the expiration of the current certification;
(2) A copy of
any non-permanent or new variances applied for and/or granted by the state fire
marshal, in accordance with Saf-C 6005.03 - 6005.04,
as adopted by the commissioner of the department of safety under RSA 153, and
as amended pursuant to RSA 153:5, I, by the state fire marshal with the board
of fire control; and
(3) A list of
any current employees who have a permanent waiver granted in accordance with
He-A 304.17(j)(2).
(e) Following an inspection, a certification
shall be renewed if the department determines that the certificate holder:
(1) Submitted
an application containing all the items required by (d) above, prior to the
expiration of the current certification;
(2) If
deficiencies were cited at the last certification inspection or investigation,
has submitted a POC that has been accepted by the department and implemented by
the certificate holder; and
(3) Is found to
be in compliance with He-A 304 at the renewal
inspection.
(f) Any certified OTP that does not submit a
complete application for renewal prior to the expiration of an existing
certification shall be required to submit an application
for initial certification pursuant to He-A 304.03.
(g) Prior to issuing a certification, the
department shall review any of the information submitted in accordance with
He-A 304.03(a)(6)-(7) and deny a certification renewal in accordance with He-A
304.10(b).
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.06 Requirements
for Organizational or Program Changes.
(a) The certificate holder shall provide the
department with written notice at least 30 days prior to changes in any of the
following:
(1) Ownership;
(2) Physical
location; and
(3) Name of the
place where services authorized by a certification are delivered.
(b) The certificate holder shall complete and
submit a new application and obtain a new or revised certification prior to
operating for:
(1) A change in
ownership; or
(2) A change in
the physical location.
(c) When there is a change in the name, the OTP
shall submit to the department a copy of the certificate of amendment from the
New Hampshire secretary of state, if applicable, and the effective date of the
name change.
(d) An inspection by the department shall be
conducted prior to operation for changes in the following:
(1) Ownership,
unless an inspection was conducted within 90 days of the date of the change in
ownership and a POC designed to address any areas of non-compliance was
submitted and accepted by the department; and
(2) The
physical location.
(e) Certifications issued for a change in
ownership shall expire on the date the license issued to the previous owner
would have expired.
(f) When there is a new administrator, the
following shall apply:
(1) The certificate holder shall provide the
department with immediate notice when an administrator position becomes vacant;
(2) The
certificate holder shall notify the department in writing as soon as possible
prior to a change in administrator, and immediately upon the lack of an
administrator, and provide the department with the following:
a. A resume identifying the name and
qualifications of the new administrator;
b. Copies of applicable licenses for the new administrator;
c. Results of a criminal records check from the
NH department of safety; and
d. The written disclosure required by in He-A
304.03(a)(7);
(3) Upon review
of the materials submitted in accordance with (2) above, the department shall
make a determination as to whether the new administrator does not have a
history of any of the criteria identified in He-A
304.04(c) and meets the qualifications of the position in He-A 304.17(a)-(b);
and
(4) If the
department determines that the new administrator does not meet the requirements
in (3) above, it shall notify the OTP in writing so that a waiver can be sought or the OTP can search for a qualified candidate.
(g) If a certificate holder chooses to cease the
operation of a certified OTP, the certificate holder shall submit written
notification to the department at least 30 days in advance, including the
following:
(1) A written
closure plan that ensures adequate care of clients until they are transferred
or discharged to an appropriate alternate setting; and
(2) A plan for
the security and transfer of all client records required by He-A 304.18.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.07); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.07 Inspections.
(a) For the
purpose of determining compliance with He-A 304, the certificate holder shall
admit and allow any representative from the department at any time during
regular business hours to inspect the following:
(1) The
facility premises;
(2) All
programs and services provided by the certificate holder; and
(3) Any records
required by He-A 304.
(b) The department shall conduct inspections
prior to:
(1) Issuance of
an initial certification;
(2) Renewal of
a certification;
(3) A change of
ownership; and
(4) A change of
physical location.
(c) In addition to (b) above, an OTP shall be
subject to inspection by the department to verify the implementation of any POC
accepted or issued by the department.
(d) A notice of deficiencies shall be issued
when, as a result of any inspection, the department
determines that the certificate holder is in violation of any of the provisions
of He-A 304.
(e) If the notice identifies deficiencies to be
corrected, the applicant shall submit a POC in accordance with He-A 304.09
within 21 days of the date on the letter that transmits the notice of
deficiencies.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.12); ss by #12178, INTERIM, eff 5-20-17,
EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.08 Waivers.
(a)
An applicant or certificate holder may request a waiver of a specific
provision of He-A 304, in writing, from the department.
(b)
A request for a waiver shall include:
(1) A specific reference to the rule for which a
waiver is being sought;
(2) A full
description of why a waiver is necessary; and
(3) A full
explanation of alternatives proposed by the applicant or certificate holder,
which shall be equally as protective of clients as the rule from which a waiver
is sought or provide a reasonable explanation why the applicable rule should be
waived.
(c) A waiver shall be permanent unless the
department specifically places a time limit on the waiver.
(d)
No provision or procedure prescribed by statue shall be waived.
(e)
A request for a waiver shall be granted if the department determines
that the alternative proposed by the requestor:
(1) Meets the
objective or intent of the rule;
(2) Does not
negatively impact the health, safety, or well-being of clients; and
(3) Does not
negatively affect the quality of OTP services.
(f)
The requestor’s subsequent compliance with the alternative provisions or
procedures approved in the waiver shall be considered equivalent to complying
with the rule for which the waiver was sought.
(g)
Waivers shall not be transferable.
(h) When a certificate holder wishes to renew a non-permanent
waiver beyond the approved period of time, the
certificate holder shall apply for a new
waiver with the renewal application or at least 60 days prior to the expiration
of the existing waiver, as appropriate, by submitting the information required
by (b) above.
(i) The request to
renew a waiver shall be subject to (b) through (f) above.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.11); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
(from He-A 304.19)
He-A 304.09 Administrative
Remedies.
(a) The department shall impose administrative
remedies for violations of He-A 304, including:
(1) Requiring a
certificate holder to submit a POC; and
(2) Imposing a
directed POC upon a certificate holder.
(b) When administrative remedies are imposed, the
department shall provide a written notice, as applicable, which:
(1) Identifies
each deficiency; and
(2) Identifies
the specific remedy(s) that has been proposed.
(c) A POC shall be developed and enforced in the
following manner:
(1) Upon
receipt of a notice of deficiencies, the certificate holder shall submit a
written POC for each item on the notice describing:
a. How the
certificate holder intends to correct each deficiency;
b. What measures
will be put in place, or what system changes will be made to ensure that the
deficiency does not recur;
c. The date by
which each deficiency shall be corrected; and
d. The position
of the employee responsible for the corrective action;
(2) The
certificate holder shall submit a written POC to the department within 21 days
of the date on the letter that transmitted the notice of deficiencies unless
the certificate holder requests, either verbally or in writing, and the
department agrees, to extend that deadline, based on the following criteria:
a.
The certificate holder demonstrates that he or she has made a good faith
effort to develop and submit the POC within the 21 calendar
day period but has been unable to do so; and
b.
The department determines that the health, safety, or well-being of
clients will not be jeopardized as a result of granting the extension;
(3) The
department shall review each POC and accept each plan that:
a. Achieves
compliance with He-A 304;
b. Addresses
all deficiencies as cited in the notice of deficiencies;
c. Prevents a
new violation of He-A 304 as a result of
implementation of the POC; and
d. Specifies
the date upon which the deficiencies will be corrected;
(4) If the POC
is acceptable, the department shall issue a certification or provide written
notification of acceptance of the POC, whichever is applicable;
(5) If the POC
is not acceptable:
a. The
department shall notify the certificate holder in writing of the reason for
rejecting the POC;
b. The
certificate holder shall develop and submit a revised POC within 14 days of the
date of the written notification from the department that states the original
POC was rejected unless, within the 14 day period, the
certificate holder requests an extension, either verbally or in writing, and
the department grants the extension, based on the following criteria:
1. The
certificate holder demonstrates that he or she has made a good faith effort to
develop and submit the POC within the 14 day period
but has been unable to do so; and
2. The
department determines that the health, safety, or well being
of clients will not be jeopardized as a result of granting the extension;
c. The revised
POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3)
above; and
d. If the
revised POC is not acceptable to the department, or is not submitted within 14
days of the date of the written notification from the department that states
the original POC was rejected, unless the department has granted an extension,
the certificate holder shall be subject to a directed POC in accordance with
(d) below;
(6) The
department shall verify the implementation of any POC that has been submitted
and accepted by:
a. Reviewing
materials submitted by the certificate holder;
b. Conducting
an on-site follow-up inspection; or
c. Reviewing
compliance during the next renewal inspection;
(7)
Verification of the implementation of any POC shall only occur after the
date of completion specified by the certificate holder in the plan; and
(8) If the POC
or revised POC has not been implemented by the completion date, at the time of
the next inspection the certificate holder shall be issued a directed POC in
accordance with (d) below.
(d) The department shall develop and impose a
directed POC that specifies corrective actions for the certificate holder to
implement when:
(1) As a result
of an inspection or investigation, deficiencies were identified that require
immediate corrective action to protect the health and safety of the clients or personnel;
(2) A revised
POC is not submitted within 14 days of the written notification from the
department or such other date as applicable if an
extension was granted by the department; or
(3) A revised
POC submitted by the certificate holder has not been accepted.
(e) If at the time of the next inspection the
directed POC referenced in (d) above has not been implemented by the completion
date stated in the directed POC, the department shall, as appropriate:
(1) Deny the application
for a renewal of a certification; or
(2) Revoke the
certification in accordance with He-A 304.10(b).
(f) The department shall offer an opportunity for
informal dispute resolution to any applicant or certificate holder who
disagrees with a deficiency cited by the department, provided that the
applicant or certificate holder submits a written request for an informal
dispute resolution to the department.
(g) The informal dispute resolution shall be
requested in writing by the applicant, certificate holder, or administrator no
later than 14 days from the date the notice of deficiencies was issued by the
department.
(h) The department shall change the notice of
deficiencies if, based on the evidence presented, the notice of deficiencies is
determined to be incorrect. The department shall provide a written notice to
the applicant or certificate holder of the determination.
(i) The deadline to submit a POC in accordance with (c)(2)
above shall not apply until the notice of the determination in (h) above has
been provided to the applicant or certificate holder.
(j) An informal dispute resolution shall not be
available for any applicant or certificate holder against whom the department
has initiated action to suspend, revoke, deny, or refuse to issue or renew a
certification.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.08); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.10 Enforcement
Actions and Hearings.
(a) Prior to taking enforcement action against an
applicant or certificate holder, the department shall send to the applicant or
certificate holder a written notice that sets forth:
(1) The reasons
for the proposed action;
(2) The action
to be taken by the department; and
(3) The right
of an applicant or certificate holder to a hearing in accordance with RSA
541-A:30, III, or He-C 200, as applicable, before the enforcement action
becomes final.
