Health Home Serving Children (HHSC)

Archived Health Homes Serving Children Documents

  • Previous Webinar Materials for Health Homes Serving Children - (Web)

NOTE: THIS FORM IS NO LONGER IN USE EFFECTIVE: May 1, 2022
This form must be used to enroll children and adolescents who are less than 18 years of age into a Health Home and must be signed by the child's parent, guardian, or legally authorized representative. Legally authorized representative for enrollment in a Health Home is defined as: "a person or agency authorized by state, tribal, military or other applicable law, court order or consent to act on behalf of a person in making health care decisions". The Health Home Consent/Information Sharing/For Use with Children Under 18 Years of Age form (DOH 5201), must also be completed after this enrollment form has been completed and signed by all necessary parties.

Please note: children who are parents, pregnant, and/or married, and who otherwise are capable of consenting, must consent for their own enrollment into a Health Home. They should do this by completing the Health Home Patient Information Sharing Consent form (DOH 5055). Instructions for completing forms are found on the Lead Health Home Resource Center page under Forms and Templates: Click here.

NOTE: THIS FORM IS NO LONGER IN USE EFFECTIVE: May 1, 2022
This form must be used for children and adolescents less than 18 years of age who have been enrolled in a Health Home and completed Health Home Consent/Enrollment/For Use with Children Under 18 Years of Age form (DOH 5200) and Health Home Consent/Information Sharing/For Use with Children Under 18 Years of Age form (DOH 5201)*. This form is to disenroll from the Health Home and take away consent to release health information for children who have been enrolled in a Health Home. Withdrawal of consent for children under age 18 must be provided by the parent, guardian or legally authorized representative. Legally authorized representative for the purpose of withdrawing consent is defined as "a person or agency authorized by state, tribal, military or other applicable law, court order or consent to act on behalf of a person in making health care decisions".

Please note: children and adolescents who are parents, pregnant, or married should not use this form to disenroll and withdraw consent to release health information. Rather, they must use the Health Home Patient Information Sharing - Withdrawal of Consent form (DOH 5058)]. Instructions for completing forms are found on the Lead Health Home Resource Center page under Forms and Templates: Click here.

NOTE: THIS FORM IS NO LONGER IN USE EFFECTIVE: May 1, 2022
This form must be used for all Medicaid members, children and adults to complete an Assessment Tool within the Uniform Assessment System-NY (UAS-NY). For Health Homes Serving Children, the care manager must obtain consent to conduct the CANS-NY functional assessment from the parent, guardian, legally authorized representative or the child if they can self-consent. Without obtaining this consent, care managers will be unable to complete a CANS-NY in the Uniform Assessment System-NY (UAS-NY)

  • New York State System of Care Expansion Project Overview - (Web) - (PDF)
  • NYS Systems of Care Project Overview for HHSC - (PDF) - February 21, 2018
  • NYS Systems of Care Pilot Counties Partners - (Web) - (PDF)
  • Evaluation Components for NYS Systems of Care - (Web) - (PDF)
  • View Resources for Health Homes Designated (Contingently) to Serve Children
  • Health Homes Serving Children Update: Readiness for Enrolling Children PDF - Video (youtube) - December 16, 2015
  • Readiness Reviews of Contingently Designated Health Homes Serving Children PDF - September 24, 2015
  • Health Homes Designated to Serve Children - Next Steps PDF - Video - June 24, 2015
  • Tailoring Health Home Model to Serve Children: Design and Implementation Updates PDF - Video - April 29, 2015
  • Health Home Implementation Webinar, Session #51 - Health Information Technology: Requirements for Health Homes PDF - Video - March 4, 2015
  • Commissioner's Advisory Panel - Tailoring Health Homes to Serve Children PDF - February 27, 2015
  • Overview for Care at Home I & II Providers Video (youtube) - PDF - August 13, 2015
  • OMH TCM Legacy Q&A FINAL PDF – September 16, 2015
  • Transitioning Office of Mental Health Targeted Case Management Program Serving Children to Health Homes PDF - Video - June 8, 2015
  • OMH TCM Serving Children Transition to Health Homes&38211;Legacy Rates PDF - August 24, 2015
  • Overview of Health Home Training Offerings for Voluntary Foster Care Providers PDF - May 14, 2015
  • Administrator Track: What it Means to be a Downstream Provider PDF - MP4 – May 26, 2015
  • Administrator Track: Outcomes and Quality Assurance PDF - June 23, 2015
  • Coming Soon!