Final Proposal- Annotated Text 2/22/2019 1

Final Proposal- Annotated Text 2/22/2019 1

Adopt He-C 6343, previously effective 7-26-18 (Document #12592, Interim), and expired 1-22-19, to read as follows: PART He-C 6343 CERTIFICATION PAYMENT STANDARDS FOR TRANSPORTATION SERVICE

PROVIDERS

Statutory Authority: RSA 170-G:4 XVIII, RSA 170-G:5 He-C 6343.01 Purpose. The purpose of this part is to identify the qualifications and performance requirements to become a provider of community based transportation services for the division for children, youth and families (DCYF) and describe transportation services that assist children and families in remedying abusive, neglectful, delinquent, and child in need of services (CHINS) behaviors. He-C 6343.02 Scope. This part shall apply to community based transportation service providers who receive financial reimbursement from the DCYF for services provided to children and families.

He-C 6343.03 Definitions.

(a) “Accompanied transportation services” means transportation of children and approved adults to and from appointments or educational programs as approved by the child’s local education agency.

(b) “Agency” means the board of directors, executive director, and employees of an organization that is incorporated and recognized by the NH secretary of state or by another state.

(c) “Applicant” means the person or entity that is requesting certification for payment as a transportation service provider. (d) “Caregiver” means an individual who is providing care for the child(ren).

(e) “Certification for payment” means the process by which DCYF approves the qualifications of, and payment to providers of transportation services.

(f) “Child or minor” means an individual from birth through age 20, except as otherwise stated in a specific provision.

(g) “Child protective service worker (CPSW)” means an employee of DCYF who has expertise in managing child protection cases to ensure families and children achieve safety, permanency and well-being. (h) “Child in need of services (CHINS)” means “child in need of services” as defined by RSA 169-D:2, II. (i) “Commissioner” means the commissioner of the department of health and human services or his or her designee. (j) “Conflict of interest” means any situation, circumstance, or financial interest, which has the potential to cause a provider’s private interest to directly or indirectly affect, influence, or interfere with the performance of his or hertheir duties as a provider for DCYF. (k) “Department” means the department of health and human services.

(l) “Destination provider” means the individual, social service agency, or other family support service provider that a child is being transported to or returning from.

(m) “Director” means the director of DCYF or his or her designee.


(n) “Division for children, youth, and families (DCYF)” means the organizational unit of the department of health and human services that provides services to children and youth referred by courts pursuant to RSA 169-A, RSA 169-B, RSA 169-C, RSA 169-D, RSA 170-B, RSA 170-C, RSA 170-H and RSA 463. (o) “Educational transportation service” means the transportation of children from their residence or other setting to their school placement and back to their residence or other setting as approved by DCYF. (p) “Foster Care” means the supervised 24-hour substitute care of a child placed away from their parent or legal guardian for whom the State has placement and care responsibility. This includes family foster homes, relative homes, pre-adoptive homes, shelters, and residential facilities. (q) “Juvenile probation and parole officer (JPPO)” means an employee of DCYF who discharges the powers and duties established by RSA 170-G:16, and supervises paroled delinquents pursuant to RSA 170-H. (r) “Medically necessary” means reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable.

(s) “Multiple motor vehicle violations” means a pattern of motor vehicle safety violations, that precludes one from providing services under He-C 6343, as determined by the NH department of safety, division of motor vehicles. (st) “NH bridges” means the automated case management, information, tracking, and reimbursement system used by DCYF.

(tu) “Outcome” means the intended result or consequence that occurs from carrying out a program or activity. (uv) “Performance indicators” means the utilization of data measurements to gauge program or activity performance.

(vw) “Private vehicle transportation services” means transportation of children and families to and from non-medicaid support services via a provider’s’ own vehicle.

(wx) “Provider” means the individual or agency that serves a child or family and receives financial reimbursement from the department.

(xy) “Public transportation services” means transportation services arranged through a travel agency to children and families to and from support services. (yz) “Quality assurance” means the process that DCYF use to monitor the quality and effectiveness of community-based transportation services.

(zaa) “Relative care” means the placement of a child, who has a legal relationship with DCYF, in a home in which one of the responsible caregivers is a person related to the child.

(aaab) “Secure transportation services” means transportation of children in law enforcement vehicles, who are considered to be at risk of flight from custody, present significant behavior management issues, or exhibit harmful behaviors toward themselves or others, and who require physical restraint while being transported.

Final Proposal- Annotated Text 2/22/2019 3 (abac) “Service authorization” means the documentation provided by DCYF indicating the division’s responsibility for payment of community-based services. (acad) “Service reports” means a written report that includes demographic and performance indicators. (adae) “Support services” means services that assist families in remedying the circumstances attributed to abuse and neglect, delinquency, and CHINS behaviors. (aeaf) “Transport aide” means an individual age 21 or older, employed by an accompanied transportation service provider who accompanies a child, and approved adult(s), to and from appointments and remains on-site with child during the appointment. When transporting children, the transport aid is required to remain on-site with the child during the appointment.

(af) “Travel Agency” means an agency engaged in selling and arranging transportation, accommodations, tours, and trips for travelers He-C 6343.04 Requirements for Accompanied Transportation Services.

