Current through Register 2024 Notice Reg. No. 52, December 27, 2024
(a) The program sponsor shall submit or cause
to be submitted on its behalf to the Department an Initial Application
Coversheet form DHCS 5014 (04/16) and written protocol, which shall serve as an
application for licensure by the Department. The protocol shall include the
following information and designated forms:
(2) A description of the geographical
surrounding areas to be served by the program, as required by the Facility and
Geographical Area form DHCS 5025 (04/16).
(3) Population and area to be served, as
required by the Facility and Geographical Area form DHCS 5025
(04/16).
(4) The estimated number
of persons in the described area having an addiction to opioids and an
explanation of the basis of such estimate, as required by the Facility and
Geographical Area form DHCS 5025 (04/16).
(5) The estimated number of persons in the
described area having an addiction to opioids who are presently in a narcotic
treatment program and other treatment programs, as required by the Facility and
Geographical Area form DHCS 5025 (04/16).
(6) The number of patients in regular
treatment, projected rate of intake, and factors controlling projected intake,
as required by the Facility and Geographical Area form DHCS 5025
(04/16).
(10) County Alcohol and
Drug Program Administrator's certification, as required by the County
Certification form DHCS 5027 (04/16), herein incorporated by
reference.
(11) Letters of
community support.
(12) Patient
identification system (physical or electronic).
(13) Control and security of patient
identification system.
(14) System
to prevent patient's multiple program registration.
(15) Organizational responsibility, as
required by the Organizational Responsibility form DHCS 5031 (04/16), herein
incorporated by reference.
(17) First-year
budget, listing available, pending, or projected funds. Copies of letters
verifying funding shall also be submitted with the protocol. Subsequent years'
budgets may be submitted as amendments to the original, approved
protocol.
(18) Schedule of patient
fees.
(19) Duties and
responsibilities of each staff member and the relationship between the staffing
pattern and the treatment goals.
(20) Each staff member's resume and Staff
Information form DHCS 5026 (04/16).
(21) Duties and responsibilities of the
medical director.
(22) Plan for
delegation of the medical director's duties, if appropriate.
(23) Training and experience of
counselors.
(25) Procedures and
criteria for patient selection.
(26) Program rules and
instructions.
(27) Facility
description, as required by the Facility and Geographical Area form DHCS 5025
(04/16).
(28) Initial, medically
determined dosage levels.
(29)
Decreasing, medically determined dosage levels for patients in detoxification
treatment and stable, medically determined dosage levels for patients in
maintenance treatment.
(30)
Operational procedures.
(31)
Procedures, which provide for cooperation with local jails for either
detoxification or maintenance treatment while in custody, in the event of
patient hospitalization or incarceration.
(32) The written policies and procedures to
be followed in the event of an emergency or disaster.
(33) Testing or analysis procedures for
illicit drug use which utilize random selection or unannounced
collection.
(34) Procedures for
scheduled termination, voluntary termination, and involuntary termination for
cause, including reasons for termination for cause.
(36) Copies of all forms developed and to be
used by the proposed program.
(37)
Facility address and dimensions, as required by the Facility and Geographical
Area form DHCS 5025 (04/16).
(38)
Amount of space devoted to narcotic treatment, including waiting, counseling,
dispensing, and storage areas, as required by the Facility and Geographical
Area form DHCS 5025 (04/16).
(39)
Days and hours of medication program dispensing, as required by the Facility
and Geographical Area form DHCS 5025 (04/16).
(40) Days and hours for other narcotic
treatment program services, as required by the Facility and Geographical Area
form DHCS 5025 (04/16).
(41) Type
of services provided and the hours of use, if the facility is also used for
purposes other than a narcotic treatment program, as required by the Facility
and Geographical Area form DHCS 5025 (04/16).
(42) Diagram of the facility housing the
narcotic treatment program and an accompanying narrative that describes patient
flow, as required by the Facility and Geographical Area form DHCS 5025 (04/16).
The diagram and narrative shall specify:
(C) Medication
administration area.
(D) Patient
body specimen collection locations for testing or analysis of samples for
illicit drug use.
(F) Parking or
transportation access.
(G) The
relation of the narcotic treatment program to the total
facility.
(43) Guarantor
Agreement, as required by the Guarantor Agreement form DHCS 5020 (04/16),
herein incorporated by reference.
(b) A protocol shall be current, detailed,
specific, and complete to permit evaluation by the Department and to provide a
basis for compliance inspections or surveys.
1. Change
without regulatory effect renumbering and amending former section
10042 to 10030 filed 6-3-91
pursuant to section 100, title 1, California Code of Regulations (Register 91,
No. 34).
2. Amendment of section and NOTE filed 3-15-96 as an
emergency; operative 3-15-96 (Register 96, No. 11). A Certificate of Compliance
must be transmitted to OAL by 7-13-96 or emergency language will be repealed by
operation of law on the following day.
3. Amendment of section and
NOTE refiled 7-8-96 as an emergency; operative 7-12-96 (Register 96, No. 28). A
Certificate of Compliance must be transmitted to OAL by 11-12-96 or emergency
language will be repealed by operation of law on the following
day.
4. Amendment of section and NOTE refiled 10-23-96 as an
emergency; operative 10-29-96 (Register 96, No. 43). A Certificate of
Compliance must be transmitted to OAL by 2-26-97 or emergency language will be
repealed by operation of law on the following day.
5. Amendment of
section and NOTE refiled 2-11-97 as an emergency; operative 2-24-97 (Register
97, No. 7). A Certificate of Compliance must be transmitted to OAL by 6-24-97
or emergency language will be repealed by operation of law on the following
day.
6. Certificate of Compliance as to 2-11-97 order transmitted to
OAL 3-4-97; disapproved by OAL and order of repeal as to 2-11-97 order filed
4-15-97 (Register 97, No. 16).
7. Amendment of section and NOTE
filed 4-15-97 as an emergency; operative 4-15-97 (Register 97, No. 16). A
Certificate of Compliance must be transmitted to OAL by 8-13-97 or emergency
language will be repealed by operation of law on the following
day.
8. Certificate of Compliance as to 4-15-97 order, including
amendment of subsections (a)(29) and (a)(42)(D), transmitted to OAL 6-2-97 and
filed 6-13-97 (Register 97, No. 24).
9. Change without regulatory
effect amending NOTE filed 4-19-2006 pursuant to section 100, title 1,
California Code of Regulations (Register 2006, No. 16).
10.
Amendment of section and NOTE filed 5-7-2020; operative 7-1-2020 (Register
2020, No. 19).
Note: Authority cited: Sections
11750,
11755,
11835
and
11839.3,
Health and Safety Code. Reference: Sections
11839.3,
11839.19,
11839.20
and
11839.22,
Health and Safety Code.
