Rocky Mountain Health Plans (RMHP) - Child Health Plan Plus (CHP+)

You do not need a referral (approval in advance) from your Primary Care Provider (PCP) to get mental or behavioral health services from a specialist, hospital, or other provider that is in RMHP’s network. Your mental health service provider may need to get approval in advance from RMHP for some services.

Example of services include but are not limited to:

• Outpatient Treatment
• Inpatient Services
• Mental Health Emergency Services
• Substance Use Disorder Services
• Medication Management
• Day Treatment
• Residential Treatment Services
• Specialized Mental Health home-based services

File a complaint about access to behavioral health care  

Your health plan is subject to the Mental Health Parity Addiction Equity Act of 2008. This means that your covered behavioral health benefits cannot be more difficult to access than physical health benefits. A denial, restriction, or withholding of behavioral health services could be a potential violation of the parity act. File a complaint with the Behavioral Health Ombudsman Office of Colorado if you have a parity concern.  

Behavioral Health Ombudsman Office of Colorado  

Call: 303-866-2789  

Email: ombuds@bhoco.org

Online: bhoco.org 

A representative of the Ombudsman Office will call or reply to you directly. You can also ask your behavioral health provider or guardian/legal representative to file a complaint for you. 

How to ask for an appeal for a child who is denied residential treatment

If you are a parent or guardian of a child under the age of 18 and your child was denied residential mental health treatment by, Rocky Mountain Health Plans, you have the right to request an additional review of this decision under the Child Mental Health Treatment Act (CMHTA). This review is performed by the Colorado Behavioral Health Administration. The Behavioral Health Administration will have an independent professional perform a free review or assessment of your child and provide a second opinion on your appeal. You must request this review within five (5) calendar days after we make our decision about your appeal. You may request this third-party review even if you do not request a State Review for your appeal. If you want to ask the Colorado Behavioral Health Administration to review the decision we made about your appeal, write, call, or fax: 

Mail:  

Colorado Behavioral Health Administration 

3824 W. Princeton Circle 

Denver, CO 80236 

Phone: 303-866-7400; State relay 711 

Fax: 303-866-7191 

We can help you find out how and where to get these services in your area. If you’re struggling or someone you love is hurting and you need to get help right away, contact Colorado Crisis Services. Coloradans can get free, confidential, and immediate help 24 hours a day, 7 days a week, 365 days a year from Colorado Crisis Services. Contact Colorado Crisis Services by calling 844-493-TALK (8255) or text TALK to 38255. You can also get online support at ColoradoCrisisServices.org.

CirrusMD provides the fastest connection to a board-certified doctor - answers to your healthcare questions are a text message away. Securely text, send photos, or video chat with a provider in the app right from your smartphone or computer. CirrusMD is available 24/7 for our Regional Organization (RAE), PRIME, CHP+ and DSNP Members at no cost.

Learn more about CirrusMD for RMHP

What Can CirrusMD Help With?

• General Health Questions: Do you have questions about medication side effects, lab orders/results, recommended health screens, or follow up questions after recent in-person care?
• Questions About Where to Receive Care: Before you schedule an in-person appointment or go to the ER, chat with a doctor instantly on CirrusMD.
• Urgent Care: coughs, fevers, sore throat, stomach pain, rashes, allergic reactions, animal/insect bites, and pediatric care such as common viral infections
• Mental Health: anxiety, depression, stress, insomnia
• Chronic Care and Prevention: Is your asthma under good control? Questions about weight loss, smoking cessation, managing diabetes, hypertension, or acne?
• Women’s Health: birth control, irregular bleeding, urinary tract infections, wellness

You can go to any doctor in our provider directory for covered services. This includes women’s services. It also includes care when you are pregnant. Some of these doctors are specialists like obstetricians, gynecologists, and certified nurse midwives. As soon as you know you are pregnant you need to begin your prenatal care. This care is very important in the first 8–12 weeks of you being pregnant and then continuing until you have your baby. Please call Member Services if you need help finding a prenatal provider. We can help support you during your pregnancy. We can talk to you to see if you are at risk of having your baby early. Our Care Coordinators can also help you with special issues such as: twins, breast-feeding, premature labor, diabetes, bed rest, and stop-smoking programs.

