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March 2018 1
ICPC Record
Introduction
The ICPC Record is created by the approval (with an Accepted decision) of an ICPC Referral.
The ICPC Referral can be created by either county workers or ICPC staff. The referrals will be
forwarded by the county workers to the ICPC staff. ICPC Staff can either accept or deny the
referral. ICPC staff along with county staff continues documentation of the work specific to the
ICPC workflow on the ICPC Record.
Related User Guides:
ICPC Referral
Imaging Person
1. The Referral Detail tab displays data from the ICPC Referral that created the ICPC Record.
Only ICPC Records created after June 16, 2017 will be linked to the ICPC Referrals. The
ICPC Records created on or before June 16, 2017 will not be linked to an ICPC Referral and
will have different functionality for some fields.
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2. The Date Received field is an editable date field when the record is not linked to an ICPC
Referral.
3. The Date Sent field prefills with the Decision Date from the ICPC Referral.
4. If the child has siblings, as identified on the Participants tab of the ICPC referral and/or
recorded on the Maintain Case page, the checkbox will be automatically checked and the
names will be listed. If additional siblings need to be documented, that can be done on the
Maintain Case page. If this checkbox is unchecked, a message displays “Unchecking the
Child has Siblings checkbox deletes all siblings listed on the ICPC Record. Do you want to
delete all siblings from the ICPC Record?”
Each sibling row is associated with a Delete hyperlink if only one of the individuals
needs to be deleted.
5. The ‘Placement Resource’, ‘Placement State’ and ‘Sibling Type’ are all user entered fields.
6. Each sibling row is associated with a Delete hyperlink.
7. The Home Study Recommendation tab displays data elements needed to document the
process associated with the Home Study and ICPC Decision on whether placement may be
approved or denied.
Note: When Wisconsin is the Sending State, the ICPC Specialists will document information on
this page. When Wisconsin is the Receiving State, the case worker is responsible for
documentation on this page.
8. The Home Study Due Date and the Home Study Sent Date fields are entered by ICPC staff.
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9. The Last Home Study Update Received field is prefilled from the date of the most recently
documented Home Study from the Home Study Update History page. It is associated with
an Edit/View hyperlink (‘Edit’ for ICPC staff and ‘View’ for County Staff) which brings the
user to the Home Study Update History page. This is where the ICPC staff will document
any correspondence regarding the Home Study. County staff have the ability to view the
history pop-up page.
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10. The Last ICPC Home Study Update Comments box is prefilled from the narrative of the
most recently documented Home Study from the Home study Update History page.
11. In the License Information group box complete the Licensee Names, Type of License, Level
of Care, and License Received On fields.
12. Click on the Imaging Search hyperlink to launch the imaging search page and choose the
appropriate license image for this provider. The License Effective From and To dates are
prefilled from the associated imaging page of the license.
13. If the License Information Group box is not applicable you can select the N/A checkbox
which will clear and disable the groupbox until the checkbox is unselected.
14. Complete the Agency Placement Recommendation and narrative box after uploading the
Home Study image.
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15. In the Documentation group box, the State ICPC specialist will make sure to upload the
100A that has been signed by the receiving state.
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16. The Request for Reconsideration tab is used to document requests to reconsider the ICPC
Decision. County workers have view only access to this tab.
Note: If a request for consideration is needed, contact the assigned ICPC Specialist. They will
walk you through the process and they will document information on this page.
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17. The Child Placement tab provides the worker with a functionality to document the child’s
ICPC placement(s). The fields in the Child Placement Notification group box are all user
editable.
Note: When Wisconsin is the Receiving State, the ICPC Specialists will document information
on this page. When Wisconsin is the Sending State, the case worker is responsible for
documentation on this page. This does not replace requirements for entering placement
documentation and does not generate a placement strip or any related financial work for the
child.
18. The Date the child was placed in receiving state field should be the date that particular
placement began. If this is the initial placement in the receiving state, then check the “This
is initial placement of child in receiving state” checkbox.
19. Select the radio button for Person or Facility and search out the placement resource via the
search link.
20. The documentation group box is where each of the subsequent 100B forms should be
documented for this ICPC record. The Type dropdown field is associated with the following
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values: 100B, 100B (Image) and Other. The Date of Document prefills from the Date of
Document on the associated Imaging Page.
21. The Agency Approval date field is editable by the county worker.
22. The Insert button at the bottom of the page will insert a new repeating group starting with
“Date child placed in receiving state” and finishing with the Agency/ICPC Approval dates to
allow for documentation of subsequent ICPC placements for the child.
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23. The Supervision Reports should be uploaded in the Documentation group box. The ‘Type’
field indicates the type of document that the associated image is; ‘Supervision Report’,
‘Supervision Report (Image)’ or ‘Other’. The Insert button inserts a new row so that
additional documents may be associated with this Supervision report.