(b) The department shall deny an application or
revoke a certification if:
(1) An
applicant or a certificate holder violated He-A 304 in a manner which poses a
risk of harm to a client’s health, safety, or well-being of a client;
(2) After being
notified of and given an opportunity to supply missing information, the
applicant or certificate holder fails to submit an application that meets the
requirements of He-A 304.03(a);
(3) Unless a
waiver has been granted, the department makes a determination that the
applicant, administrator, or certificate holder has been found guilty of or
plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation
of any person, in this or any other state, or had an investigation for abuse,
neglect, or exploitation adjudicated and founded by the department or any
administrative agency in this or any other state;
(4) An
applicant, certificate holder, or any representative or employee of the
applicant or certificate holder:
a. Provides
false or misleading information to the department;
b. Prevents,
interferes, or fails to cooperate with any inspection or investigation
conducted by the department; or
c. Fails to
provide requested files or documents to the department;
(5) The certificate
holder has submitted a POC that has not been accepted by the department in
accordance with He-A 304.09(c)(3) and has not submitted a revised POC as
required by He-A 304.09(c)(5);
(6) The
certificate holder failed to fully implement or continue to implement a POC
that has been accepted or directed by the department in accordance with He-A
304.09(c)(3) or (d);
(7) The
certificate holder is cited a third time under He-A 304 for the same violation
within the last 5 years or 3 inspections;
(8) A certificate
holder, or its corporate officers, has had a certification revoked and submits
an application during the 5-year prohibition period specified in (h) below;
(9) The
applicant or certificate holder fails to employ a qualified administrator;
(10) The
certificate holder fails to pay the certification and administration fee
required by He-A 304.11; or
(11) An
applicant or certificate holder had a check returned to the department for
insufficient funds and has not re-submitted the outstanding fee in the form of
money order or certified check.
(c) An applicant or certificate holder shall have
30 days after receipt of the notice of enforcement action to request a hearing
to contest the action.
(d) If a written request for a hearing is not made
pursuant to (c) above, the action of the department shall become final.
(e) The department shall order the immediate
suspension of a certification, the cessation of services, and the transfer of
care of clients when it finds that the health, safety, or well-being of clients
is in jeopardy and requires emergency action in accordance with RSA 541-A:30,
III.
(f) If an immediate suspension is upheld, the
certificate holder shall not resume operating until the department determines
through inspection that compliance with He-A 304 is
achieved.
(g) Hearings under this section shall be
conducted in accordance with RSA 541-A and He-C 200.
(h) When a certification has been denied or
revoked, the applicant, certificate holder, or administrator shall not be
eligible to re-apply for a certification or be employed as an administrator for
5 years if the denial or revocation specifically pertained to his or her role
in the OTP.
(i) The 5 year period
referenced in (h) above shall begin on:
(1) The date
that the department’s decision to revoke or deny the certification became
effective, if no appeal is filed; or
(2) The date a
final decision upholding the action of the department is issued,
if a request for a hearing was made and a hearing was held.
(j) Notwithstanding (h) above, the department
shall consider an application submitted after the decision to revoke or deny
becomes final if the applicant demonstrates that circumstances have changed to
the extent that the department now has good cause to believe that the applicant
has the requisite degree of knowledge, skills,
and resources necessary to maintain compliance with the provisions of He-A 304.
(k) No ongoing enforcement action shall preclude
the imposition of any remedy available to the department under RSA 541-A or
He-A 304.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.09); ss by #12178, INTERIM, eff 5-20-17,
EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.11 Certification and Administration
Fee.
(a)
In accordance with RSA 318-B:10, VII(f):
(1) Providers of an OTP which had clients in the
previous calendar year shall submit to the department a certification and
administration fee of $8 per client served in the previous calendar year; and
(2) Providers of an OTP which had no clients in
the previous calendar year shall submit to the department a certification and
administration fee of $1000.
(b)
The fee in (a) above shall be paid to the department no later than
February 15th of each year.
(c)
The number of clients served in a calendar year shall be calculated as
follows:
(1) The number of unique clients who were
enrolled and received treatment in that year, regardless of how long the
treatment lasted or the effectiveness of the treatment;
(2) A client who has been enrolled and has
received treatment more than once in a calendar year shall be counted as a
single client for that year;
(3) A client who is enrolled and is receiving
treatment across a calendar year, as part of a single admission shall be
counted in each year; and
(4) A client who is admitted only for guest
dosing in the year shall not be included in this count.
(d)
Documentation of the number of clients served as described in (c) above
shall be submitted with the payment.
(e)
If a provider of more than one OTP submits a single payment for all of its OTPs, the documentation in (d) above shall
indicate the client census described in (c) above by OTP location.
(f)
The certification and administration fee shall be paid by check or money
order, in the exact amount of the fee, made payable to “Treasurer, State of New
Hampshire.”
(g)
Any fee submitted to the department in the form of a check or money
order and returned to the state for any reason shall be processed in accordance
with RSA 6:11-a.
Source. #7496, eff 5-23-01; amd by #7599, eff 11-20-01; ss by #9476, eff 5-22-09 (from
He-A 304.13); ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.12 Duties and Responsibilities
of All Certified OTPs.
(a)
The certificate holder shall comply with all federal, state, and local
laws, rules, codes, ordinances, licenses, permits, and approvals, and any rules
promulgated thereunder, as applicable.
(b)
The certificate holder shall define, in writing, the scope and type of
services to be provided by the OTP.
(c)
The certificate holder shall monitor, assess, and improve, as necessary,
the quality of care and services provided to clients on an ongoing basis.
(d)
The certificate holder shall develop and implement written policies and
procedures governing its operation and all services provided. Such policies
shall be submitted to the bureau upon request.
(e)
If an existing policy fails to support the health, safety, and
well-being of clients, staff, and the public, the OTP shall be required to
submit a POC in accordance with He-A 304.09.
(f)
All policies and procedures shall be reviewed annually and revised as
needed.
(g)
All staff shall receive a minimum of 8 hours annually of in-service
training on OTP policies and procedures.
(h)
The certificate holder shall:
(1) Employ an administrator responsible for the
day-to-day operation of the OTP; and
(2) Establish, in writing, a chain of command
that sets forth the line of authority for the operation of the OTP and the
staff position(s) to be delegated the authority and responsibility to act on
the administrator’s behalf when the administrator is absent.
(i) The certificate
holder shall post the following documents in a public area:
(1) The current certification issued in
accordance with these rules;
(2) A copy of the certificate holder’s policies
and procedures relative to the implementation of client rights and
responsibilities, including client confidentiality per 42 CFR Part 2; and
(3) The certificate holder’s plan for fire
safety, evacuation, and emergencies identifying the location of, and access to,
all fire exits.
(j) The certificate holder or any employee shall
not falsify any documentation or provide false or misleading information to the
department.
(k) The certificate holder shall comply with all
conditions of warnings, administrative remedies, and enforcement actions issued
by the department, and all court orders.
(l) The certificate holder shall admit and allow
any department representative to inspect the certified premises and all
programs and services that are being provided at any time during regular
business hours for the purpose of determining compliance with these rules.
(m) Certificate holders shall:
(1) Report all critical incidents to the bureau
in writing as soon as possible and no more than 24 hours following the incident;
(2) Report all contact with law enforcement to
the bureau in writing as soon as possible and no more than 24 hours following
the incident;
(3) Report all media contacts to the bureau in
writing as soon as possible and no more than 24 hours following the incident;
(4) Report all sentinel events to the department
as follows:
a. Sentinel
events shall be reported when they involve any individual who is receiving
services governed by this rule;
b. Upon discovering
the event, the OTP shall provide immediate verbal notification of the event to
the bureau, which shall include:
1. The reporting individual’s name, phone
number, and agency/organization;
2. Name and date of birth (DOB) of the
individual(s) involved in the event;
3. Location, date, and time of the event;
4. Description of the event, including what,
when, where, how the event happened, and other relevant information, as well as
the identification of any other individuals involved;
5. Whether the police were involved due to a
crime or suspected crime; and
6. The identification of any media that had
reported the event;
c. Within 72
hours of the sentinel event, the OTP shall submit a completed “Sentinel Event
Reporting Form” (February 2017), available at https://www.dhhs.nh.gov/dcbcs/documents/reporting-form.pdf
to the bureau;
d. Additional
information on the event that is discovered after filing the form in c. above
shall be reported to the bureau, in writing, as it becomes available or upon
request of the bureau; and
e. Reporting in
c. and d. above shall be completed through the E-Studio web application,
available at https://nh.same-page.com;
(5) Submit additional information regarding (1) –
(4) above if required by the department; and
(6) Report the event in (1) – (4) above, as
applicable, to other agencies as required by law.
(n) The certificate holder shall implement
policies and procedures for reporting:
(1) Suspected child abuse, neglect, or
exploitation, in accordance with RSA 169-C:29-30; and
(2) Suspected abuse, neglect, or exploitation of
adults, in accordance with RSA 149-F:49.
(o) The certificate holder shall report all
positive tuberculosis test results for personnel to the department’s bureau of
disease control in accordance with RSA 141-C:7, He-P 301.02
and He-P 301.03.
(p) Certificate holders shall develop policies
and procedures to implement state and federal regulations on client
confidentiality, including provisions outlined in 42 CFR, Part 2, RSA 172:8-a,
and RSA 318-B:12.
(q) A certificate holder shall, upon request,
provide a client or the client’s guardian or agent, if any, with a copy of his
or her client record.
(r) All records required for certification shall
be legible, current, accurate, and available to the department during an
inspection or investigation conducted in accordance with these rules.
(s) Any certificate holder that maintains
electronic records shall develop written policies and procedures designed to
protect the privacy of clients and personnel that are consistent with all state
and federal regulations and, at a minimum, include:
(1) Procedures for backing up files to prevent
loss of data;
(2) Safeguards for maintaining the
confidentiality of information pertaining to clients and staff; and
(3) Systems to prevent tampering with information
pertaining to clients and staff.
(t) The certificate holder’s service site(s)
shall:
(1) Be accessible to a person with a disability
using ADA accessibility and barrier free guidelines per 42 U.S.C. 12131 et seq;
(2) Have a reception area separate from service areas;
(3) Have private space for personal consultation,
charting, service delivery, and social activities, as applicable;
(4) Have secure storage of active and closed
confidential client records; and
(5) Have separate and secure storage of toxic
substances.
(u) The certificate holder shall establish and
monitor a code of ethics for the OTP and its staff, as well as a mechanism for
reporting unethical conduct to the department, appropriate licensing boards,
and any other oversight entities.
