Section He-C 6355.03 - Renewal of Applications(a) A licensed foster care program seeking to renew the certification as a foster care program shall file for renewal of certification no later than 3 months prior to the expiration date of the current certification.(b) The executive director or designee shall complete and sign Form 2612R "Certification for Payment Renewal Application - Foster Care Programs" (January 2015), affirming or agreeing to the following: (1) "I have reviewed the Administrative Rules He-C 6355 and He-C 6446 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 6355 and He-C 6446. I further understand that DCYF has the right to verify information contained in this application."(2) "I attest that the program is in compliance with He-C 6355, He-C 6446 and the applicable Medicaid rules, and that all information provided as part of the application, and in the required attachments is true and complete to the best of my knowledge."(3) "I certify that the following pre-employment checks were completed for all staff, and reviewed as required in He-C 6355.04, a criminal record check, a BEAS state registry check, a DCYF central registry check and a NH motor vehicle record check."(4) "I understand and agree to cooperate with a site visit as part of the application process."(5) "The information contained in this application is correct to the best of my knowledge."(c) The foster care program shall provide the following information on the renewal application: (1) A narrative which shall include: a. A description of any changes made to the program during the last certification period; andb. The results of the most recent self-evaluation reviewing the program's performance in meeting identified goals and outcomes; and(2) Attachments documenting the following:a. A description of the foster care program being proposed, the documented need for the program, and how individual needs of children and families will be met, including but not limited to, clinical provisions, medical, educational, recreational, independent living, transitional and permanency services, as applicable and how the program promotes the safety, permanency and well-being of children and families, including specialized services that are supported by certifications and/or accreditations;b. Any changes made to the program's board of directors and the names, addresses, and telephone numbers of the new board members;c. The names and job functions of any personnel hired since the last certification; andd. A copy of the program's license and/or operational approval, in accordance with the following: 1.For programs in New Hampshire, a copy of the license issued in accordance with RSA 170-E:31; or
2.For programs outside of New Hampshire, documentation from the corresponding state's regulatory agency(ies);
e. A completed Form 2426 "Residential Resource Guide Provider Form," (January 2015) .(d) The foster care program shall cooperate with the department during all site visits conducted in accordance with He-C 6355.27(b) (2) .N.H. Admin. Code § He-C 6355.03
Amended byVolume XXXIV Number 33, Filed August 14, 2014, Proposed by #10640, Effective 7/29/2014, Expires7/26/2015.Amended byVolume XXXV Number 10, Filed March 12, 2015, Proposed by #10783, Effective 2/13/2015, Expires2/13/2025.