Faida na Huduma

Faida

Washirika wa Afya wa Kaskazini Mashariki (NHP) wanataka wanachama wetu kuboresha afya zao kwa kutumia manufaa yao. NHP itachanganya manufaa yako ya kimwili na kitabia ili kutibu mtu mzima na kuboresha matokeo yako ya afya. Unaweza kuuliza Mratibu wa Utunzaji ili kuhakikisha kuwa timu yako ya afya inazungumza na kila mmoja. Hii ni programu ya bure.

Unaweza kukagua Kitabu cha Mwongozo cha Health First Colorado ili kujifunza kuhusu manufaa yako. Ikiwa ungependa nakala ya kitabu hiki cha mwongozo, tafadhali tupigie kwa 888-502-4189 na tutakutumia nakala.

Kwa maelezo kuhusu manufaa ya Uchunguzi wa Mapema, Uchunguzi na Tiba, bofya EPSDT.

Wanachama wote katika shirika la kikanda watapokea faida sawa za kiafya ambazo zimefunikwa chini ya Health First Colorado (Programu ya Medicaid ya Colorado).

Wanachama wote katika shirika la kikanda watapokea faida sawa za meno ambazo zimefunikwa chini ya Health First Colorado (Programu ya Medicaid ya Colorado). Unaweza tazama video ili kupata maelezo zaidi kuhusu manufaa na huduma za meno zinazopatikana kwa Wanachama wa Health First Colorado (Programu ya Medicaid ya Colorado).

Wanachama wote katika shirika la kikanda watapokea faida sawa za kiafya ambazo zimefunikwa chini ya Health First Colorado (Programu ya Medicaid ya Colorado). Unaweza tazama video ili kupata maelezo zaidi kuhusu manufaa ya kimwili na huduma zinazopatikana kwa Wanachama wa Health First Colorado (Programu ya Medicaid ya Colorado).

Wanachama wote katika shirika la kikanda watapokea faida sawa za maduka ya dawa ambazo zimefunikwa chini ya Health First Colorado (Programu ya Medicaid ya Colorado). Unaweza jifunze kuhusu faida ya duka la dawa ili kujua zaidi kuhusu malipo ya pamoja. Unaweza pia kuzungumza na PCP wako, Mratibu wa Utunzaji, au Washirika wa Afya wa Kaskazini Mashariki ili kujua zaidi kuhusu dawa au dawa zinazoshughulikiwa.

Wanachama wote katika shirika la kikanda watapokea manufaa sawa ya maduka ya dawa ambayo yanafunikwa chini ya Health First Colorado (Mpango wa Medicaid wa Colorado). Unaweza kujifunza kuhusu faida ya duka la dawa ili kujua zaidi kuhusu malipo ya pamoja. Unaweza pia kuzungumza na PCP wako, Mratibu wa Huduma, au Health Colorado ili kujua zaidi kuhusu dawa au dawa zinazoshughulikiwa. Baadhi ya maagizo yanaweza kuhitaji ombi la idhini ya awali (PAR). Tafadhali zungumza na mtoa huduma wako wa msingi kuhusu dawa zako. Unaweza kupata orodha ya hivi majuzi zaidi ya dawa unazopendelea (PDL) kwenye https://hcpf.colorado.gov/pharmacy-resources#PDL.

Wanachama wote katika shirika la kikanda watapokea faida sawa za ujauzito ambazo zimefunikwa chini ya Health First Colorado (Programu ya Medicaid ya Colorado). Unaweza tazama video ili kupata maelezo zaidi kuhusu manufaa ya kimwili na huduma zinazopatikana kwa Wanachama wa Health First Colorado (Programu ya Medicaid ya Colorado).


Huduma

Kutafakari, yoga, mimea na acupuncture hutumiwa na watu wengi kuwasaidia kupata afya. Baadhi ya njia hizi ni za manufaa, wakati nyingine hufanya kidogo au hata zinaweza kusababisha madhara. Ukiamua kutumia mbinu mbadala ya uponyaji ili kukusaidia upone, ni muhimu kukumbuka baadhi ya mambo.