(v) The certificate holder shall maintain
specific written policies on the following:
(1) Client rights and responsibilities;
(2) Grievance policies and procedures for staff
and clients including:
a. Specific time
frames for written responses to the client’s written request for consideration
or reconsideration of a OTP decision;
b. Process for escalating unresolved grievances
within the OTP; and
c. Information about making complaints to the department;
(3) Progressive discipline, leading to
administrative discharge, including behaviors that may lead to progressive
discipline and/or administrative discharge;
(4) Policies on client alcohol and other drug use
while receiving OTP services;
(5) Policies to create a tobacco-free
environment, which, at a minimum, shall:
a. Include the smoking of any tobacco product,
the use of oral tobacco products or “spit” tobacco, and the use of electronic
devices for smoking or vaping;
b. Apply to employees, clients, and visitors;
c. Prohibit the use of tobacco products within
the OTP’s facilities at any time;
d. Include whether or not
use of tobacco products is prohibited outside of the facility on the grounds
and if use of tobacco products is allowed outside of the facility on the
grounds:
1. There shall be a designated smoking area(s)
which is located at least 20 feet from the main entrance;
2. All materials used for smoking in this area,
including cigarette butts and matches, shall be extinguished
and disposed of in appropriate containers; and
3. OTPs shall ensure periodic cleanup of the
designated smoking area;
e. Prohibit the use of tobacco in any OTP owned vehicle;
f. Prohibit tobacco use in personal vehicles
when transporting clients or staff on authorized business;
h. Post the tobacco free environment policy in
the OTP’s facilities and vehicles; and
i. Provide the policy to employees, clients, and
visitors at orientation, as applicable;
(6) Drug-free workplace policy and procedures,
including a requirement for the filing of written reports of actions taken in
the event of staff misuse of alcohol or other drugs;
(7) Client and staff exposure to synthetic
opioids, including but not limited to fentanyl and carfentanyl;
(8) Procedures for the prevention, detection, and
resolution of controlled substance misuse and diversion, which shall:
a. Apply to all personnel;
b. Be the
responsibility of a designated employee or interdisciplinary team; and
c. Include the
following:
1. Education;
2. Procedures
for monitoring the distribution and storage of controlled substances;
3. Voluntary
self-referral by employees who are misusing substances;
4. Co-worker
reporting procedures;
5. Drug testing procedures to include at a minimum,
testing where reasonable suspicion exists;
6. Employee
assistance procedures;
7. Confidentiality;
8. Investigation,
reporting, and resolution of controlled drug misuse or diversion; and
9. The consequences for violation of the controlled
substance misuse and diversion prevention policy;
(9) A client medication policy;
(10) Urine specimen collection, as applicable,
that:
a. Ensures that collection is conducted in a
manner that preserves client privacy as much as possible; and
b. Minimizes falsification;
(11) Safety and emergency procedures on the
following:
a. Medical emergencies;
b. Infection control and universal precautions,
including the use of protective clothing and devices;
c. Reporting employee injuries;
d. Fire monitoring, warning, evacuation, and
safety drill policy and procedures;
e. Emergency closings; and
f. Posting of the above safety and emergency procedures;
(12) Procedures
for protection of client records that govern use of records, storage, removal,
conditions for release of information, and compliance with the 42 CFR, Part 2
and the Health Insurance Portability and Accountability Act (HIPAA); and
(13) Procedures
related to quality assurance and quality improvement.
(w) The OTP shall
ensure that all staff having direct contact with clients have been trained in
the administration of naloxone and that naloxone kits are readily available for
staff use at all times.
(x) The OTP shall
ensure that all staff have annual in-service training in the content and
implementation of He-A 304.
Source. #7496, eff 5-23-01; amd by #7599, eff 11-20-01; ss by #9476, eff 5-22-09 (from
He-A 304.10); ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.13 Hours of Operation.
(a)
An OTP shall be open 7 days a week except for state and federal holidays
and for emergency closures.
(b)
Dispensing hours shall be flexible enough to permit a client who is
working or attending school to receive his or her methadone/buprenorphine
without jeopardizing such work or school.
(c)
OTPs shall make reasonable accommodations for clients who are unable to
utilize standard dispensing hours in (b) above due to work or school, including
but not limited to allowing the client to dose outside of standard dispensing
hours, but within the OTP’s normal business hours.
(d)
An OTP shall maintain hours of operation that:
(1) Include day, evening, or both, and weekend
hours to accommodate client need;
(2) Permit clients to receive medication
individually and within 15 minutes of their scheduled dosing appointments; and
(3) Are posted at the facility and otherwise made
available to clients.
(e)
An OTP shall provide clients with written notice at least 15 days prior
to any change of standard hours of operation.
(f)
Pursuant to 42 CFR 8.12, clients shall be permitted to receive a take
home dose for a day that the OTP is closed for business due to a state or
federal holiday or an emergency closure.
(g)
An OTP shall establish and implement written procedures for emergency closures
and holiday closures. Such procedures shall have been filed with the bureau.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
(from He-A 304.16)
He-A 304.14 Community Concerns.
(a)
An OTP shall have and implement policies and procedures that are
designed to reduce the risk of its clients causing
disruption to the community such as by loitering near the OTP facility premises
or acting in a manner that might constitute disorderly conduct or harassment.
(b)
Clients who repeatedly cause disruption to the community or to the OTP
shall be evaluated for possible administrative discharge from the OTP pursuant
to the OTP’s policies.
(c)
Each OTP shall have a specific plan describing its efforts to avoid
disruption of the community and actions it will take to respond to community
concerns.
(d)
If the OTP’s plan in (c) above fails to prevent such disruption, the OTP
shall provide the bureau with a written POC in accordance with He-A 304.09.
(e)
The OTP shall take steps to prevent clients from operating a motor
vehicle while under the influence of intoxicating liquor or any controlled
drug, prescription drug, over-the-counter drug, or any other chemical
substance, natural or synthetic, which impairs a person's ability to drive,
including but not limited to:
(1) Developing,
maintaining, and implementing a policy regarding identifying signs of impairment;
(2) Assessing the client for impairment from
alcohol and/or illicit or prescribed medications at the time of dosing;
(3) For those clients that are suspected to be
impaired, requiring the client to take an instant oral fluid or urine drug
screen prior to dosing;
(4) For those clients whose drug screen in (3)
above is negative:
a. Requiring the client to wait 2 hours and take
a second instant oral fluid or urine drug screen; or
b. If a medical professional identifies that
impairment is the result of an underlying medical condition that requires
immediate medical intervention, providing or procuring such intervention prior
to the second screening in a. above;
(5) If the drug screen in (3) or the second drug
screen in (4) above is positive, the client shall only be provided with a dose
that day as follows:
a. A licensed practitioner determines that it is
medically safe for the client to be given a dose; and
b. Staff can confirm that the client will be
transported by a person who is not impaired;
(6) If a client appears to be impaired, taking
reasonable steps to prevent the client from operating a motor vehicle while
impaired; and
(7) If unable to prevent the client from
operating a motor vehicle while impaired, contacting law enforcement to report
that the client may be operating a motor vehicle while impaired to the extent
allowable under 42 CFR Part 2.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09; ss by #12178, INTERIM, eff 5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
(from He-A 304.17)
He-A 304.15 Client Fee Schedule.
(a) The certificate
holder shall maintain a current fee schedule for each program, which shall be
clearly posted in a public area and a copy shall be available upon request.
(b) The certificate
holder shall maintain procedures regarding collection of fees from clients,
private or public insurance, and other payers responsible for the client’s
finances.
(c) At the time of
screening and admission the certificate holder shall provide the client, and
the client’s guardian, agent, or personal representative, if any, with a
listing of all charges and identify what care and services are included in the
charge.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.14); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.16 Clinical Services.
(a) Each OTP shall
have and adhere to a clinical care manual which includes policies and
procedures related to all clinical services provided.
(b) All clinical
services provided shall:
(1) Focus on
the client’s strengths;
(2) Be
culturally competent with regard to the clients being served;
(3) Be client
and family centered;
(4) Be evidence
based, as demonstrated by meeting one of the following criteria:
a. The service shall be included as an evidence-based
mental health and substance use disorder intervention on the SAMHSA National
Registry of Evidence-Based Programs and Practices (NREPP), http://www.nrepp.samhsa.gov/ViewAll.aspx;
b. The services shall be published in a
peer-reviewed journal and found to have positive effects; or
c. The OTP shall be able to document the
services’ effectiveness based on the following:
1. The service
is based on a theoretical perspective that has validated research; or
2. The service is supported by a documented body of
knowledge generated from similar or related services that indicate effectiveness;
(5) Be trauma
informed, which means designed to acknowledge the impact of violence and trauma
on people’s lives and the importance of addressing trauma in services; and
(6) Be
delivered in accordance with:
a. The American Society of Addiction Medicine
(ASAM) Criteria: Treatment Criteria for Substance-Related, Addictive, and
Co-Occurring Conditions, Third Edition (2013), henceforth referred to as “ASAM
Criteria (2013)” available as noted in Appendix A; and
b.
The Treatment Improvement Protocols (TIPS) and Technical
Assistance Publications (TAPS) published by SAMHSA and available at https://store.samhsa.gov/list/series?name=TIP-Series-Treatment-Improvement-Protocols-TIPS-&pageNumber=1
and https://store.samhsa.gov/list/series?name=Technical-Assistance-Publications-TAPs-&pageNumber=1,
respectively, and as
noted in Appendix A:
1. “TAP 19: Relapse Prevention with Chemically
Dependent Criminal Offenders, Counselor's Manual” (1/2006 edition);
2. “TAP 21-A: Competencies for Substance Abuse Treatment
Clinical Supervisors” (1/2013 edition);
3. “TAP 21: Addiction Counseling
Competencies: The Knowledge, Skills, and Attitudes of Professional Practice”
(11/2015 edition);
4. “TAP 34: Disaster Planning Handbook for Behavioral
Health Treatment Programs” (5/2012 edition);
5. “TIP 51: Substance Abuse Treatment: Addressing the
Specific Needs of Women” (11/2015 edition);
6. “TIP 55: Behavioral Health Services for People Who Are
Homeless” (11/2015 edition);
7. “TIP 59: Improving Cultural Competence” (11/2015
edition);
8. “TIP 60: Using Technology-Based Therapeutic Tools
in Behavioral Health Services” (11/2015 edition);
9. “TIP 41: Substance Abuse Treatment: Group Therapy”
(10/2015 edition);
10. “TIP 45: Detoxification and Substance Abuse Treatment”
(10/2015 edition);
11. “TIP 27: Comprehensive Case Management for
Substance Abuse Treatment” (10/2015 edition);
12. “TIP 39: Substance Abuse Treatment and Family Therapy”
(10/2015 edition);
13. “TIP 50: Addressing Suicidal Thoughts and
Behaviors in Substance Abuse Treatment” (10/2015 edition);
14. “TIP 52: Clinical
Supervision and Professional Development of the Substance Abuse Counselor”
(9/2014 edition);
15. “TIP 56:
Addressing the Specific Behavioral Health Needs of Men” (5/2014 edition);
16. “TIP 57:
Trauma-Informed Care in Behavioral Health Services” (3/2014 edition);
17. “TIP 58:
Addressing Fetal Alcohol Spectrum Disorders (FASD)” (12/2013 edition);
18. “TIP 44: Substance
Abuse Treatment for Adults in the Criminal Justice System” (9/2013 edition);
19. “TIP 42: Substance
Abuse Treatment for Persons With Co-Occurring Disorders” (7/2013 edition);
20. “TIP 35: Enhancing
Motivation for Change in Substance Abuse Treatment” (1/2013 edition);
21. “TIP 48: Managing
Depressive Symptoms in Substance Abuse Clients During Early Recovery” (1/2013
edition);
22. “TIP 46: Substance
Abuse: Administrative Issues in Outpatient Treatment” (12/2012 edition);
23. “TIP 34: Brief
Interventions and Brief Therapies for Substance Abuse” (9/2012 edition);
24. “TIP 36: Substance
Abuse Treatment for Persons with Child Abuse and Neglect Issues” (7/2012 edition);
25. “TIP 29: Substance
Use Disorder Treatment for People With Physical and
Cognitive Disabilities” (7/2012 edition);
26. “TIP 37: Substance
Abuse Treatment for Persons With HIV/AIDS” (7/2012 edition);
27. “TIP 32: Treatment
of Adolescents With Substance Use Disorders” (4/2012
edition);
28. “TIP 54: Managing
Chronic Pain in Adults With or in Recovery From Substance Use Disorders”
(1/2012 edition);
29. “TIP 53: Addressing
Viral Hepatitis in People With Substance Use Disorders” (12/2011 edition); and
30. “TIP 21: Combining
Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice
System” (4/2008 edition).