(a) Accompanied transportation service providers shall:

(1) Be an enrolled NH medicaid provider; (2) Be an agency, not an individual; (3) Employ a program coordinator who shall:

a. HaveHas a bachelor’s degree in a social services discipline or related field or 5 years’ experience in providing direct service to families;

b. HaveHas one year of experience in a supervisory capacity, as confirmed by a copy of a resume;

c. Recruits, hires, trains, and supervises the transport aides;

d. Receives referrals from DCYF;

e. Assigns transport aides to provide transportation services;

f. Communicates service changes to staff, as needed;

g. Conducts program staff meetings at least monthly with each aide to review the status of referrals and transportation activities, and to address any problems or barriers;

h. Reports any concerns or difficulties immediately to CPSW and JPPO;

i. BeIs available 5 days a week during DCYF business hours; and

j. HaveHas a pool of available transport aides who are available 7 days a week to provide services at times that best serve children and families;

(4) Have a written plan for providing services when a transport aide cannot provide the scheduled service;

(5) Employ transport aides who shall:


a. Be at least 21 years of age; b. Have at minimum, a high school diploma or equivalency;

c. Possess a valid driver’s license;, and maintain a copy of the license in their agency’s personnel file;

d. Provide proof that their vehicle is registered in accordance with RSA 261:40 and inspected in accordance with RSA 266:1;

e. Provide proof of current automobile liability insurance that includes coverage for accidental injury and death, and coverage for the transporting of another; , and maintain a copy of the policy in their agency’s file;

f. Have no convictions for impaired driving or multiple motor vehicle violations; , and maintain a copy of the motor vehicle record in their agency’s file;

g. Have no conviction for a felony or crime against persons; and maintain a copy of each aide’s criminal record in the agency’s personnel file;

h. Have no founded cases of child abuse or neglect; and maintain a copy of each aide’s central registry check in the agency’s personnel file; i. Not drive under the influence of alcohol or drugs pursuant to RSA 265-A;

j. Submit to yearly drug and alcohol testing as determined by the program coordinator except for newly hired transport aides who shall be tested within 6 months from date of hire then yearly thereafter;

k. Not provide service in excess of 12 hours in a 24 hour period; and

l. Not be related to any service recipient or any member of the service recipients family for whom they provide the service;

(6) The provider shall maintain a copy of the following for each transportation aide in the aide’s personnel file:

a. Current driver’s license;

b. Automobile liability insurance;

c. Motor vehicle record;

d. Criminal record report; and

e. Central registry check. (67) Have written personnel policies which are available for inspection at the time of a quality assurance review as described in He-C 6343.21;

(78) Conduct and document annual staff performance evaluations and training logs making them available for inspection at the time of a quality assurance review;


(89) Have a written policy in place regarding missed appointments by client families which includes notifying the CPSW or JPPO immediately, followed by a written report within 24 hours, when a parent or child fails to show up for a scheduled transport;

(910) Maintain records available for inspection during quality assurance reviews, as described in He-C 6343.2021;

(1011) Provide transport aides with a written itinerary for each trip that includes but is not limited to:

a. The name of the child and the caregiver;

b. The name of the driver who is picking up the child;

c. The name of the driver who is returning the child, if different from the pick-up driver;

d. The date, time, and pick up location;

e. The destination;

f. The destination provider;

g. The time of the scheduled appointment or visit;

h. The estimated time of return to the child’s caregiver; and

i. A field for the signature of the caregiver upon pick up;

(1112) Review with the transport aide, prior to beginning work with children and annually thereafter, RSA 169-CChapter 169-C of the NH revised statutes annotated, specifically sections on definitions, immunity from liability, and persons required to report, for all employees and volunteers, who have access to children, prior to beginning their work with children;

(1213) Provide transport aides with:

a. Ten hours of training during their first 6 months of employment which includes training relating to accepted transportation practices, personal safety, child safety, and behavior management; and

b. Fifteen hours of training annually that includes topics relating to accepted transportation practices, personal safety, child safety, cultural sensitivity, behavior management, safe driving education, and indicators of child abuse and neglect;

(1314) Maintain training records that include trainer signed certificates or letters of attendance that specify dates, hours, and training topics that are available at the time of quality assurance reviews or monitoring; and

(14)(15) Notify DCYF within 24 hours of any transportation aide’s motor vehicle infraction or arrest that would result in the inability to lawfully operate a vehicle in NH.