  • Health First Colorado haitalipia dawa nyingi mbadala. Utalazimika kulipa kutoka mfukoni.
  • Ikiwa PCP wako ni kliniki ya jumuiya, angalia ili kuona kile wanachotoa. Baadhi ya kliniki hutoa yoga, kutafakari, tiba ya masaji na mazoea ya uponyaji wa kitamaduni.
  • Fanya utafiti ili kujifunza mengi uwezavyo kuhusu matibabu. Usitegemee tu kile marafiki au familia wanasema. Soma vitabu na makala. Fanya utafiti kwenye mtandao.
  • Zungumza na PCP wako ili kujua kama anajua chochote kuhusu matibabu unayotaka. Anaweza kukupa maelezo zaidi, au hata anaweza kukuelekeza.
  • Ikiwa unapanga kuchukua virutubisho vya mitishamba, ni hivyo muhimu sana kuongea na daktari anayekuandikia dawa. Watu wengi wanaamini kwamba virutubisho vya mitishamba ni salama kwa sababu ni vya asili. Hii sio kweli kila wakati. Baadhi yana dawa zenye nguvu, ambazo zinaweza kusababisha athari mbaya wakati unachukuliwa na dawa ulizoagiza.
  • Jua ni kiasi gani matibabu yatagharimu. Mara nyingi watu hushangaa kujua kwamba baadhi ya matibabu mbadala ni ghali sana.

Hapana. Hakuna huduma ambazo hatutoi kwa sababu ya pingamizi za maadili au za kidini.

Ndiyo! Wataalamu wafuatao wanaweza kuhusika katika timu yako ya matibabu. Wanaweza pia kutoa upangaji wa huduma na utunzaji. Kila mmoja ana utaalam maalum. Lakini, kila mmoja pia ni sehemu ya timu ya matibabu. Hakikisha Mtoa Huduma wako wa Msingi (PCP) anajua kuhusu huduma zozote unazopokea na mtaalamu wa afya ya tabia.

  • Madaktari wa magonjwa ya akili ni madaktari (MD AU DO). Wana mafunzo maalum katika magonjwa ya akili. Daktari wa magonjwa ya akili atamtathmini mgonjwa. Pia hufanya utambuzi na kuagiza dawa. Wakati mwingine, watatoa aina zingine za matibabu pia. Wanafanya kazi na timu ya matibabu. Wanapanga huduma katika hospitali na baada ya kutokwa. Madaktari wengine wa magonjwa ya akili pia hutoa ushauri nasaha, mmoja mmoja au kwa vikundi. Aina nyingine pekee ya mtaalamu anayeweza kuagiza dawa ni muuguzi.
  • Wanasaikolojia kuwa na mafunzo maalum ya kutathmini na kutibu matatizo ya kihisia. Katika majimbo mengi, mtu aliye na leseni ya kliniki ya kufanya mazoezi ana Ph.D. Wanafanya uchunguzi wa akili ili kusaidia kufanya utambuzi. Wanaweza pia kutoa matibabu ya mtu mmoja mmoja, kikundi na familia. Wengine wana kazi zingine zinazofanana na zile zinazofanywa na wauguzi wa magonjwa ya akili na wafanyikazi wa kijamii.
  • Wauguzi wa magonjwa ya akili kuwa na mafunzo maalum katika uwanja huu. Kwa ujumla wana jukumu kubwa la kutunza wagonjwa moja kwa moja katika mazingira ya hospitali. Pia hutoa huduma hii katika programu za matibabu ya mchana na kliniki za vituo vya afya ya akili vya jamii. Wanaweza pia kutoa ushauri wa mtu mmoja mmoja, kikundi na familia.
  • Wafanyakazi wa kijamii kufanya kazi na mtu binafsi, familia na jamii kuratibu matunzo katika nyanja zote za maisha ya mtu. Baadhi ya watu wana mahitaji makubwa na wanaweza kuhusika na mifumo mingi (yaani afya ya akili, mfumo wa mahakama, huduma za ufundi stadi, huduma za matibabu, n.k.) Uratibu wa utunzaji ni muhimu ili kupata huduma nzuri. Wafanyakazi wa Jamii wanaweza pia kutoa ushauri wa mtu binafsi, familia au kikundi.
  • Washauri kuwa na mafunzo maalum katika kanuni za ushauri. Wanasaidia wateja wao kupata suluhu za matatizo. Washauri wa Kitaalamu wenye Leseni (LPC's) na Madaktari wa Ndoa na Familia wenye Leseni (LMFT's) wamefunzwa kufanya kazi na familia na masuala ya familia. LPC na LMFT zote mbili zina digrii za uzamili.
  • Wasimamizi wa kesi kuratibu matunzo na huduma katika jamii. Wanasaidia wateja wao kupata huduma kutoka kwa mashirika mbalimbali ya jamii. Kwa ujumla wao hufanya kazi katika Kituo cha Afya ya Akili ya Jamii au wakala walio chini ya mkataba wa Afya ya Akili ya Jamii.
  • Waganga wa kienyeji ni watu wanaojua kuhusu taratibu za tiba asilia. Watu wengi wameona mazoea haya kuwa ya manufaa sana. Hizi ni pamoja na curanderismo na mazoea ya uponyaji ya Wenyeji wa Amerika.
  • Washauri Rika ni watu wanaopata nafuu kutokana na ugonjwa wa akili na wamepata mafunzo ya ujuzi wa kimsingi wa ushauri nasaha. Wanaweza kutoa usaidizi kutoka kwa mtazamo wa mtu ambaye amepata ugonjwa wa akili au matumizi mabaya ya dawa.

