Psychiatric Services In Hospitals Benefit

What psychiatric services in hospitals are available to Health First Colorado (Colorado's Medicaid program) members?
Health First Colorado covers psychiatric inpatient care in general hospitals for Health First Colorado members when services are medically necessary to treat a covered psychiatric condition. Health First Colorado members are assigned to a regional organization which helps the member plan the best way to treat mental health concerns.

How do I get services?
It is recommended that you call your regional organization or talk to your primary care doctor about any mental health concerns you have (for example, depression, excessive worrying, or drinking too much). If you think you need either inpatient or outpatient services for a mental health concern, your doctor or BHO can refer you to the appropriate providers for services.

To contact your regional organization in order to request mental health services, you may call the telephone number on your Health First Colorado card. If you are at risk of injuring yourself or someone else, you may go to an emergency room (ER). If you go to the ER, hospital staff will evaluate you and contact your regional organization to help plan the best way to treat your concerns.

Are there any limits on services?
Psychiatric services for adults in general hospitals are limited to no more than 45 days. Children ages 20 and under may go beyond this limit with prior authorization.

Are all services approved?
Services must be medically necessary and covered by Health First Colorado. Your doctor, or an emergency room doctor, can help you decide whether you need to be in the hospital for a mental illness. Your regional organization can talk to you about all of the services available to you.

Are psychiatric services provided in specialized psychiatric hospitals?
Services can be provided in a specialized psychiatric hospital if approved by your regional organization. Your doctor or psychiatrist can request this coverage if it is medically necessary.

What kind of hospital outpatient mental health services are available?
Outpatient mental health services may be provided in a variety of settings including community mental health centers, federally qualified health centers, general hospitals or by individual practitioners. Outpatient services in specialized psychiatric hospitals are not covered.

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