Presumptive Transfer of the Responsibility for Specialty Mental Health Services (SMHS) When a Dependent Child/Youth Resides Out of County
0600-505.21 | Revision Date: 1/9/2019

Overview

This procedural guide outlines the guidelines and procedures for the presumptive transfer of the responsibility for providing, arranging and paying for Specialty Mental Health Services (SMHS) from the county of original jurisdiction to the county in which the foster child resides.

Table of Contents

Version Summary

This is a brand new policy.

POLICY

Presumptive Transfer (AB 1299)

There are specific guidelines and procedures to follow with regards to out of county placements. This policy pertains to the transfer of the responsibility for providing, arranging and paying for Specialty Mental Health Services (SMHS).

Absent any exceptions as established by the law, the responsibility for providing, arranging and paying for SMHS must promptly transfer from the county of original jurisdiction to the county in which the foster child resides.

  • For any foster child who is placed by a placing agency out of the county of original jurisdiction on or after July 1, 2017, the responsibility to provide or arrange for the provision of and payment for SMHS will transfer to the county of residence.
  • For any foster child who resides in a county other than the county of original jurisdiction after June 30, 2017, who is not receiving SMHS consistent with his or her mental health needs as specified in the child’s client plan, the responsibility to provide or arrange for the provision of and payment for SMHS will be transferred to the Mental Health Plan (MHP) in the county of residence.
  • For any foster child who resides in a county other than the county of original jurisdiction after June 30, 2017, and who continues to reside outside the county of original jurisdiction after December 31, 2017, the responsibility for the provision and payment of SMHS will be transferred to the county of residence no later than the child’s first regularly scheduled status review hearing in the 2018 calendar year.

DCFS will continue to have jurisdiction over and supervision of the child/youth. In addition, the responsibility for the Drug Medi-Cal benefit for substance use disorder treatment services remains with the county of original jurisdiction, even if the responsibility for the provision of, and payment for, SMHS has transferred to the child or youth’s county of residence.

Most of the functions related to the processing of Presumptive Transfers are centralized through the Bureau of Clinical Resources and Services (BCRS), with a designated Single Point of Contact (SPOC) who can be reached via the AB 1299 Desk. Questions and inquiries from staff and other parties related to presumptive transfers are directed to this desk. Additional information on AB 1299 can also be found on the AB 1299 website.

DCFS must ensure that the out of county address is updated in MEDS as soon the child has changed address but no later than 2 business days after the final determination of presumptive transfer.

Specialty Mental Health Services (SMHS)

Specialty Mental Health Services (SMHS) may include crisis intervention, assessments, therapy services (individual, family and group), targeted case management services, collateral services, rehabilitative services, Therapeutic Behavioral Services (TBS) and medication services. Services are provided in multiple settings including clinics, schools and in the field in client’s homes.

Screening/Assessment

DCFS shall ensure that the child or youth has been provided a mental health screening prior to completing the steps for presumptive transfer. To facilitate timely provision of mental health services, the MHP in the foster child’s county of residence is required to accept an assessment, if one exits, of needed SMHS for the foster child from the MHP in the county of original jurisdiction. Upon presumptive transfer, the MHP of residence may update an assessment or conduct a new assessment if clinically indicated, but these updates or new assessments may not delay the provision of SMHS to the child.

Children placed out-of-county will not be referred for a Multidisciplinary Assessment Team (MAT) assessment.

Expedited Transfers

Expedited transfers are processed when a foster child or youth is in imminent danger to themselves or others or experiencing an emergency psychiatric condition, MHPs must provide SMHS immediately, and without prior authorization. Expedited transfers must occur within 48 hours of out-of- county placement. There may be instances when a child or youth must be moved out of county for his or her safety and a CFT meeting/consultation cannot occur prior to placement. In these instances, DCFS must immediately contact the MHP in the county of residence to notify the MHP of the placement and the need to provide or arrange and pay for SMHS to meet the needs of the child or youth.

For all other situations wherein a child/youth needs immediate intensive mental health services prior to or while in transition to presumptive transfer taking into full effect, CSWs should begin the linkage process by completing a CSAT packet through the Referral Portal. The Service Linkage Specialist will review the packet and will forward to the AB 1299 Desk, to assist with contacting DMH and/or the MHP in the county of residence where the child resides.

