1. (a) Residents who have medical or behavioral health needs, or both, requiring specialized care necessitates programming that incorporates an increased awareness of the unique needs, as well as attention, adaptation, and accommodative measures beyond what are considered routine. For the purposes of this section, such medical or behavioral health needs are those defined in He-C 4001.01(bj), and which may be congenital, developmental, or acquired through disease, trauma, or environmental causes, and which impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.

2. (b) SCPs shall comply with:

   1. (1) He-C 4001.01 through He-C 4001.25, He-C 4001.31, and this section; and
   2. (2) Any other federal, state, and professional standards related to the treatment of any medical diagnosis of any resident.

3. (c) In addition to the policies required in He-C 4001.14 and He-C 4001.15, SCPs shall have written policies and procedures governing the operation of the program relative to the provision of services, available for review by the unit, that include the following:

   1. (1) Intake and admissions procedures that clearly state the criteria for the SCP population to be served;
   2. (2) A description of the services provided within the program to meet the special medical needs of the residents;
   3. (3) A description of the professional services provided on site and in the local community that will be contracted or accessed to ensure the special medical needs of the residents are met;
   4. (4) The organizational chart, job descriptions of staff, and contracts with medical staff, clinical staff, and consultants used to meet the special medical needs of the population being served; and
   5. (5) How direct care staff will be orientated and trained to prepare to work with the population being served.
4. (d) The program director, together with relevant members of the administration, clinical, and direct-care staff, shall annually review all policies and procedures and revise them as needed to ensure consistency with current practice and professional standards.

5. (e) All clinical services provided by the licensee shall:

   1. (1) Focus on the residents strengths;
   2. (2) Be sensitive and relevant to the diversity of the residents;
   3. (3) Be child and family-centered; and
   4. (4) Be designed to acknowledge the impact of violence and trauma on resident’s lives, which shall be addressed in the services provided.
6. (f) The licensee shall assess and monitor the quality of care and services it provides to residents on an ongoing basis.

7. (g) SPCs providing behavioral health services shall employ or contract with:

   1. (1) A clinical coordinator who shall:

      1. a. Be a full-time employee;
      2. b. Meet the definition of clinical staff in He-C 4001.01(j); and
      3. c. Have 2 years post-graduate experience in human services; and

   2. (2) Clinical staff to meet the needs of the residents who shall:

      1. a. Be a full-time employee or a part-time employee with a minimum of 22 hours a week; and
      2. b. Meet the criteria specified in He-C 4001.01(j).

8. (h) SCPs shall:

   1. (1) Provide administrative services that include the appointment of a full-time, on-site program director who is responsible for the day-to-day operations of the SPC, who meets the requirements specified in He-C 4001.19(g);
   2. (2) Contract with or employ professional staff to meet the needs of residents, including but not limited to clinical, medical, and social needs;
   3. (3) Employ direct care staff to implement service plans on a daily basis;
   4. (4) Assign all direct care staff and clinical staff to a staff person who has supervisory or administrative responsibility and experience suitable to the goals of the program and the responsibilities of the staff supervised;
   5. (5) Require direct care and clinical staff to have scheduled supervision with the assigned supervisor regarding resident’s needs and methods of meeting those needs, which shall occur a minimum of weekly or more frequently as needed;
   6. (6) In addition to He-C 4001.19(b), provide orientation for all new employees to acquaint them with the program's philosophy, organization, policies, and services. No new direct care staff shall be solely responsible for residents until they have completed the orientation;
   7. (7) Ensure that all staff who perform direct care to residents or who are providing treatment, education, and recovery support services shall be under the direct supervision of a licensed clinical supervisor pursuant to the supervision requirements in Alc 400; and
   8. (8) Require that all personnel follow the orders of the licensed practitioner for each resident and encourage the residents to follow the licensed practitioner’s orders.
9. (i) An SCP that is not able to meet the needs of any resident whom requires specialized care, as described in this section, shall notify the unit and expeditiously seek an alternative placement, which can provide for the resident’s needs on a long-term basis and ensure that all needs are met until such time transfer or discharge can safely occur.