(b) The transport aide, referenced in (a)(5) above, shall:

(1) Have a means of communication so appointments can be scheduled or canceled; (2) Carry and present identification to the child’s caregiver and to destination providers;


(3) Not be responsible for transferring information between a child’s parent or caregiver and the service provider, CPSW, JPPO, or parent being visited;

(4) Maintain professional behavior while transporting children;

(5) During vehicle operation:

a. Comply with RSA 263 regarding drivers and licenses;

b. Comply with RSA 265:107-a regarding child passenger restraints required during vehicle operation; and

c. Ensure that all vehicle occupants use safety restraints pursuant to RSA 265:107-a and that passengers under the age of 12 are secured in the back seat of the vehicle;

(6) Notify the CPSW or JPPO immediately, followed by a written report within 24 hours, of any injury that occurs during a trip or visit, such as a traffic accident or if the youth was assaultive or attempted to run away; and

(7) Maintain a file on each child served which includes:

a. Referral information about the child;

b. Transport logs with the name of the transport aide and driver;

c. Log of service provision including service dates, pick up and return locations, the signature of the caregiver, or destination provider, mileage, highway tolls, and parking fees, for billing substantiation;

d. Copies of required reports to be submitted to DCYF; e. Billing records; and

f. Family related information and correspondence for other providers.;

(c) The provider shall comply with:

(1) Licensing, registration, and approval from state licensing bodies,Be registered with the secretary of state prior to applying for certification;

(2) Comply with Tthe medical assistance requirements of He-W 500 and He-M 426;

(3) Comply with Tthe confidentiality statutes of RSA 169-B:35, RSA 169-C:25, RSA 169-D:25, RSA 170-B:2319, RSA 170-C:14, and RSA 170-G:8-a; and

(4) Comply with Tthe child abuse and neglect reporting requirements of RSA 169-C:29-30.

(d) The provider and his or her employees shall not have a conflict of interest as defined in He-C 6343.03(j).

(e) The provider shall maintain liability insurance. (f) Failure to comply with the rules of this chapter shall result in:

(1) Denial of an applicant pursuant to He-C 6343.24;


(2) Revocation of certification for payment of a provider pursuant to He-C 6343.24; or (3) Denial of reimbursement.

He-C 6343.05 Requirements for Educational Transportation Services. (a) Educational transportation service providers shall:

(1) Be approved by the child’s local education agency; (2) Have an exemption as a licensed foster parent pursuant to He-C 6347; (3) For agencies, be certified as an accompanied transportation service provider according to He-C 6343.:04; or (4) Be certified for private vehicle transportation services according to He-C 6343.06.

(b) Individual applicants for educational transportation services approved by a child’s local education agency shall; (1) Complete, sign, date, and submit to the department Form 2615 “Application for

Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (January 2019) and include documentation of approval by a local education agency to DCYF;, and

(2) Include an updated approval from the local education agency annually after the

original applicationthereafter; and (32) Comply with the provisions of He-C 6343.06 and He-C 6343.11. (c) Individual applicants for educational transportation services with an exemption for foster care licensing shall:

(1) Provide notification of foster care licensing to the DCYF community-based services specialist;

(2) Maintain foster care licensing according to He-C 6347 to maintain certification for educational transportation services; and

(3) Comply with the provisions of He-C 6343.06 and He-C 6343.11.

(d) Agency applicants for educational transportation services certified as accompanied transportation providers shall comply with the provisions of He-C 6343.04 and He-C 6343.09.

(e) Applicants for educational transportation services certified as private vehicle transportation providers shall comply with the provisions of He-C 6343.06 and He-C 6343.11. (f) Failure to comply with the rules of this chapter shall result in: (1) Denial of an applicant pursuant to He-C 6343.24; or (2) Revocation of certification for payment of afor an existing provider pursuant to He-

C 6343.24.; or


(3) Denial of reimbursement. He-C 6343.06 Requirements for Private Vehicle Transportation Services. (a) An individual who provides transportation services, including individuals who provide foster and relative care, via his or her own vehicle shall:

(1) Possess a valid driver’s license;

(2) Maintain automobile insurance liability coverage for the transportation of others;

(3) Have no conviction for impaired driving or multiple motor vehicle violations;

(4) Not drive under the influence of alcohol or drugs pursuant to RSA 265-A;

(5) During vehicle operation, ensure that all vehicle occupants use safety restraints pursuant to RSA 265:107-a and that passengers under the age of 12 are secured in the back seat of the vehicle;

(6) Submit documentation to DCYF for He-C 6343.06 (a)(1) through (3) above, which shall includes copies of driver’s licenses, automobile liability insurance policies, and motor vehicle records as well as a completed NH department of safety, division of state police Form DSSP 256 “Criminal History Record Information Release Authorization Form”, and a completed Form 2503, “DCYF Central Registry Name Search Authorization”criminal records release authorization form and central registry name search authorization at the time of application and re-certification;

(7) Comply with:

a. Licensing requirements pursuant to RSA 263, and registration requirements pursuant to RSA 261, , prior to applying for certification;

b. The medical assistance requirements of He-W 500 and He-M 426;

c. The confidentiality statutes of RSA 169-B:35, RSA 169-C:25, RSA 169-D:25, RSA 170-B:2319, RSA 170-C:14, and RSA 170-G:8-a;

d. The child abuse and neglect reporting requirements of RSA 169-C:29-30; and e. RSA 265:107-a, child passenger restraints required;

(8) Review RSA169-C, specifically sections on definitions, immunity from liability, and persons required to report for all employees and volunteers, who have access to children prior to beginning their work with children and annually thereafter;

(9) Not have a conflict of interest as defined in He-C 6343.03(j);

(10) Maintain a log of service provision including service dates, pick up and return locations, the signature of the provider, or destination provider, mileage, highway tolls, and parking fees for billing substantiation; and (11) Be at least 18 years old.


