Ky.gov
Effective: 5/22/2025

C7.11 Out of State Placement for Treatment

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​A child may be placed out-of-state ​(OOS) for treatment when the child's assessed ​service needs cannot be met by the available service array in the state of Kentucky. 

Practice Guidance

Procedure

  1. The SSW submits a Clinical Services Branch (CSB) Consult Request Form through the regional placement coordinator (RPC) after consultation with appropriate regional leadership and a determination that the child has intensive and/or complex treatment needs and all in-state possibilities have been exhausted (please see SOP G1.6 Consults for Clinical Services Youth​).​​​​
  2. The RPC submits the request to the Children’s Review Program (CRP) statewide placement office for review and submission to the CSB.​
  3. After review of the request and CSB approval is received, the CRP statewide placement office seeks the approval of the Department for Community Based Services (DCBS) Division of Protection and Permanency (DPP) director or designee to begin the out-of-state (OOS) placement referral process by emailing a search request to the DPP director or designee.
  4. Upon review and concurrence with the DPP director or designee and the Clinical Services Branch, an email approving the search is sent to the CRP statewide placement office. 
  5. The CRP statewide placement office follows the steps below upon receipt of approval from the DPP director or designee:
    1. ​​​​Contacts potential OOS treatment providers, prioritizing (in part) according to proximity to the child’s home county; 
    2. Provides instructions to the potential provider regarding participation with Kentucky Medicaid and pre-approval, and follows up as appropriate; 
    3. Informs the RPC, FSOS, and SSW once an appropriate placement with a Kentucky Medicaid provider is located. 
  6. ​If the FSOS and SSW agree with the placement, the CRP statewide placement office contacts the facility to determine when the child can be admitted. 
  7. The SSW submits the ICPC 100A Interstate Compact on the Placement of Children (ICPC) Request electronically through TWIST utilizing the ICPC Referral Packet Checklist for Out of State Residential Placements and ensures the referral packet contains the information below in the following order: 
    1. The ICPC Cover Letter; 
    2.  ICPC-100A;
    3. Correspondence (letter/email) from CRP or regional/central office that states in-state placements are not appropriate; 
    4. Acceptance letter/correspondence from the OOS facility; 
    5. Memo of approval from the DPP director or designee; 
    6. Current court commitment/custody orders, dated within the last twelve (12) months (calendars or dockets do not meet this requirement); 
    7. Current assessment;
    8. Admission/discharge information from other recent treatment programs; 
    9. Information regarding the child’s DSM V diagnosis and IQ; 
    10. Completed ICPC Financial/Medical Plan; 
    11. Title IV-E eligibility (DCBS-1262A-Title IV-E Eligibility Financial Budget form). 
  8. ​The deputy compact administrator (DCA) of Kentucky notifies the SSW and/or the FSOS in writing of the receiving state’s determination upon receipt. 
  9. The service region administrator (SRA) assigns a regional designee to follow up on the financial aspect of the placement (including Medicaid precertification). 1
  10. The SSW notifies the RPC and the DCA of Kentucky, using the ICPC-100B Interstate Compact Report on the Child's Placement Status, when the child is placed or if the child will not be placed in the facility. The ICPC-100B should be submitted to the DCA within three (3) working days of admission to the OOS placement. 
  11. The DCA of Kentucky sends written correspondence (ICPC-100B) to the DCA of the receiving state; 
  12. When transporting a child, the SSW follows the procedures outlined in SOP C7.40 Transportation and Out-of-State Travel with a Child in the Custody of the Cabinet​. ​
  13. The SSW notifies the DCA of Kentucky in writing/email if the child is placed in the approved OOS facility and the child returns or is released back to Kentucky. 
  14. The SSW has the facility sign a DPP-1278R-Out of State Psychiatric Hospital/Residential Program Services Agreement or similar provider agreement at the time of the child's admission to an OOS facility. 
  15. The DCA of Kentucky closes the interstate case and copies the SSW or FSOS on the correspondence. 2
  16. The SSW, FSOS, service region clinical associate (SRCA), CSB representative, NCI, managed care organization (MCO) representatives, and program staff participate in follow-up calls every four (4) weeks to monitor progress and discharge readiness until the youth is discharged and returned to placement in Kentucky. This will serve as the treatment team meeting.
  17. The SSW, at minimum:
    1. Conducts a private face-to-face contact in the child’s placement setting annually; 
    2. Conducts a video conference with the child monthly to assess the child’s safety and well-being in placement and to ensure the child's identified needs are being served appropriately. Phone contact may be used if technological barriers prevent video conferencing. If the child’s developmental stage prevents meaningful communication over video or phone, the SSW may communicate with the child’s placement provider; 
    3. Conducts weekly phone contact with the child; contact may be virtual/video if preferred; and
    4. Documents all contact with the youth and provider in the TWIST service recording, including photographs of the youth.


​Clarifications and Contingencies

  • If the OOS provider is a designated qualified residential treatment program (QRTP) in the receiving state:
  • According to ICPC rules, when a child is placed in a residential treatment facility OOS, the placement facility is primarily responsible for the child's supervision and care, meaning that the child welfare agency in the receiving (placement) state does not conduct monthly courtesy face-to-face visits with the child within the facility.
  • The Out-of-Home Care Branch approves out-of-state providers prior to placement of Kentucky youth by, at minimum, confirmation of good standing from the receiving state's title IV-E agency.​


Upon decertification of Medicaid payment for the child's treatment and placement, the regional designee:

  1. Requests that the provider assist with an appeal; 
  2. Completes the following steps if the appeal is not successful: 
    • Notifies the director of DPP in central office at (502) 564-6852; and 
    • ​Consults with the SSW and FSOS and notifies the RPC as to whether a new search for an in-state placement is appropriate.
OOS placement may be considered when:

  1. ​It has been determined that a child's assessed treatment needs cannot be met within the in-state provider network; 
  2. The child needs placement in a restrictive treatment setting, such as a  residential child-caring institution or psychiatric residential treatment facility (PRTF) and no in-state providers have accepted for placement after two (2) in-state referrals have been completed; or
  3. The child needs placement in a restrictive treatment setting, such as a residential child-caring institution or PRTF  and the only in-state providers to accept have waiting lists  of two (2) months or longer. 

