Information Available in the Handbook and Website

December 15, 2017

Dear enrolled or eligible BHI Member, This letter is about your behavioral health benefits through Health First Colorado, Colorado’s Medicaid Program. You are getting this because you or someone in your household is enrolled or eligible for this program. Behavioral Healthcare, Inc. (BHI) manages your behavioral health benefits.

Information Available in the Handbook and Website The Health First Colorado Handbook and BHI’s Welcome Letter have information about all Health First Colorado benefits, including behavioral health benefits. You can also find information at our website (www.bhicares.org) or the Health First Colorado website (www.healthfirstcolorado.com), including:  Your behavioral health benefits: o Details on services that need a referral or approval o Services that are included and excluded from your Medicaid coverage o Benefit limits for out-of-network services  Finding a provider in our network  Getting care outside of our network  Getting care after normal business hours

 Getting emergency care and BHI’s policy on when to directly access emergency care or use 911 services  A full list of your rights and responsibilities as a member

 Making a complaint, requesting a State Fair Hearing, and appealing a decision about your benefits – what to do and by when

 Advanced directives to protect your right to make medical decisions for yourself, and how to discuss your medical decisions with your provider

 Our privacy policies for collecting, using, and sharing your information. Our Notice of Privacy Practices is attached. For questions, contact our Member Services Department at 303-361-8100 option 1 or 1-844-818-2485 (toll-free) or 1-844-528-0372 (TTY).

Charges for Services and Physician Incentives There are no copays or charges for covered behavioral health services. Additionally, BHI does not have physician incentive plans; BHI approves or denies services solely due to the need for care and presence of coverage

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for Children and Youth Health First Colorado members who are 20 years old or younger get special benefits to stay healthy. These benefits are to prevent or treat any health, dental, or developmental problem. EPSDT covers any

Phone: 303-361-8100 | Toll Free: 844-818-2485 | Fax: 303-364-2240 | 1290 Chambers Road | Aurora, Colorado 80011 | bhicares.org medically necessary care, even if it’s not usually a covered benefit. You are automatically enrolled and all Health First Colorado providers can offer the EPSDT services.  Children 18 years old and younger can get EPSDT with no co-pay for any covered service.

 Adults 19 and 20 years old can get EPSDT, but may have a small co-pay for some services.

 Children in Department of Social and Human Services custody can get ESPDT with no co-pay if they are 18 or younger. They may have some co-pays if they are 19 or 20.

Colorado Mental Health Treatment Act (CMHTA) Children under the age of 18 may be able to get residential, community, or transitional treatment services under the Child Mental Health Treatment Act (CMHTA). Contact the CMHTA liaison at your local Community Mental Health Center or call BHI at (303) 361-8100 to ask about authorization for services.

Community Resources Find support in the community. Check www.bhicares.org to learn about 24/7 hotlines and programs that help with substance abuse treatment, housing, care management, and more.

Quality of Services BHI has a Quality Improvement (QI) Department that is in charge of the clinical and service improvement activities of BHI. We work to make sure your services are safe, appropriate to your needs, and in line with state and federal rules or call us to learn about our quality projects and goals. You can also get a copy of our Annual Quality Report. If you have any questions about the QI Department or to request a copy of the QI Program Description or the Annual Quality Report, please give us a call or go to www.bhicares.org.

For Information, Help, and Questions We offer free copies of the handbook and provider directory. We also offer large print documents and materials in Spanish as well as in other common languages. We will send these to you within 5 days of your request. To contact us:  303-361-8100 option 1 (local)

 1-844-818-2485 (toll-free)

 1-844-528-0372 (TTY) – for members who are deaf, hard of hearing, or have speech impairments

We offer translation, TDD, and interpreter services to all members free of charge, simply call any of the numbers above. If you have a question about a service that needs approval or a benefit that was denied, call Utilization Management at the numbers above. You can call 24 hours a day, 7 days a week. For all other questions, including information about the structure and/or operation of BHI, we are here Monday through Thursday from 8:00 a.m. to 5:00 p.m., and on Friday from 8:00 a.m. to 4:00 p.m.

Member Services Department Behavioral Healthcare, Inc. 303-361-8100 option 1

Behavioral Healthcare, Inc. (BHI) complies with applicable Federal and state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identify, or sex. BHI does not exclude people or treat them differently because of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. BHI:  Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats)  Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages

If you need these services, contact the BHI’s Office of Member and Family Affairs Department, Civil Rights Coordinator. If you believe that BHI has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator 1290 Chambers Road Aurora, CO 80011 303-361-8100 option 1 Toll Free: 1-844-818-2485 TTY: 1-844-528-0372 Fax: 303-361-8251 [email protected]

You can file a grievance in person or by mail, fax, or email. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html.

Si necesita esta carta en letra grande, casete, o en otro idioma, por favor llámenos al (303) 361-8100. Si desea usar el servicio TTY/TTD, llame a 1(844) 528-0372.

If you need assistance understanding the information in this letter, including written or oral translation, we can help you. You can get help by calling Behavioral Healthcare Inc. at (303) 361-8100/TTY 1 (844) 528-0372 or State Relay 711 for callers with speech or hearing disabilities.

Phone: 303-361-8100 | Toll Free: 844-818-2485 | Fax: 303-364-2240 | 1290 Chambers Road | Aurora, Colorado 80011 | bhicares.org ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-818-2485 opción 8 (TTY: 1-844-528-0372).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-818-2485 Tùy chọn 8 (TTY: 1-844-528-0372).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-844-818-2485 按 8（TTY：1-844-528-0372）。

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-844-818- 2485 선택권 8 (TTY: 1-844-528-0372) 번으로 전화해 주십시오.

ВНИМАНИЕ: Если вы говоритенарусскомязыке , то вамдоступныбесплатныеуслугиперевода . Звоните 1-844-818-2485 вариант 8 (телетайп : 1-844-528-0372).

ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-844-818-2485 አማራጭ (መስማት ለተሳናቸው: 1-844-528-0372).

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم -1 2485-818-844 اختيار 8 (رقم هاتف الصم والبكم: 844-528-0372-1).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-844-818-2485 auswahl 8 (TTY: 1-844-528-0372).

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-844-818-2485 option 8 (ATS : 1-844-528-0372).

धन दनहस: तपरल नपल बलनहन भन तपरक ननमत भष सहत सवहर ननशलक रपम उपलब छ । फन गनहस 1-844-818-2485 ववकलप (ददवर: 1-844-528-0372) ।

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-844-818-2485 x8 (TTY: 1-844-528-0372).

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-844-818- 2485 選択 8 (TTY: 1-844-528-0372）まで、お電話にてご連絡ください。

XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-844-818-2485 x8 (TTY: 1-844-528-0372).

توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلت زبانی بصورت رایگان برای شما فراهم می باشد. با 1-844-818-2485 انتخاب TTY: 1-844-528-0372) 8) تماس بگیرید.

Phone: 303-361-8100 | Toll Free: 844-818-2485 | Fax: 303-364-2240 | 1290 Chambers Road | Aurora, Colorado 80011 | bhicares.org Dè ɖɛ nìà k ɛ dyé ɖ é gbo: Ɔ j ǔ ké m Ɓɔ[ às ɔ - wù ù-po-ny ɖ ɔ ] j ní, ǔnìí, à wu ɖ u kà kò ɖ ò po-po ɔɓɛ ìn m gbo kpáa. Ɖ á 1-844-818-2485 x8 (TTY:1-844-528-0372)