Community Referral For Health Home Care Management Services printable pdf download

LAKE SHORE HEALTH HOME SERVICES (HHUNY WESTERN)

COMMUNITY REFERRAL FOR HEALTH HOME CARE MANAGEMENT SERVICES

Lake Shore Health Home Services, a HHUNY Partner, is accepting referrals from the community (community

organizations, individuals and/or family members) for enrollment of eligible individuals into Health Home Care

Management Services. Individuals must meet all eligibility requirements to be considered for enrollment.

Health Home Care Management Services Eligibility:

1. Individual currently has active Medicaid; AND;

2. Individual resides in the following County: Erie County; AND;

3. Individual meets the NYS DOH eligibility criteria of: two chronic conditions, or HIV/AIDS and the risk

of developing another chronic condition or, one or more serious mental illnesses; AND;

4. Individual has significant behavioral, medical or social risk factors which can be addressed through care

management.

How to Make a Referral to HHUNY

1. Complete the attached Community Referral Application Form, including as much detail as possible to

allow HHUNY to verify eligibility for health home services.

2. Attached a signed “Consent to Disclosure of Health Information” Form

3. Send the completed Application and Consent via secure e-mail or fax, or mail to:

HHUNY Community Referral Coordinator

Email:

Fax:

585-613-7670

Mail: Tracy Marchese, Community Referral Coordinator

New York Care Coordination Program - Health Homes of Upstate New York

1099 Jay Street, Bldg. J

Rochester, NY 14611

Approved individuals will be assigned to a Care Management Agency who will conduct outreach and attempt to

engage the person in health home services. Health Home services are voluntary and the individual will be asked

to consent during the outreach and engagement process.

If you have questions regarding the completion or status of this application, please contact: HHUNY

Community Referral Coordinator at 585-613-7642.

HHUNY also provides Health Homes Services in the counties of Allegany, Cayuga, Cattaraugus, Chautauqua, Chemung, Cortland, Genesee, Livingston, Madison,

Monroe, Onondaga, Ontario, Orleans, Oswego, Schuyler, Seneca, Steuben, Tompkins, Tioga, Wayne, and Yates County. Please contact the Community Referral

Coordinator to make a referral for services in any of these counties.

Chautauqua County Department of Mental Hygiene - Huther Doyle

Lake Shore Health Home Services - Onondaga Case Management Services