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Rocky Mountain Health Plans - PRIME

Medicaid

Rocky Mountain Health Plans - PRIME is a Medicaid Managed Care plan for adults or those with a disability who live in certain counties on the Western Slope of Colorado and meet income and other requirements.

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Benefits & Features

Preventive and Routine Care

  • Even if you are not sick, it is very important to get routine care and preventive screenings.
  • Annual routine physicals for adults are covered.
  • Preventive visits to your PCP and your obstetrician/gynecologist (OB/GYN) are covered. This includes physical exams and   well-child care.
  • Routine health screenings are covered, such as colorectal cancer screening, depression screening, diabetes testing, high blood pressure screening, cholesterol screening, HIV/STD screenings, breast cancer screening, cervical cancer screening, osteoporosis screening, prostate cancer screening and more!
  • For children from birth to 3 years old: well-child visits are covered as needed for their age.
  • For members over 3 years old: 1 routine physical exam is covered each year.

Mental health care

RMHP covers the following Health First Colorado mental health services:

  • Behavioral health assessments
  •  Electroconvulsive therapy
  •  Inpatient psychiatric hospital services
  •  Medication management
  •  Outpatient day treatment
  •  Outpatient hospital services
  •  Psychological or neuropsychological testing including administering tests, interpreting results and preparing reports (does not include educational testing, vocational testing or testing for medical conditions)
  •  Psychotherapy: family, individual, individual brief, and group counseling and therapeutic contact
  • Targeted case management services

RMHP also works closely with the Community Mental Health Centers in your area. They may also have additional services available, such as:

  • Vocational services
  • Intensive case management
  • Prevention/early intervention activities
  • Clubhouse and drop-in centers
  • Residential
  • Assertive community treatment (ACT)
  • Recovery services
  • Respite services

Some of these behavioral health care services require prior authorization. Your provider will know which services must be approved by RMHP before you can receive them.

Substance Use Disorder (SUD) treatment

Substance use disorder treatment may be covered by RMHP. Contact RMHP for more details.

NOTE: SUD is covered for pregnant women through Special Connections. See Important Community Phone Numbers in the Member handbook to contact Special Connections. Beginning in 2021, additional SUD benefits are covered. Members now have additional coverage (4 levels of care) including inpatient withdrawal management and residential treatment.

  • Medically Managed Withdrawal Management (WM) Services — Level 3.7 WM
  • Medically Monitored Intensive Inpatient Services — Level 3.7
  • Clinically Managed High Intensity Residential Services — Level 3.5
  • Clinically Managed Population-Specific High Intensity Residential Services — Level 3.3
  •  Clinically Managed Low Intensity Residential Services — Level 3.1

For Inpatient withdrawal management:

  • Level 3.7 WM is considered a behavioral health benefit
  • Level 4 WM is considered a physical health benefit

SUD Treatment and services is managed by RMHP Behavioral Health Utilization Team. Prior authorization for treatment and services may be required. Please talk to your provider about contacting RMHP before you receive SUD services.

Refer to Member handbook for more information and exclusions.

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

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. See the Covered services and benefits section in the Member handbook for more details.

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 coordination may also be referred to as Care management or case management.  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:

Member Services at 1-800-421-6204 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/co. 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.

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 1-800-421-6204, 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.

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 received before you joined RMHP.
  • Keep seeing your other doctors for 75 calendar days. You can keep getting the same care you received 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.

If you have a question, need help with your health care, or have a special need, please contact us.

We’re here to help. Call Member Services at 1-800-421-6204. Representatives are available Monday–Friday, 8:00 a.m.–5:00 p.m. 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 myuhc.com/communityplan.

X-rays and diagnostic tests to find out what is wrong are covered. They need to be ordered by your PCP or specialist.

Language Help

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 800-421-6204 or State Relay 711 for callers with speech or hearing disabilities.

Si necesita ayuda con la información en este documento 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 800-421-6204 o State Retransmisión 711 para personas con discapacidad auditiva o del habla.

Medicines

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. 

Nurse Hotline

The Health First Colorado Nurse Advice Line provides Health First Colorado (Colorado’s Medicaid program) members free medical information and advice, in both English and Spanish, 24 hours a day, every day of the year. Call 1-800-283-3221 to:

  • Talk to a nurse who will answer medical questions, give care advice, and help you decide if you should see a provider right away.
  • Get help with medical conditions such as diabetes or asthma.
  • Get advice on the type of doctor that may be right for your medical condition.
  • The Nurse Advice Line can’t help with clinic appointments or medication refills. Call your health care provider’s office if you need help with these.

RMHP Care Coordination has nurses that can also help you with many needs. You can contract the RMHP Care Coordination team through the Member Services phone number, 1-800-421-6204.

Phone Services

Colorado Lifeline Service is a government assisted wireless service that provides discounted home phone or cell phone services to eligible low income families and individuals. Colorado Lifeline Service discounts are offered to qualified Colorado customers who meet certain eligibility requirements such as, government assistance or a household income that is at or below 135% of the federal poverty level. Customers can check their Eligibility for the Program, apply online and avail the benefits, along with Discounts and Offers.

Select the prepaid plan that best fits your needs. There are several prepaid plans available under TAG Mobile Colorado Lifeline Services. You can change your plan every month to fit your lifestyle or you can add minutes anytime at your convenience.

Free Lifeline Government Cell Phone Service in Colorado (tagmobile.com)

Quit using Tobacco or Vaping Product

Free QuitLine tobacco cessation counselor — Call 800-QUIT-NOW (1-800-784-8669) or visit www.coquitline.org

Therapy Services

Habilitative therapy and devices

Habilitative services and devices include therapy and medical equipment that helps a person retain, learn, or improve skills and functioning for daily living. Habilitative therapy is covered for certain Health First Colorado members ages 19 through 64. Eligible members includes people who qualify for Health First Colorado due to the eligibility expansion through the Affordable Care Act. Coverage includes outpatient physical, occupational, and speech therapy benefits for the purposes of habilitation in addition to rehabilitation. Eligible members may receive habilitative therapy and devices when they are approved in advance by RMHP.

Rehabilitation

Therapy because of an injury or sickness is covered. This includes medically necessary:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Pulmonary therapy
  • Cardiac rehabilitation

Member Resources

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Rocky Mountain Health Plans PRIME

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