Below is a list of frequently asked questions have been collected from technical assistance. Additional FAQs will be released at a later date. If there are questions, please contact DHCS PresumptiveTransfer@dhcs.ca.gov or CDSS cwshealth@dss.ca.gov. 

The California Department of Health Care Services (DHCS), The California Department of Social Services (CDSS), and The Catalyst Center, developed these Frequently Asked Questions (FAQs) to provide additional guidance to Mental Health Plans (MHPs), placing agencies (county child welfare agencies, juvenile probation departments and Tribes with a Title IV-E agreement), and Short-term Residential Therapeutic Programs (STRTPs), Community Treatment Facilities (CTFs), Group Homes (GHs), and Children’s Crisis Residential Programs (CCRPs) regarding implementation of AB 1051 (Stats. 2022, Ch. 402) Presumptive Transfer as outlined in BHIN 24-025/ACL 24/43.

1. What are the circumstances that would make presumptive transfer applicable to SMHS for youth placed in an STRTP, CTF, GH, or admitted to a CCRP in another county pursuant to Welfare and Institutions Code (WIC) section 14717.2(b)?

Reference: Welfare and Institutions Code (WIC) Section 14717.1, WIC Section 14717.2, subd.(b)(1), WIC § 14717.2, subd.(b)(2)

Prior to the passage of AB 1051, the responsibility for arranging, providing, and paying for specialty mental health services (SMHS) was presumptively transferred to the county of residence and applied to all out-of-county placements. With the passage of AB 1051, certain circumstances apply to presumptive transfer when a youth is placed in an STRTP, CTF, or GH, or admitted to a CCRP. Pursuant to WIC Section 14717.2, the MHP in the county of original jurisdiction of a child or youth in foster care shall retain responsibility to arrange, provide, and pay for, SMHS if a child or youth is placed out of county in a STRTP, CTF, or GH, or admitted to a CCRP, except when limited circumstances exist. Those circumstances are:

1. The child or youth’s case plan specifies that the child or youth will transition to a less restrictive placement in the same county as the facility in which the child or youth has been placed or admitted.
2. The placing agency determines, as informed by the Child and Family Team (CFT), that the child or youth will be negatively impacted if responsibility for providing or arranging for SMHS is not transferred to the same county as the facility in which the child has been placed or admitted. The placing agency is required to document in the case record the basis for making this determination.

The placing agency, as informed by the CFT has authority to determine whether either of these circumstances exists. The determination should be based on the best interest of the child or youth and should help ensure that the appropriate SMHS are provided timely. If the placing agency determines either of these circumstances exists, then responsibility for arranging, providing, and paying for SMHS for a youth in a STRTP, CTF, GH, or CCRP is subject to the same presumptive transfer provisions applicable to placement in a home-based setting.

In general, circumstances that may support consideration of an exception if there would be impact to the child or youth include, but are not limited to, the following:

• A youth is placed by County A in a STRTP in County B. The youth’s case plan reflects that the goal is for long term or permanent placement with a specific resource family who also resides in County B upon the youth’s readiness to transition from the STRTP to a less restrictive setting.

• The lack of ability to continue services with the existing treatment provider due to the distance between the placement and the treatment team and inability for the county of original jurisdiction to provide or arrange for an equivalent provider in the county of residence.

• The MHP in the county of original jurisdiction is providing timely SMHS through a provider in the county of origin that the child or youth had a relationship with prior to being placed out of county. However, the placing agency and the CFT determine that the burden of traveling to the county of original jurisdiction is negatively impacting the child or youth.

2. When a child or youth is placed in a STRTP, CTF, or GH, or admitted to a CCRP outside their county of original jurisdiction, and the placing agency determines that the child will be negatively impacted if responsibility for providing SMHS is not presumptively transferred, can the MHP in the county of residence refuse the transfer of responsibility?

Reference: ACIN 21-113/BHIN21-060

No. The MHP in the county of residence does not have the authority to deny the placement or refuse responsibility for providing, arranging, and paying for SMHS in this scenario. The MHP in the county of residence is responsible for providing, arranging, and paying for SMHS when the placing agency determines, as informed by the CFT, and the basis for that decision is documented in the case record, that the child or youth will be negatively impacted if responsibility for providing or arranging for SMHS is not transferred from the MHP in the county of original jurisdiction to the MHP in the county of residence. This does not constitute a requirement for the county of residence MHP to establish a new contract with or arrange payment for the provision of SMHS with the facility in which the child is located. The MHP has the authority to provide the service or arrange and pay for services through an alternative contracted SMHS provider so long as the MHP ensures that medically necessary SMHS are being provided to the child within the applicable timely access requirements. If the MHP in the county of residence is not in agreement with this responsibility, the MHP in the county of residence must continue arranging, providing, and paying for SMHS for the child or youth until another MHP is determined to be responsible and the disagreement is fully resolved. The arbitration process shall not delay medically necessary services to members. (Cal. Code Regs. tit. 9 § 1850.420.)

