Section He-C 6341.09 - Application Process for Payment Standards for Communication Access Services(a) Applicants who seek initial certification for payment for communication access 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 based services certification specialist shall assess the need for communication access 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.(c) If there is a need for a service based in (b) above, DCYF shall forward an application packet to the applicant which includes: (1) Form 2609 "Application for Certification and Enrollment of Communication Access Service Providers" (November 2018 Edition);(2) A "State of New Hampshire Alternate W-9" (October 2016 Edition); and(d) Each individual or agency applicant shall complete, sign, date and submit Form 2069 "Application for Certification and Enrollment of Communication Access Service Providers" (November 2018 Edition), and provide the following: (1) A copy of the individual applicant's licenses to practice communication access services or for agency applicants, a master list that includes the name, type of license, and the date of license expiration for each staff member providing communication access services;(2) A resume or curriculum vitae for each individual applicant, or if agency applicant, the executive director;(3) A program brochure, if available;(4) A completed, signed, and dated, "State of New Hampshire Alternate W-9" (October 2016 Edition); and(5) For an individual applicant for foreign language communication access services, the names and addresses of 2 references who can verify professional experience and expertise.(e) In addition to the information requested in (d) above, the applicant shall complete, sign, date, and submit Part F "Statement of Affirmation" of Form 2609 "Application for Certification Enrollment of Communication Access Service Providers" (November 2018 Edition), that states: (1) I have reviewed Administrative Rule He-C 6341 and will adhere to the rules as an enrolled provider. I understand that DCYF has the right to verify information contained in this application; and(2) I understand and agree that any individual or agency providing services with whom I employ or subcontract will have a current and valid license for the service being provided.(f) In addition to the information requested in (c) and (d) above, an individual applicant and agency applicant staff member, who provides communication access services, shall complete, sign, date, and submit Part E "Information" of Form 2609 "Application for Certification Enrollment of Communication Access Service Providers" (November 2018 Edition), that states: "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."
N.H. Admin. Code § He-C 6341.09
(See Revision Note at part heading for He-C 6341) #9392, eff 3-1-09
Amended by Volume XXXVIII Number 23, Filed June 7, 2018, Proposed by #12535, Effective 5/24/2018, Expires 11/20/2018.Amended by Volume XXXVIII Number 50, Filed December 13, 2018, Proposed by #12684, Effective 11/30/2018, Expires 11/30/2028.