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Substance Use Disorder (SUD) Benefit

Substance Use Disorder (SUD) Benefit

Rocky Mountain Health Plans is responsible for authorizing inpatient and residential substance use disorder treatment stays as part of administering Health First Colorado’s capitated behavioral health benefit. On January 1, 2021, Health First Colorado, Colorado’s Medicaid program, will expand its substance use disorder (SUD) benefit. Residential and inpatient treatment and withdrawal management services will be added to the Department of Health Care Policy & Financing existing list of covered SUD services, giving Members access to a full range of treatment options.


Trainings

 
 

Prior Authorization Notification Process

The following services require preauthorization before the Member starts treatment:

  • Level 3.7- Medically Monitored Intensive Inpatient
  • Level 3.5- Clinically Managed High-Intensity Residential
  • Level 3.3- Clinically Managed Population-Specific High-Intensity Residential
  • Level 3.1- Clinically Managed Low-Intensity Residential
  • Level 2.1- Intensive Outpatient Programming (IOP)

To obtain prior authorization for these services, please complete Initial SUD Authorization form [this should be linked here] along with clinical documentation supporting the ASAM level of care and fax it to 970-257-3986 or secure email it to BHVM@RMHP.org.

These services require 24 hour notification of admission:

  • Level 3.7WM- Medically Monitored Withdrawal Management
  • Level 3.2WM- Clinically Managed Withdrawal Management

To notify of an admission, please call us at 855-886-2832, email us at BHVM@RMHP.org or fax us at 970-257-3986. We will need the Member’s name, date of birth, and the level of care.

Frequently Asked Questions

 

Resources

 
 

Questions

For questions about the new Medicaid Substance Use Disorder (SUD) benefit please contact SUD Support at SUDSupport@rmhp.org.