10. (j) SCPs shall assess each resident within 24 hours of admission to determine each resident’s needs and abilities on the following:

    1. (1) Walking and ambulation;
    2. (2) Transfers;
    3. (3) Ability to self-evacuate;
    4. (4) Fall risk;
    5. (5) Mood and behavior;
    6. (6) Communication;
    7. (7) Nutrition and oral health;
    8. (8) Medications and treatments including nebulizers and oxygen;
    9. (9) Personal hygiene and assistance with activities of daily living;
    10. (10) Whether or not safety devices, such as helmet, mittens, or safety belt, are needed; and
    11. (11) Nursing care and services.

11. (k) The assessment conducted in accordance with (j) above shall be:

    1. (1) Incorporated into the resident’s service plan and treatment plan; and
    2. (2) Documented in the resident’s file and available for review by unit staff.

12. (l) In addition to the treatment plan required in He-C 4001.30, SCPs shall develop a service plan, meaning a written guide, in consultation with the resident and parent, guardian, agent, or personal representative, as applicable, as a result of the assessment conducted in accordance with (j) above for the provision of care and services which shall:

    1. (1) Be completed within 24 hours of the completion of the assessment and within 24 hours of the completion of subsequent assessments;
    2. (2) Identify the resident's needs;
    3. (3) Identify the services that the SCP will provide and the staff person responsible for providing or arranging for the services while the resident is in care;

    4. (4) Include the following areas:

       1. a. Educational;
       2. b. Vocational;
       3. c. Health, including medical, dental, and ancillary services;
       4. d. Behavior management, including specific individual modifications of the restraint plan, if necessary;
       5. e. Life skills; and
       6. f. Social services, including family work, psychological and psychiatric services, and counseling;
    5. (5) Be made available to all personnel for residents whom they assist;
    6. (6) Be completed in consultation with the resident and parent, guardian, agent, or personal representative, as applicable, and if any of these individuals are unable or unwilling to participate, it shall be documented in the resident record; and
    7. (7) Be available on site for review by the unit.

13. (m) The service plan identified in (l) above shall include on an ongoing basis:

    1. (1) The date a problem or need was identified as a result of the assessment conducted in (k) above;
    2. (2) A description of the problem or need;
    3. (3) The goal or objective of the plan;
    4. (4) The action or approach to be taken;
    5. (5) The responsible person(s) or position; and
    6. (6) The date of reevaluation, review, or resolution.
14. (n) The licensee shall explain all service plans to all child care personnel responsible for implementing the service plan, to the resident’s parent, guardian, agent, or personal representative, as appropriate, and to the resident in a manner consistent with their maturity and capacity to understand.

15. (o) All service plans shall be reviewed and updated as often as necessary, but no less frequently than every 6 months to re-assess the resident’s needs and determine if:

    1. (1) The service plan will be continued for another 6 months;
    2. (2) The service plan will be revised to meet the needs of the resident;
    3. (3) The service plan will be discontinued because the plan is no longer needed; and
    4. (4) Shall be available for review by the unit.

16. (p) Progress notes shall be written at least every 90 days and include, at a minimum:

    1. (1) Service plan outcomes;
    2. (2) The resident’s physical, functional, and mental abilities; and
    3. (3) Changes in behavior, such as eating habits, sleeping pattern, and relationships.

17. (q) If a resident refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

    1. (1) Inform the resident of the potential results of their refusal;
    2. (2) Notify the licensed practitioner and parent, guardian, agent, or personal representative, if any, of the resident’s refusal of care; and
    3. (3) Document in the resident’s record the refusal of care and the resident’s reason for the refusal.

18. (r) If a resident is non-verbal or incapable of understanding the need for care or services as identified in (q) above but exhibits behaviors that represent refusal of any care or services:

    1. (1) Such behaviors shall be documented in the resident’s record; and
    2. (2) Staff shall consult with appropriate personnel of the SCP to determine if the care plan requires modifications or if the needs of the resident exceed the services that the SCP is able to provide.
19. (s) The licensee shall insure that medically necessary glasses, hearing aids, prosthetic devices, corrective physical or dental devices, or any equipment necessary or treatments prescribed by the examining physician are provided to the resident if the resident’s parent, guardian, agent, or personal representative, as applicable, does not provide them.
20. (t) The licensee shall not require any resident to receive medical treatment or screening when the parents or guardians of such resident object based on religious beliefs.

