Action: An Action is when the Behavioral Health Organization (BHO) does any of the following:  

1. Denies all or part of a requested mental health service, including the type or level of service. 
2. Reduces, changes, or ends treatment that was already approved.
3. Denies payment, in whole or in part, for a service.
4. Denies a request to obtain treatment outside the network, in rural areas.
5. Fails to provide services in timely manner.
6. Fails to act within approved time frames to resolve grievances and appeals.

Appeal: An Appeal is when a member disagrees with an Action by the BHO and asks for a review of the Action. 

Behavioral Health Organization (BHO):  This is an organization that the state of Colorado contracts with to arrange for mental health services for Medicaid members. There are five BHOs in the state.

Care Coordinator: A Care Coordinator can be your therapist or case manager. He or she is your primary mental health provider and responsible for coordinating your mental health services and keeping your records.

Community Mental Health Center:  Community mental health centers offer mental health services. There are seventeen community mental health centers in Colorado. Each center serves from one to several counties. See Community Mental Health Centers to find the center that serves your county. 

Covered Benefits: The mental health services you can get if you are on Medicaid.

Designated Client Representative (DCR):  This is a person whom you name to file a grievance or appeal on your behalf. You must do this in writing.

Early Periodic Screening, Diagnosis and Treatment (EPSDT): A health care program for children who get Medicaid. It covers children ages birth to 21. EPSDT provides health checkups, nutritional checkups, baby shots and other services.

Grievance:   A Grievance is when you complain about your mental health services, a provider or staff. You can file a Grievance about anything you are not satisfied with.

Notice of Action: This is a letter that the BHO sends you explaining the Action it is taking and your Appeal rights.

Out of Area Care: The mental health services you get when you are outside of the counties covered by your BHO. 

Primary Care Physician (PCP): The doctor you have chosen to provide your medical care.

Provider: An organization or individual who provides mental health services. A provider can be a mental health center, a hospital or an individual.

State Fair Hearing Process:  This is a hearing before a state administrative law judge and is available for Appeals only.

Waiver Program: These are special programs to help people with special health care needs stay in their home and community.