N.H. Admin. Code § He-P 601.05

Current through Register No. 45, November 7, 2024

Section He-P 601.05 - Application Requirements

(a) Each applicant shall complete and submit an application entitled Form 3720 "Request for Certification of Other Qualified Agency" (5/2012) verifying the following:

"I verify that the information provided in this application is accurate to the best of my knowledge. Neither the executive director or if applicable the executive officers have been named as the perpetrator in a founded determination of abuse, neglect, or exploitation following a protective investigation conducted by the department pursuant to RSA 161-F: 42-57, or following a similar investigation conducted by another state. I affirm my programs are in compliance with RSA 161-I, He-P 601, including the requirement for criminal record checks for all personal care workers, and other applicable laws and rules. I understand that providing false information shall be grounds for denial, suspension, or revocation of a certification."

(b) Along with Form 3720 "Request for Certification of Other Qualified Agencies", each applicant shall submit the following:

a. For program design and program administration, policies and procedures:

1. A description of the OQA program goals and objectives and how it supports consumer directed care;

2. A description of the OQA policy regarding intake and admission and/or exclusion criteria;

3. An explanation of how the agency will ensure that clients will have choice over his/her personal care worker(s) and indicate if a client will be able to choose his or her personal care worker other than from the agency's own pool of workers;

4. An indication if the agency will allow clients who have a legal representative to participate in the program;

5. An explanation of what supports or education are offered to each client on how to manage his or her care and management of his or her personal care worker;

6. A description of how a client's plan of care is designed including who is involved in developing the plan and how the OQA monitors its use, such as face to face interviews with the client, and how BEAS case managers are involved;

7. Specification of any other monitoring process(s) the agency uses or plans to use for ensuring the quality of personal care services such as client satisfaction surveys. If available, include samples of the tools used to collect this information;

8. A description of the annual OQA program evaluation plan indicating measurable goals and objectives and how progress will be measured;

9. A current, dated organizational chart of the OQA program illustrating lines of authority, responsibility/communication, and staff assignment, including date, staff names, and position titles;

10. A description of the policies for programmatic access related to the American with Disabilities Act, for example, alternative formats, and include the program's web address;

11. A description of and a copy of the written confidentiality policy;

12. A description of and a copy of the agency's policies and procedures for screening potential staff members including the procedures for conducting criminal history checks and BEAS state central registry checks on potential personal care workers;

13. An explanation of what customer service system procedures the agency currently utilized or what the agency plans to utilize, to include a toll-free number for clients, the hours the toll-free number is staffed, and if the agency has a messaging service, and the procedures that are in place for returning calls; and

14. An indication of how the agency informs each client of his or her rights and responsibilities for participating in the program, and include a copy of the written rights and responsibilities, grievance procedures, and service-termination policies you provide to each client; and

b. For staffing, supervision, and training:

1. A copy of the staff orientation plan including for certified personal care workers;

2. A description of the policies regarding staff supervision provided to personal care workers by the OQA;

3. The OQA program job descriptions that delineate the roles and responsibilities for the executive director and the director of personal care services;

4. An indication of how the agency informs each personal care worker of his or her rights and responsibilities and include a copy of the written rights and responsibilities, grievance procedures, and service termination policies the OQA provides to each personal care worker;

5. Identification of how the OQA informs the client and his or her worker about how to report incidences to the state according to the requirements of the state's adult protection and the department's ombudsman's program laws and indicate if the agency would like pamphlets on the adult protection law to provide to clients;

6. An explanation of the process for resolving incidences and/or reporting incidences to the state according to the requirements of the state's adult protection laws. Indicate if you keep a record of incidences.

7. A copy of the emergency back-up plan the agency provides to clients in the event a personal care worker fails to report to work and how the agency informs the client of these procedures. Indicate if the agency has a worker registry that the client may access to find a substitute worker;

8. A description on how training is provided to the individuals employed by your agency to provide personal care services and include what the qualifications of the person(s) providing the training and the type and frequency of ongoing training provided;

9. Details on the schedule for regular in service OQA staff training for OQA staff including an indication of:

i. If the OQA provides additional/ongoing training to caregivers, if the OQA determines additional training is needed; or

ii. If the OQA routinely provides additional training, and if so how often is the additional training provided; and

10. A copy of the training manual, workbook, or other written training instructions.

(c) For initial certification, each applicant shall submit the following documents to the department:

(1) A document demonstrating financial viability in one of the following forms:

a. The most recent financial statement or annual report;

b. The most recent financial audit;

c. A letter from an accountant indicating financial viability of the agency; or

d. A letter from a financial institution demonstrating financial solvency of the agency;

(2) Current proof of authorization from the secretary of state to do business in New Hampshire; and

(3) A copy of the Internal Revenue Service (IRS-) notice that includes the organization's federal employer identification number.

(d) An OQA applying for renewal of certification shall submit:

(1) The information described above in (a) through (c) within 90 days of the expiration of the current certification;

(2) A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 601.16, if applicable; and

(3) If requested by the department, any documentation related to plans of correction developed and implemented pursuant to He-P 601.08.

(e) If information required in (a) through (c) above are incomplete or missing, the department shall notify the applicant.

(f) The applicant shall provide the missing information to the department within 10 days of being notified of an incomplete application or missing supporting documentation.

(g) The department shall process the applications in accordance with RSA 541-A:29.

(h) Applications shall be denied in accordance with He-P 601.06.

(i) If an initial or renewal application is denied, the applicant or OQA shall not provide personal care services.

N.H. Admin. Code § He-P 601.05

(See Revision Notes # 1 and #2 at chapter heading for He-P 600) #9898-A, eff 3-29-11 (paras (b)-(h)); #9898-B, eff 3-29-11 (para (a))

Amended by Volume XL Number 41, Filed October 8, 2020, Proposed by #13115, Effective 10/1/2020, Expires 10/1/2030