Related Information

  • Clinical Services Branch
    275 East Main Street, 3E-D
    Frankfort, KY 40621

Footnotes

  1. The designee’s name is given to the provider at the time of the child’s admission. 
  2. It is recommended that a pre-placement visit be scheduled if at all possible.


​

Documents

Revisions

​12/6 Deletion:  

  1. Requests approval to begin out of state referrals if no new possibilities are formulated; 1 
  2. Contacts potential out of state placements, prioritizing (in part) according to proximity to the child’s home county upon approval of the search by the CRP statewide placement office; 
  3. Provides instructions to the potential provider as to participation with Kentucky Medicaid and pre-approval, and follows up as appropriate; 
  4. Informs the SSW once an appropriate placement with a Kentucky Medicaid provider is located. 2 

12/5/22  Change submission of request from Out-of-Home Care branch to Clinical Services Branch.  

5/2025

A child may be placed in an out-of-state ​(OOS) placement when the child's assessed ​service needs cannot be met by the available service array in the state of Kentucky. is in need of specialized services that are not available in the state of Kentucky.​​​​​

  1. The SSW submits a Clinical Services Branch (CSB) Consult Request Form through the regional placement coordinator (RPC) after consultation with appropriate regional leadership and a determination that the child has intensive and/or complex treatment needs and all in-state possibilities have been exhausted (please see SOP G1.6 Consults for Clinical Services Youth​).​​​​
  2. The regional placement coordinator (RPC) submits the request to the Children’s Review Program (CRP) statewide placement office for review and submission to the CSB.​​
  3. After review of the request and CSB approval is received, the CRP statewide placement office seeks the approval of the Department for Community Based Services (DCBS) Division of Protection and Permanency (DPP) director or designee to begin the OOS placement referral process by emailing a search request to the DPP director or designee.
12.  The SSW follows procedures outlined in SOP 4.54 Transportation and Out of State Travel with a Child in the Custody of the Cabinet​ when transporting a child. ​

  1. The Regional Placement Coordinator (RPC) consults with the Children’s Review Program (CRP) statewide placement office when it has been determined that a child needs the services of an OOS facility and all in-state possibilities have been exhausted: 
  2. ​The CRP statewide placement office seeks the approval of the Department for Community Based Services (DCBS) Division of Protection and Permanency (DPP) director or designee to begin the OOS placement referral process by emailing a request to the Clinical Services Branch. ​
11  The SSW obtains travel approval from the interstate office and forwards it to the SRA. 
13.  The SSW follows procedures outlined in SOP 4.54 Transportation and Out of State Travel with a Child in the Custody of the Cabinet​ when transporting a child. ​


17. The SSW, FSOS, service region clinical associate (SRCA), CSB representative, NCI, managed care organization (MCO) representatives, and program staff participate in follow-up calls every four (4) weeks to monitor progress and discharge readiness until the youth is discharged and returned to placement in Kentucky. This will serve as the treatment team meeting.


16.  The SSW, FSOS, service region clinical associate (SRCA), CSB representative, NCI, managed care organization (MCO) representatives, and program staff participate in follow-up calls every four (4) weeks to monitor progress and discharge readiness until the youth is discharged and returned to placement in Kentucky. This will serve as the treatment team meeting.

17.  The SSW, at minimum:

    1. Conducts a private face-to-face contact in the child’s placement setting annually; 
    2. Conducts a video conference with the child monthly to assess the child’s safety and well-being in placement and to ensure the child's identified needs are being served appropriately. Phone contact may be used if technological barriers prevent video conferencing. If the child’s developmental stage prevents meaningful communication over video or phone, the SSW may communicate with the child’s placement provider; 
    3. Conducts weekly phone contact with the child; contact may be virtual/video if preferred; and
    4. Documents all contact with the youth and provider in the TWIST service recording, including photographs of the youth.
  • If the OOS provider is a designated qualified residential treatment program (QRTP) in the receiving state:
  • According to ICPC rules, when a child is placed in a residential treatment facility OOS, the placement facility is primarily responsible for the child's supervision and care, meaning that the child welfare agency in the receiving (placement) state does not conduct monthly courtesy face-to-face visits with the child within the facility.
  • The Out-of-Home Care Branch approves out-of-state providers prior to placement of Kentucky youth by, at minimum, confirmation of good standing from the receiving state's title IV-E agency.​

Upon decertification of Medicaid payment for the child's treatment and placement, the regional designee:

  1. Requests that the provider assist with an appeal if a child is decertified; 
  2. Completes the following steps if the appeal is not successful: 
    • Ensures that payment to the provider will come from the regional budget as agreed on the DPP-1285R Out of State Psychiatric Hospital/Residential Program Services Agreement, or similar provider agreement; ​


2.  The child needs placement in a restrictive treatment setting, such as a  residential child-caring institution or psychiatric residential treatment facility (PRTF) and no in-state providers have accepted for placement after two (2) in-state referrals have been completed; or​

3.  The child needs placement in a restrictive treatment setting, such as a residential child-caring institution or PRTF and the only in-state providers to accept have waiting lists of two (2) months or longer. ​