OTHER THINGS YOU SHOULD KNOW ABOUT YOUR SERVICES

Are there limits on the services I can get?
Yes, Medicaid limits the individual therapy sessions and inpatient hospital days. You may not use more than 35 individual therapy sessions in one year. You may not use more than 45 days per year for inpatient hospital stays. There are some exceptions to these limits. You can talk to your Care Coordinator or CHP Office of Member and Family Affairs if you have questions about this, at 1-800-804-5040.

There may be exceptions to these limits for youth, ages 20 and under, who have been screened under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. Please see the EPSDT section in the handbook to learn more.

Even though there are limits to individual therapy and inpatient days, there are many services that are not limited. These include appointments for medications, group therapy, wellness classes, peer services, clubhouses, support groups and many more services.

How do I get my Medications?

Colorado Prescription Drug Program
The State of Colorado has a Preferred Drug List (PDL) for many Medicaid members who need prescription medication. The PDL is a list of drugs that the state does not require prescribers to get prior approval to prescribe. Drugs that are not on this list need approval from the state. This means that some drug choices are limited.

Medicaid members get their psychiatric (mental health) medications in one of two ways: 

• If you have Medicaid only, you get psychiatric medications through the state fee-for-service Medicaid prescription program. Currently, only certain psychiatric medications for Attention Deficit Hyperactive Disorder (ADHD) are included on the Colorado Preferred Drug List (PDL). The state has a process that will allow people with serious mental illness to get the prescriptions they need, even if those medications are not on the PDL.
• If you have Medicare and Medicaid (dual eligible), you must enroll in a Medicare Part D plan. Since you are dual eligible, you can get help to pay for your medications. If your Part D plan will not pay for certain classes of drugs, then Medicaid will pay. One of these excluded classes is a mental health drug class, benzodiazepines.  

You can get more information about the PDL and any future changes by:

• Going to the state website www.colorado.gov/cs/Satellite/HCPF/HCPF/1221647964046 
• Calling the state Pharmacy Liaison at 303-866-3583, 1-800-866-3513, or
• Calling the CHP’s Office of Member and Family Affairs at 1-800-804-5040.

Dual eligible persons who need help signing up with a Medicare Part D plan can contact Medicare at 1-800-633-4227 or the State Health Insurance Assistance Program at 1-888-696-7213.

How much does it cost to get mental health services?

As a Medicaid Member, you are entitled to get mental health services at no cost to you. There are no co-pays for your mental health services. If you get a bill for any mental health services, contact CHP at 1-800-804-5040.

What if I want a second opinion about my treatment or diagnosis?

You may have questions or concerns about your treatment or services, and you want a review of this. You have the right to get a second opinion about your mental health care or diagnosis. To get a second opinion, call CHP’s toll free number at 1-800-804-5008.

What If I Have Other Insurance in addition to Medicaid?

By law, Medicaid is always the last payer. If you have insurance in addition to Medicaid (such as Medicare or private insurance) you MUST follow the rules of that insurance company when seeking services. For example, you must use the providers in your insurance company’s network. You also must follow their rules for preauthorization. If your other insurance does not cover a mental health service that is covered by Medicaid, you can ask CHP to provide that service. If you can’t find a Medicare Provider, you can ask CHP to help you at 1-800-804-5008.

If you do not follow the rules of your other insurance company and that company denies payment, then Medicaid will reduce what it pays. If that happens, you WILL have to pay the difference. Call your primary insurance company for a list of their providers and to find out their rules for preauthorization.

How can I get transportation to appointments?

If you can't walk or you are so sick that you can’t get to your appointments by using regular means of transportation (walk, drive a car or take a bus), talk with your care provider or a case manager. Ask them about how you may be able to get a ride to your appointment. They can help you find a way. The mental health center numbers are in Appendix A.