Miss. Code. tit. 18, pt. 6, ch. 1, 18-6-1-H, 18-6-1-H-VII, app 18-6-1-H-VII-E
When a child's parent or legal guardian is proposing to place a child into a residential treatment facility in another state, the Referral Packet must contain the following:
* Cover letter (in triplicate) that includes the financial and medical plan for each child.
* Form ICPC-100A (original and 4 copies) completed and signed by "sending party" for each child.
* Social history (in triplicate) for each child that includes the basis on which the particular residential treatment facility was selected.
* Educational, medical, psychiatric, and/or psychological reports (in triplicate) on each child, if appropriate.
* Verification of each child's eligibility for Title IV-E Medicaid benefits, current and in the proposed placement.
When an agency or a court is proposing to place a child into a residential treatment facility, the agency or an officer of the court is responsible for preparing the ICPC Referral Packet, using the guidelines developed by the Sending State ICPC office. A copy of the court order (in triplicate) must be included to show who has legal custody of the child.
CONTENT ICPC REFERRAL PACKET
Proposed Placement with Birth Parent, Relative, or Foster Care
The ICPC Referral Packet for placement with a birth parent, relative or foster care in another Member State should include:
* Form ICPC-100A on each child, completed and signed by person/agency with authority to be the "Sending Agency" as defined in Article II (b) (original and 4 copies)
* Cover letter (in triplicate) that includes -
a. Reason out-of-state placement is being pursued;
b. Statement indicating the person/agency/court that has legal custody of each child;
c. Permanency goal and brief statement of case plan for each child (including identification of specific service(s) needed by each child) and the expected achievement date(s);
d. Plans for meeting cost of care in other state, including who is financially responsible for each child;
e. Indication of each child's eligibility or ineligibility for
* Title IV-E Medicaid benefits;
* SSI benefits;
a. Request for evaluation of the proposed caretaker and identifying information about the proposed caretaker, including type of resource (e.g., foster family, relative family, etc.).
* Social summary on EACH child (in triplicate)
* Court order(s) on EACH child (in triplicate) that shows -
a. Court has jurisdiction over each child;
b. Date of adjudicatory hearing for each child;
c. Person/agency who has legal custody of each child;
d. Person/agency who has physical custody of each child.
Miss. Code. tit. 18, pt. 6, ch. 1, 18-6-1-H, 18-6-1-H-VII, app 18-6-1-H-VII-E