Narcotic Treatment Programs
Narcotic Treatment Program Exception Request
The NTP Exception Request form is to facilitate the submission of patient exceptions to state regulations California Code of Regulations (CCR), Title 9, Chapter 4 in accordance with Section 10425. This form is intended for exceptions that only require DHCS state approval and do not require SAMSHA’s federal approval. This does not preclude other forms of notifications. DHCS may grant a temporary exception request in accordance with CCR, Title 9, Section 10425 for individual licensed NTP locations on a per patient basis.
Patient exception requests to 42 CFR, Part 8, must be submitted through the CSAT portal as these are federal laws which require both DHCS and SAMHSA’S approval.
All approved exception requests must be documented and maintained in the patient’s file.
DHCS 1834 NTP Exception Request Form to State Regulations Only
NTP Exception Request Flow Chart Diagram
Applications and Forms
Application for License Renewal– DHCS 4029
Interim Treatment Patient Notification – DHCS 4032
Narcotic Treatment Program Initial Application – DHCS 5014
Guarantor Agreement – DHCS 5020
Facility and Geographical Area – DHCS 5025
Staff Information – DHCS 5026
County Certification – DHCS 5027
Organizational Responsibility – DHCS 5031
Patient Death Report – DHCS 5048
Affiliated and Associated Acknowledgement – DHCS 5134
Application for Protocol Amendment – DHCS 5135
Submit all forms and supporting documents to:
Department of Health Care Services
Counselor & Medication Assisted Treatment Section, MS2603
PO BOX 997413
Sacramento, CA 95899-7413
Mobile Narcotic Treatment Programs
- BHIN 24-005 Mobile Narcotic Treatment Programs (MNTP). This BHIN sets forth the requirements that a MNTP shall comply with lawful implementation and operation in California and establishes an application process for Narcotic Treatment Programs (NTPs) to apply for a MNTP component.
- Mobile Narcotic Treatment Programs (MNTP) Toolkit
- Mobile Narcotic Treatment Program Initial Application – DHCS 1830
- Application for License Renewal – DHCS 1831
- Application for Protocol Amendment – DHCS 1832
- MNTP Licensure Webinar
Narcotic Treatment Program Licensure Fees
The Licensing and Certification Division (LCD) will now accept online payments using electronic money transfers processed through an Automated Clearing House (ACH) network. Providers looking to pay fees electronically can follow the instructions provided within the following link: https://www.govone.com/PAYCAL/DHCS/Account.