(b) Private vehicle transportation service providers shall not be reimbursed for transporting his or her own children or other household family members not associated with the DCYF case. (c) Private vehicle transportation service providers shall notify DCYF within 24 hours of any motor vehicle infraction or arrest that would result in the inability to lawfully operate a vehicle in NH. (d) Failure to comply with the rules of this chapter shall result in:


(2) Revocation of certification for payment of a provider pursuant to He-C 6343.24; or

(3) Denial of reimbursement.

He-C 6343.07 Requirements for Public Transportation Services.

(a) Travel agencies who arrange public transportation services shall:

(1) Be registered with the NH secretary of state and submit proof of such to DCYF; and

(2) Comply with licensing and registration requirements prior to applying for certification if applicable.

(b) Failure to comply with the rules of this chapter shall result in:


(2) Revocation of certification for payment of a provider pursuant to He-C 6343.24; or (3) Denial of reimbursement.

He-C 6343.08 Requirements for Secure Transportation Services.

(a) Secure transportation services shall be provided for children who:

(1) Are before the court as runaways, escapees, or absconders pursuant to the interstate compact on juveniles, RSA 169-A;

(2) Are before the court adjudicated as delinquent children pursuant to RSA 169-B;

(3) Are before the court adjudicated as children in need of services pursuant to RSA 169-D;

(4) Are considered to be at risk of flight from custody;

(5) Present significant behavior management issues;

(65) Exhibit safety concerns regarding themselves or others; or

(76) Require physical restraint while being transported, as applicable.

(b) Providers of secure transportation services shall:

(1) Use law enforcement personnel to transport children;

(2) Maintain custody of court- transported children until the court releases custody of the child from law enforcement or are otherwise relieved by court security or other authorized personnel;


(3) Use only trained officers who are certified by the NH police standards and training council;

(4) Maintain a copy of certification by the NH police standards and training council in the provider’s personnel file, which shall be available for review at the time of an on-site quality assurance monitoring visit;

(5) Use only county or municipal law enforcement department secure vehicles assigned by that department for the secure transportation of juveniles; and

(6) Maintain records to substantiate billing which shall be available for inspection and include:

a. A log of transports;

b. Pick up location, destination, time, and date;

c. Name of officer transporting;

d. Name of JPPO;

e. Name of child transported;

f. Mileage; and

g. Any incidents that occurred such as, traffic accidents, if the youth was assaultive or attempted to run away.

(c) Failure to comply with the rules of this chapter shall result in:

(1) Denial of an applicant pursuant to He-C 6343.24; or

(2) Revocation of certification for payment of afor an existing provider pursuant to He-C 6343.24.; or (3) Denial of reimbursement.

He-C 6343.09 Application Process For Payment Standards For Accompanied Transportation Services. (a) Applicants who seek initial certification for payment standards for accompanied transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification. (b) The DCYF district office supervisor or DCYF community, family, and program support certification specialist shall assess the need for services, based on the following criteria:

(1) The number of children and families who require services exceeds the available community resources;

(2) A specialized service is necessary to meet the unique needs of children and families, and there are no currently certified providers who can provide the specialized service; or

(3) Any other case circumstance which requires the provision of services pursuant to a court order.

Final Proposal- Annotated Text 2/22/2019 11 (c) If there is a need for a service based on (b) above, DCYF shall forward an application packet to the applicant which includes:

(1) Form 2614 “Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers” (MarchXXXXX 2019)”;

(2) A “State of New Hampshire Alternate W-9” (October 2016); and

(3) A copy of He-C 6343; and

(4) A budget form.

(d) Each applicant shall complete, sign, date, and submit Form 2614“Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers” (MarchXXXXX 2019) to DCYF within 30 days of receipt, together with all the attachments in He-C 6343.09(c).;

(e) Each agency staff member listed in Part C: “Agency Staff” shall sign and datesubmit a signed and dated Part D: “Staff Information” of Form 2614 “Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers” (MarchXXXXX 2019) certifying the following: “I declare that all the information contained above is true, correct and complete to the best of

my knowledge and belief. I acknowledge that the provision of false information in the application is basis for denial of the application.”

(f) Each submitted and signed Part D: “Agency Staff” of Form 2614 “Application for Certification

and Enrollment of Accompanied or Agency Educational Transportation Service Providers” (MarchXXXXX 2019) shall be signed and dated by the executive director or designee, certifying the following:

“I certify that a: Current criminal records check for this individual is completed and on file at the agency; Current copy of the individual’s Department of Motor Vehicle Report is on file at the agency; Current copy of the individual’s driver’s insurance is on file at the agency.”

(g) Each applicant shall sign and datesubmit a signed and dated Part F: “Authorization/Statement of Understanding” as part of Form 2614 “Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers” (March XXXXX 2019) certifyingthat states the following:

“I have reviewed the Administrative Rules He-C 6343 and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rules He-C 6343. I further understand that DCYF has the right to verify information contained in this application. The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application.”


