Health Home Enrollment and Referral

To refer a patient to the BAHN Health Home, Montefiore Care Management, please provide the information requested below and press the submit button at the bottom of the page. The form will be submitted to the BAHN Health Home’s administrators, and a BAHN representative will acknowledge receipt of the referral form.

The BAHN Health Home can help you and your patients who have multiple comorbidities; have frequent avoidable ED visits or hospitalizations; are experiencing functional decline; have behavioral health issues or financial issues that affect their compliance with treatment; need help with medication compliance or affording medication; or who could benefit from end of life or advanced illness planning.

Note: For Health Home enrollment: the following components need to be confirmed:

  1. Medicaid Eligibility for Health Home Services (active Medicaid and coverage that is compatible with Health Home)
  2. Conditions for Eligibility: Qualifying chronic conditions are any of those included in the major categories of the 3M Tm Clinical Risk Groups (CRGs)identified in Health Home Policy
  3. Appropriateness Criteria

If you have questions or prefer to speak to a BAHN Health Home representative, call the BAHN Central line at 1-855-680-2273 or email BAHNCentral@montefiore.org.

If you need to include any additional information in the referral, please select “other” under the Social Determinants of Health Assessment section and provide details.

* Indicates Required Fields

Referral Source Contact Information

Consent to refer information

Medical Consenter for Referrals Under 21 Years of Age

Consent to Refer Note : For Individuals under 21 a consent to refer and Medical consenter information is required

Health Home Clinical Eligibility Criteria

Medicaid Members to be eligible to enroll in Health Home must have:

  • Two or more chronic conditions and at least one risk factor or,
  • One single qualifying condition and at least one risk factors from risk assessment

One of the following single qualifying conditions *

Or two or more chronic conditions *

Risk Assessment *

Referrals are eligible for Health Home services if at least one of the following risk factors apply:

Social Determinants of Health Assessment