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Health Home Implementation Webinar

Medicaid Redesign Team Supportive Housing Health Home Pilot Project

Medicaid State Plan Amendment

Health Homes by County

Albany

1. Capital Region Health Connections (Samaritan Hospital)

  • Main Contact: Rachel Handler 518-271-3188, handlerr@nehealth.com
  • Member Referral Number: 1-855-358-4482 or 518-371-3301

Allegany

1. Chautauqua County Department of Mental Hygiene

Bronx

1. Bronx Lebanon Hospital Center

2. Bronx Accountable Healthcare Network Health Home (BAHN)

  • Main Contact: Nicole Jordan-Martin 914-378-6151, nijordan@montefiore.org
  • Alternate Contact: Obidi Ikpeze 914-378-6151, oikpeze@montefiore.org
  • Alternate Contact: Jacqueline Santiago 914-378-6151, jacsanti@montefiore.org
  • Referral Contact: Obidi Ikpeze 914-378-6151, oikpeze@montefiore.org
  • Referral Contact: Jacqueline Santiago 914-378-6151, jacsanti@montefiore.org

3. Community Care Management Partners (CCMP), LLC (Visiting Nurse Service of New York Home Care)

4. Community Health Care Network (Queens Coordinated Care Partners)

5. New York City Health and Hospitals Corporation

Broome

1. Catholic Charities of Broome County

2. United Health Services Hospital

Cattaraugus

1. Chautauqua County Department of Mental Hygiene

Cayuga

1. Central New York Health Home Network

2. Onondaga Case Management Services, Inc.

3. St. Joseph's Care Coordination Network

Chautauqua

1. Chautauqua County Department of Mental Hygiene

Chemung

1. Onondaga Case Management Services, Inc.

Chenango

Clinton

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Columbia

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

Cortland

1. Onondaga Case Management Services, Inc.

Delaware

Dutchess

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Erie

1. Health Homes of Upstate New York – Western (Alcohol and Drug Dependency Services, Inc.)

2. Greater Buffalo United Accountable Healthcare Network

3. Health Home Partners of Western New York (Mental Health Services Erie County SE Corp V (Spectrum)

  • Main Contact: Bruce Nisbit 716-662-2040 nisbetb@shswny.org
  • Alternate Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Amy Ditta 716-539-1762 dittaa@shswny.org

Essex

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Franklin

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Fulton

1. St. Mary's Healthcare

Genesee

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Greene

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

Hamilton

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Herkimer

1. Central New York Health Home Network

Jefferson

1. Central New York Health Home Network

Kings (Brooklyn)

1. Community Health Care Network (Queens Coordinated Care Partners)

2. Coordinated Behavioral Care Inc. DBA Pathways to Wellness

3. New York City Health and Hospitals Corporation

4. Southwest Brooklyn Health Home LLC d/b/a Brooklyn Health Home (Maimonides Medical Center)

Lewis

1. Central New York Health Home Network

Livingston

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Madison:

1. Central New York Health Home Network

2. Onondaga Case Management Services, Inc.

3. St. Joseph's Care Coordination Network

Monroe

1. Greater Rochester Health Home Network (Anthony L. Jordan Health Center)

2. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Montgomery

1. St. Mary's Healthcare

Nassau

1. FEGS Health & Human Services System

  • Main Contact: Sue McKenna 516-505-2003 x 312285, smckenna@fegs.org
  • Main Contact: Melissa Firmes 631-691-7080 x 332238 , smckenna@fegs.org
  • Alternate Contact: Steve Rutter 516-505-2003 x 312211, srutter@fegs.org
  • Referral Contact: Allegra D'Alo 516-505-2003 x 312342, adalo@fegs.org
  • Referral Contact: Gina Lassera 631-691-7080 ext 332390, glaserra@fegs.org
  • Nassau Member Referral Line: 855-544-8484
  • Suffolk Member Referral Line: 855-838-0021

2. North Shore LIJ Health Home

New York (Manhattan)

1. Community Care Management Partners (CCMP), LLC (Visiting Nurse Service of New York Home Care)

2. Continuum Health Home Network (St. Luke's-Roosevelt Hospital Center)

  • Main Contact: Miriam Martinez 212-523-2025, mimartinez@chpnet.org
  • Alternate Contact: Kristina Monti 212-523-5002, KMonti@chpnet.org
  • Referral Contact: Kristina Monti 212-523-5002, KMonti@chpnet.org

3. Heritage Health and Housing Home Network: Heritage Health Home Network (Heritage Health and Housing Inc., Northern Manhattan Health Home Network Inc.)