(h) In addition to the requirements in (dc)-(g) above, applicants shall submitprovide the following information:

(1) A resume or curriculum vitae for the program coordinator;

(2) A copy of the agency’s organizational structure;

(3) A complete, signed, and dated “State of New Hampshire Alternate W-9” (October 2016);

(34) A copy of their budgetcomplete, signed, and dated “Budget Form” (XXXXX Edition); and

(45) A program brochure, if available;

(56) A statement indicating whether the applicant or any direct service staff:

a. Has ever had their automobile or general liability insurance canceled;

b. Has ever been convicted of a felony or any crime against a person and if so, the name of the court, the details of the offense, the date of conviction and the sentence imposed;

c. Has ever been subject to disciplinary action by a licensing body or professional society, been found civilly liable for professional misconduct, or found to have committed an ethical violation by a state or national professional association or any other state’s regulatory board, and if so, the name of the licensing body or professional society, the reasons, dates, and results; and

d. Is currently listed in any child abuse and neglect state registry as having abused or neglected a child, and if so, the dates and reasons;.

(67) A written description of the agency’s no show and cancellation policy; (78) A written description of the agency’s quality assurance plan including the method of handling client complaints; (89) The agency’s record keeping and confidentiality policies; (910) Description of what is provided to the transportation aides for agency identification; and (1011) A written description of services that includes the cost of the service and the parent’s obligation to repay a portion of the service provision.

He-C 6343.10 Application Process For Payment Standards For Educational Transportation Services.

(a) Applicants who seek initial certification for the provision of educational transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.

(b) The DCYF district office supervisor or DCYF community, family, and program support certification specialist shall assess the need for services, based on the following criteria:





(c) If there is a need for a service based on (b) above, DCYF shall:(1) Verify existing documentation and certification(s) for applicants asserting they meet one of the requirements of He-C 6343.05(a); (2) Follow the provisions of He-C 6343.11 for applicants meeting the requirements of 6343.05(a)(1), (2) or (4); or

(3) Follow the provisions of He-C 6343.09 for applicants meeting the requirements of 6343.05(a)(3).

He-C 6343.11 Application Process For Payment Standards For Private Vehicle Transportation Services.

(a) Individual applicants who seek initial certification for the provision of private transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.





(c) If there is a need for a service based on (b) above, DCYF shall forward an application packet to the applicant which includes:

(1) Form 2615 “Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (XXXXX 2018);

(2) A “State of New Hampshire Alternate W-9” (October 2016);

(3) A NH department of safety, division of state police Form DSSP 256 “Criminal History Record Information Release Authorization Form” (XXXXX Edition) for the provider unless the provider is a licensed foster care provider;


(4) A Form 2503 “DCYF Central Registry Name Search Authorization” (XXXXX Edition) for the provider unless the provider is a licensed foster care provider; and

(5) A copy of He-C 6343.

(d) Each applicant shall submit a complete and submit, signed, and dated Form 2615 “Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (March 2019May 2018) to DCYF within 30 days of receipt, together with all the attachments in He-C 6343.11(g). (e) Each applicant shall sign and datesubmit a complete, signed and dated Part C: “Applicant Information” of Form 2615 “Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (MarchXXXXX 2019) certifyingthat states the following:

“I declare that all the information contained above is true, correct and complete to the best of my knowledge and belief. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

(f) Each applicant shall sign and datesubmit a signed and dated Part D: “Authorization/Statement of Understanding” of Form 2615 “Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (MarchXXXXX 2019) certifyingthat states the following:

“I have reviewed the Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers. I further understand that DCYF has the right to verify information contained in this application.

The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

(g) Each applicant shall submitprovide the following information with Form 2615 “Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers” (MarchXXXXX 2019):

(1) A completed “State of New Hampshire Alternate W-9” (October 2016); (2) A completed Form 2503 “DCYF Central Registry Name Search Authorization”, (February 2017) or Authorization for DCYF to obtain. This will not be required if the applicant is currently licensed as a Ffoster Ccare provider under He-C 6347;

(3) A completed NH department of safety, division of state police DSSP 256 “Criminal History Record Information Release Authorization Form” This will not be required if the applicant is currently licensed as a Ffoster Ccare provider under He-C 6347; and

(4) A copy of the provider’s motor vehicle record from the NH department of safety, division of motor vehicles.


He-C 6343.12 Application Process For Payment Standards For Public Transportation Services.

(a) Applicants who seek initial certification for payment standards for public transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.





(c) If there is a need for a service based on (b) above, DCYF shall forward an application packet to the applicant which shall includes:

(1) Form 2616 “Application for Certification and Enrollment of Public Transportation Service Providers” (March 2019May 2018);

(2) A “State of New Hampshire Alternate W-9” (October 2016); and

(3) A copy of He-C 6343.

(d) Each applicant shall complete and submit a complete, signed, and dated Form 2616 “Application for Certification and Enrollment of Public Transportation Service Providers” (MarchXXXXX 2019) to DCYF within 30 days of receipt, together with proof of registration with the New Hampshire secretary of state.

