Current through Register 2024 Notice Reg. No. 38, September 20, 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:
(1) Plan of operation.
(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).
(7) Program goals.
(8) Research goals.
(9) Plan for evaluation.
(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.
(16) Program
sponsor.
(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.
(24) Counselor
caseload.
(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.
(35) Fair
hearings.
(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:
(A) Waiting
areas.
(B) Office space.
(C) Medication administration area.
(D) Patient body specimen collection locations for
testing or analysis of samples for illicit drug use.
(E) Record storage area.
(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.
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.