Ndiyo! Masharti haya yanaweza kukusaidia kuelewa zaidi kuhusu aina za huduma za afya ya akili ambazo zinashughulikiwa na Health First Colorado.

Ikiwa unapata huduma za wagonjwa wa nje, unaweza kwenda kwenye kituo cha afya ya akili cha jamii. Unaweza pia kwenda kwa mtoa huduma ambaye yuko katika mazoezi ya faragha. Mtoa huduma huyu anaweza kuwa na mazoezi ya moja kwa moja, au wanaweza kuwa sehemu ya kundi la watoa huduma. Baadhi ya watoa huduma ni sehemu ya kliniki, hospitali, au wanaweza kuwa katika ofisi ya PCP wako.

Vituo vya afya ya akili vya jamii kwa kawaida hutoa huduma nyingi zaidi kuliko watoa huduma mmoja. Ikiwa una mahitaji mengi, kituo cha afya ya akili cha jamii kinaweza kuwa chaguo bora kwako. Kuna aina nyingi za huduma za afya ya kitabia. Inaweza kusaidia kujua ni nini kila aina ya huduma inalenga kufanya. Ikiwa una swali kuhusu aina fulani ya huduma, zungumza na mtaalamu wako. Sio kila programu hutoa huduma hizi zote.

  • Ushauri kwa Wagonjwa wa Nje inatolewa kwa mtaalamu au ofisi ya PCP au katika kituo cha afya ya akili cha jamii. Watu wazima, watoto na vijana wanaweza kupata ushauri nasaha kwa wagonjwa wa nje. Kawaida hudumu chini ya saa moja. Ushauri wa wagonjwa wa nje unaweza kujumuisha tiba ya mtu mmoja hadi mwingine. Hapa ndipo utazungumza na mshauri peke yako. Tiba ya kikundi ni pale unapozungumza kuhusu matatizo na kikundi cha watu. Pia kuna tiba ya familia. Hapa ndipo wewe na wanafamilia wako mnazungumza na mshauri.
  • Usimamizi wa Kesi Nzito inatolewa wakati watu wana mahitaji mengi ambayo yanasaidiwa vyema na huduma maalum. Huduma za Usimamizi wa Kesi Nzito ni huduma za kijamii. Ni kwa ajili ya watu wanaohitaji msaada wa ziada ili kuishi katika jamii. Msimamizi wa kesi ataratibu huduma hizi au kukuunganisha kwa huduma na mashirika mengine.
  • Huduma za Matibabu ya Nyumbani ni huduma za uponyaji zinazotolewa katika nyumba ya mtu. Hii inafanywa wakati mazingira ya nyumbani ni sehemu muhimu ya matibabu.
  • Usimamizi wa Dawa ni ukaguzi unaoendelea wa jinsi dawa zako zinavyofanya kazi. Inafanywa tu na daktari au mtaalamu mwingine aliyefunzwa na aliyeidhinishwa.
  • Hospitali ya sehemu (hospitali ya siku) hutoa huduma zote za matibabu ya hospitali ya magonjwa ya akili. Lakini badala ya kukaa hospitalini, wagonjwa huenda nyumbani kila jioni.
  • Huduma za Mgogoro ni za dharura za afya ya kitabia. Zinapatikana masaa 24 kwa siku, siku 7 kwa wiki. Wanaweza kutolewa katika chumba cha dharura cha hospitali, na timu ya shida ya rununu, au kituo cha shida.
  • Nyumba za Kikundi cha Tiba au Makazi ya Jumuiya ni muundo wa hali ya maisha. Ni za watu ambao hawahitaji huduma za hospitali za wagonjwa. Lakini, watu hawa wanahitaji huduma za matibabu za saa 24.
  • Matibabu ya hospitali ya wagonjwa ambapo wagonjwa hupokea matibabu kamili ya kiakili. Ni mpangilio wa hospitali na inafanya kazi masaa 24 kwa siku. Programu hizi ni sawa kwa watu ambao pia wanahitaji huduma za matibabu.
  • Kitengo cha Matibabu ya Papo hapo hutoa aina kamili ya matibabu ya akili. Inatolewa katika mpangilio wa mpangilio wa saa 24 kwa siku. Kiwango hiki cha utunzaji ni cha watu wanaohitaji huduma zilizopangwa kwa saa 24 lakini si huduma za hospitali.
  • Programu zinazoendeshwa na watumiaji au rika zinaendeshwa na watu ambao wameishi uzoefu wa ugonjwa wa akili. Programu ni pamoja na vituo vya kuacha, vilabu na vilabu vya kazi. Zinaweza kuendeshwa na Wanachama pekee, au zinaweza kuendeshwa kwa ushirikiano na programu za kitaaluma. Wanatoa fursa za kijamii, vikundi vya usaidizi, ushauri wa rika na shughuli za burudani.
  • Mipango ya Msaada kwa Jamii ni mipango iliyoundwa ambayo hutoa huduma za afya ya akili. Pia wanatoa mafunzo ya stadi za kuishi kila siku. Mafunzo haya yanajumuisha bajeti na usafi. Pia inajumuisha ujuzi wa kijamii na burudani, utunzaji wa nyumba na ujuzi mwingine.