(e) Each applicant shall sign and date submit a signed and dated Part C: “Authorization/Statement of Understanding” of Form 2616 “Application for Certification and Enrollment of Public Transportation Service Providers” (MarchXXXXX 2019) certifying that states the following:

“I have reviewed the Administrative Rules He-C 6343 and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rules He-C 6343. I further understand that DCYF has the right to verify information contained in this application. The information contained in this application is correct to the best of my knowledge, I acknowledge that the provision of false information in the application id s basis for denial of the application.”

He-C 6343.13 Application Process For Payment Standards For Secure Transportation Services.


(a) Applicants who seek initial certification for payment standards for secure transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.

(b) The DCYF district office supervisor or the DCYF community, family, and program support certification specialist shall assess the need for services based on the following criteria:

(1) The number of children and families who require services exceeds the available community resources; (2) A specialized service is necessary to meet the unique needs of children and families, and there are no current certified providers who can provide the specialized service; and (3) Any other case circumstance which requires the provision of services pursuant to a court order.

(c) If there is a need for services based on the criteria in (b) above, DCYF shall forward an application packet to the applicant, which shall includes:

(1) Form 2613 “Application For Certification and Enrollment of Secure Transportation Service Providers” (MarchXXXXX 2019); (2) A “State of New Hampshire Alternate W-9” (October 2016); and (3) A copy of He-C 6343.

(d) Each applicant shall submit a completed, signed, and dated Form 2613 “Application for Certification and Enrollment of Secure Transportation Service Providers” (MarchXXXXX 2019) to DCYF within 30 days of receipt, together with a completed “ State of New Hampshire Alternate W-9” (October 2016).

(e) Each applicant shall sign and datesubmit a signed and dated Part B: “Authorization/Statement of Understanding” of Form 2613 “Application for Certification and Enrollment of Secure Transportation Service Providers” (XXXXX 2019) certifying that states the following:

“I have reviewed the Administrative Rules He-C 6343 and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rules He-C 6343. I further understand that DCYF has the right to verify information contained in this application. The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

He-C 6343.14 Review of Continued Certification Compliance.

(a) Transportation service providers shall complete and submit a complete, signed, and dated Form 2617 “Review of Continued Certification for Transportation Service Providers” (MarchXXXXX 2019) as provided by DCYF within 30 days of the receipt.


(b) Part C of Form 2617 “Review of Continued Certification for Transportation Service Providers” (MarchXXXXX 2019) shall be signed and dated by each direct service staff of accompanied transportation services providers certifyingand include the following affirmation:

“I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

(c) Each submitted and signed Part C of Form 2617 “Review of Continued Certification for Transportation Service Providers” (MarchXXXXX 2019) submitted by an accompanied transportation service provider agency shall have the following attestation signed and dated by the program coordinator or executive director:

“I certify that a criminal record check for this individual is completed an on file at the agency.” (d) The provider shall sign and datesubmit a signed and dated Part D “Statement of Affirmation” of Form 2617 “Review of Continued Certification for Transportation Service Providers” (MarchXXXXX 2019) certifyingthat certifies the following:

“I have reviewed the Administrative Rule He-C 6343 Certification for Payment Standards for Transportation Service Providers and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers. I further understand that DCYF has the right to verify information contained in this application.

The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

(e) Each applicant shall submit the following with Form 2618 “Review of Continued Certification for Transportation Service Providers” (March 2019): (1) A “State of New Hampshire Alternate W-9” (October 2016); (2) A Current list of the Board of Directors that shall include the following information of

each person: a. Full Name; b. Office held; c. Professional affiliation; d. Address; and e. Telephone number; (3) Automobile and general liability insurance certificates; and (4) Resume or curriculum vitae for the program coordinator or executive director.


(fe) Renewal of certification shall be made by filing a signed and dated Form 2616 “Review of Continued Certification for Transportation Service Providers” (MarchXXXXX 2019) and shall be based on a review and verification of the provider’s compliance with He-C 6343 and the specific requirements for the certification of Transportation Service provided.

(gf) Providers who fail to submit a review form within 30 days of receipt shall have their certification revoked in accordance with He-C 6343.24 and be denied payment.

(hg) Continuance of certification shall be based on a review and verification of the provider’s compliance with service requirements.

(ih) Review of continued certification compliance shall:

(1) Occur every 5 years from the date of issue for:

a. Accompanied transportation service providers;

b. Public transportation service providers; and c. Secure transportation service providers; and

(2) Occur every year for private vehicle transportation service providers with the exception of a foster parent licensed through He-C 6347 who is also certified as a private vehicle transportation service provider. Continued certification review shall coincide with renewal of their foster care license.

He-C 6343.15 Notification of Changes.

(a) For the period of certification, the provider shall notify DCYF in writing within 10 days of any change in the information contained in the application or recertification application and provide documentation of the change.

(b) At the time of expiration of mandatory state driver’s licenses, private vehicle transportation providers shall submit a copy of the renewed license to DCYF.

(c) Failure to notify DCYF of any change shall result in revocation of certification in accordance with He-C 6343.24 and denied payment.

He-C 6343.16 Billing Requirements for Transportation Services.

(a) Providers shall be certified as a provider of transportation services and authorized to provide the services by a CPSW or JPPO.

(b) The provider shall not bill DCYF for services that are to be reimbursed by any other entity.

(c) Medicaid-enrolled providers providing medicaid-covered services shall not be reimbursed by DCYF.