The array and intensity of mental health services offered by an out of county MHP will differ from county to county. The MHP where the child resides is responsible for determining all mental health service needs and linking appropriately.

Child and Family Team (CFT)

In accordance with the State’s instructions, discussions regarding presumptive transfer should occur with the Child and Family Team (CFT) members, and as applicable, in consultation with other professionals who serve the child or youth. The CFT members will engage in considering the out of county placement, appropriateness of the presumptive transfer of SMHS and/or of its waiver.

If SMHS are presumptively transferred, the mental health provider(s) from the county of residence becomes part of the child or youth’s CFT. The county of jurisdiction remains responsible for convening the CFT meetings regardless of the county of residence or presumptive transfer.

Waiver of Presumptive Transfer

Presumptive transfer can only be waived by DCFS if the following two conditions are met:

  1. A demonstration that the MHP in the county of original jurisdiction i.e. for Los Angeles County, the Department of Mental Health (DMH) can contract, arrange for and deliver timely services within 30 days.
  2. An individualized determination has been made that at least one of the below exception criteria applies:
    • The transfer would negatively impact mental health services, or delay access to services
    • The transfer would interfere with the family reunification efforts documented in the individual case plan
    • The foster child’s placement in a county other than the county of original jurisdiction is expected to last less than six months
    • The foster child’s residence is within 30 minutes of travel time to his or her established SMHS care provider in the county of original jurisdiction.

If there is a request to waive the presumptive transfer, the transfer is put on hold until the request is considered and a decision is made by DCFS or the court.

Short-Term Residential Therapeutic Program (STRTP)

Placements in STRTPs are intended to be short-term i.e. the duration of his or her stay is expected to last less than six months and then will return to LA County after treatment, therefore, placement in an STRTP would potentially qualify as an exception to presumptive transfer. In this situation a waiver may be granted, provided that LA County can contract, arrange for and deliver timely services within 30 days.

The evaluation of the appropriateness of the Presumptive Transfer or its waiver should be on-going taking into account the current circumstances and case plan, within the CFT framework.

PROCEDURE

Processing a Presumptive Transfer of SMHS

When a child/youth/NMD is placed out of county and within California, an automatic notification to the AB1299 Unit will occur when a placement packet is generated.

AB 1299 Desk Responsibilities

  1. Upon receipt of the automatic notification of an out of county placement, the CSW is automatically contacted to discuss the appropriateness of presumptive transfer and the need to engage the CFT in this process.
  2. If presumptive transfer is deemed appropriate, request the most recent consent for services, and as applicable, consent for medication, including the JV-220; and the most recent mental health records, including the most recent mental health screening and/or assessment.
  3. Send the DCFS 6091, Notification Regarding Out of County Placement, Presumptive Transfer of Mental Health Services within three business days to the following:
    • Foster child
    • CFT Coordinator (if not the CSW)
    • Child’s attorney
    • Biological parent(s)/guardian, as appropriate
  4. Within three business days, send the DCFS 6097, Notification of Presumptive Transfer for DMH and MHP, to the county of residence and LA DMH through their SPOC.
    • Attach or arrange to send the MHP of residence the most recent consent for services, and consent for medication, including the JV-220; and the most recent mental health records, including the most recent mental health screening and/or assessment.
    • Ensure that the out of county address has been previously updated in MEDS by the Revenue Enhancement staff and if not, request that it is done within 2 business days from the determination of presumptive transfer.
  5. Record the transfer using the CWS/CMS AB 1299 Special Project Code.
  6. Respond to Presumptive Transfer inquiries received from DCFS staff and outside parties, as applicable.
  7. If and when the child is placed back within LA county (county of jurisdiction), notify the following to advise that the responsibility for providing or arranging for the provision of SMHS is returning to LA County.