Ni muhimu kutetea mahitaji yako. Unapaswa kuuliza maswali kila wakati mtaalamu anapopendekeza aina fulani ya matibabu ya afya ya akili. Maswali unayopaswa kuuliza ni pamoja na:

  • Je, unatarajia kuwa nitakuwa katika kiwango hiki cha matibabu hadi lini?
  • Je, ni faida gani za huduma au programu hii? Je, ni hasara gani za huduma au programu hii?
  • Je, aina hii ya matibabu itasaidia vipi kwa tatizo langu hasa?
  • Je, Health First Colorado itagharamia?

Ikiwa huna wasiwasi kuhusu majibu unayopata, au bado una maswali, pata maoni ya pili. Kama mwanachama wa Medicaid, una haki ya kupata maoni ya pili.

Ndiyo! Shirika la kikanda lina manufaa mapya ambayo hukuruhusu kupokea hadi vikao sita (6) katika ofisi ya PCP wako. Uliza PCP wako kama tayari wanatoa huduma hizi katika ofisi zao. Ikiwa PCP wako hatatoa tiba hii katika ofisi zao, tunaweza kukusaidia kupata rufaa kwa watoa huduma wengine ili kuhakikisha mahitaji yako ya afya ya kitabia yametimizwa. Tupigie tu kwa 888-502-4189 kwa usaidizi. Hii ni simu ya bure.

Ndiyo. Hakuna vikwazo (vizuizi) kwa nani unaweza kuona. Iwapo hujafurahishwa na chaguo zinazopatikana katika mtandao wetu wa watoa huduma, mtoa huduma unayependelea anaweza kukuuliza makubaliano ya kesi moja. Mkataba wa kesi moja utaidhinishwa ikiwa mtoa huduma atatimiza vigezo vilivyobainishwa na serikali vya uandikishaji wa Medicaid na anaweza kuthibitishwa na Carelon Behavioral Health.

Unaweza kubofya Mawimbi ambalo ni Shirika la Huduma Zinazosimamiwa (MSO) ambalo hutoa huduma maalum za matumizi ya dawa za kulevya kwa Wanachama wa Health First Colorado. MSOs zinafadhiliwa na Ofisi ya Colorado ya Afya ya Tabia.

Je, umewahi kufikiria ungefanya nini ikiwa hungeweza kutumia usafiri unaotegemea? Je, ungeshughulikiaje kazi zako za kila siku? Nani angekusaidia? Mara nyingi watu hutafuta marafiki au jamaa kuwasaidia kwa usafiri. Hii inaweza kuwa chaguo nzuri kwako, lakini sio rahisi kwao kila wakati.