(d) Providers shall accept payments in full for non-medicaid services it provides and in no event shall DCYF be liable for any payments hereunder in excess of such available and appropriated funds.

(e) DCYF shall determine the need for services and the determination shallwill be binding on the provider.

(f) Providers shall notify DCYF within 10 business days of any changes, , in tax information by completing and submitting an updatedand submit to DCYF a complete, signed, and dated “State of New Hampshire Alternate W-9” (October 2016) with current tax information.

(g) Providers shall provide services or care without discrimination as required by 42 U.S.C 2000d, et seq., as amended, and without discrimination on the basis of handicap as required by 29 U.S.C 794, as amended.

(h) The provider’s certification shall terminate upon date of sale or transfer of ownership or close of the agency.

(i) Billing for private vehicle service providers shall be for mileage, highway tolls, and parking fees for authorized transportation at rates determined by the DHHS rate setting unit.

He-C 6343.17 Billing Process for Transportation Services.

(a) Providers shall request a service authorization form prior to service delivery.

(b) Services provided without service authorization shall not be paid.

(c) Accompanied and educational transportation service providers shall bill DHHS for non-medicaid eligible recipients and services via paper claims.

(d) All other transportation service providers shall bill DHHS for non-medicaid eligible recipients and services via paper claims or electronic claims submission.

(e) For paper claims submission, a provider shall complete and submit to the department a copy of the complete, signed, and dated Form 2110 “Service Authorization” (October 2016) for future billings if authorized service dates span a date range.

(f) For electronic claims submission, a provider shall :

(1) Rrequest a web billing account from DHHS by completing and submitting a complete, signed, and dated Form 2679 “Provider Web Billing User Account Request Form” (October 2016).

(g) Both the user and the user’s supervisor, if the user is an employee, shall sign the form described in (f) certifying the following: that includes the following certification statements:

“I understand that provider billing requirements are governed by administrative rules (He-C 6339, He-C 6340, He-C 6348, He-C 6350, He-C 6914) which is incorporated herein by reference and I agree to abide by these requirements.”;


“I understand and agree that as a provider, I am responsible for any and all billing invoices submitted by me or on my behalf by my authorized representative, whether user is an employee authorized as a billing representative or authorized billing representative of a management service company.”; “I understand and agree that any payments made which are based on inaccurate or fraudulent billing, whether submitted by me or by my authorized user will be recovered from me by DHHS.”; “I understand and agree that it is my responsibility to notify the Division for Children, Youth, and Families by contacting Provider Relations when a user no longer required access to the web billing application.”; “I understand that by submitting an invoice via the Provider Web Billing Application I am certifying that the invoice is true and accurate.”; “I understand and agree that information obtained via the Provider Web Billing Application is confidential and can be used solely for the purposes of administering Division for Children, Youth, and Families (DCYF) Services.”; “I understand and agree that I am responsible for my authorized representative, employee, and/or any management service company’s use of the Provider Web Billing Application.”; and “I understand and agree that I must access my web account at least every ninety (90) days or my account will be de-activated.”;

(h2) After the provider complies with (f) above, the DHHS shall issue to the providerBe issued a log on and personal identification number (PIN) by DHHS for use in accessing the provider web billing user account.; and (i3) Neither tThe provider nor any authorized representative, shall not transfer his or her log on or PIN, or allow use of his or her log on or PIN by any other person.

He-C 6343.18 Billing Period.

(a) A provider shall bill within one year of service provision.

(b) Any bill received for payment one year after service date shall be denied pursuant to RSA 126-A:3.

(c) Providers shall submit bills at least on a monthly basis.

He-C 6343.19 Billing Discrepancies. Questions regarding billing discrepancies shall be directed to the provider relations’ staff of the bureau of administration operations in DCYF.

He-C 6343.20 Record-Keeping and Record Retention.


(a) Providers shall retain records for a period of no less than 7 years after the completion date of a provided service for each bill submitted to the department, the medicaid fiscal agent or a private insurance company.

(b) Records shall clearly document the extent of the care and services provided to children and families, when those services are charged to the department, and information regarding any payment claimed.

He-C 6343.21 Quality Assurance Activities of Transportation Service Providers.

(a) Providers shall be subject to quality assurance reviews conducted by DCYF to determine the quality of services pursuant to RSA 170-G:4, XVIII, using a variety of activities that may include a combination of record reviews, performance data measurements, and visits to providers.

(b) For the purposes of assessing compliance and for quality assurance reviews, providers shall allow:

(1) Scheduled or unscheduled on-site visits by DCYF; (2) Interviews with providers and program staff; and (3) A review of program documents to determine continued compliance with He-C 6343 including all service reports.

He-C 6343.22 Monitoring of Accompanied Transportation Service Providers.

(a) Providers shall submit an annual report to DCYF no later than 30 days following the end of the calendar year.

