California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 4 - Department of Alcohol and Drug Programs › Chapter 4 - Narcotic Treatment Programs › Subchapter 2 - Licensure of Narcotic Treatment Programs › Article 1 - Program Licensure › Section 10030 - Protocol for Proposed Programs

Current through Register 2024 Notice Reg. No. 28, July 12, 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.