24. The insert button in the Supervision Reports group box will insert an additional Report
Group box for subsequent Supervision Reports.
Note: When Wisconsin is the Sending State, the ICPC Specialists will document information on
this page. When Wisconsin is the Receiving State, the case worker is responsible for
documentation on this page.
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25. The Record Closure tab displays detail related to the closure of the ICPC Record. In addition
to being able to document the closure date and reason, narrative, and related documentation.
Note: When Wisconsin is the Sending State, the ICPC Specialist will document information on
this page. When Wisconsin is the Receiving State, the case worker is responsible for
documentation on this page. The ICPC Record must be closed before closing a case in
eWiSACWIS. If the placement has ended and the ICPC Record must be closed, contact the
assigned ICPC Specialist so that they may close the record.
26. Fill in the required fields and select the Save button. Based on the selection made, different
fields become required.
27. In the Documentation group box, upload the required documents based on the closure
reason. The Date of Document date prefills with the Date of Document from the associated
image.
28. The Historic tab displays ICPC detail documented on the ICPC Records created on or before
June 16, 2017. All fields on the tab are static text and not editable.
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Automated Messages
Out of State Placement Title Out of State Placement
Purpose: To inform the provider worker that a child has been placed in an Out of Home
Placement with the Service Type of Out of State Placement.
Description: This message is created when an Out of State placement is documented for a child.
Subject: New Out of State Placement
To: Primary worker assigned to the provider where the child has just been placed, and
any worker with a Job Class of ICPC specialist that has an assignment to the case.
Message: A new Out of State placement has been created with provider
{PRVD_NAME_PRVD_ID} with a begin date of {EPISODE_DT_BGN} for
{CURRENT_PLACEMENT_CHILD_NAME} in case {CASE_ID}.
Processing: This message is created by final approval of an Out of State placement when
launched from the OHP with the Service type of Out of State Placement page.
Upon successful save of the “Out of Home Placement” with final approval, the
“Out of State Placement has been created” automated message will be triggered
when the following is true:
The save indicates final approval and the OHP has a Service Type that
belongs to the new reference group of ‘ICPCOOST’
Out of State Placement Ending Title Out of State Placement Ending
Purpose: To inform the provider worker that a child’s placement has been ended in an OHP
with the Service Type of Out of State Placement.
Description: This message is created when an Out of State placement is ended.
Subject: Out of State Placement Ending
To: Primary worker assigned to the provider where the child has just been placed, and
any worker with a Job Class of ICPC specialist that has an assignment to the case.
Message: A service for {CHILD_NAME_CHILD_ID} with provider
{PRVD_NAME_PRVD_ID} was ended on {EPISODE_DT_END} with a reason
of: {SRVC_END_RSN}.
Please see the {CASE_NAME_AND_CASE_NUM} case for more information.
Processing: “Upon successful save of the “Service Ending” page the “Out of State
Placement has been ended” automated message will be triggered when the
following is true:
The save indicates the Service Ending has final approval and the Out of
Home Placement has a Service Type that belongs to the new reference
group of ‘ICPCOOST’
Final Placement Closure Date Has Been Completed
Title Final Placement Closure Date Has Been Completed
Purpose: To inform of a placement closure date completed for the ICPC Record
Subject: Final Placement Closure Date has been completed
To: To all ICPC workers assigned to the case with an assignment type of ICPC
associated with the ICPC Record being updated.
Message: A final placement closure date has been completed for [child name], DOB [DOB],
in the [Case name] [(ID)].case.
Processing: This message is created when user enters date into “Final Placement Closure” field
on the ICPC Record and saves the changes
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ICPC Decision Needed
Title ICPC Decision Needed
Purpose: To inform the ICPC State workers that a Home Study Decision is Needed.
Subject: ICPC Decision Needed
To: To all state workers with an ICPC assignment to the case of the triggering ICPC Record.
Message: An ICPC Home Study Recommendation has been made and an ICPC Placement
Decision is needed for [Child] in case [Case].
Processing: This message is created upon save of the ICPC Record page by a non-state worker, when
Agency Placement Recommendation changed (and is not null)
ICPC Placement Decision Complete
Title ICPC Placement Decision Complete
Purpose: To inform the ICPC county worker that a Home Study Decision is Complete.
Subject: ICPC Placement Decision Complete
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: The Home Study Recommendation for [Child] in case [Case] has been reviewed and
placement is [ICPC Placement Decision]. The Home Study and decision have been sent
to [Sending State].
Processing: This message is created upon save of the ICPC Record page if the Receiving State is WI,
when the ICPC Placement Decision changed (and is not null)
ICPC Home Study and Placement Decision Complete
Title ICPC Home Study and Placement Decision Complete
Purpose: To inform the ICPC county worker that a Home Study Decision is Complete.