(c)
All OTPs shall offer the following clinical services:
(1) Screening
and evaluation services;
(2) Treatment services;
(3) Recovery
support services;
(4) Transfer
and discharge services; and
(5) Client
record services.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.15); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.17 Personnel
Requirements.
(a) The OTP shall employ an administrator responsible for the day
to day operations of the OTP.
(b) Administrators appointed after the 2018
effective date of these rules shall be at least 21 years of age and have a
minimum of one of the following combinations of education and experience:
(1) A
bachelor’s degree from an accredited institution and one year of relevant
experience working in a substance use disorders treatment related field;
(2) An associate’s degree from an accredited institution plus 3
years of relevant experience working in a substance use disorders treatment
related field; or
(3) A New
Hampshire license as an RN, MLADC, LADC, or other licensed behavioral health
practitioner, with at least one year of relevant experience working in a
substance use disorders treatment related field.
(c) The OTP shall
employ a medical director that meets the requirements of He-A 304.23.
(d) The OTP shall
meet the minimum staffing requirements:
(1) At least one:
a. Masters licensed alcohol and drug counselor
(MLADC); or
b. Licensed alcohol
and drug counselor (LADC) who also holds the licensed clinical supervisor (LCS)
credential;
(2) Sufficient staffing levels that are
appropriate for the services provided and the number of clients served;
(3) All unlicensed staff providing treatment,
education, and/or recovery support services shall be under the direct
supervision of a licensed supervisor;
(4) No licensed supervisor shall supervise more
than 8 unlicensed staff;
(5) Unlicensed staff shall receive at least one
hour of supervision for every 20 hours of direct client contact;
(6) Supervision shall be provided on an
individual or group basis, or both, depending upon the employee’s need,
experience, and skill level;
(7) Supervision shall include following
techniques:
a. Review of case records;
b. Observation of interactions with clients;
c. Skill development; and
d. Review of case management activities; and
(8) Supervisors shall maintain a log of the
supervision date, duration, content, and who was supervised by whom.
(e) Individuals licensed or certified by the NH
board of licensing for alcohol and other drug use professionals
or any other NH licensing board shall receive supervision in accordance with
the requirements set forth for the license(s) held by the individual.
(f) The certificate holder shall develop a current job description for all
staff, including contracted staff,
volunteers, and student interns, which includes:
(1) Job title;
(2) Physical requirements of the position;
(3) Education and experience requirements of the position;
(4) Duties of the position;
(5) Positions supervised; and
(6) Title of immediate supervisor.
(g) For all applicants for employment, for all
contractors, for all volunteers, and for all student interns, the certificate
holder shall:
(1) Require
those individuals listed in (d) above to sign a release to allow the OTP to
obtain his or her criminal record;
(2) Obtain and
review a criminal records check from the New Hampshire
department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed
by the New Hampshire board of nursing;
(3) Review the
results of the criminal records check in (2) above in accordance with (h)
below; and
(4) Verify the
qualifications of all applicants prior to employment.
(h) Unless a waiver is granted in accordance with
(j)(2) below, the certificate holder shall not offer employment, contract with,
or engage a person in (g) above, if the person:
(1) Has been
convicted of a felony in this or any other state;
(2) Has been
convicted of a sexual assault, other violent crime, assault, fraud, theft,
abuse, neglect, or exploitation in this or any other state;
(3) Has had a
finding by the department or any administrative agency in this or any other
state for assault, fraud, theft, abuse, neglect, or exploitation of any person;
or
(4) Otherwise
poses a threat to the health, safety, or well-being of clients.
(i) If the
information identified in (h) above regarding any person in (g) above is
learned after the person is hired, contracted with, or engaged, the certificate
holder shall immediately notify the department and either:
(1) Cease
employing, contracting with, or engaging the person; or
(2) Request a
waiver of (h) above.
(j) If a waiver of (h) above is requested, the
department shall review the information and the underlying circumstances in (h)
above and shall either:
(1) Notify the
certificate holder that the person cannot or can no longer be employed,
contracted with, or engaged by the certificate holder if, after investigation,
it determines that the person poses a threat to the health, safety, or
well-being of a client; or
(2) Grant a
waiver of (h) above if, after investigation, it determines that the person does
not pose a current threat to the health, safety, or well-being of a client.
(k) The certificate holder shall check the names
of the persons in (g) above against the bureau of elderly and adult services
(BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-W 720, prior
to employing, contracting with, or engaging them.
(l) The certificate holder shall not employ,
contract with, or engage, any person in (g) above who is listed on the BEAS
state registry unless a waiver is granted by BEAS.
(m) In lieu of (g) and (k) above, the licensee
may accept from independent agencies contracted by the certificate holder a
signed statement that the agency’s employees have complied with (g) and (k)
above and do not meet the criteria in (h) and (l) above.
(n) All staff, including contracted staff,
volunteers, and student interns, shall:
(1) Meet the educational, experiential, and
physical qualifications of the position as listed in their job description;
(2) Be licensed, registered, or certified as
required by state statute and as applicable;
(3) Receive an orientation within the first 3
days of work or prior to direct contact with clients and annually thereafter,
which includes:
a. The OTP’s code of ethics, including ethical
conduct and the reporting of unprofessional conduct;
b. The OTP’s policies on client rights and
responsibilities and complaint procedures;
c. Confidentiality requirements as required by
He-A 304.12(p);
d. Grievance procedures for both clients and
staff as required in He-A 304.12(v)(2);
e. The duties and responsibilities and the
policies, procedures, and guidelines of the position they were hired for;
f. Topics covered by both the administrative and
personnel manuals;
g. The OTP’s infection prevention program;
h. The OTP’s fire,
evacuation, and other emergency plans which outline the responsibilities of
personnel in an emergency; and
i. Mandatory
reporting requirements for abuse or neglect such as those found in RSA 161-F
and RSA 169-C:29; and
(4) Sign and
date documentation that they have taken part in an orientation as described in
(3) above;
(o) Prior to having
contact with clients, employees, contractors, volunteers, and student interns
shall:
(1) Submit to the certificate holder proof of a
physical examination or a health screening conducted not more than 12 months
prior to employment which shall include at a minimum the following:
a. The name of the examinee;
b. The date of the examination;
c. Whether or not the examinee has a contagious
illness or any other illness that would affect the examinee’s ability to
perform their job duties;
d. Results of a 2-step tuberculosis (TB) test,
Mantoux method, or other method approved by the Centers for Disease Control (CDC);
and
e. The dated signature of the licensed health practitioner;
(2) Be allowed to work while waiting for the
results of the second step of the TB test when the results of the first step
are negative for TB; and
(3) Comply with
the requirements of the Centers for Disease Control and Prevention “Guidelines
for Preventing the Transmission of M.
tuberculosis in Health-Care Settings” (2005 edition), available as noted in
Appendix A, if the person has either a positive TB test, or has had direct contact
or potential for occupational exposure to M.
tuberculosis through shared air space with persons with infectious
tuberculosis.
(p) Employees,
contractors, volunteers, and student interns who have direct contact with
clients who have a history of TB or a positive skin
test shall have a symptomatology screen of a TB test.
(q) The certificate
holder shall maintain and store in a secure and confidential manner, a current
personnel file for each employee, contractor, volunteer, and student intern.
(r) A personnel file
shall include, at a minimum, the following:
(1) A completed
application for employment or a resume, including:
a. Identification data; and
b. The education
and work experience of the employee;
(2) A copy of the current job description or
agreement, signed by the individual, that identifies the:
a. Position title;
b. Qualifications and experience; and
c. Duties required by the position;
(3) Written verification that the person meets
the OTP’s qualifications for the assigned job description, such as school
transcripts, certifications, and licenses as applicable;
(4) A signed and dated record of the orientation
required by (n)(3) above;
(5) A copy of each current New Hampshire license,
registration, or certification, including CPR certification, as applicable;
(6) Records of screening for communicable
diseases results required in (o) above;
(7) Written performance appraisals for each year
of employment or engagement including a description of any corrective actions,
supervision, or training determined by the person’s supervisor to be necessary;
(8) Documentation of annual in-service education
required in He-A 304.12(x);
(9) Information as to the general content and
length of all continuing education or educational programs attended;
(10) A signed statement acknowledging the receipt
of the OTP’s policy setting forth the client’s rights and responsibilities,
including confidentiality requirements, and acknowledging training and
implementation of the policy;
(11) A statement, which shall be signed at the
time the initial offer of employment is made and then annually thereafter,
stating that he or she:
a. Does not have a felony conviction in this or
any other state;
b. Has not been convicted of a sexual assault, other
violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a
threat to the health, safety, or well-being of a client; and
c. Has not had a finding by the department or
any administrative agency in this or any other state for assault, fraud, theft,
abuse, neglect, or exploitation of any person;
(12) Documentation of the criminal records check
and any waivers per (g) and (j) above; and
(13) The
results of a check of the BEAS state registry per (k) above.
(s) An individual need
not re-disclose any of the matters in (r)(11) above if the documentation is
available and the department has previously reviewed the material and
determined that the individual can continue employment, contract, or
engagement.
(t) All OTPs using
the services of independent contractors as personnel shall ensure that each
personnel file includes a written
agreement that describes the services that will be provided.
Source. #7496, eff 5-23-01;
ss by #9476, eff 5-22-09 (from He-A 304.16); ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.18 Client Record System.
(a) Each OTP shall have policies and procedures
to implement a comprehensive client record system that complies with this
section.
(b) In addition to (a) above, the OTP shall enter
client information into the department’s Web Information Technology System
(WITS), at https://nh.witsweb.org/, or subsequent web based database, as follows:
(1) No later
than 3 days following admission to the OTP, the OTP shall complete the
following WITS modules:
a. Client information (profile), including:
1. Name(s);
2. Gender;
3. Date of birth;
4. Last 4 digits of the client’s social security
number;
5. Ethnicity, if provided by the client;
6. Race, if provided by the client;
7. Special needs, if any;
8. Sexual orientation, if provided by the client;
9. Preferred language;
10. Veteran status;
11. Family member veteran status; and
12. Contact information;
b. Intake transaction, including:
1. Intake facility;
2. Intake staff;
3. Method of initial contact;
4. Town of residence;
5. Referral source;
6. Case status;
7. Initial contact date;
8. Intake date;
9. Pregnancy status, if applicable;
10. HIV testing history, if provided by the client;
11. History of injection drug use;
12. Information on court mandates for treatment;
13. Presenting problem; and
14. Service domain;
c. Admission, including;
1. Admission type;
2. Admission staff;
3. Admission date;
4. Codependent status;
5. Treatment history;
6. Emergency department utilization;
7. Mental health status, if provided by the client;
8. Planned opiate replacement therapy;
9. Education level;
10. Community based support group utilization;
11. Employment status;
12. Income;
13. Payer information;
14. Living situation;
15. Marital status;
16. Number of dependents;
17. Substance use information;
18. Arrest history, if provided by the client;
and
19. Diagnostic information; and
d. Program enrollment, including:
1. Program name;
2. Enrolling staff;
3. Program start date;
(2) No later
than 3 days following discharge from the OTP, the OTP shall complete the
following WITS modules:
a. Program disenrollment, including:
1. Program end date; and
2. Termination reason; and
b. Discharge, including:
1. Discharge date;
2. Date of last contact;
3. Discharge staff;
4. Discharge reason;
5. Community based support group utilization;
6. Arrest history, if provided by the client;
7. Pregnancy status, if applicable;
8. Relationship status;
9. Living arrangement;
10. Employment status;
11. Emergency department utilization;
12. Town of residence;
13. Substance use information; and
14. Diagnosis information; and
(3) No later
than 3 days following a change to any of the information in (1) and (2) above,
the information shall be updated in WITS.