WellHop and Simplifed are programs to provide support for expectant moms during their pregnancy and beyond. Click on these links for more information: WellHop & SimpliFed.

Refer to Member handbook for more information and exclusions. 

Care coordination is a way that RMHP helps members coordinate services for serious illnesses or injuries or helps to provide individualized support for complex or special needs. Care Coordinators at RMHP work with your doctors to make sure they talk to each other about your care. Sometimes your doctor or hospital may tell RMHP that an RMHP member needs a Care Coordinator. Care Coordinators also check to see if other services may work for you. This helps to make sure you are getting care that is medically necessary. You can also call and ask us for help.

Here is how to reach us:

Call Member Services at 1-877-668-5947 and ask to speak to a Care Coordinator

• If you need language assistance you can call us.
• If you are Deaf, hard of hearing, or have a speech disability, dial 711 for Relay Colorado or use our Live chat on uhccp.com/CO or member secure website at myuhc.com/communityplan
• Care Coordination staff are available Monday through Friday, 8:00 a.m. to 5:00 p.m.
• After hours you can leave a message and we will call you back the next business day.

The following are covered vision services:

• This plan covers age-appropriate vision screening and routine eye exam.
• One routine eye exam is covered per calendar year.
• Routine vision services do not require pre-authorization.
• This plan provides a $150 credit per member per calendar year towards the purchase of lenses, frames, and/or contacts. Lenses, frames, and/or contacts can be purchased from an in-network or out-of-network provider.
• This plan covers specialty vision services to an in-network provider.
• A specialty vision service is when you see a vision provider for something other than a routine exam. Your specialty vision provider may need to submit a pre-authorization request to RMHP.
   

Through DentaQuest; Learn more about Adult Dental Benefits and DentaQuest (https://hcpf.colorado.gov/dental-benefits) Contact DentaQuest to find out more: 1-855-225-1729, TTY: 711 DentaQuest.com/Colorado

Dental Services through DentaQuest include: Services include cleanings, fillings, root canals, crowns, and partial dentures. There are no co-pays applicable. Limit: Annual adult (21 years old and up) benefit of up to $1,500 per state fiscal year which runs from July 1 – June 30. Emergency and dentures benefits are not subject to this limit. There is no limit for children’s services (21 years old and under). There are no exclusions. Sometimes a prior authorization is needed, check https://www.healthfirstcolorado.com/glossary/prior-authorization-request-need-one/ to determine if a prior authorization is needed.

Have questions? Visit myUHC.com, email us at rmhp_member_services@uhc.com, or call Member Services at 1-877-668-5947, TTY 711, 8 am – 5 pm, MST, Monday – Friday.

You understand that any email you send to us outside of the MyUHC portal may have your protected health information in it. That email will be sent unencrypted. When an email is sent unencrypted there might be a risk that someone else could read it. The contents of the unencrypted email could be disclosed. 

Respiratory therapies are covered as ancillary services in an inpatient facility as well as in an outpatient setting. See Member Handbook for more details.

If you want to change your PCP, go to the secure member website (myuhc.com/communityplan) and follow the steps for picking a new PCP. You can change your PCP at any time. Information in the provider directory includes the names, titles, addresses and telephone numbers of providers that are in RMHP’s network. This means you can see these providers without contacting RMHP first.

If you need a provider directory or need help finding a PCP in your area, call Member Services. RMHP’s online provider directory can be found at uhccp.com/CO or by logging into your secure member website at myuhc.com/communityplan. This directory gives you information about contracted providers in your area who speak languages other than English, and which providers accept new patients.

If you are changing doctors because you moved, call CHP+ Eligibility and Enrollment Broker, 1-888-367-6557 to let them know your address has changed. You can also update your address in your PEAK account. Call Member Services if you need help changing your PCP..

With a diagnosis of diabetes, we offer support with: inpatient nutrition counseling, outpatient nutrition and self-management training and follow-up visits for members diagnosed as diabetic.

