Member Rights and Responsibilities

Your Rights

You have the right to:

1. Receive a member handbook and get information about your coverage, plans, benefits, services, advance directives, or disenrollment rights (see below).
2. Be treated with respect and consideration for your culture, privacy, and dignity .
3. Get information in a way you can easily understand. This includes language services.
4. Get information from your provider about treatment choices and alternatives for your health condition.
5. Be involved in all decisions about your health care, obtain a second opinion, and say “no” to any treatment offered.
6. Not be secluded or restrained as a punishment or to make things easier for your provider.
7. Ask for and get a copy of your medical records from your provider and ask that they be changed or corrected.
8. Get quality, available, and nearby health care services in a timely and coordinated way.
9. Use your rights to file a complaint or tell others your view of services without fear of being treated poorly.
10. Any other rights guaranteed by law, for example the Health Insurance Portability and Accountability Act (HIPAA) and Americans with Disabilities Act (ADA).
11. Be free from discrimination based on race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, disability, health status including Acquired Immune Deficiency Syndrome (AIDS) or whether you have made an advance directive.
12. Ask your health plan for help if your provider does not offer a service you need because of moral or religious reasons and be told if your provider stops seeing members or has changes in services.

Your Responsibilities

You have the responsibility to:

1. Understand your rights.
2. Follow the Health First Colorado’s (Colorado’s Medicaid Program) handbook to learn about your benefits and how to use them.
3. Treat other members, your providers, and their staff with respect.
4. Choose a Primary Care Medical Provider (PCMP). Click here if you want to choose a different PCMP. ➚
5. Go to your appointments on time or call your provider if you will be late or cannot keep your appointment and pay for services you get that are not covered by Health First Colorado.
6. Tell your provider and Health First Colorado if you have any changes to your family, income, jobs, other insurance, or address within 10 days of the change.
7. Tell your treatment team (PCMP, specialist, therapist, or care coordinator) information they need to care for you, such as your symptoms or if you do not understand your treatment plan or want to learn more.
8. Follow your treatment plan and take medications as prescribed and tell your provider about side effects or if your medications are not helping.
9. Invite people who will be helpful and supportive to you to be included in your treatment.
10. Report suspected member or provider fraud or abuse to Member Fraud at 844-475-0444 or Provider Fraud at 855-375-2500. Or go to CO.gov/hcpf/how-reportsuspected-fraud.

Access to Care Standards

Northeast Health Partners (NHP) ensures that our network is able to meet all members’ needs for access to care to serve physical and behavioral health care needs, care coordination needs, and allow members’ freedom of choice of providers. This standard of care is available for all members, regardless of eligibility criteria.

• Primary Care Medical Providers (PCMPs) are required to serve Health First Colorado (Colorado’s Medicaid Program) members as their nearby medical home.
• Behavioral Health Providers are required to provide services to members on a timely basis.
• All Providers aim to meet high access-to-care standards such as:
• Provide reasonable hours of operation, including 24-hour availability of information, referral, and treatment for emergency medical conditions.
• 24/7 phone coverage with access to a clinician that can triage Member’s health need.
• Appointment availability on weekends and extended weekday hours
• Short waiting times in the reception area.

All Providers also aim to serve members on a timely basis, as follows:

• Urgent Care – within twenty-four (24) hours after the initial identification of need.
• Outpatient follow-up appointments – within seven (7) days after discharge from a hospitalization.
• Non-urgent Symptomatic Care Visit – within seven (7) days after the request.
• Well Care Visit – within one (1) month after the request; unless an appointment is required sooner to ensure the provision of screenings in accordance with Department’s accepted Bright Futures schedule.
• Emergency Behavioral Health Care – by phone within fifteen (15) minutes after the initial contact, including TTY accessibility; in person within one (1) hour of contact in Urban and suburban areas, in person within two (2) hours after contact in Rural and Frontier areas.
• Non-urgent, Symptomatic Behavioral Health Services – within seven (7) days after a member’s request.

Administrative intake appointments or group intake processes will not be considered as a treatment appointment for non-urgent symptomatic care. NHP will not place members on wait lists for initial routine service requests.