The California Department of Social Services (CDSS) has issued instructions regarding the implementation of AB 1299 regarding presumptive transfer of specialty mental health services (SMHS) for children, youth, and non-minor dependents in foster care.

In the event that a child, youth, or non-minor dependent is taken into foster care and moved to a different county, the responsibility for arranging and paying for adequate SMHS is transferred to the new county of residence.

For expedited transfers, the county must provide, arrange, and pay for SMHS within forty-eight hours of when the child is placed. If the child is in imminent danger or an emergency psychiatric condition arises, SMHS must be provided immediately without prior authorization. If a child is moved and a Child and Family Team (CFT) cannot meet, the county-placing agency is to alert the Mental Health Plan in the new county of residence to the need to provide, arrange, and pay for SMHS.

For foster children or youths who reside in counties other than the county of original jurisdiction after June 30, 2017, who continue to reside outside of the county of original jurisdiction after December 31, 2017, and/or for whom the responsibility to provide, arrange, and pay for SMHS has not been transferred to the new county of residence, placing agencies must complete all duties to notify conditions of presumptive transfer, waiver requests, and waiver decisions ten days before the child’s next status review after December 31, 2017.

Placing agencies must provide information about presumptive transfer requirements, the exceptions, and the right to request a waiver to: the foster child and their attorney, the agency responsible for making mental health care decisions for the foster child, and the social worker and/or juvenile probation officer. These details should also be added to the child’s case file.

Counties must give fourteen days notice of a child’s out-of-county placement to the child’s parent/legal guardian, the child, and their attorney, unless the child’s safety would be endangered by delay or prior notice. In the event that a child is not receiving SMHS, placing agencies are still required to notify the MHP in the new county of residence.

If a child’s placement status changes and the child is moved back into their original county of residence, the placing agency in the original county must notify the MHP in the former county of residence and the county of original jurisdiction.

CDSS also mandates the creation of a Child and Family Team (CFT), which integrates the child with providers, caregivers, and other support structures. Recent instructions encourage that case planning and the CFT process include MHPs and county placing agencies, especially when the case involves an out of county placement. The county of original residence must continue to collaborate with the county of placement to establish and maintain a single CFT for each child.

The presumption of transfer may be waived on a case by case basis, which places a “hold” on the transfer of responsibility. Exceptions are determined by the placing agency in the county of original jurisdiction in coordination with the CFT. A waiver request must be made within seven  days of the placing agency’s decision to move the child out of their original county of residence. If granted, exceptions mandate that responsibility for providing SMHS remains in the county of original jurisdiction if that county can demonstrate the existence of, or ability to establish within thirty (30) days, a contract with SMHS providers.

A Short-Term Residential Therapeutic Program (STRTP) is a congregate care facility, which includes SMHS services. Placement into a STRTP is considered a temporary exception to presumptive transfer, as it is expected to be last less than six months with the child returning home after treatment.

In the event that a waiver request is denied or otherwise contested, the individual who requested the waiver can request judicial review within seven days of the initial denial of the waiver. The court will then have five days to set a hearing on the matter, and during that time, a hold is placed on the presumptive transfer.

Additionally, children who are covered under the Kinship Guardianship Assistance Program (Kin-GAP) are no longer considered dependents of the court so the county of original jurisdiction retains responsibility for SMHS.

Children whose adoptions are finalized and who receive assistance under the Adoption Assistance Program are also not covered by presumptive transfer. The MHP in the county of residence of the youth’s adoptive parents retain responsibility for authorizing and re-authorizing SMHS.

When a foster child is presumptively transferred, it is not intended that the child be covered by multiple MHP’s. Under certain circumstances, however, counties may simultaneous provide SMHS if, for example, the county of original jurisdiction has an established relationship with the child and will continue paying for MHP during the child’s transition. If the county has an established relationship with the child’s substantial support system, and the providers will continue to be involved in the child’s life after the out-of-county placement, the original county of jurisdiction will continue to arrange and provide for the child’s SMHS.

CDSS does not, in existing presumptive transfer law, distinguish between inpatient and outpatient SMHS. Specific conditions apply to psychiatric inpatient services, depending on the circumstance. Because psychiatric inpatient services are not considered foster care placements, children are to be returned to the county of original residence following inpatient hospital stays.

Responsibility for drug Medi-Cal benefits remains with the county of original jurisdiction, even under conditions of presumptive transfer. Counties are expected to collaborate on the provision of necessary substance use disorder services for foster children placed outside the county of original jurisdiction.  (ACL 18-60, June 22, 2018.)