Placement in a Residential Facility – A referral packet for placement in a residential

Placement in a Residential Facility – A referral packet for placement in a residential facility must contain the following documents: 1. A completed ICPC-100A; 2. A court order showing the child’s legal status, which must be signed and dated within a year of the packet’s submission; 3. Documentation indicating the Sending Agency has authority to place the child; 4. A social summary of the child, which must include background information, reason for the placement, and a current assessment of the child and family; 5. A current case history, if applicable; 6. A copy of the child’s case plan and/or psychological evaluation, if applicable; 7. A letter of acceptance from the residential facility; 8. MDCPS Pre-screening Form Reg-2; 9. A statement indicating all options in the Sending State have been exhausted; 10. A financial and medical agreement, which must describe who is responsible for the costs of the placement; 11. An explanation of the child’s IV-E eligibility and IV-E documentation, if applicable; 12. A copy of the child’s birth certificate; 13. A copy of the child’s Social Security card; and 14. A placement disruption agreement. The original referral packet and two (2) copies may be mailed to the ICPC Unit or a complete referral packet may be scanned and emailed to the ICPC Unit. The Receiving State ICPC Office must verify the status of the residential treatment facility’s license before approving the placement. Monitoring the Residential Facility 1. The Receiving State ICPC Office must maintain a record of all children placed in a residential facility through the ICPC process. 2. The Receiving state ICPC office must notify the Sending State of any significant change to a residential facility’s status that may put the child at risk. 3. A social worker in the residential facility must provide supervision reports to the Sending State for children that are in the state’s custody.