Home and Community-Based Services Waiver Program "Bridges to Health" (B2H)
B2H Forms
- Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB) - OCFS-8000 Referral Form
(OCFS-8000 58 KB) (OCFS-8000 PDF 16 KB) - OCFS-8001 Authorization for Release of Health Information
(OCFS-8001 70 KB) (OCFS-8001 PDF 16 KB) - OCFS-8002 Understanding the Bridges to Health Medicaid Waiver Program
(OCFS-8002 43 KB) (OCFS-8002 PDF 20 KB) - OCFS-8003 Freedom of Choice Form
(OCFS-8003 37 KB) (OCFS-8003 PDF 8 KB) - OCFS-8004 Application Form for Enrollment
(OCFS-8004 72 KB) (OCFS-8004 PDF 22 KB) - OCFS-8005A Level of Care for Children with Serious Emotional Disturbances - SED
(OCFS-8005A 74 KB) (OCFS-8005A PDF 24 KB) - OCFS-8005B Level of Care ICF-MR-Eligibility Determination Form for Children with Developmental Disabilities -DD
(OCFS-8005B 84 KB) (OCFS-8005B PDF 15 KB) - OCFS-8005C Level of Care for Children with Medical Fragility - MedF Pediatric Patient Review Instrument
(OCFS-8005C 216 KB) (OCFS-8005C PDF 24 KB) - OCFS-8006 Change of Provider Form
(OCFS-8006 64 KB) (OCFS-8006 PDF 12 KB) - OCFS-8007 Health Care Integrator Selection Form
(OCFS-8007 44 KB) (OCFS-8007 PDF 11 KB) - OCFS-8008 Waiver Participants Rights Form
(OCFS-8008 49 KB) (OCFS-8008 PDF 19 KB) - OCFS-8009 Notice of Decision- Authorization
(OCFS-8009 64 KB) (OCFS-8009 PDF 20 KB) - OCFS-8010A Notice of Decision - Denial of Enrollment
(OCFS-8010A 70 KB) (OCFS-8010A PDF 20 KB) - OCFS-8010B Notice of Decision - Denial of Waiver Services
(OCFS-8010B 76 KB) (OCFS-8010B PDF 21 KB) - OCFS-8011A Notice of Decision - Discontinuance from Waiver Program
(OCFS-8011A 79 KB) (OCFS-8011A PDF 23 KB) - OCFS-8011B notice of Decision Discontinuance of Waiver Services - Service Providers and or Reduction of Services
(OCFS-8011B 91 KB) (OCFS-8011B PDF 24 KB) - OCFS-8012 Wait List Notification Form
(OCFS-8012 50 KB) (OCFS-8012 PDF 11 KB) - OCFS-8014 Reauthorization Form
(OCFS-8014 58 KB) (OCFS-8014 PDF 36 KB) - OCFS-8015A Health Care Integration Agency Quarterly-Annual Report
(OCFS-8015A 176 KB) (OCFS-8015A PDF 21 KB) - OCFS-8015B Serious Incident Review Committee Quarterly Report
(OCFS-8015B 74 KB) (OCFS-8015B PDF 18 KB) - OCFS-8017 Individualized Health Plan-IHP and Projected Budget
(OCFS-8017 228 KB) (OCFS-8017 PDF 56 KB)(OCFS-8017 Excel 32 KB) - OCFS-8018 Service Summary Form
(OCFS-8018 87 KB) (OCFS-8018 PDF 35 KB) - OCFS-8019 Progress Notes
(OCFS-8019 38 KB) (OCFS-8019 PDF 9 KB) - OCFS-8020 Detailed Service Plan
(OCFS-8020 84 KB) (OCFS-8020 PDF 34 KB) - OCFS-8021 Serious Reportable Incident Form
(OCFS-8021 100 KB) (OCFS-8021 PDF 16 KB) - OCFS-8022 Status Progress Report
(OCFS-8022 58 KB) - OCFS-8023 Serious Reportable Incident Response Form
(OCFS-8023 60 KB) (OCFS-8023 PDF 14 KB) - OCFS-8024 Grievance - Complaint Packet
(OCFS-8024 110 KB) (OCFS-8024 PDF 22 KB) - OCFS-8025 Certificate of Attendance
(OCFS-8025 32 KB) (OCFS-8025 PDF 7 KB) - OCFS-8026 Loss of Eligibility Recommendation Form
(OCFS-8026 76 KB) (OCFS-8026 PDF 15 KB) - OCFS-8027 Contact Information List
(OCFS-8027 105 KB) (OCFS-8027 PDF 16 KB) - OCFS-8028 Accessibility Modifications and or Adaptive and Assistive Equipment Discription Cost Projection and Final Cost
(OCFS-8028 78 KB) (OCFS-8028 PDF 17 KB) - OCFS-8030 Transition Plan
(OCFS-8030 86 KB) (OCFS-8030 PDF 15 KB) - OCFS-8034 Qualification Form
(OCFS-8034 59 KB) (OCFS-8034 PDF 14 KB) - OCFS-8035 Schedule A - Waiver Service Provider Commitment form
(OCFS-8035 106 KB) (OCFS-8035 PDF 34 KB) - OCFS-8036 Medication Error Report
(OCFS-8036 50 KB) (OCFS-8036 PDF 8 KB)
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- B2H Home
- About B2H
- CONNECTIONS (CONX)/Welfare Management System (WMS) Instructions
- CONNECTIONS B2H Job Aid
- Request for Applications (RFA)
- B2H Program Manual (Updated 01/2012)
- B2H Forms (Updated 01/2011 & 01/2012)
- B2H Waitlist
- Approved Rates for B2H Waiver Program (PDF)
- General Information System (GIS)
- Training Reference Guide (PDF)
- Bridges to Health (B2H) Informational Video for Caseworkers
- Frequently Asked Questions
- Overview of B2H Waiver Program Documentation Requirements