Kufikiria mapema kuhusu usafiri wako kunaweza kukupa amani ya akili endapo gari lako litaharibika, au jirani yako akisogea. Unapaswa kujifunza kuhusu uchaguzi wa usafiri katika eneo lako na uamue ni chaguo gani linafaa zaidi kwako.

Usafiri unaweza kutolewa na aina mbalimbali za watu na magari, ikiwa ni pamoja na watu wa kujitolea, mabasi, teksi, au huduma ya gari iliyo na vifaa maalum. Mashirika ya kidini au ya kiraia yanaweza pia kuwa na madereva na magari ya kujitolea. Kinachopatikana katika jumuiya yako kitatofautiana kulingana na mahali unapoishi.

Afya Kwanza Colorado na Usafiri

Kwa ujumla, unatarajiwa kufika kwenye miadi yako kwa kutumia usafiri wa kawaida, kama vile kutembea, kuendesha gari, kupanda basi, kupanda na rafiki n.k. Wakati mwingine unaweza usiweze kutembea, au uko hivyo. mgonjwa kwamba huwezi kutumia njia ya kawaida ya kusafiri. Unaweza kuzungumza na PCP wako au Mratibu wa Huduma ili kukusaidia kupanga usafiri kwa ajili yako. Waulize kuhusu jinsi unavyoweza kupata usafiri hadi miadi yako.

IntelliRide alikuwa wakala wa usafirishaji wa huduma za usafirishaji wa matibabu zisizo za dharura kwa Jimbo la Colorado. Kuanzia tarehe 1 Agosti 2021, wanachama wanaoishi katika kaunti ya Weld pekee ndio watakaotumia IntelliRide kuratibu miadi yao. Ikiwa huishi katika Kaunti ya Weld, unaweza kuratibu safari za miadi yako moja kwa moja na mtoa huduma wako wa usafiri unayempendelea.

Nenda kwa https://hcpf.colorado.gov/sites/hcpf/files/NEMT-Service_Areas_0.pdf, ili kupata mtoa huduma wa usafiri wa ndani, wasiliana na kituo chetu cha simu kwa 888-502-4189, au zungumza na mratibu wako wa utunzaji.

IntelliRide itaendelea kuchakata fomu zako za kurejesha mileage. Unaweza kupata fomu hizo kwa https://gointelliride.com/colorado/member-resources/. IntelliRide pia itakuwa na jukumu la kuratibu usafiri wowote unaohitajika kimatibabu wa nje ya jimbo au wa ndege.

Nyumbani ni mahali ambapo, unapolazimika kwenda huko, lazima wakuchukue ndani."
-Robert Frost

Nyumba ya Matibabu ni njia ya utunzaji wa afya inayofuata kanuni hizi za msingi:

  • Utunzaji Unapatikana — unaweza kupata huduma za afya unapozihitaji na mahali unapozihitaji.
  • Utunzaji ni Ushirikiano - timu, sio mtu mmoja tu, hutoa huduma ya afya yako.
  • Utunzaji Unazingatia Mtu na Familia - wewe ni sehemu ya kufanya maamuzi kuhusu huduma yako ya afya.
  • Care is Continuous — you have a relationship with your team. Your health care team is with you for the long haul.
  • Care is Comprehensive — you get all the services you need through one door. Your PCP and care coordinator will arrange for you to see specialists, mental health or other providers to keep you healthy.
  • Care is Coordinated — care coordinators will help you organize all of your appointments and visits.
  • Care is Compassionate — providers and staff treat you and your problems with respect and dignity
  • Care is Culturally Effective — you will get care in a place and from people who understand and respect your culture and language needs.

How Can You Work With Your Medical Home?

It is important to know that keeping yourself healthy is a partnership between you and your care providers. You can do several things to make this partnership successful.

  • Know the members of your health care team and how to contact them. Keep this information handy; sharing it with a family member or someone else you can trust.
  • Take charge of your health care and be assertive. Ask questions when you don’t understand what you need to do. Learn about your illness by asking your provider for other resources. If you disagree with your provider, say so. If it’s hard for you to be assertive, consider taking someone along to your appointments.
  • Stay organized. Keep your scheduled appointments and follow-up with any lab work or tests that are ordered for you.
  • Communicate actively. If you need to cancel or reschedule an appointment, call in advance to notify your care provider. If your condition changes, tell your provider. Talk to your providers about your health goals and anything that might get in the way of achieving them.
  • Be honest with your health care team about what you are doing or not doing.
  • Follow directions carefully. When your doctor prescribes a medication, follow the instructions about when to take it and how much to take.
  • Be proactive. Tell your doctor about new symptoms, even if you think they might not be important. Good health starts with prevention. Dealing with problems when they are small can help save you time and discomfort.
  • Think about wellness, rather than sickness. You can improve your health and life satisfaction by making changes in your lifestyle. Consider changes such as quitting smoking, exercising more, eating healthy foods, and stopping dangerous behaviors.