CSW Responsibilities

  1. Upon being contacted by the AB 1299 Desk, immediately consult with the CFT, including the mental health services provider, regarding the presumptive transfer of mental health services.
    • Provide the requested information within 3 business days of AB 1299 Desk electronic request for information.
    • For planned out of county placements: consult with the CFT prior to the placement, if possible, or as soon as an upcoming out of county placement is known. Notify the AB 1299 Desk of the plan as soon as possible of the planned out of county placement.
    • When possible it is best to plan out of county placements prior to the placement, to ensure that the CFT is engaged in the discussions regarding the planned out of county placement and presumptive transfer.
    • The TA/EW updates the MEDS to the out of county address as soon as notified of the address change but should not be later than 2 business days of presumptive transfer notification.
  2. Upon notification by the AB 1299 Desk, immediately provide them:
    • The most recent consent for services
    • Consent for medication (as applicable), including the JV-220
    • The most recent mental health records, including the most recent mental health screening and/or assessment
  3. Document/incorporate the presumptive transfer, in the Case plan under Relevant Social, Cultural, and Physical Factors.
  4. If there are any unresolved issues regarding presumptive transfer, consult with AB 1299 Desk as necessary.

If there is a Request to Waive the Presumptive Transfer

The following individuals may request to waive the presumptive transfer of SMHS:

  • The child
  • Person or agency that is responsible for making mental health care decisions on behalf of the child
  • Child’s attorney

This will trigger a waiver request. The waiver request must be made to DCFS within 7 calendar days of the date of the notice of presumptive transfer.

Requests for waivers are received and processed by the AB 12 Desk. Following the determination of the waiver request, any of the above parties may request a Judicial Review if they do not agree with the decision.

AB 1299 Desk Responsibilities

  1. If a waiver request or contest of the presumptive transfer is received following the notification of presumptive transfer, notify the following that a waiver request has been received and that the presumptive transfer is on hold until a decision on the waiver request is made:
    • Foster child
    • CFT Coordinator or CSW
    • Child’s attorney
    • Biological parent(s), as appropriate
    • The person or agency that is responsible for making mental health care decisions on behalf of the child
    • The person who requested the waiver of presumptive transfer
    • SPOC of the MHP where the child resides
    • LA DMH
  2. Review the request in consultation with the CFT and DMH and make a determination regarding the waiver request within 5 business days from the receipt of the waiver request.
  3. Within three business days of the determination of the waiver request: send the DCFS 6091 to the following notifying them of DCFS’ decision (approval or denial). For a denial, attach the JV 214, and JV 214-INFO:
    • Foster child
    • CFT Coordinator or CSW
    • Child’s attorney
    • Biological parent(s), as appropriate
    • The person or agency that is responsible for making mental health care decisions on behalf of the child
    • The person who requested the waiver of presumptive transfer
    • SPOC of the MHP where the child resides
    • LA DMH
  4. Record the waiver approval using the CWS/CMS AB 1299 Special Project Code.

CSW Responsibilities

  1. If the waiver request is received directly from parties authorized to make a request, forward/notify the AB 1299 Desk.
  2. Provide the information/documentation requested by the AB 1299 Desk.
  3. Continue to engage the CFT, including the mental health services provider, in the discussions regarding the presumptive transfer of mental health services and need of a waiver.
  4. Document/incorporate the waiver request or objection to the presumptive transfer and basis for the approval/denial determination in the case plan under Relevant Social, Cultural, and Physical Factors.

SCSW Responsibilities

  1. Review and as appropriate, approve the ex-parte and/or court report.

If there is a Request for a Judicial Review

Following the denial of a waiver request, the individual who requested the waiver or any other party to the case who disagrees with the presumptive transfer, waiver denial or determination may request a judicial review. The objecting party may either file a request for a hearing at Court or contact their attorney who can request a hearing on their behalf. A request for a hearing must be made by filing a Request for Hearing on Waiver of Presumptive Transfer (form JV-214). If a hearing is requested, a copy of the form JV-214 must be provided to DCFS within seven court days of the petitioner’s being noticed of the DCFS’ determination on the request for waiver of presumptive transfer.