(b) The annual report shall include the following information:

(1) Service provided and changes in strategies that resulted in effective outcomes;

(2) Issues with the service utilization and observations about shifts in the targeted service population;

(3) Barriers discovered in the system of care;

(4) Proposed enhancements to performance indicators,

(5) Training topics presented over the past year for transportation aides; and

(65) Annual statistics for:

a. The number of referrals received;

b. The number of referrals serviced; and


c. The number of referrals not serviced and the reason for not servicing. Statistical information as agreed upon by the DCYF community, family, and program support certification specialist and the program coordinator.

He-C 6343.23 Waivers.

(a) Applicants or providers who request a waiver of a requirement in He-C 6343 shall submit a written request to the commissioner or his or her designee that includes the following information:

(1) The reason for requesting the waiver; (2) The anticipated length of time the requested waiver will be needed including permanent waivers; (3) Assurance that if the waiver is granted the quality of service and care to children, youth and families will not be affected; (4) A written plan to achieve compliance with the rule or explaining how the provider will satisfy the intent of the rule, if the waiver is granted; (5) How the service will be affected if the waiver is not granted; (6) Evidence that the agency's board of directors has approved the waiver request, such as, minutes of the board meeting documenting that the request was approved or a signature of the board's president or chairman; (7) A statement that the rule for which a waiver is being requested is not related to compliance with the life safety code or environmental health and safety issues, unless approved in writing by the fire inspector, local health officer, or public health services; and (8) The signature of the person requesting the waiver.

(b) A waiver shall be granted if:

(1) The department concludes that authorizing deviation from compliance with the rule from which waiver is sought does not contradict the intent of the rule and the rule does not conflict with statute; and

(2) The alternative proposed ensures that the object or intent of the rule will be accomplished.

(c) When a waiver is approved, the applicant’s or provider’s subsequent compliance with the alternative approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

He-C 6343.24 Denial of Application and Revocation of Certification.

(a) An application shall be denied or provider certification revoked if:

(1) DCYF determines that the state does not have a need for the service;


(2) The applicant or provider, or the individual acting on the applicant’s or provider’s behalf, submits materially false information to DCYF;

(3) The provider knowingly retained an employee for whom there has been a conviction for a felony or any crime against a person;

(4) The provider has been convicted of a felony or any crime against a person, which has not been annulled or overturned;

(5) There has been disciplinary action taken against a provider by a licensing body or professional society, a finding of civil liability made for professional misconduct, or a finding of an ethical violation made by a state or national professional association or any other state’s regulatory board, which has not been annulled or overturned;

(6) There has been a cancellation of insurance by the provider’s insurance company;

(7) There has been abusive or neglectful treatment of a child by a provider as determined by any state statute;

(8) The foster care provider has had their foster care license revoked;

(9) A local education agency has revoked authorization for an educational transportation service provider;

(10) The provider failsThere has been a failure to submit a copy of renewed driver’s license at the time of expiration; or

(11) The provider fails There has been failure to comply with He-C 6343.

He-C 6343.25 Notification of Denial or Revocation.

(a) If DCYF denies an application for certification or revokes an existing certification, DCYF shall send notice of the denial or revocation to the applicant or provider by certified mail.

(b) The notice shall:

(1) Inform the applicant or provider of the facts or conduct upon which DCYF bases its action; (2) Advise the applicant or provider of their right to request reconsideration of DCYF’s decision pursuant to He-C 6343.26; and (3) In the case of an existing certification, inform the provider that the revocation shall not take effect until the provider has had an opportunity through an appeal, pursuant to RSA 170-G:4-a and He-C 6343.27, to show compliance with all lawful requirements for retention of the certification.


He-C 6343.26 Request for Certification Reconsideration.

(a) A request for certification reconsideration shall:

(1) Be filed within 30 days of the date of receipt of the letter sent by DCYF;

(2) Be submitted in writing; and

(3) Be filed with the director of DCYF.

(b) The DCYF director shall grant or deny the request pursuant to He-C 6343.27.

(c) The applicant or provider shall be notified of the decision, in writing by the director.

(d) The applicant or provider may appeal the DCYF director’s decision pursuant to He-C 6343.27.

He-C 6343.27 Appeals.

(a) Applicants or providers who wish to appeal DCYF’s decision shall file an appeal pursuant to RSA 170-G:4-a with the commissioner.

(b) The appeal shall be:

(1) Made in writing and state the reasons for the appeal pursuant to RSA 170-G:4-a; (2) Filed within 14 working days of the date of receipt of written notification; and (3) Signed and dated;

(c) Pursuant to RSA 170-G:4-a and He-C 200, the commissioner or designee and 2 members of the DCYF advisory board shall hear the appeal.

APPENDIX

Rule Statute the Rule Implements He-C 6343.01 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.02 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.03 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.04 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.05 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.06 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.07 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.08 RSA 170-G:4, XVIII; RSA 170-G:5 and RSA 161:2, VI He-C 6343.09 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.10 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.11 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.12 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.13 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.14 RSA 170-G:4, XVIII; RSA 170-G:5


He-C 6343.15 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.16 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.17 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.18 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.19 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.20 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.21 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.22 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.23 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.24 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.25 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.26 RSA 170-G:4, XVIII; RSA 170-G:5 He-C 6343.27 RSA 170-G:4, XVIII; RSA 170-G:5

Documents

Final Proposal- Annotated Text 2/22/2019 1