Take care of your mental health. If you are having problems with your mood, thoughts or behavior, tell your health care team. You may need to be evaluated for mental health treatment. Mental health is a need that is like any other health concern. There is no need to feel ashamed or embarrassed if you need this kind of help.

Our main concern at Northeast Health Partners is to give you high quality healthcare services that meet your needs. The quality of our services is important to us. We want you to be satisfied with your providers and your access to services. If you are not satisfied, we would like you to let us know by calling 888-502-4189.

Below are some questions you might want to ask yourself to evaluate your healthcare experience. If you have more than two or three “No” answers, you might want to decide if your current healthcare team is the best fit for you. Treatment works best when there is a good fit between providers and patients.

  • Do my healthcare providers care about me as a person?
  • Does my healthcare team take enough time to explain my condition and their recommended approach to treating it?
  • Do they explain things in language and words I understand?
  • Does my care provider seem pleased when I ask questions about my treatment?
  • Does my provider help me to feel empowered to make my own healthcare decisions?
  • Does my provider talk to me about my goals and expectations for treatment?
  • Can I access my health care team when I need to?
  • Does my provider keep his/her appointments with me?
  • Is the time I have to wait for appointments reasonable?
  • Does my provider refer me to other providers when needed?
  • Does my provider have resources for me when I am in crisis or after regular business hours?
  • Do I trust my provider’s skills and knowledge?
  • Do I feel comfortable raising concerns to my provider or disagreeing with him/her?

There may be times when you want to talk to a different provider about your illness or about a treatment your provider suggests. This is called a “second opinion.” As a Northeast Health Partners (NHP) Member, you have the right to get a second opinion. If you want another medical opinion, tell your PCP you would like a second opinion.

You can also call NHP’s Customer Service at 888-502-4089. They can answer questions and help you get a second opinion.

There is no cost for you to get a second opinion. If you want another provider’s opinion after you get an approved second opinion, you may have to pay for it.

Your PCP is your Medical Home. Your Primary Care Provider (PCP) takes care of all your main health care needs. Your PCP will get to know your health history, take care of your basic medical needs, and make referrals when you need them. He or she will work with you to keep you healthy! Your PCP is with you for the long term.

What to Expect from Your PCP

  • Give you most of the medical services you need.
  • Provider referrals to specialists.
  • Order prescriptions or tests for you.
  • Keep your medical records up-to-date.
  • Give you advice and answer your questions about your health needs.
  • Give you regular physical exams.
  • Give you covered immunizations (shots) as needed.
  • Keep track of your preventive health needs such as screenings (mammograms, pap smears, etc.) and immunizations (shots).
  • Talk with you about advance health directives.

Regular Check-Ups to Stay Well

It is important to get regular check-ups. Your PCP will decide how often you need to get a check-up. A check-up can find health problems early – before they become serious.

If you have not seen a doctor for a while, or if you have been getting your care through the emergency room, you should make an appointment for a check-up with your PCP.

Education and Advice

Your PCP can talk to you about your health needs and give you advice about things you can do to stay healthy. They include:

  • Family Planning services
  • Education about good eating habits
  • Exercise Programs
  • Programs to quit smoking

If you are pregnant, you should see your provider right away for prenatal care. You should not drink alcohol, take any drugs not prescribed by your PCP, or smoke. It is unhealthy for you and your baby.

Being a partner in your care

Because you are a partner in your care, it is important that you give your PCP all of the information he/she needs to make good medical decisions. It is important that your PCP knows your medical history, allergies, diseases or other problems. It is important to be honest and open with your PCP. This means telling the truth about your good and bad habits.

It is also important to keep your appointments. When you need to see your PCP, call the office for an appointment. Your appointment time is important and should be taken seriously. Please arrive at your appointments on time. If you cannot keep an appointment, call the office right away and let them know. When you call to cancel, you can make another appointment. If you do not call to cancel, this is a “no show.” Some offices may refuse to see you again if you are a frequent “no show.” This is not a punishment. It is because the doctor’s time is valuable. If you miss an appointment, you may be taking away time from another patient who needs health care.

