Attach the following documents to the community relations plan

							Attach the following documents to the community relations plan:

1. Documentation that the transportation systems will provide reasonable
   access to the program for persons in need of treatment. (RCW
   70.96A.410(1)(g).

2. Program outcome data showing your agency is able to provide appropriate
   treatment services to assist persons in meeting legislative goals of RCW
   70.96A(1)(h):

   •     Abstinence for opiates and opiate substitutes.
   •     Obtaining mental health treatment.
   •     Improving economic independency.
   •     Reducing adverse consequences associated with illegal use of
         controlled substances.

3. At least three letters of support from health care providers from the
   proposed service area that demonstrate the OTP will have appropriate
   relationships with the existing health care system.

4. Policies and procedures that describe:

   •     Cost of services to clients.
   •     Sliding fee scales.

5. Documentation that the proposed program fosters acceptable, quality
   health care that includes:

   a. Documentation of your agency’s ability to employ sufficient, qualified
      personnel to provide adequate chemical dependency treatment, facility
      security, patient safety, and other special needs of patients, or that verify
      that the qualified personnel are available and can be recruited.

   b. Assurance that the proposed OTP services will be provided in a manner
      that ensures safe and adequate care to the patients to be served and
      meet applicable federal and state laws, rules, and regulations. The
      assessment must include:

   c. Does your agency, or any member of your governing body have:

        i.    A history, in this state or elsewhere, of a criminal conviction, which is
              reasonably related to the applicant's competency to exercise
              responsibility for the ownership or operation of a health care facility.

       ii.    Has your agency or any member of your governing body had a
              license to operate a health care facility denied, suspended, revoked,
              or involuntarily cancelled?

       iii.   Has your agency or any member of your governing body had a
        license to practice a health profession denied, suspended, or
        revoked?

  iv.   Has your agency or any member of your governing body been
        decertified as an OTP provider because of failure to comply with
        applicable state or federal requirements?

d. If you answered yes to any of the above questions, provide
   documentation of clear, cogent, and convincing evidence that you can
   and will operate the proposed OTP in a manner that:

   i. Ensures safe and adequate care to the patients to be served.
  ii. Conforms to applicable federal and state requirements.

e. Copies of any OTP certificates, approvals, licenses, accreditations your
   agency or any of the owners have received within the past six years from
   any state or national certification, licensing, or accreditation body along
   with an authorization to contact them to obtain information regarding
   your competency to exercise responsibility for the ownership of an OTP.