AB 1299 Desk Responsibilities

  1. If a request for a judicial review or JV 214 is received, notify the CSW, SCSW, ARA and RA. And forward the JV 214 or any written request and/or documentation received.
  2. Obtain the minute order or JV 215, and based on the Court’s decision, send the DCFS 6091 to the following, notifying them of the decision (approval or denial):
    • Foster child
    • CFT Coordinator or CSW
    • Child’s attorney
    • Biological parent(s), as appropriate
    • The person or agency that is responsible for making mental health care decisions on behalf of the child
    • The person who requested the waiver of presumptive transfer
    • SPOC of the MHP where the child resides
    • LA DMH
  3. Record the presumptive transfer or waiver decision using the CWS/CMS AB 1299 Special Project Code.
    • If the court approves the waiver request, the responsibility for authorization of and payment for SMHS will remain with DCFS
    • If the court denies the waiver request, the presumptive transfer will remain

CSW Responsibilities

  1. If a copy of the judicial review request is received directly from the requesting party or notified by Court, immediately notify the AB 1299 Desk.
  2. If a hearing is scheduled and as ordered by Court, complete the court report by the due date using the following AB 1299 Court Report Guide .
  3. Consult and obtain any needed information for the court report from the AB 1299 Desk.
  4. Provide the report to the court, all parties to the case, and the person or agency that requested the waiver no later than two court days after the hearing is set.

SCSW Responsibilities

  1. Review and as appropriate, approve the ex-parte and/or court report.

When DCFS Initiates the Waiver

DCFS may initiate a waiver of the presumptive transfer if the criteria are met.

AB 1299 Responsibilities

  1. After reviewing the information received from the CSW, consult with LA DMH SPOC regarding the waiver.
  2. If DMH confirms that waiver is appropriate, send the DCFS 6091 indicating the waiver approval, within 3 business days to the following:
  3. Record the waiver approval using the CWS/CMS AB 1299 Special Project Code.

CSW Responsibilities

  1. Provide the information/documentation requested by the AB1299 Desk.
  2. Document/incorporate the waiver in the case plan under Relevant Social, Cultural, And Physical Factors.
APPROVALS

SCSW

  • DCFS 280
  • Court report
HELPFUL LINKS

Attachments

Court Report Guide for Judicial Review of Presumptive Transfer (AB 1299)

County Points of Contact for Presumptive Transfer

Forms

CWS/CMS

Ex Parte Application and Order

DCFS 280, Technical Assistance Action Request

DCFS 6091, Notification Regarding Presumptive Transfer (PT) of Mental Health Services, Waiver of Presumptive Transfer, Receipt of a Waiver of Presumptive Transfer Request and/or Decision or Court Order on a Request for a Waiver of Presumptive Transfer of Mental Health Services

DCFS 6097, Notification of Presumptive Transfer to LA DMH and MHP

LA Kids

JV 214, Request for Hearing on Waiver of Presumptive Transfer

JV 214-INFO, Instructions for Requesting a Hearing to Review Waiver of Presumptive Transfer of Specialty Mental Health Services

REFERENCED POLICY GUIDES

0070-548.01, Child and Family Teams

0080-502.10, Case Plans

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0100-510.46, Out of County Placements

0600-500.05, Multidisciplinary Assessment Team (MAT) Assessments and Meeting

STATUTES AND OTHER MANDATES

All County Letter (ACL) 17-77, Mental Health and Substance Use Disorder Services (MHSUDS) Information Notice No. 17-032

ACL 17-81 - Out of County Placements of Dependents in Foster Care

ACL 18-60 - Presumptive Transfer Policy Guidance

Rules of Court 5.67 – provides the rules when court reviews the presumptive transfer

WIC Section 36l.2(g)(2) – In the event that there are no appropriate placements available in the parent's or guardian's county of residence, a placement may be made in an appropriate place in another county, preferably a county located adjacent to the parent's or guardian's community of residence.

WIC Section 36l.2(g)(4) – When it has been determined that it is necessary for a child to be placed in a county other than the child's parent's or guardian' s county of residence, the specific reason the out-of-county placement is necessary shall be documented in the child's case plan. If the reason the out-of-county placement is necessary is the lack of resources in the sending county to meet the specific needs of the child, those specific resource needs shall be documented in the case plan.

WIC Section14717.1 - Absent any exceptions as established by the law, the responsibility for providing or arranging for specialty mental health services shall promptly transfer from the county of original jurisdiction to the county in which the foster child resides.