What is the Child Youth Mental Health Treatment Act?

The Child Youth Mental Health Treatment Act is a law that allows families to access community and residential treatment services for their child without having to go through the dependency and neglect process, when there is no abuse or neglect of the child.

How is the child’s eligibility determined?

For children with Health First Colorado (Colorado’s Medicaid Program), the child must have a mental illness, and require residential level of care determined by the regional organization.

Where do you go to apply?

Only a parent, legal guardian, or child over the age of 15 may apply for services under the Act. If the child has Health First Colorado, contact the regional organization listed on their Health First Colorado card. The regional organization will provide an assessment to determine your child’s eligibility.

What is the parent/guardian role once the child is admitted to a residential facility?

Family involvement is essential to successful treatment outcomes. This includes participation in developing the treatment plan, review of the child’s progress, family therapy, and discharge planning.

What if the child is denied services by the mental health agency? If services are denied, the mental health agency will provide written recommendations of appropriate services for the child and family. The family will need to make decisions and explore resources to pay for these services. The mental health agency will also inform the parent/guardian about the appeal process. If the local appeal supports the denial, the parent/guardian may appeal to the Office of Behavioral Health if the child does not have Health First Colorado. If the child is Medicaid-eligible, the parent/guardian or the regional organization may appeal to the Department of Health Care Policy and Financing (Colorado Medicaid).

What happens if the local mental health agency and county department of human/social services are uncertain about which agency is responsible for providing services under the Act?

The agencies should first use their local inter-agency dispute resolution process. If the matter is not resolved at that level, it should be referred to the Office of Behavioral Health, which will convene a committee to review and recommend a resolution.

Substance Use Disorder Services

Medicaid eligible members may receive outpatient alcohol and drug treatment services when there is a covered substance use diagnosis. All services must be medically necessary as determined by a licensed behavioral health professional. Treatment need is based on an individual assessment that reflects evidence-based clinical treatment guidelines. Court ordered services may or may not be medically necessary and could be reviewed by a Peer Advisor for determination.

Tangazo la Ushirikiano wa Utunzaji Uwajibikaji (ACC):

Medicaid Utilization Management ensures members receive:

  • Access at the appropriate level of care;
  • Interventions that are appropriate for their diagnosis and level of care; and
  • An independent process for reviewing appropriate placement in treatment settings.

For referrals to Substance Use Disorder providers, call the Access to Care Line associated with your regional organization:

  • Health Colorado, Inc. at 1- 888-502-4185
  • Northeast Health Partners at 1-888-502-4189

The following table describes substance use disorder services covered under this Behavioral Health Plan.

Substance Use Disorder Service Service Description
Case Management This service functions in the capacity of assessment, planning, linkage to community resources, monitoring, advocacy, consultation, and collaboration. All of which focus on engaging members in treatment and moving toward recovery.
Emergency Care This service provides life-threatening care to members experiencing a crisis related to substance use.
Withdrawal Management These services involve screening, assessing, planning and monitoring withdrawal symptoms for members who experience mild to moderate withdrawal symptoms when substance use is discontinued.
Outpatient Treatment The treatment system for substance use disorders in community or office-based settings. Treatment is comprised of multiple service components, including: assessment, individualized treatment planning, individual and group counseling; intensive outpatient treatment; case management; medication assisted therapy; and peer support services.
Opiate Medication Assisted Therapy These services are provided in an outpatient setting. They include the administration of opioid agonist therapies with methadone, buprenorphine, or another approved controlled substance to reduce the effects of opioid withdrawal and cravings. Other outpatient treatment services include individual and/or group counseling to assist the member in focusing on recovery.
Peer Services Support services are non-clinical services that are offered during treatment to support members in their recovery goals. These services are often provided by a trained peer specialist/recovery coach who has been in recovery for a minimum of 12 months.

An emergency is a condition that may cause lasting harm or loss of life or limb. An emergency requires immediate treatment. You do not need approval for emergency care.