Coverage for a life or limb-threatening emergency if transported in a licensed ambulance. See Member Handbook for more detail and exclusions.

Durable Medical Equipment-Maximum of $2,000 per calendar year. See Member Handbook for further details for this benefit.

Who can provide home health care/home infusion therapy?

Benefits are provided for services performed by a home health agency that can arrange and provide nursing services, home health aide services and other therapeutic services. Home infusion therapy is when a nurse comes to your home to give you a medication intravenously (through an IV) or with a shot. Please see Member Handbook for additional covered services.
 

Medically Necessary Covered Services for patients that are generally and typically provided by acute care general Hospitals. Hospital Services shall also include services rendered in the emergency room and/or the outpatient department of any Hospital. Except for a Medical Emergency or Written Referral, Hospital Services are Covered Services only when completed by Participating Providers. Please see Member Handbook for other details.
 

If you are new to RMHP and you have special health care needs and are seeing a doctor that is not on our list, you can:

• Keep seeing your previous primary care doctor for 60 calendar days. You can keep getting the same ongoing care you got before you joined RMHP.
• Keep seeing your other doctors for 75 calendar days. You can keep getting the same care you got before you joined RMHP.
• Keep seeing your previous primary care doctor if you are in your fourth through ninth month of pregnancy. You can keep seeing your previous primary care doctor until you finish the care you need following the birth of your child.

Having special health care needs can be frightening and difficult, but RMHP is here to help you. We want you to follow your doctor’s treatment plan and learn about your special needs. Our nurses and Care Coordinators will work with you one-on-one.

Kidney Dialysis is covered with $0 copay.

Benefits are provided for diagnostic services received in a provider’s office when they are required to diagnose or monitor a symptom, disease or condition. Benefits for diagnostic services done in a provider’s office include, but are not limited to, the following:

• X-ray and other radiology services,
• Laboratory and pathology services, and
• Ultrasound services for non-pregnancy related conditions.

For pregnancy-related ultrasounds, see the Maternity and newborn child-care section of the Member Handbook.

If you need help with the information in any RMHP document, including written/ oral translation; or in a different format like large print or as an audio file, we can help you at no cost. You can get help by calling Rocky Mountain Health Plans (RMHP) at 877-668-5947 or State Relay 711 for callers with speech or hearing disabilities.

Si necesita ayuda con la información en cualquier documento de RMHP incluida la traducción oral/escrita, un formato diferente (como letra grande), o un archivo de audio, podemos ayudarlo sin costo. Puede obtener ayuda llamando Rocky Mountain Health Plans (RMHP) al 877-668-5947 o State Retransmisión 711 para personas con discapacidad auditiva o del habla.

Covered as part of wellness checkups with your Primary Care Provider.  

The most up-to-date list of prescription medications covered under this plan is on RMHP’s website at uhccp.com/CO. A paper copy is available at no cost by calling Member Services. The name of the document that lists covered prescription medications for this plan is RMHP PRIME and CHP+ formulary. The RMHP PRIME and CHP+ formulary also provides information about coverage guidelines, quantity limits, which medications that require pre-authorization, and what to do if you are prescribed a medication that is not on the list.

This plan covers up to a 90-day supply of a prescription maintenance medications from an in-network pharmacy. Some medications are limited to 30-day supplies at one time. Mail order fills up to a 90-day supply. Prescription contraceptives, including oral contraceptives (the Pill), contraceptive patches, and vaginal ring contraceptives, can be covered for up to a 12 month (1 year) supply after filling 3 months of the same contraceptive. Please see Member Handbook for more information.
 

Free QuitLine tobacco cessation counselor — Call 800-QUIT-NOW (800-784-8669) or visit www.coquitline.org

Covered as part of regularly scheduled childhood and adult preventive services.

Coverage for outpatient physical rehabilitation (physical, occupational, and/or speech therapy) includes up to 30 visits per calendar year per diagnosis.

For children ages 0-3, additional therapies as described above, are unlimited for those members who qualify for Early Intervention Services.