In order for a residential treatment program to be certified as a highly intensive or level 4 treatment program it shall comply with the following:

1. (a) He-C 4001 or for out-of-state programs, the applicable licensing rules and laws in their state;
2. (b) Providing highly structured services, both on-site and in the community, as needed to directly affect the educational, physical, intellectual, emotional, and social needs of the children and families;

3. (c) Maintaining a multi-disciplinary, self-contained means of service delivery to meet the needs identified within the treatment plan, as follows:

   1. (1) There shall be a clinical staff to child ratio of one clinical staff to 8 children;
   2. (2) Clinical services shall be provided through the residential treatment program’s on-site program unless a special circumstance is identified through the treatment plan to support utilizing a community provider;
   3. (3) Clinical staff shall provide treatment interventions to meet the individual needs of the children and families served and shall provide a therapeutic group-living experience;
   4. (4) Unless otherwise specified in the child’s treatment plan, any combination of individual, group, or family counseling services shall be provided to each child or the family a minimum of 3 times a week consisting of a minimum of 45 minutes per session, or the equivalent of that total time over several sessions;
   5. (5) The staff requirements shall be in accordance with He-C 6530.11 (c), d), (j) and (k), and family-centered services component shall operate in accordance with the written policy required by as described in He-C 6350.10(b); and

   6. (6) The residential treatment program shall organize its clinical staff and family workers in a flexible manner so long as families are seen face-to-face no less than one time per week, unless otherwise specified in the child’s treatment plan, as follows:

      1. a. Technology shall be allowed to be used to supplement clinical services as a part of the child’s treatment; and
      2. b. The utilization of a video-conferencing technology shall not replace face-to-face contact unless documented in the child’s treatment plan with the agreement of the treatment team as identified in He-C 6350.13;

4. (d) Be staff-secure and be able to serve those children whose needs require a high level of treatment and supervision as follows:

   1. (1) There shall be a minimum of direct care staff to child ratio of one staff to 3 children during hours when children are awake;
   2. (2) During sleeping hours there shall be a staff to child ratio of one staff to 5 children with a minimum 2 staff in a program building at all times regardless of ratio; and
   3. (3) An out-of-state program shall comply with the staffing requirements of the state in which it operates, provided that the staff to child ratio is sufficient to ensure the residents’ safety and that children have prompt access to services and treatment. The program shall provide the documentation of the staff ratio as defined in He-C 6350.02(x) and maintained by the program, to the department if it does not comply with (c)(1) above and (d)(1) and (2) above;

5. (e) Educational services to children shall comply with RSA 193:1 and Ed 306 as follows:

   1. (1) The program shall use public schools pursuant to Ed 300, non-public schools pursuant to Ed 400, or private providers of special education pursuant to Ed 1100 as approved by the NH state board of education;
   2. (2) The agency shall operate and maintain approval as a non-public school pursuant to Ed 400 and a private provider of special education pursuant to Ed 1100 as approved by the NH state board of education;
   3. (3) Programs in another state shall follow the requirements of their state agency or local authority which approves educational programs; and
   4. (4) Agencies which operate community based acute treatment (CBAT) or intensive community based acute treatment (ICBAT) shall coordinate tutoring with the child’s sending school district;
6. (f) When a child is discharged to a family home, the program shall provide transitional and aftercare services for a minimum of 30 days unless that program is an CBAT or ICBAT; and

7. (g) Highly intensive programs may also include the short term category of CBAT and ICBAT and shall follow the above.

   Source. #14490, eff 1-22-26, EXPIRES: 1-22-36

   He- C 6350.20 Psychiatric Residential Treatment Facility (PRTF). In order for a residential treatment program to be certified as a PRTF program, it shall:

8. (a) Be an inpatient treatment facility where treatment is directed by a physician in a highly clinical, active treatment setting in accordance with 42 CFR 441.151(a)(1), and shall be:

   1. (1) A psychiatric hospital that undergoes CMS approved surveys;
   2. (2) A hospital with an inpatient psychiatric program; or
   3. (3) A psychiatric facility that is not a hospital and is appropriately accredited;
9. (b) Be licensed in accordance with RSA 151, equivalent license of the state in which it operates, or applicable license approved by the department;
10. (c) Be enrolled in New Hampshire medicaid;
11. (d) Comply with He-C 830 or applicable rules from the state in which they operate;
12. (e) Comply with He-C 6420;
13. (f) Comply with 42 CFR 441 Subpart D and 42 CFR 483 Subpart G and all applicable laws;
14. (g) Demonstrate accreditation with a national accrediting body in accordance with 42 CFR 441.151;
15. (h) Maintain the treatment documentation required in He-C 6350.12(j) and (k), He-C 6350.13, He-C 6350.14, and He-C 6420;

16. (i) Maintain a multi-disciplinary, self-contained means of service delivery to meet the needs identified within the treatment plan as follows:

    1. (1) There shall be a clinical staff to child ratio of one clinical staff to 6 children;
    2. (2) There shall be a psychiatrist who is available 24 hours a day and 7 days a week;
    3. (3) There shall be nursing staff onsite 24 hours a day and 7 days a week;
    4. (4) Clinical services shall be provided through the residential treatment program’s on-site program unless a special circumstance is identified through the treatment plan to supplement specialized treatment through utilizing a community provider;
    5. (5) Clinical staff shall provide treatment interventions to meet the individual needs of the children and families served and shall provide a therapeutic group-living experience;
    6. (6) Unless otherwise specified in the child’s treatment plan or court order, any combination of individual, group, or family counseling services shall be provided to each child or the family a minimum of 3 times a week consisting of a minimum of 45 minutes per session, or the equivalent of that total time over several sessions. This shall include family therapy if clinically indicated;
    7. (7) The staff requirements shall be in accordance with He-C 6530.11 (c), (d), (j) and (k), and the family-centered component shall operate pursuant to the parent handbook required by He-C 6350.10(b); and

    8. (8) The residential treatment program shall organize its clinical staff and family workers in a flexible manner so long as families are seen face-to-face no less than one time per week, unless otherwise specified in the child’s treatment plan, as follows:

       1. a. Technology may be used to supplement clinical services as a part of the child’s treatment; and
       2. b. The utilization of a video-conferencing technology shall not replace face-to-face contact unless documented in the child’s treatment plan with the agreement of the treatment team as identified in He-C 6350.13;

17. (j) The program shall be staff-secure and may be structurally secure to be able to serve those children whose needs require the highest level of treatment and supervision, as follows:

    1. (1) There shall be a minimum staff to child ratio of one staff to 4 children during hours when children are awake and a staff to child ratio of one staff to 6 children during sleeping hours;
    2. (2) Programs shall be prepared to provide supplemental staff during times of need or crisis;
    3. (3) Out-of-state programs shall adhere to the staffing requirements of the state in which the services are provided only if the staff ratio is sufficient to ensure child safety and that children have prompt access to treatment and services. The program shall provide documentation of the ratio maintained by the program to the department if it does not comply with (i)(1)-(3) above and (j)(1) above, as long as they maintain the ratio required by the equivalent license in (b) above and the required ratio of (f) above;
    4. (4) The facility shall not use staff who are also counted in ratio on other units of the facility in order to meet the unit staffing ratios; and
    5. (5) Justification of the ratio maintained by the program in accordance with the statutory or regulatory authority of the state or other entity dictating the ratio; and

18. (k) If there is an educational program on site the educational services to children shall comply with RSA 193:1 and Ed 306, as follows:

    1. (1) The program shall use public schools pursuant to Ed 300, non-public schools pursuant to Ed 400, or private providers of special education pursuant to Ed 1100 as approved by the NH state board of education;
    2. (2) The agency shall operate and maintain approval as a non-public school pursuant to Ed 400 and a private provider of special education pursuant to Ed 1100 as approved by the NH state board of education; or public or non-public school;
    3. (3) Programs in another state shall follow the requirements of their state agency or local authority which approves educational programs; or
    4. (4) The agency shall coordinate tutoring with the child’s sending school district.

Source. #14490, eff 1-22-26, EXPIRES: 1-22-36