(c) The client record shall include, but not be
limited to:
(1) A record of
all client screenings, including, but not limited to:
a. The client name
and/or unique client identifier generated by WITS;
b. Client demographic information, including but
not limited to:
1. Pregnancy status;
2. Primary, secondary, and tertiary substance,
severity frequency and method;
3. Age of first use;
4. Intravenous drug use status;
5. Presence of a co-occurring mental health disorder;
6. Past 30 days arrests, if provided by the client;
7. Gender;
8. Veteran status;
9. Past 14 day
administration of Narcan; and
10. Involvement with the criminal justice and/or
child protection systems;
c. The client referral source;
d. The date of initial contact from the client
or referring provider;
e. The date of screening; and
f. The result of the screening, including the
reason for denial of services if applicable;
(2)
Identification data;
(3) The date of
admission;
(4) If either
of these have been appointed for the client, the name and address of the
guardian and the representative payee;
(5) The name,
address, and telephone number of the person to contact in the event of an emergency;
(6) Contact
information for the person or entity referring the client for services, as applicable;
(7) The name,
address, and telephone number of the primary health care provider;
(8) The name, address, and telephone number of the
behavioral health care provider, if applicable;
(9) The name
and address of the client’s public or private health insurance provider(s), or
both, if applicable;
(10) The
client’s personal health history;
(11) The
client’s mental health history;
(12) Current medications;
(13) Signed
receipt of notification of client rights;
(14) Documentation of all elements of the initial
screening and evaluation required by He-A 304.21;
(15) The
individual treatment plan, as required by He-A 304.23(e)-(g), updated at
designated intervals in accordance with He-A 304.23(h)-(i);
(16) Documentation that is consistent with SAMHSA’s
“TAP 21: Addiction Counseling Competencies” (2015 edition), available as noted
in Appendix A, of all client services, including, but not limited to:
a. Record of all doses provided to the client;
and
b. Progress notes detailing all services
required in:
1. He-A 304.15(c);
2. He-A 304.22(a)-(b);
3. He-A 304.23(c)-(d), (j), and (r);
4. He-A 304.24;
5. He-A 304.25(b); and
6. He-A 304.27(a);
(17) A
narrative discharge summary, as required by He-A 304.28(f);
(18) Release of
information forms compliant with 42 CFR, Part 2;
(19) Signed
informed consent to treatment, including but not limited to an explanation of
the department’s access to client records;
(20) Any
correspondence pertinent to the client;
(21) Any other
information the OTP deems relevant; and
(22) For any
client who is placed on a waitlist:
a. All referrals to and coordination with
interim services or reason that such referrals were not made;
b. All client contacts between screening and
removal from the waitlist; and
c. The date the client was removed from the
waitlist and the reason for removal.
(d) All client records maintained by the OTP or its contractors shall be strictly confidential.
(e) All confidential information shall be
maintained in compliance with 42 CFR, Part 2.
(f) OTPs shall retain client records after the
discharge or transfer of the client, as follows:
(1) For a
minimum of 7 years for an adult; and
(2) For a
minimum of 7 years after age of majority for children.
(g) In the event of an OTP closure, the OTP shall
arrange for the continued management of all client records. The closing OTP shall notify the department
in writing of the address where records will be stored and specify the person
managing the records.
(h) The closing OTP shall arrange for storage of
each record through one or more of the following measures:
(1) Continue to
manage the records and give written assurance to the department that it will
respond to authorized requests for copies of client records within 10 working days;
(2) Transfer
records of clients who have given written consent to another certified OTP; or
(3) Enter into
a limited service organization agreement with a
certified provider to store and manage records.
Source.
#9476, eff
5-22-09; ss by #12178, INTERIM, eff
5-20-17, EXPIRED: 11-16-17
New. #12476, eff 2-16-18
He-A 304.19 Quality
Management.
(a) On a quarterly basis, OTPs shall conduct a
client record review of a minimum of 10% of the open client records, in order to evaluate the delivery of services identified in
the treatment plan and to ensure that clients’ needs are being met.
(b) OTPs shall document the results of the review
in (a) above in a quarterly quality management report, including:
(1) The number
of records reviewed;
(2) A summary
of the review results;
(3) A
description of any deficiencies identified;
(4) The
corrective action taken and/or planned to address the deficiencies identified
in (3) above including the dates action was taken or will be taken;
(5) An
evaluation of the effectiveness of the corrective action taken; and
(6) A summary
of unmet service needs.
(c) OTPs shall plan and take any remedial action
necessary to address deficiencies in service delivery identified in the
quarterly quality management report in (b) above.
(d) OTPs shall retain the quarterly quality
management report in (b) above for 2 years and make them available to the
department upon request.
Source.
#9476, eff
5-22-09 (from He-A 304.17); ss by #12178, INTERIM, eff 5-20-17, EXPIRES:
11-16-17
New. #12476, eff 2-16-18
He-A 304.20 Client
Eligibility, Admission, and Denial of Services.
(a) An OTP shall determine eligibility for
admission in accordance with 42 CFR 8.12 (e) and ASAM Criteria (2013),
available as noted in Appendix A.
(b) When an OTP’s service capacity has been
reached, the OTP shall maintain a waiting list of clients screened but not
offered services.
(c) Regardless of service capacity, an OTP shall
admit pregnant women for treatment within 2 business days of initial contact,
and if the OTP is unable to admit within 2 business days, such a client shall
be referred to the department for assistance.
(d) Clients shall be admitted for services from a
waiting list in the following order of priority:
(e) OTPs shall admit clients for services
according to the order of priority described below:
(1) Pregnant
women shall be admitted for treatment within 2 business days of initial
contact, and if the OTP is unable to admit within 2 business days, such a
client shall be referred to the department for assistance;
(2) Individuals
who have been administered Narcan to reverse the effects of an opioid overdose
either in the 14 days prior to screening or in the period between screening and
admission to the OTP;
(3) Individuals
with a history of injection drug use;
(4) Individuals
with substance use and co-occurring mental health disorders;
(5) Veterans
with substance use disorders; and
(6) Individuals
with substance use disorders who are involved with the criminal justice system
or child protection system.
(f) For any client who is denied services, the
OTP shall:
(1) Inform the
client of the reason for denial;
(2) Assist the
client in identifying and accessing appropriate available services.
(g) The OTP shall not deny services to a client
solely because the client evidences one or more of the
following:
(1) Previously
left services against the advice of staff;
(2) Relapsed
from an earlier service episode;
(3) Is on any
class of medications, including but not limited to opiates or benzodiazepines,
unless treatment with methadone/buprenorphine is contraindicated; or
(4) Has been
diagnosed with a mental health disorder.
(h) A client who meets the criteria in (a) shall
only be denied services if:
(1) The client
was previously administratively discharged from services for abusive, violent,
or illegal behavior; or
(2) The client
is unable to demonstrate an ability to pay for services.
(i) The OTP shall
report on (c) – (e) above at the request of the department.
Source. #12476, eff 2-16-18
He-A 304.21 Screening
and Evaluation Requirements.
(a) A screening interview shall be conducted by a
licensed counselor, unlicensed counselor under supervision of a licensed
supervisor, or CRSW in accordance with SAMHSA’s “TAP 21: Addiction Counseling
Competencies” (2015 edition), available as noted in Appendix A.
(b) The information gathered during the interview
in (a) above shall be used to determine:
(1) The
likelihood that the client meets criteria for an opioid use disorder as
described in the American
Psychiatric Association’s “Diagnostic and Statistical Manual of Mental
Disorders (DSM-5),” Fifth Edition (2013), available as noted in Appendix A;
(2) An estimate
of the appropriate initial level of care for the client based on ASAM Criteria
(2013), available as noted in Appendix A; and
(3) Whether or
not the client fits into a priority population as established in He-A
304.20(b).
(c) For clients who require treatment services as
determined by the screening interview in (a) above, a clinical evaluation
interview shall be conducted and documented:
(1) By a
licensed counselor or unlicensed counselor under supervision of a licensed supervisor;
(2) In
accordance with SAMHSA’s “TAP 21: Addiction Counseling Competencies” (2015
edition), available as noted in Appendix A;
(3) Utilizing
an evidence-based evaluation tool;
(4) Addressing
all ASAM Criteria (2013), available as noted in Appendix A, domains; and
(5) Including
an HIV/AIDS screening, to include:
a. The provision of information;
b. Risk assessment;
c. Intervention and risk reduction education,
and
d. Referral for testing, if appropriate, within
7 days of admission.
(d) The information gathered during the interview
in (a) above shall be used to:
(1) Determine
if a client meets DSM-5 criteria for a opioid use
disorder and to document the appropriate DSM-5 diagnosis(es);
(2) Determine
the appropriate initial level of care for the client based on ASAM Criteria
(2013), available as noted in Appendix A; and
(3) Develop the
client’s treatment plan in accordance with He-A 304.23.
(e) Each client shall have a medical examination
conducted in accordance with 42 CFR Part 1, 8.12(f)(2).
Source. #12476, eff 2-16-18
He-A 304.22 Opportunity
To Participate in Withdrawal Management Required.
(a) A licensed practitioner shall ensure, and
shall document in the client’s record, that each client is offered the
opportunity to participate in a methadone/buprenorphine withdrawal management
program instead of a maintenance treatment program at the time of admission, at
least every 6 months thereafter, and upon client request.
(b) When clinically appropriate based on ASAM
Criteria (2013), available as noted in Appendix A, the licensed practitioner
shall encourage clients to choose a methadone/buprenorphine withdrawal
management program instead of a maintenance treatment program. Such
encouragement shall not be considered a requirement to participate in a
withdrawal management program.
(c) The licensed practitioner shall document in
the client’s record the clinical appropriateness of the form of treatment
chosen.
Source. #12476, eff 2-16-18
(formerly He-A 304.05)
He-A 304.23 Required
Medical and Clinical Services.
(a)
The OTP shall have a designated medical director who shall be
responsible for all medical services.
(b)
The medical director shall ensure that, for every client:
(1) Treatment plans are prepared and updated
pursuant to (f)-(i) below;
(2) The client’s need for methadone/buprenorphine
maintenance is evaluated at least every 6 months;
(3) Any controlled substances prescribed for a
client are clinically justified and documented in accordance with all
applicable regulations, statutes, and rules; and
(4) A determination is made regarding the
client’s need for any other specialized services, such as treatment for other
substance use disorders, medical services, or psychiatric services, and any
such conditions are identified and treated or a
referral is made to an appropriate service provider.
(c)
Upon a client’s admission, the OTP shall conduct a client orientation,
either individually or by group, to include the following:
(1) Rules,
policies, and procedures of the OTP and facility;
(2) Obtaining
consent, which is compliant with 42 CFR Part 2, relative to the OTP reporting
to law enforcement that a client may be operating a motor vehicle while
impaired in as described in He-A 304.14(e);
(3)
Requirements for successfully completing the program;
(4) The
administrative discharge policy and the grounds for administrative discharge;
(5) All
applicable laws regarding confidentiality, including the limits of
confidentiality and mandatory reporting requirements; and
(6) Requiring
the client to sign a receipt that the orientation was conducted.