Medical Emergency

Examples of a medical emergency include:

  • Chest pain
  • Choking
  • Trouble breathing
  • Loss of speech
  • Paralysis (unable to move)
  • Unconsciousness (blacking out)
  • Convulsions or seizures
  • Sudden onset of severe pain
  • Poisoning
  • Severe cuts or burns
  • Severe or unusual bleeding
  • Any vaginal bleeding if you are pregnant
  • A serious accident
  • A physical attack or rape
  • Head or eye injuries
  • High fever
  • Feeling like you are going to hurt yourself or someone else

What to do in an Emergency

  • Go directly to the nearest hospital Emergency Room (ER)
  • Dial 911 for an ambulance if you need help getting to an emergency room fast

After the emergency is over

Make an appointment with your PCP for follow-up care. Do not go back to the ER where you were treated unless your PCP tells you to.

Urgent Care

There are times when it is hard to know if your situation is an emergency. If you are not sure, here are some ways to help you decide if a situation is an emergency:

  • Call your PCP. Northeast Health Partners’ PCP’s have on-call staff to answer patient questions after hours.
  • If you can’t reach your PCP, call the Nurse-Advice-Line. The call is free and the line is staffed 24 hours a day, 7 days a week with registered nurses (RN’s). Their number is 1-800-283-3221.

Your PCP or the nurse will help you decide if you need to go to your PCP’s office, an urgent care center or the ER.

When you talk to your PCP or the Nurse Advice Line, be ready to tell them as much as you know about the medical problem. Be ready to tell them:

  • What the problem is
  • How long have you been having the problem (pain, bleeding, etc)
  • What has been done for the problem so far

Your PCP or the Nurse Advice Line may ask other questions to help them decide if:

  • You need an appointment
  • You should go to an urgent care center
  • You should go to the emergency room

Examples of Urgent Medical Conditions:

  • Most broken bones
  • Sprains
  • Minor cuts and burns
  • Mild to moderate bleeding

Examples of conditions that do not usually need Urgent or Emergency care:

  • Colds and flu
  • Sore throat
  • Sinus congestion
  • Rash
  • Headaches

With these conditions, call your PCP to make an appointment and tell them about your symptoms or illness. If you are unsure, call the PCP or the Nurse Advice Line at 800-283-3221.

Health First Colorado Co-Pays

As of July 1, 2023, Health First Colorado members will not have to pay co-pays for most services, except an $8 co-pay for each non-emergency room visit. Some services covered by Health First Colorado (Colorado’s Medicaid Program) have a co-pay. Co-pays are dollar amounts some members must pay to their provider when they receive certain services. Different services can have different co-pay amounts, but the same service will always have the same co-pay amount every time the member has to pay it. Health First Colorado members never have to pay more than the co-pay for a covered service. Updated Co-pay Information

Co-Pay Maximum

There is a monthly co-pay maximum for Health First Colorado members. This means once a member has paid up to a certain amount in co-pays in a month, they do not have to pay any more co-pays for the rest of that month. Health First Colorado will automatically notify you when your household has reached its co-pay maximum for the month. The head of household will receive a letter showing the household has reached the monthly limit, and how the limit was calculated. You can find out more on the Health First Colorado Co-Pays webpage.

Members Without Co-Pays

Some Health First Colorado members never have co-pays. These members are:

  • Children who are ages 18 and under
  • Pregnant women (includes pregnancy, labor, birth and up to six weeks after delivery)
  • Members who live in a nursing home
  • Members who get hospice care
  • American Indian or Alaska Native members
  • Former foster care children ages 18 through 25

Services Without Co-Pays

Some services never have co-pays. Examples of these services include:

  • Emergency services
  • Family planning services and supplies
  • Behavioral health services
  • Preventive services, such as yearly checkups, and vaccines

Co-Pay Amounts

Service type Description Co-pay
Inpatient hospital services Care at a hospital when you stay overnight $0 per day
Outpatient surgery at an Ambulatory Surgery Center Outpatient surgery that takes place at an Ambulatory Surgery Center $0 each visit
Outpatient hospital non-emergent emergency room visit Care in the emergency room when it is not an emergency. $8 each visit
Outpatient hospital services Care at a hospital when you are not admitted for a stay $0 each visit
Primary Care Physician and specialist services Care you get from your Primary Care Physician or specialists outside of a hospital $0 each visit
Clinic services Visit to a health center or clinic $0 each day of service
Laboratory services Blood tests and other lab work $0 each day of service
Radiology services X-rays*, CTs, MRIs *Dental X-rays do not have co-pays $0 each day of service
Prescription drugs or services (each prescription or refill) Medications $0 for generic and $3 for brand name drugs. Same co-pays for a 3-month supply by mail