Section 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.(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" (March 2019) ";(2) A "State of New Hampshire Alternate W-9" (October 2016); and(d) Each applicant shall complete and submit Form 2614 "Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers" (March 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 date Part D: "Staff Information" of Form 2614 "Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers" (March 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 Part D: "Agency Staff" of Form 2614 "Application for Certification and Enrollment of Accompanied or Agency Educational Transportation Service Providers" (March 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 date 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 2019) certifying 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 (c) -(g) above, applicants shall submit the following:(1) A resume or curriculum vitae for the program coordinator;(2) A copy of the agency's organizational structure;(3) A copy of their budget;(4) A program brochure, if available;(5) 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; andd. 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;(6) A written description of the agency's no show and cancellation policy;(7) A written description of the agency's quality assurance plan including the method of handling client complaints;(8) The agency's record keeping and confidentiality policies;(9) Description of what is provided to the transportation aides for agency identification; and(10) 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.N.H. Admin. Code § He-C 6343.09
(See Revision Note at part heading for He-C 6343) #9390, eff 3-1-09
Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12592, Effective 7/26/2018, Expires 1/22/2019.Amended by Volume XXXIX Number 16, Filed April 18, 2019, Proposed by #12750, Effective 3/26/2019, Expires 3/26/2029.