(d)
Pregnancy testing shall be conducted as follows:
(1) Unless
contraindicated by sexual orientation or physiological factors, a OTP shall test monthly for pregnancy any female client of
childbearing age who is using methadone/buprenorphine;
(2) If
pregnancy is confirmed, the OTP shall:
a. Refer the client for health care for her
pregnancy; and
b. Coordinate her
treatment with all health care providers involved in her prenatal care; and
(3) If a pregnant client refuses to obtain primary
care for her pregnancy, staff shall ask the client to sign a statement
indicating she has refused such care, or shall
document the client’s refusal of care and refusal to sign.
(e) A licensed counselor or unlicensed counselor
under the supervision of a licensed supervisor shall develop and maintain a
written treatment plan for each client in accordance with SAMHSA’s “TAP 21:
Addiction Counseling Competencies” (2015 edition), available as noted in
Appendix A, which addresses all ASAM Criteria (2013), available as noted in
Appendix A, domains.
(f) Treatment plans shall be developed in the
first session following the evaluation.
(g) Individual treatment plans shall contain, at
a minimum, the following elements:
(1) Goals,
objectives, and interventions written in terms that are specific, measurable,
attainable, realistic, and timely.
(2) Identifies
the recipient’s clinical needs, treatment goals, and objectives;
(3) Identifies
the client’s strengths and resources for achieving goals and objectives in (1)
and (2) above;
(4) Defines the
strategy for providing services to meet those needs, goals, and objectives;
(5) Identifies
referral to outside providers for the purpose of achieving a specific goal or
objective when the service cannot be delivered by the OTP;
(6) Provides
the criteria for terminating specific interventions;
(7) Includes
specification and description of the indicators to be used to assess the
individual’s progress;
(8)
Documentation of participation by the client in the treatment planning
process or the reason why the client did not participate; and
(9) Signatures
of the client and the counselor agreeing to the treatment plan, or if
applicable, documentation of the client’s refusal to sign the treatment plan.
(h) Treatment plans shall be reviewed no less
frequently than every 4 sessions or every 4 weeks, whichever is less frequent
and updated based on any changes in any of the ASAM Criteria (2013) domains,
available as noted in Appendix A.
(i) Treatment plan updates
shall include:
(1)
Documentation of the degree to which the client is meeting treatment
plan goals and objectives;
(2)
Modification of existing goals or addition of new goals based on changes
in the client’s functioning relative to ASAM Criteria (2013), available as
noted in Appendix A, domains and treatment goals and objectives;
(3)
Documentation that the ASAM Criteria (2013), available as noted in
Appendix A, transfer, discharge, and continuing care criteria were reviewed
with the client in each of the ASAM Criteria (2013), available as noted in
Appendix A, domains and that the client, counselor and licensed practitioner
have jointly concluded that:
a. The client requires continued treatment at
the current level of care; or
b. The client requires treatment at a higher or
lower level of care and the updated treatment plan reflects transition to that
level of care; and
(4) The
signature of the client and the counselor agreeing to the updated treatment
plan, or if applicable, documentation of the client’s refusal to sign the
treatment plan.
(j) In addition to the individualized treatment
planning in (d) above, all OTPs shall provide client education on:
(1) Substance
use disorders;
(2) Relapse prevention;
(3) Infectious diseases associated with injection drug
use, including but not limited to, HIV, hepatitis, and TB;
(4) Sexually
transmitted diseases;
(5) Emotional,
physical, and sexual abuse;
(6) Nicotine
use disorder and cessation options;
(7) The impact
of drug and alcohol use during pregnancy, risks to the fetus, and the
importance of informing medical practitioners of drug and alcohol use during pregnancy;
(8) Education around neonatal abstinence syndrome
(NAS) for pregnant women to include significant others and/or care givers as appropriate;
(9) Working
with family or significant others;
(10) Living and
coping skills;
(11) Medication
and drug education;
(12) Dealing
with a positive drug screen;
(13) Education,
vocational training, employment, or any combination thereof; and
(14) Education about acquired
immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV).
(k)
Based on the client’s treatment plan, methadone/buprenorphine
maintenance treatment shall include medication and clinical services as
detailed in Table 304.01.
(l)
The OTP shall maintain the client with a dose adequate to alleviate all
withdrawal symptoms;
(m)
The OTP shall establish client dosing based on individual need, as
detailed in the client’s treatment plan; and
(n)
The OTP shall provide flexible dosage tapering at the client’s request.
(o)
Upon a client’s compliance with required treatment and counseling and
the negative results for all drug screens conducted, the required number of
hours of counseling shall be reduced and the allowed number of take-home doses
shall be increased, in accordance with Table 304.01 below:
Table 304.1 Treatment,
Counseling, and Take-Home Schedule
Consecutive Days
in Compliance with He-A 304.24(o) |
Required Hours
of Counseling per Month |
Allowed days supply of Take-Home Doses per Week |
1-90 |
8 |
0 |
91-180 |
8 |
1 |
181-364 |
6 |
2 |
365-540 |
4 |
3 |
541-730 |
4 |
4 |
731-909 |
2 |
5 |
910+ |
1 |
6 |
(p)
For clients who are required to engage in 8 hours of counseling per
month, the OTP may reduce the number of hours by up to 4 hours if clinical
staff determine that such a reduction will not result in an increased risk
assessment in any of the ASAM Criteria (2013), available as noted in Appendix
A, dimensions.
(q)
An OTP shall not issue more than a 6-day supply of take-home doses to a
client in one week.
(r)
Required substance use disorder counseling shall be based on the
client’s individualized treatment plan and be consistent with ASAM Criteria
(2013), available as noted in Appendix A, and SAMHSA’s TIPS and TAPS standards,
as applicable, and include, at a minimum:
(1) Any combination of individual, group, or
family substance use disorder treatment services;
(2) Case management services, which may be
substituted on an hour-for-hour basis for up to 25% of the required counseling
hours; and
(3) Discussion
between clinical staff and the client regarding the commencement of a
methadone/buprenorphine discontinuance plan, with projected target dates for
implementation, which may:
a. Be short-term or long-term in nature based on
the client’s need and preference; and
b. Include
intermittent periods of methadone/buprenorphine maintenance between
discontinuance attempts.
(s) If the licensed practitioner determines that
split dosing is medically necessary, the OTP shall request a split-dose
exception on-line, using the SAMHSA OTP Exception Request website at
https://otp-extranet.samhsa.gov/login.aspx?ReturnUrl=%2f.
(t) Such requests shall include, as appropriate:
(1) OTP
identification number;
(2) Patient
identification number;
(3) OTP name;
(4) OTP contact
information;
(5) Requestor information;
(6) Patient
admission date;
(7) Patient’s
current dosage;
(8) Medication type;
(9) Patient’s
attendance schedule;
(10) Employment
status;
(11) Nature of
the change request;
(12) Start date
of the requested change;
(13) End date
of the requested change;
(14) Number of
doses to be dispensed during the exception period;
(15)
Justification for the change request;
(16) Regulatory
compliance information; and
(17) Submitting
physician information and dated signature.
(u)
The OTP shall provide group education and counseling as follows:
(1) The OTP
shall maintain an outline of each educational and group therapy session
provided; and
(2) All group
counseling sessions shall be limited to 12 clients or fewer per counselor.
(v) All client activities and services shall be
documented in accordance with SAMHSA’s “TAP 21: Addiction Counseling
Competencies” (2015 edition), available as noted in Appendix A, and He-A
304.18.
Source. #12476, eff 2-16-18
(formerly He-A 304.06)
He-A 304.24 Drug Screens.
(a)
An OTP shall perform, or have performed, drug screens of clients as
described in this section.
(b)
All new clients shall have a minimum of a drug screen upon admission and
randomly every week thereafter for the first 3 months of treatment.
(c) After the first 3 months of
treatment, all clients shall have a minimum of one drug screen performed
randomly every month.
(d) All required drug screens shall
include, at a minimum, the following substances or
their metabolites:
(1) Opiates;
(2) Methadone;
(3) Buprenorphine;
(4) Amphetamines;
(5) Cocaine;
(6) Benzodiazepines;
(7) Cannabis; and
(8) Methamphetamine.
(e)
A drug screen shall be considered positive for illicit substances only
if the substance identified is not being used under the supervision of and as
directed by a licensed practitioner.
(f)
When a client disputes the results of a positive drug screen, the screen
shall only be considered positive after confirmatory testing by a Clinical
Laboratory Improvement Amendments (CLIA) certified laboratory.
Source. #12476, eff 2-16-18
He-A 304.25 Take-Home
Medications.
(a)
An OTP’s staff shall approve take-home methadone/buprenorphine only for
a client who meets the take-home criteria in accordance with 42 CFR Part
8.12(h)(4)(i)(2).
(b)
In addition to the criteria in (a) above, a client shall complete
individual or group counseling specific to the safe transport and storage of
take-home medication to prevent diversion, theft, or use by another person,
each time the client is eligible for consideration of an additional
unsupervised take-home dose.
(c)
Prior to granting take-home privileges, and each time the client’s
progress is reviewed, the licensed practitioner shall document in the client’s
record that the criteria in (a) above have been met and that, in his or her
judgment, the potential risk of diversion or misuse is outweighed by the
rehabilitative benefits to be derived from decreasing the frequency of clinic
attendance and the client’s demonstrated overall responsibility in the handling
of methadone/buprenorphine.
(d)
A client for whom take-home methadone/buprenorphine is authorized may be
provided with one day of extra medication if the client’s regular pickup falls
on a state holiday.
(e)
For clients who demonstrate a need for a more flexible take-home
methadone/buprenorphine schedule in order to enhance
and extend their rehabilitative and community reintegration progress, an OTP
may request of the department, approval to permit a client to follow a
temporary take-home medication regimen.
(f)
The department shall approve such requests in (e) above if it determines
that:
(1) The client is unable to comply with the
required treatment, counseling, and/or take-home schedule because of
exceptional circumstances such as:
a. Illness;
b. Personal or family crisis;
c. Travel difficulties, such as bad weather; or
d. Other hardship that would similarly prevent
the client’s compliance;
(2) The licensed practitioner has found the client to be responsible in
using methadone/buprenorphine as required in (c) above;
(3) The licensed practitioner has determined that
a temporary reduction in clinic attendance is appropriate;
(4) The client is not given more than a 2-week
supply of methadone/buprenorphine at one time;
(5) The reasons for permitting a temporary
reduction in clinic attendance have been recorded by in the client’s record;
(6) Staff have determined that the rehabilitative
benefit the patient derived from decreasing the frequency of clinic attendance
outweighs the potential risks of diversion; and
(7) The licensed practitioner has submitted such
requests on-line, using the SAMHSA OTP Exception Request Website at https://otp-extranet.samhsa.gov/login.aspx?ReturnUrl=%2f,
including:
a. OTP identification number;
b. Patient identification number;
c. OTP name;
d. OTP contact information;
e. Requestor information;
f. Patient admission date;
g. Patient’s current dosage;
h. Medication type;
i. Patient’s attendance schedule;
j. Employment status;
k. Nature of the change request;
l. Start date of the requested change;
m. End date of the requested change;
n. Number of doses to be dispensed during the
exception period;
o. Justification for the change request;
p. Regulatory compliance information; and
q. Submitting physician information and dated
signature.