The placing agency is required to make placement determinations that are in the best interest of the youth, as informed by the CFT, the Qualified Individual (QI) assessment (when a STRTP level of care is being considered), and in collaboration with the Interagency Placement Committee in order to determine the most appropriate level of care and services. The placing agency should engage a county mental health representative from the county of origin and a mental health representative from the county of residence in the CFT process to help inform the best foster placement and related decisions for a child or youth based on each youth’s unique circumstances and mental health needs. When determining if the youth will be negatively impacted if responsibility for providing or arranging for SMHS is not transferred, it is essential for the placing agency to collaborate and closely partner with the MHP in the county of original jurisdiction, the MHP in the county of residence, and the provider as part of the placement/admission process. In the case of an Indian child, the Tribe is a required member of the CFT and must be consulted for placement decisions.  

AB 2083 (Ch. 815, Stats. 2018) established the mechanism for cross-system collaboration within both a county and state framework to ensure a coordinated, timely, and trauma-informed System of Care approach is provided to youth in foster care. By enacting WIC section 16521.6, AB 2083 created a clear and distinct framework that is designed to support the implementation of effective presumptive transfer policy, among other policies, at the local level. Specifically, there are three required components of the memorandum of understanding (MOU) required by subdivision (a) of WIC section 16521.6 that are applicable to effective presumptive transfer implementation: care coordination, cross-system participation and engagement in the CFT process, and financial resource management and coordination. CDSS and DHCS recommend utilizing the AB 2083 System of Care infrastructure to establish clear local protocols for the processes and requirements pertaining to presumptive transfer. These processes should ensure collaboration across county jurisdictions with other Interagency Leadership Teams (ILTs) and how those local partners support cross-county coordination.

3. When a child or youth is placed in a STRTP, CTF, or GH, or admitted to a CCRP outside of their county of original jurisdiction, can the placing agency automatically apply the “negative impact” provision (WIC section 14717.2(b)(2)) allowing for presumptive transfer of responsibility for SMHS to the county of residence for all children or youth when placed in a STRTP, CTF, or GH, or admitted to a CCRP outside of their county of original jurisdiction?

Reference: WIC Section 14717.2, subd.(c).

No. Subdivision (b)(2) of WIC section 14717.2 provides that the placing agency may determine, as informed by the CFT, whether the youth will be negatively impacted if responsibility for providing or arranging for SMHS is not transferred to the same county as the facility in which the child or youth has been placed or admitted. If the placing agency determines that the child or youth will be negatively impacted, then responsibility for providing or arranging for SMHS presumptively transfers from the county of original jurisdiction to the county of residence. The basis for the application of presumptive transfer must be documented in the case record.

A negative impact may be a delay in access to or disruption of treatment, developmental, and/or permanency needs that poses a significant risk to the child or youth’s mental health. A delay in access or disruption of treatment are examples and are not an exhaustive list of circumstances for what a negative impact could be. These circumstances should be considered on an individualized basis and the determination that subdivision (b)(2) of WIC Section 14717.2 applies should be evaluated based on an individual child or youth’s specific needs or circumstances.

4. Are placing agencies required to notify the county MHP responsible for SMHS of a child or youth’s placement?

Reference: WIC Section14717.1, subd.(f)(1); 14717.2, subd. (d)(1)., WIC Section 14717.1, subd(f)(2)

Yes. Placing agencies are required to notify the MHP that will be responsible for providing, arranging, and paying for SMHS for a child or youth of the placement prior to placing the youth in an out-of-county STRTP, CTF, GH, or admitted to a CCRP. In the case of an Indian child, the placing agency shall provide information to the child’s Tribe about which MHP is responsible for arranging and paying for SMHS for the child. If notification before placement is not possible, the placing agency must notify the appropriate MHP no later than three (3) business days from the date the child or youth arrives at the facility. BHIN 24-025/ACL 24-43 provides additional information regarding the placing agency’s notification obligations and the expectations for collaboration and documentation. County Fiscal Letter (CFL) 25/26-86 provides funding for notification to MHPs and implementation activities outlined in BHIN 24-025/ACL 24-43. The placing agency shall document in the case record which MHP is responsible for providing or arranging and paying for the SMHS of the child or youth in foster care who is placed outside of their county of original jurisdiction into one of the above specified facilities. Frequent and early communication among the placing agency, the MHP in the county of residence, the MHP in the county of original jurisdiction, and the MHP that holds the contract with the facility if the host MHP is not the county of residence and the STRTP, CTF, GH, or CCRP is critical to support a collaborative process for decision-making that prioritizes the child or youth’s individual needs. Such communication supports service delivery, continuity of care, and timely payment of providers. Notably, such communication aligns with the practice behaviors, leadership behaviors, and values articulated in the Integrated Core Practice Model which provides additional information regarding the placing agency’s notification obligations and the expectations for collaboration and documentation.