Get Ny Doh Health Home Care Management/c-yes Referral For Home And Community Based Services (hcbs) To 2019-2025

This guide provides a detailed overview and step-by-step instructions for successfully completing the NY DoH Health Home Care Management/C-YES Referral for Home and Community Based Services (HCBS) form online. By following these instructions, users can ensure all relevant information is submitted accurately to facilitate access to necessary services.

Follow the steps to accurately complete the HCBS referral form.

1. Begin by clicking the ‘Get Form’ button to obtain the document and open it for editing.
2. In SECTION I, fill in the child's name, Medicaid CIN number, address, date of birth, and sex. This information identifies the child for whom services are requested.
3. Provide the preferred method of contact, selecting either email or phone, and enter the parent or guardian's name and contact details.
4. Select the target population from the provided options which may include serious emotional disturbance, medically fragile, developmental disabilities, and other categories.
5. Indicate the referral type by checking the appropriate box for initial, subsequent, or finalized referrals.
6. Fill in the date of the level of care (LOC) if it has been obtained and verified, and if applicable, note any Medicaid managed care enrollment date.
7. Provide the plan name, care manager name, care management agency, and designated lead health home details.
8. In the part where the home and community based service provider are indicated, complete the details of the selected provider, including their address and contact number.
9. Check the service(s) being requested, ensuring to note desired goals or needs to be addressed for each service.
10. Finally, review all entered information for accuracy, save your changes, and either download, print, or share the completed document as needed.

Complete your referral form online today to ensure timely access to necessary home and community based services.