Source. #12476, eff 2-16-18
He-A 304.26 Treatment Requirements for
Withdrawal Management.
(a) For each client participating in
withdrawal management, the OTP shall administer methadone/buprenorphine in a
way designed for the client to reach an opioid-free state and to make progress
in the ASAM Criteria (2013), available as noted in Appendix A, domains within a
period of up to 180 days.
(b)
All requirements of He-A 304.23 through He-A 304.25 for treatment shall
apply to withdrawal management.
(c)
Before a withdrawal management program is repeated, the licensed
practitioner shall document in the client’s record that the client continues to
be or is again physiologically dependent on opioids.
(d)
Withdrawal management shall not be repeated unless a licensed
practitioner documents in the client’s record that the client continues to be
or is again physiologically dependent on opioids; and
(e)
Repetition of withdrawal management episodes shall be determined in
accordance with 42 CFR Part 8.
Source. #12476, eff 2-16-18
(formerly He-A 304.06)
He-A 304.27 Discontinuance
of Methadone/Buprenorphine.
(a)
At the time of admission and every 6 months thereafter, the OTP shall
provide each client with a written protocol to request discontinuance of
methadone/buprenorphine treatment, including but not limited to:
(1) The client’s right to request discontinuance
of treatment at any time;
(2) The process to be followed in making this
request; and
(3) The procedure for filing any grievances
related to this process.
(b)
An individual methadone/buprenorphine discontinuance plan shall be
developed and implemented for all clients who request discontinuance.
(c)
The determination to voluntarily discontinue methadone/buprenorphine
shall be left to the judgment of the client, in consultation with staff.
(d)
If staff do not agree with the client’s decision to discontinue
methadone/buprenorphine, the staff shall document such disagreement in the
client’s record.
(e)
Reduction of a client’s methadone/buprenorphine dosage shall:
(1) Be ordered and overseen by medical staff;
(2) Occur gradually in a manner that facilitates
the client’s discontinuance, as determined by the medical staff; and
(3) Be in accordance with the client’s treatment
goals.
(f)
In situations where staff have determined that onsite discontinuance is
undesirable, such as due to the client’s aggressive behavior:
(1) Alternative arrangements shall be offered by
the staff; and
(2) If the client refuses all
of the arrangements, the refusal shall be documented by staff in the
client’s record.
(g)
OTPs shall have procedures to modify a client’s discontinuance protocol
or to engage the client in withdrawal management or maintenance services in the event that a client relapses during discontinuance.
(h)
Continued services and supports necessary to support the client through
and for up to 90 days after the discontinuance process shall be provided by the
OTP in consultation with the clinical staff.
(i) OTPs shall have discharge policies as
required by He-A 304.28.
Source. #12476, eff 2-16-18
(formerly He-A 304.11)
He-A 304.28 Client Discharge and
Transfer.
(a) A client shall
be discharged from an OTP for the following reasons:
(1) Program
completion or transfer based on changes in the client’s functioning relative to
ASAM Criteria (2013), available as noted in Appendix A; or
(2) Program
termination, including:
a.
Administrative discharge;
b. The client
left the program before completion against advice of treatment staff; and
c. The client
is inaccessible, such as the client has been jailed or hospitalized.
(b)
An OTP may administratively discharge a client from a treatment program
only if:
(1) The client’s behavior on OTP premises is
abusive, violent, or illegal;
(2) The client repeatedly causes disruption to
the community or to the OTP and fails to change their behavior subsequent to
written notice of the required behavior change;
(3) The client fails to pay fees within 5
business days after being informed in writing and counseled regarding financial
responsibility and possible sanctions including discharge;
(4) The client has had unexcused absences on 3
consecutive medication days, and the medical director, after a reevaluation of
the client, has determined that administrative discharge is warranted;
(5) Clinical staff documents therapeutic reasons
for discharge, including but not limited to:
a. The client
becoming unwilling to participate in achieving their treatment goals; or
b. The client
continuing to use alcohol or other drugs in a manner that poses a risk to
either the client’s physical well-being or public safety;
(6) The client is non-compliant with prescription
medications; or
(7) The client violates OTP rules in a manner
that is consistent with the OTP’s progressive discipline policy.
(c)
If a client is administratively discharged due to financial reasons in
(b)(2) above, the OTP shall provide medically supervised withdrawal in
accordance with (d) below, regardless of the client’s ability to pay.
(d)
If a client is being administratively discharged for any reason, they
shall have the opportunity to participate in medically supervised withdrawal as
follows:
(1) The OTP shall maintain the client with a dose
adequate to alleviate all withdrawal symptoms;
(2) The OTP shall establish client dosing based
on individual need, as detailed in the client’s treatment plan;
(3) The OTP shall provide flexible dosage
tapering at the client’s request;
(4) The OTP shall develop a detoxification
schedule with daily dosage reductions of not more than 10 percent of the
original dose;
(5) The OTP shall conduct daily observation of
the client, monitoring for withdrawal symptoms;
(6) Methadone/buprenorphine shall be administered
daily; and
(7) Take-home medications shall not be allowed
during medically supervised withdrawal.
(e)
Clients may transfer between OTPs subject to the following:
(1) When a client transferring to a program has
received a medical examination within 3 months prior to admission, the OTP
shall not conduct a new medical examination unless requested by the licensed practitioner;
(2) The OTP to which a client transfers shall
include copies of the previous medical examination in the client’s record
within 30 days of admission;
(3) Upon receipt of an appropriately executed
release of information, an OTP shall provide to the receiving OTP the client’s
clinical record, including attendance, dosage, previous 3 drug screens, and all
pertinent medical information, even if the client still has an outstanding
financial balance;
(4) Clients who
have qualified for unsupervised take home doses at their previous
methadone/buprenorphine opiate treatment program shall continue to receive
unsupervised take home doses at the same level, not to exceed 6 take home doses
per week, as long as the receiving OTP has verified the client’s compliance in
his or her previous program;
(5) When transferring a client, the counselor
shall:
a. Complete a
progress note on the client’s treatment and progress towards treatment goals,
to be included in the client’s record; and
b. Update the
client evaluation and treatment plan; and
(6) When transferring a client to another
treatment program, the current OTP shall forward copies of the following
information to the receiving OTP, only after a release of confidential
information is signed by the client:
a. The
discharge summary in (f) below;
b. Client demographic information, including the
client’s name, date of birth, address, telephone number, and the last 4 digits
of his or her Social Security number; and
c. A diagnostic
assessment statement and other assessment information, including:
1. TB test results;
2. A record of
the client’s treatment history; and
3. Documentation
of any court-mandated or OTP-recommended follow-up treatment.
(f) In all cases of client discharge or transfer,
the counselor shall complete a narrative discharge summary, including, at a
minimum:
(1) The dates
of admission and discharge or transfer;
(2) The
client’s psychosocial substance use history and legal history;
(3) A summary of the client’s progress toward
treatment goals in all ASAM Criteria (2013), available as noted in Appendix A, domains;
(4) The reason
for discharge or transfer;
(5) The
client’s DSM-5 diagnosis and summary, to include other assessment testing
completed during treatment;
(6) A summary
of the client’s physical condition at the time of discharge or transfer;
(7) A continuing care plan, as applicable,
including all ASAM Criteria (2013),
available as noted in Appendix A,
domains; and
(8) The dated
signature of the counselor completing the summary.
(g) The discharge summary shall be completed no
later than 7 days following a client’s discharge or transfer from the OTP.
(h) The
counselor shall meet with the client at the time of discharge or transfer to
establish a continuing care plan that:
(1) Includes
recommendations for continuing care in all ASAM Criteria (2013), available as
noted in Appendix A, domains;
(2) Addresses
the use of community based support groups; and
(3) Assists the
client in making contact with other agencies or
services.
(i) The counselor
shall document in the client record if and why the meeting in (h) could not
take place.
Source. #12476, eff 2-16-18
PART He-A 305 VOLUNTARY REGISTRY FOR RECOVERY HOUSES
He-A 305.01 Purpose. The purpose of this part is to establish and
administer a voluntary registry for operators of certified recovery houses, establish a process for receiving complaints for
registered-certified recovery houses, and to allow for the distribution of a
list of registered recovery houses pursuant to RSA 172-B:2,V.
Source. #12821,
INTERIM, eff 7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.02 Definitions.
(a) “Alcohol and drug free environment”
means an environment in which the use of alcohol and illicit drugs are prohibited and includes alcohol and drug free housing.
(b) “Business day” means a day in
which the department conducts normal business operations. This term excludes
weekends and holidays.
(c) “Commissioner” means the
commissioner of the New Hampshire department of health and human service or his
or her designee.
(d) “Certifying body” means an agency
designated by the commissioner to provide voluntary certification for recovery houses based on standards set by the National
Alliance for Recovery Residences (NARR).
(e) “Complaint process” means the
procedure to accept and respond to concerns about a specific recovery house reported by residents or other individuals to the
department.
(f) “Department” means the New
Hampshire department of health and human services.
(g) “New Hampshire Recovery
House Registry” means the list of certified recovery houses voluntarily registering
with the department, and provided by the department pursuant to this part.
(h) “Operator” means the lawful
owner of a recovery house or a person employed and designated by the owner of
the recovery house to have primary responsibility for the daily operation of
the recovery house including maintaining standards and conditions supportive of
substance use disorder recovery.
(i) “Recovery house” means a residence, commonly known as a
sober home, that provides or advertises as providing an alcohol and drug free
environment for persons recovering from substance use disorders. This term does
not include a halfway house, treatment unit, or detoxification facility.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.03
Registration Application Submission.
(a) Each applicant shall:
(1) Complete and submit to the department a “New
Hampshire Recovery Housing Registration Form” (December 2020) signed by the operator of the recovery house; and
(2) Submit a copy of their current NARR certification document issued by the
certifying body.
(b) The applicant shall mail, hand-deliver, or email the
requirements in (a) above to:
Department of Health and Human Services
Division of Behavioral Health Services
Bureau of Alcohol and Drug Services
105 Pleasant Street
Concord, NH 03301
@dhhs.nh.gov
Source. #12821,
INTERIM, eff 7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.04
Processing of Application and
Issuance of Registration.
(a) An application for registration shall be complete when the
department determines that the registration required in
He-A 305.03(a) has been received by the department.
(b) Within 15 business days of the
department’s receipt of the completed application under (a) above, applicants shall be included in the New Hampshire Recovery House Registry and shall be
sent an email confirming registration.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.05
Expiration and Renewal.
(a) A recovery house registration shall expire
one year from the registration approval date.
(b) All registered recovery
houses shall complete and submit a renewal application “New Hampshire Recovery
Housing Registration Form” (December 2020) at least 30 days prior to the
expiration of registration.
(c) Each applicant shall
submit a copy of their current certification document issued by the certifying
body with the renewal application in (b) above.
(d) Within 15 business days of the department’s
receipt of the completed renewal application, applicants shall be included in
the New Hampshire Recovery House Registry and shall be sent an email confirming
registration.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.06 Requirements for
Organizational or Service Change.
(a) All registered recovery houses shall provide
the department with written notice at least 30 days prior to changes for any of
the following:
(1) Ownership;
(2) Physical location;
(3) Name;
(4) Number of beds; and
(5) Changes in services available to residents.
(b) All registered recovery houses shall provide
the department with written notice within 5 days of any changes to the status of their NARR certification.
