Oishei Healthy Kids
1100 Main Street
Buffalo, NY 14209
Two Referral Pathways
Community Referrals: Typically made by entities or providers that are not Health Homes or Care Managers.
- Initial Users (December 1, 2016, effective date for beginning to enroll children in Health Home): LDSS, LGU/SPOA and Plans will have access to the MAPP referral portal to make a community referral to Health Home for children only
- Future Phases: Over time, the State will expand access to the MAPP referral portal by identifying and authorizing other entities that are natural points of contact in the systems of care that impact children to make referrals through the MAPP referral portal (School districts, county probation departments, pediatricians, emergency rooms, early intervention initial care coordinators, etc.)
Direct Referrals: Made by Health Homes and Care Management Agencies (CMAs)/Voluntary Foster Care Agencies (VFCA)
Health Home Appropriateness Criteria
Individuals must meet the chronic condition criteria and be appropriate for health home care management.
Appropriateness Criteria: Individuals meeting the Health Home eligibility criteria must be appropriate for the intensive level of care management provided by Health Homes.
Assessing whether an individual is appropriate for Health Homes includes determining if the person is:
- At risk for an adverse event (e.g., death, disability, inpatient or nursing home admission, mandated preventive services, or out-of-home placement)
- Has inadequate social/family/housing support, or serious disruptions in family relationships
- Has inadequate connectivity with healthcare system
- Does not adhere to treatments or has difficulty managing medications
- Has recently been released from incarceration, placement, detention, or psychiatric hospitalization
- Has deficits in activities of daily living, learning or cognition issues
- Is concurrently eligible or enrolled, along with either their child or caregiver, in a Health Home
Functional Limitations Requirements for Serious Emotional Disorder (SED) Definition of Health Home
To meet definition of SED for Health Home the child must have experienced the following functional limitations due to emotional disturbance over the past 12 months (from the date of assessment) on a continuous or intermittent basis
- Ability to care for self (e.g. personal hygiene; obtaining and eating food; dressing; avoiding injuries); or
- Family life (e.g. capacity to live in a family or family like environment; relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or
- Social relationships (e.g. establishing and maintaining friendships; interpersonal interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or
- Self-direction/self-control (e.g. ability to sustain focused attention for a long enough period of time to permit completion of age-appropriate tasks; behavioral self-control; appropriate judgment and value systems; decision-making ability); or
- Ability to learn (e.g. school achievement and attendance; receptive and expressive language; relationships with teachers; behavior in school).
*Any diagnosis in these categories can be used when evaluating a child for SED. However, any diagnosis that is secondary to another medical condition is excluded.