4. Coordinated Behavioral Care Inc. DBA Pathways to Wellness

5. New York City Health and Hospitals Corporation

6. The New York and Presbyterian Hospital

Niagara

1. Niagara Falls Memorial Medical Center

2. Health Home Partners of Western New York (Mental Health Services Erie County SE Corp V (Spectrum))

  • Main Contact: Bruce Nesbit 716-662-2040 nisbetb@shswny.org
  • Alternate Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Amy Ditta 716-539-1762 dittaa@shswny.org

Oneida

1. Central New York Health Home Network

Onondaga

1. Onondaga Case Management Services, Inc.

2. St. Joseph's Care Coordination Network

Ontario

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Orange

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Orleans

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Oswego

1. Onondaga Case Management Services, Inc.

2. St. Joseph's Care Coordination Network

Otsego

Putnam

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Queens

1. North Shore LIJ Health Home

2. Community Health Care Network (Queens Coordinated Care Partners)

3. New York City Health and Hospitals Corporation

Rensselaer

1. Capital Region Health Connections (Samaritan Hospital)

Richmond (Staten Island)

1. Coordinated Behavioral Care Inc. DBA Pathways to Wellness

Rockland

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Saratoga

1. Visiting Nurse Service of Schenectady and Saratoga Counties, Inc

2. Glens Falls Hospital

Schenectady

1. Visiting Nurse Service of Schenectady and Saratoga Counties, Inc

Schoharie

Schuyler

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Seneca

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

Steuben

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

St. Lawrence

1. Central New York Health Home Network

Suffolk

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. FEGS Health & Human Services System

  • Main Contact: Sue McKenna 516-505-2003 x 312285, smckenna@fegs.org
  • Main Contact: Melissa Firmes 631-691-7080 x 332238 , smckenna@fegs.org
  • Alternate Contact: Steve Rutter 516-505-2003 x 312211, srutter@fegs.org
  • Referral Contact: Allegra D'Alo 516-505-2003 x 312342, adalo@fegs.org
  • Referral Contact: Gina Lassera 631-691-7080 ext 332390, glaserra@fegs.org
  • Nassau Member Referral Line: 855-544-8484
  • Suffolk Member Referral Line: 855-838-0021

3. North Shore LIJ Health Home

Sullivan

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Tioga

1. Onondaga Case Management Services, Inc.

Tompkins

1. Onondaga Case Management Services, Inc.

Ulster

1. Institute for Family Health (Ulster County)

Warren

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Washington

1. Adirondack Health Institute, Inc.

2. Glens Falls Hospital

Wayne

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)

  • Main Contact: Adele Gorges 585-613-7656, agorges@ccsi.org
  • Main Contact: John Lee 585-613-7642, Johnlee@beaconhs.com
  • Referral Contact: Tracy Marchese 585-613-7642tracy.marchese@beaconhs.com
  • Member Referral Line: 1-855-613-7659

Westchester

1. Hudson River Healthcare (DBA) CommunityHealth Care Collaborative (CCC)

2. Hudson Valley Care Coalition (Open Door Family Medical Center)

Wyoming

1. Health Home Partners of Western New York (Mental Health Services Erie County SE Corp V (Spectrum))

  • Main Contact: Bruce Nisbit 716-662-2040 nisbetb@shswny.org
  • Alternate Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Christopher Hartnett 716-539-1794 hartnettc@shswny.org
  • Referral Contact: Amy Ditta 716-539-1762 dittaa@shswny.org

Yates

1. Health Homes of Upstate New York (Huther Doyle Memorial Institute, Inc.)