(c) All registered recovery houses shall complete
and submit a new application for registry prior to operating under a:
(1) Change in ownership; or
(2) Change in physical location.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.07
Complaints and Criteria for
Exclusion from the Registry.
(a) The department shall receive and
review complaints that meet the following conditions:
(1) Complaints submitted by residents or former
residents of certified recovery houses listed on the NH voluntary certified
recovery house registry and based on the complainant’s first-hand knowledge
regarding the allegation(s) or complaints by a third-party authorized to represent
the complainant’s concern about their safety or legal rights, which shall be
referred to the proper authority;
(2) Complaints concerning the health of residents
and safety of the recovery house;
(3) Complaints concerning the management of the
recovery house including, but not limited to, house environment, financial
procedures, staffing, house rules and regulations, recovery support
environment, or any other concerns affecting the complainant; and
(4) Complaints concerning illegal activities or
threats.
(b) Complainants shall complete and submit form
“NH Recovery Housing Complaint Form” (June 2021) via mail, hand-delivery, or email to:
Department of Health and
Human Services
Division of Behavioral
Health Services
Bureau of Alcohol and Drug
Services
105 Pleasant Street
Concord, NH 03301
recoveryhousing@dhhs.nh.gov
(c) The department shall track all complaints.
(d) A complainant may request that the
complainant’s identity be kept confidential throughout the complaint
investigation process subject to the following:
(1) The complainant might be contacted by the
certifying body, or other investigative bodies related to legal and consumer
fraud, to confirm and gather additional information concerning the complaint;
and
(2) The complainant’s identity shall not be shared
with the recovery house that the complaint is filed against without the
complainant’s expressed permission, subject to legal requirement concerning
complainants involving illegal activities, harm or threats of harm, or violations
of consumer protections laws.
(e) The department shall review all
complaints upon receipt and send them to the certifying body for action, and/or
shall directly refer complaints that concern illegal activities, harm or
threats of harm, or violations of consumer law or suspected non-compliance with
state or federal laws to the appropriate authority.
(f) The department shall remove a recovery house
from the registry based on complaints concerning illegal activities, harm or imminent threats of harm, or
violations of consumer protections laws referred to and investigated by the
appropriate authority.
(g) The certifying body shall notify the owner of the recovery
house regarding the complaint with the details of the complaint excluding the
identity of the complainant within 15 business days of receipt.
(h) For complaints reviewed by the
certifying body, the department shall be provided the following by the
certifying body:
(1) Quarterly reports on certified houses that
are out of compliance with NARR standards and what actions were taken; and
(2) An annual report on all certified recovery
house complaints that includes the number of investigations and the results of
each.
(i)
The certifying body shall notify the
department within 3 days of the results of their complaint investigation and
their recommendations concerning the following:
(1) Revocation or suspension of NARR certification;
(2) Referral for investigation by law enforcement
agencies of reports of illegal activities, physical harm, or threats;
(3) Facility deficiencies including overcrowding,
unclean conditions, need for repairs or any other concerns related to the NARR
standards that endanger the welfare of the residents;
(4) Referral for investigation by the consumer
protection bureau of reports of violation of consumer protection laws; or
(5) Non-compliance with other state and federal
laws.
(j) Upon notification from the
certifying body the department shall review the recommendation provided by the
certifying body and remove the recovery house from the registry whose
certification has been revoked or suspended.
(k) A recovery house that is removed from the
registry shall be notified within one business day of their removal from the
registry.
(l) A recovery house shall not be
placed back on the registry until it is determined by the certifying body that
compliance with the NARR standards and He-A 305 is achieved, and certification
has been restored.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.08 Duties and Responsibilities
of the Registered.
(a) All registered recovery houses shall meet the
following criteria:
(1) Register prior to the registration expiration
date as required in He-A 305.05 above; and
(2) All registered recovery
houses shall follow all applicable federal, state, and local laws.
(b) All registered recovery houses may
advertise as being on the New Hampshire Recovery House Registry.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.09 Publication and
Dissemination of Recovery House Registration List. The department shall:
(a) Compile and maintain a list of registered
recovery houses;
(b) Publish the list on
the bureau of drug and alcohol website found at https://www.dhhs.nh.gov/dcbcs/bdas/recovery-house-registry.htm;
(c) Distribute the list directly to the bureau of
drug and alcohol services’ contracted vendors; and
(d) Make the list available to anyone upon
request.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
He-A 305.10 Referral to Registered
Recovery Houses. A state agency or vendor with a state or federally funded
contract that is providing treatment or recovery support services to a person
shall not refer the person to recovery housing unless the recovery housing is
registered pursuant to this part.
Source. #12821, INTERIM, eff
7-1-19, EXPIRED: 12-30-19
New. #12969, eff 1-8-20;
ss by #13150, INTERIM, eff 12-30-20, EXPIRED 6-28-21
New. #13223, eff 6-26-21
Appendix A: Incorporation by Reference Information
Rule |
Title |
Obtain at: |
He-A 304.16(b)(6)a.; .20(a); .21(b)(2), (c)(4), (d)(2); .22(b); .23(e),
(h), (i)(2), (i)(3), (p),
(r); .27(a); .28(a)(1), (f)(3), (f)(7), (h)(1) |
ASAM Criteria:
Treatment Criteria for Substance-Related, Addictive, and Co-Occurring
Conditions, Third Edition (2013) |
Publisher:
American Society of Addiction Medicine (ASAM). The ASAM Criteria (2013) can be purchased online
through the ASAM website at: http://www.asamcriteria.org/. Cost = $95 (non-members) or $85 (members). Discounts
are available for large purchases. |
He-A 304.16(b)(6)b.1.-4. |
1. “TAP 19: Relapse
Prevention with Chemically Dependent Criminal Offenders, Counselor's Manual”
(1/2006 edition); 2. “TAP 21-A:
Competencies for Substance Abuse Treatment Clinical Supervisors” (1/2013
edition); 3. “TAP 21: Addiction
Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional
Practice” (11/2015 edition); 4. “TAP 34: Disaster
Planning Handbook for Behavioral Health Treatment Programs” (5/2012 edition) |
Publisher: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment, www.samhsa.gov. The Technical
Assistance Publications (TAPS) are available at: https://store.samhsa.gov/list/series?name=Technical-Assistance-Publications-TAPs-&pageNumber=1 |
He-A 304.16(b)(6)b.5.-30. |
5. “TIP 51: Substance
Abuse Treatment: Addressing the Specific Needs of Women” (11/2015 edition); 6. “TIP 55: Behavioral
Health Services for People Who Are Homeless” (11/2015 edition); 7. “TIP 59: Improving
Cultural Competence” (11/2015 edition); 8. “TIP 60: Using
Technology-Based Therapeutic Tools in Behavioral Health Services” (11/2015
edition); 9. “TIP 41: Substance
Abuse Treatment: Group Therapy” (10/2015 edition); 10. “TIP 45:
Detoxification and Substance Abuse Treatment” (10/2015 edition); 11. “TIP 27:
Comprehensive Case Management for Substance Abuse Treatment” (10/2015
edition); 12. “TIP 39: Substance
Abuse Treatment and Family Therapy” (10/2015 edition); 13. “TIP 50: Addressing
Suicidal Thoughts and Behaviors in Substance Abuse Treatment” (10/2015
edition); 14. “TIP 52: Clinical
Supervision and Professional Development of the Substance Abuse Counselor”
(9/2014 edition); 15. “TIP 56: Addressing
the Specific Behavioral Health Needs of Men” (5/2014 edition); 16. “TIP 57:
Trauma-Informed Care in Behavioral Health Services” (3/2014 edition); 17. “TIP 58: Addressing
Fetal Alcohol Spectrum Disorders (FASD)” (12/2013 edition); 18. “TIP 44: Substance
Abuse Treatment for Adults in the Criminal Justice System” (9/2013 edition); 19. “TIP 42: Substance
Abuse Treatment for Persons With Co-Occurring Disorders” (7/2013 edition); 20. “TIP 35: Enhancing
Motivation for Change in Substance Abuse Treatment” (1/2013 edition); 21. “TIP 48: Managing
Depressive Symptoms in Substance Abuse Clients During Early Recovery” (1/2013
edition); 22. “TIP 46: Substance
Abuse: Administrative Issues in Outpatient Treatment” (12/2012 edition); 23. “TIP 34: Brief
Interventions and Brief Therapies for Substance Abuse” (9/2012 edition); 24. “TIP 36: Substance
Abuse Treatment for Persons with Child Abuse and Neglect Issues” (7/2012
edition); 25. “TIP 29: Substance
Use Disorder Treatment for People With Physical and Cognitive Disabilities”
(7/2012 edition); 26. “TIP 37: Substance
Abuse Treatment for Persons With HIV/AIDS” (7/2012 edition); 27. “TIP 32: Treatment of
Adolescents With Substance Use Disorders” (4/2012 edition); 28. “TIP 54: Managing
Chronic Pain in Adults With or in Recovery From Substance Use Disorders”
(1/2012 edition); 29. “TIP 53: Addressing
Viral Hepatitis in People With Substance Use Disorders” (12/2011 edition);
and 30. “TIP 21: Combining
Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the
Justice System” (4/2008 edition). |
Publisher: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment, www.samhsa.gov. The Treatment
Improvement Protocols (TIPS) are available free of charge
at: |
He-A
304.17(o)(3) |
Guidelines for
Preventing the Transmission of M.
tuberculosis in Health-Care Settings, 2005 edition |
Publisher: U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention Available free
of charge from the CDC website at www.cdc.gov. |
He-A 304.18(c)(16)c.; 304.21(a); 304.21(c)(2); 304.23(e); and 304.23(u) |
TAP 21:
Addiction Counseling Competencies, 2015 edition |
Publisher: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment, www.samhsa.gov Available free of charge at: http://store.samhsa.gov/shin/content//SMA12-4171/SMA12-4171.pdf |
He-A 304.21(b)(1) |
Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), Fifth Edition (2013) |
Publisher: The American Psychiatric Association
(APA). The DSM-5 can be purchased on
line at: The publication is available at a variety of
formats and price points from $96 to $210. |
APPENDIX B
Rule |
RSA/Federal
Citation |
He-A 301, 302, 303 (all
sections) Specific provisions implementing specific statutes are listed
below. |
|
He-A 301 |
RSA 172:8-b, III; RSA 172:10 |
He-A 302.04(d)(8)-(9) |
RSA 172:14 |
He-A 302.05 |
RSA 318-B: 10, VII(b)(3) |
He-A 302.04(e)(4) He-A 302.05(a)(10)c He-A 302.05(c)(7) He-A 302.09(e)(1) |
He-A 302.04(e)(4) He-A 302.05(a)(10)c He-A 302.05(c)(7) He-A 302.09(e)(1) |
He-A 302.06 He-A 302.07 He-A 302.08 He-A 302.10 |
RSA 318-B: 10, VII(b)(4) |
He-A 302.09 |
RSA 318-B: 10, VII(b)(5) |
He-A 302.11(b) |
RSA 172:2-a |
He-A 303.04(b)(1) |
RSA 172:2-a |
He-A 303.06 |
RSA 318-B:10, VII(b)(7) |
He-A 303.08(a)(5) |
RSA 172:14 |
He-A 304 |
RSA 172:2-a; RSA 172:8-b,
II; RSA 318-B:10, VII & VIII |
He-A 305.01- He-A 305.10 |
RSA 172-B:2, V-VI; RSA 161:4-a, XI |