Subject: ICPC Home Study and Placement Decision Complete
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: The Home Study and Placement Decision for [Child] in case [Case] has been completed
by [Receiving State] and placement is [ICPC Placement Decision]. Please complete a
100B as required.”
Processing: This message is created upon save of the ICPC Record page if the Sending State is WI,
when the ICPC Placement Decision changed (and is not null)
March 2018 14
ICPC 100B Approval Needed
Title ICPC 100B Approval Needed
Purpose: To inform the ICPC state worker that an ICPC 100B Approval is Needed.
Subject: ICPC 100B Approval Needed
To: To all state workers with an ICPC assignment to the case of the triggering ICPC Record.
Message: A 100B for the placement of [Child] in [Case] requires your review and approval.
Processing: This message is created upon save of the ICPC Record page by a non-state worker, when
Agency Approval on the Child Placement tab changed (and is not null)
ICPC 100B Approved, Supervision Requested
Title ICPC 100B Approved, Supervision Requested
Purpose: To inform the ICPC county worker that an ICPC 100B Approval has been approved.
Subject: ICPC 100B Approved, Supervision Requested
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: The 100B for the placement of [Child] in case [Case] has been approved and sent to the
[Receiving State] ICPC Office to request supervision of the child.
Processing: This message is created upon save of the ICPC Record page if the Sending State is WI,
when the ICPC Approval on the Child Placement tab changed (and is not null)
ICPC 100B Approved, Initiate Supervision
Title ICPC 100B Approved, Initiate Supervision
Purpose: To inform the ICPC county worker that an ICPC 100B Approval has been approved.
Subject: ICPC 100B Approved, Initiate Supervision
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: [Child] in case [Case] has been placed in Wisconsin and [Sending State] is requesting
supervision of the child. Please review the 100B and initiate supervision
Processing: This message is created upon save of the ICPC Record page if the Receiving State is WI,
when the ICPC Approval on the Child Placement tab changed (and is not null)
ICPC Supervision Report Approval Needed
Title ICPC Supervision Report Approval Needed
Purpose: To inform the ICPC state worker that an ICPC Supervision Report Approval is Needed.
Subject: ICPC Supervision Report Approval Needed
To: To all state workers with an ICPC assignment to the case of the triggering ICPC Record.
Message: A Supervision Report for [Child] in the case [Case] requires your review and approval
Processing: This message is created upon save of the ICPC Record page by a non-state worker, when
Agency Approval on the Supervision Reports tab changed (and is not null)
March 2018 15
ICPC Supervision Report
Title ICPC Supervision Report
Purpose: To inform the ICPC county worker that an ICPC Supervision Report has been received.
Subject: ICPC Supervision Report
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: ICPC Supervision Report for [Child] in case [Case] has been received from [Receiving
State] and uploaded in the ICPC Record for your review.
Processing: This message is created upon save of the ICPC Record page if the Sending State is WI,
when the ICPC Approval on the Supervision Reports tab changed (and is not null)
ICPC 100B Closure Approval Needed
Title ICPC 100B Closure Approval Needed
Purpose: To inform the ICPC state worker that an ICPC Closure Approval is Needed.
Subject: ICPC 100B Closure Approval Needed
To: To all state workers with an ICPC assignment to the case of the triggering ICPC Record
Message: The placement of [Child] in the case [Case] has ended and the ICPC Record may be
closed following approval.
Processing: This message is created upon save of the ICPC Record page by a non-state worker, when
Agency Approval on the Record Closure tab changed (and is not null)
ICPC Record Closure Approved
Title ICPC Record Closure Approved
Purpose: To inform the ICPC county worker that an ICPC Closure has been approved.
Subject: ICPC Record Closure Approved
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: The ICPC Record for [Child] in the case [Case] has been closed. You may continue
with any case maintenance and/or case closure.
Processing: This message is created upon save of the ICPC Record page if the Sending State is WI,
when the ICPC Record Closure Date on the Record Closure tab changed (and is not null)
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ICPC Placement Closure Approved
Title ICPC Placement Closure Approved
Purpose: To inform the ICPC county worker that an ICPC 100B Closure has been approved.
Subject: ICPC Placement Closure Approved
To: To the worker with primary assignment to the case of the triggering ICPC Record
Message: The placement of [Child] in case [Case] has ended and the 100B and any additional
closing documents from [Sending State] have been uploaded in the ICPC
Record. [Child FN]’s ICPC Record has been closed and supervision of [Child FN] is no
longer required.
Processing: This message is created upon save of the ICPC Record page if the Receiving State is WI,
when the ICPC Record Closure Date on the Record Closure tab changed (and is not null)
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