To submit a RA request, send the DHS Reasonable Accommodation Request form (DHS-13) and supporting documentation, if required, to the DHS Disability, Access and Functional Needs (DAFN) Unit at DAFNRARequests@dhs.nyc.gov and copy DHS-HCFReferral@dhs.nyc.gov. If the client is currently assigned to a shelter site, please include the Program Director on the email.

• If a need for an RA is obvious/apparent (e.g., a client that uses a wheelchair needs a wheelchair accessible bathroom), supporting documentation is not required.

• If the need is not obvious/apparent, supporting documentation (e.g., letters from treating physicians/clinicians, medical records) is required. Supporting documentation should speak to why the client needs the requested RA.

• A HIPAA Authorization form is not required but is very helpful. It enables the review team to reach out if they need additional information or to help get documentation for a client if they need help.
• If you are submitting a HIPAA form along with the RA request form, please make sure that the HIPAA is filled out completely otherwise it’s invalid and cannot be used.
• When completing the section on page 2 that requires the provider’s information, be as specific as possible. Do not just include the name of the hospital.
• For more information and copies of forms, please visit: https://www.nyc.gov/site/dhs/about/applicants-and-clients-with-disabilities.page 

Contact DHS-HCFreferral@dhs.nyc.gov for assistance when assigned shelters, safe havens or street outreach teams do not respond to the institutional referral within two business days. Use the email subject heading "Assistance requested: No response to institutional referral to DHS assignment".

All patients:

• Complete Institutional Referral Form
• Signed patient consent to discharge to shelter

• Psychiatric evaluation
• Recent psychiatric progress note
  
• Psychosocial evaluation

Clinical evaluations are required for successful placement in safe havens, supportive housing, or other residential placements.

In-patient medical/surgery admission for more than 60 days, referred from nursing home or short/long term rehab facility and/or ADL functioning may be in question:

• Patient review instrument (PRI), must be current and accurate
• Recent PT/OT note

• Cognitive assessment, e.g. MMSE, MOCA
  

If requesting expedited placement in a specialized shelter:

• Tuberculosis test results 
  
  

All patients upon discharge:

• Discharge summary and medication list
  
  

• Supportive housing-related documents, such as psychosocial evaluation and HRA 2010e application

Applications from hospitals are more likely to be approved.

Institutional referrals must meet the following criteria in order for the referral to be deemed complete and a determination of medical appropriateness to be made:

1. Institutional Referral Form must be fully complete. Institutional Referral Forms with missing information will be returned to the sender.

2. All referrals must attach a signed patient consent form.

3. Institutional Referral Form is incomplete.

4. Patients who meet absolute medical exclusion criteria are not eligible for shelter. 

   • The most common absolute medical exclusion criteria is the patient needing assistance with activities of daily living (ADLs). These patients should be discharged to a higher level of care, such as supportive housing or assisted living. See residential placement options.

   • Patients who need absolute medical exclusion criteria and present to shelter intake will be instructed to return to the hospital.

5. Patients cannot be eligible for other types of permanent or short-term housing or emergency shelter. All applicable non-DHS residential placement must be attempted prior to discharging to DHS.

6. Patients must have at least one follow-up medical appointment listed on their referral.

7. Patients with a history of street or subway homelessness should be enrolled in Safe Options Support (SOS) prior to the referral. Patient consent is not required for enrollment.

8. Patients with a history of serious mental illness who are not engaged in care must be enrolled in Shelter-Partnered ACT or another mobile mental health program prior to the referral.

9. All required medical documentation must be provided (listed below under "What medical documentation do I need to send with the institutional referral form?").

Referrals are processed in the order they are received. If any section of the form is incomplete or requested documentation missing, the form will not be reviewed and will be returned to the sender. Ensuring that the referrals meet all of the above criteria prior to submission will facilitate a more timely determination of medical appropriateness.

DHS is required to ensure safety in shelter. According to New York State regulations, a person should not be placed in shelter if they:

• Have a mental/physical condition that causes danger to self/ others

• Requires services beyond what shelter is able to provide

Discharge on business days only, 9AM to 3PM. Do not discharge on holidays, during code red or code blue, or during an emergency.

Discharge patients with:

• Two-week supply of medications and a pharmacy available (and delivers) city-wide

  • Consider long-acting medications

  • Simplify regimens so patients can self-manage

  • Enroll patients unlikely to adhere to treatment in medication management services

• All necessary medical and assistive equipment

• Discharge summary, medication list and follow-up care plan instructions using a method the patient is likely to retain (paper, text message, app, web portal, or other)

• Discharge after a full meal, and with weather-appropriate clothing and shoes

• Coordinate accompaniment and transportation from health care facility to shelter for medically complex patients unlikely to be able to follow through on their own

Give the patient Handout for Patients Discharged to Shelter.

Inform patients to arrive to the shelter before the daily curfew of 11pm in order to secure their bed placement on the date of discharge agreed upon with the assigned shelter.