21. (u) Programs providing SUD services shall:

    1. (1) Provide administrative services that include the appointment of a full-time, on-site program director who is responsible for the day-to-day operations, who shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

       1. a. A bachelor’s degree from an accredited institution and one year of relevant experience working in a health related field;
       2. b. A New Hampshire license as an RN, with at least one-year relevant experience working in a health related field;
       3. c. An associate’s degree from an accredited institution plus 3 years relevant experience in a health related field;
       4. d. A MLADC or LADC license issued by the state of New Hampshire; or
       5. e. Licensed by the New Hampshire board of mental health practice with at least one year of relevant experience working in SUD treatment;

    2. (2) Employ or contract with a medical director who:

       1. a. Is a licensed practitioner who is licensed in the state of New Hampshire; and
       2. b. Has experience providing medical services to residents with behavioral health or substance use disorder needs;
    3. (3) Employ or contract with a nurse who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN or LPN with at least 2 year's relevant experience in substance use disorder treatment or behavioral health services;
    4. (4) Employ or contract with a clinical services director who is a LADC or MLADC licensed by the New Hampshire board of licensing for alcohol and other drug use professionals or an individual licensed by the board of mental health practice and who has at least 2 years relevant experience in treatment of SUD or behavior services;
    5. (5) Employ or contract with additional professional staff to meet the needs of residents, including but not limited to clinical, medical, and social needs; and
    6. (6) Employ direct care staff to implement service plans on a daily basis.

22. (v) In programs providing SUD services, all direct care personnel shall be at least 21 years of age unless they are:

    1. (1) A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or
    2. (2) Involved in an established educational program working under the supervision of licensed staff.

23. (w) In addition to (u) and (v) above, all programs providing SUD services shall:

    1. (1) Ensure that all staff who perform direct care to residents or who are providing treatment, education, and recovery support services shall be under the direct supervision of a licensed clinical supervisor pursuant to the supervision requirements in Alc 400;
    2. (2) Require all personnel to follow the orders of the licensed practitioner for each resident, and encourage the residents to follow the licensed practitioner’s orders; and
    3. (3) Require staff to obtain continuing education requirements, in accordance with Alc 400, and maintain documentation of the training in the employee’s individual personnel file for review by the unit.

24. (x) In programs providing SUD services, the services shall be evidence-based by meeting one of the following:

    1. (1) The services shall be included as an evidence-based mental health and substance abuse intervention on the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Evidence-Based Practices Resource Center” available at https://www.samhsa.gov/libraries/evidence-based-practices-resource-center?f%5B0%5D=resource_topic%3A20277 , (as accessed and printed on January 27, 2025), available as noted in Appendix A;
    2. (2) The services are published in a peer reviewed journal and found to have positive effects; or
    3. (3) The treatment and support service provider shall be able to document the services effectiveness based on a theoretical model with validated research or a documented body of research generated from similar services that indicates effectiveness.

25. (y) In addition to (x) above, programs providing SUD services, shall deliver those services in accordance with:

    1. (1) The American Society of Addiction Medicine’s (ASAM), “The ASAM Criteria”, (Fourth edition), available as noted in Appendix A; or
    2. (2) The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Knowledge Application Program (KAP) Resource Documents and Manuals” (July 2020 edition), available at https://www.samhsa.gov/kap/resources, or as noted in Appendix A.
26. (z) Programs operating a SCP shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for program staff for the prevention, control, and investigation of infectious and communicable diseases.

27. (aa) The infection control program shall include written procedures for:

    1. (1) Proper hand washing techniques;
    2. (2) The utilization of universal precautions;
    3. (3) The management of residents with infectious or contagious diseases or illnesses;
    4. (4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 904; and
    5. (5) The reporting of infectious and communicable diseases as required by He-P 301.

28. (ab) The infection control education program shall address at a minimum the:

    1. (1) Causes of infection;
    2. (2) Effects of infections;
    3. (3) Transmission of infections; and
    4. (4) Prevention and containment of infections.

Source. #13151, eff 12-30-20; ss by #14214, eff 4-1-25