1. (a) Applicants for provision of IDSP services shall:

   1. (1) Submit a completed application, “Impaired Driver Service Provider (IDSP) Application” (December 2023), attesting to the following:

      “I will remain in compliance with all applicable state and federal regulations, including He-A 500, and any and all program/service descriptions, specific staffing requirements, and appropriate staff credentials, as they relate to the program(s)/service(s) identified in this application”; and

   2. (2) Provide the following supporting documentation to the department:

      1. a. Proof of general and professional liability insurance;
      2. b. Copies of relevant certifications, licenses, or other documentation that supports the individual’s qualifications to provide the services outlined in He-A 500;
      3. c. A narrative describing how the provider will ensure continuity of care for clients should the IDSP be unable to provide services, and a statement regarding how client records will be stored, should the IDSP become incapacitated;

      4. d. Documentation of having met the criteria outlined in He-A 510.01(g)(4), if applicable, which shall include a certificate of training or a letter of attendance from the course leader which includes the following:

         1. 1. The course titles;
         2. 2. The sponsoring agencies;
         3. 3. The dates of attendance; and
         4. 4. The number of course hours; and
      5. e. The provider’s signature agreeing to abide by the requirements of He-A 500 and all applicable state and federal rules and laws.
2. (b) Applicants shall meet the applicable licensing, certification, and clinical standards for the level of care and services for which they are applying.
3. (c) Applicants shall agree, in writing, to abide by He-A 500 and other applicable state and federal rules and laws.

4. (d) The applicant shall email the application to the IDCMP Coordinator, or mail or hand-deliver the documents to:

   Department of Health and Human Services

   Bureau of Drug and Alcohol Services

   Impaired Driver Services Coordinator

   105 Pleasant Street

   Concord, NH 03301

Source. #10240, eff 1-1-13; ss by #13846, eff 1-6-24, EXPIRES: 1-6-34