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Confirming transfer of TennCare benefits to the Medicaid program in the Receiving State;

Clarifiying any board payments or other assistance to be provided by the Department; and

Confirming the date of entry of request for payment and arranging/providing notice for transportation including child’s belongings.  


The CFTM will also address pertinent requirements and responsibilities for the proposed placement resource to include responsibility to establish and identify  vendors in the receiving state who will provide counseling or medical services for the child in accordance to the family permanency plan, responsibility to secure financial assistance on behalf of the child through TANEF or confirmation of Foster Board or other payment to be made by TN DCS as agreed upon, responsibility to cooperate with the receiving state for supervision and responsibility for the maintenance of their approval of licensure as a resource parent, pursuant to the policy of the receiving state.  The CFTM will be documented in the TFACTS.


Upon completion of the CFTM and prior to placement of a child into the approved resource home in the receiving state, the TN DCS Regional staff will forward a copy of the ICPC 100A approving the placement and the study or report which documents the study process and approval to the TN DCS Regional PSD/RPS staff  who will complete entering pertinent data on  the out-of-state Resource Home in the TFACTS in accordance to RHET and D-RHET Protocol; properly noting the date of the approval for the resource home, which is  the date of the signature of the Receiving State ICPC Administrator on the ICPC 100A.  The documents will be kept in the Resource Home file as required.  Any other documents regarding this out-of-state resource home, i.e. monthly supervision conducted by the receiving state and periodic re-assessment to maintain approval or licensure as a resource home are to be shared and retained in the Resource Home File


The TN DCS Regional staff will scan/e-mail to the designated TN ICPC Administrator a completed ICPC Form 100B, Interstate Compact Report on the Child’s Placement Status (CS-0523) which identifies the date that the child physically left the jurisdiction of the State of TN.


The TN DCS Regional PSD/RPS staff will document the placement of this child into the specific resource home in the TFACTS.


TN DCS Regional staff will maintain a copy of ICPC documents identified in this section in the Family Case File per TN DCS Policy 31.5 Organization of Family Case Files.

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 26

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