Current through Register No. 40, October 3, 2024
(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
