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Dear Applicant,
Enclosed please find an application
for the Delaware County Single Point of Access (SPOA) which
is the access point to obtain Care Management and
Residential Services for children or adolescents under the
age of 21 who are diagnosed with a Serious Emotional
Disturbance and have experienced functional limitations over
the past 12 months.
The “Children’s Single Point of
Access Application (Part 1)” needs to be completed and
submitted along with a copy of a recent (within 6 months)
Comprehensive Assessment and/or Psychiatric Assessment.
Please note that there are now two consent forms included in
this application.
·
The Consent for Release of Information is
REQUIRED in order for us to access the information we
need to process this application.
·
The Children's Single Point of Access (C-SPOA)
Patient Information Retrieval Consent is highly recommended,
but is NOT required. However, since it will help us
to coordinate services for the child, we strongly
encourage the parent/guardian to sign it.
The services available through SPOA
are covered by Medicaid. Please complete this form no
matter what other insurance the child has, or if the child
has no insurance. C-SPOA services are available for all
children in NYS, regardless of their insurance or
immigration status. We can link the family with a resource
to assist them with the Medicaid application process and may
be able to provide services in the interim.
The application is reviewed by the
SPOA Committee and if eligible for services, the
child/adolescent is assigned to a service provider. Both
the parent/guardian and the referral source are notified of
the disposition of the request for services.
Applications can be faxed
(607-832-6082) or mailed.
If you have any questions, please feel free to contact me at 607-832-5888Sincerely,
Delaware County SPOA Program Coordinator for Children and
Adults
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