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Medicaid Information

Printable Handbook

As a Medicaid member, you are part of the Prepaid Mental Health Plan (PMHP). If you live in Utah County, your PMHP provider for mental health services is Wasatch Mental Health.  Your PMHP provider for substance use disorder is Utah County Department of Drug and Alcohol Prevention and Treatment (aDDAPT)

Como miembro de Medicaid, Usted es parte del Plan Pre-pagado de Salud Mental. Si vive en el condado de Utah, el proveedor que le corresponde para los servicios de salud mental es Wasatch Mental Health. El proveedor para el trastorno de uso de sustancias es Utah County Department of Drug and Alcohol Prevention and Treatment. Utah County (aDDAPT)

Wasatch Mental Health will provide you with the mental health services if you need them. aDDAPT will provide you with substance use disorder services if you need them.

Wasatch Mental Health le proveerá los servicios de salud mental si es que los necesita. aDDAPT del condado de Utah le proveerá los servicios de trastorno de uso de sustancias si es que los necesita.

You cannot choose a different mental health plan or a different substance use disorder plan, but you might be able to choose your provider. (In Section 1, see Services from Providers, page 10, and in Section 2, see Services from Providers, page 24). 

Usted no puede elegir otro plan de salud mental u otro plan de trastorno de uso de sustancias, pero es posible que pueda elegir el proveedor. (En el sección 1, véase Servicios de Proveedores, página 10, y sección 2, Servicios de Proveedores, página 24.)

This handbook explains the Medicaid mental health and substance use disorder services that the PMHP covers.

Este folleto explica los servicios de salud mental de Medicaid y los servicios de trastorno de uso de sustancias que ofrece PMHP.

Section 1 of this handbook explains the Medicaid mental health services that Wasatch Mental Health covers. 

Sección 1 de este folleto explica los servicios de salud mental de Medicaid que ofrece Wasatch Mental Health

Section 2 of this handbook explains the Medicaid substance use disorder services aDDAPT covers.  (Section 2 starts on page 18).

Sección 2 de este folleto explica los servicios de trastorno de uso de sustancias que ofrece aDDAPT. (Seccion 2 comienza en la página 18.)

 

You can get this handbook and other written information in Spanish. You can also get them on compact disc (CD) in either English or Spanish.  For help, call 801-373-4760 or

1-866-366-7987.

 

Usted puede obtener este manual y cualquier otra información escrita en español. También puede obtenerlos en cintas compactos (CD) tanto en español como en inglés. Para obtener ayuda, llame al 801-373-4760 o al 1-866-366-7987.

Section 1

Medicaid Mental Health Services – Wasatch Mental Health

Wasatch Mental Health provides mental health care for children, youth and adults.  If you need mental health services, call the clinic nearest your home. (See Getting Mental Health Services, page 6). You can also call Wasatch Mental Health’s main office at 801-373-4760 or 1-866-366-7987.  A staff member will help you with scheduling, office locations, and treatment services.

Covered Mental Health Services

What mental services are covered?

Inpatient hospital care for mental health problems and outpatient services for mental health problems are covered. Outpatient mental health services include:

  • Evaluations
  • Psychological Testing
  • Individual and Group Therapy
  • Family Therapy
  • Individual and Group Therapeutic Behavioral Services
  • Medication Management
  • Individual Skills Training and Development
  • Psychosocial Rehabilitation Services (Day Treatment)
  • Peer Support Services
  • Targeted Case Management Services

 

 

We will give you the services you need after we meet with you to talk about your needs.  During your first appointment, the intake worker will talk with you about appropriate providers, whether they are taking new clients and the non-English languages they speak.

 

Services are provided by licensed mental health professionals, including doctors, nurses, psychologists, social workers, professional counselors, marriage and family therapists, case managers, etc.  If you want more information on any of these services, call Wasatch Mental Health’s main office at              801-373-4760 or 1-866-366-7987.

Are any other services covered?

Yes, other services are:

  • Electroconvulsive Therapy (ECT)
  • Interpreter Services

 

Also, if you have Traditional Medicaid, there are some other services that might be covered based on your needs.  Your provider can talk with you about these services:

 

  • Respite Care                              
  • Psychoeducational Services
  • Personal Services
  • Supportive Living

 

Transportation

How can I get help with transportation to my mental          health services?

 

Traditional Medicaid Members

You may be able to get help with rides to your mental health services.  If you do not have a ride, call the Department of Workforce Services (DWS) to get a bus pass:

 

  • DWS:  801-526-0950 or 1-866-435-7414

 

If you cannot ride the bus, Logisticare may be able to help with non-emergency rides:

 

  • Logisticare: 1-855-563-4403

 

UTA Flex Trans is a special bus service that might be able to help:
 

  • Flex Trans:  1-877-882-7272, ext. 6

To learn more about help with rides, see the Medicaid Member Guide.  You can find the guide online or call Medicaid with questions:

  • Medicaid Member Guide at Medicaid.utah.gov or
  • Call Medicaid at 1-800-662-9651

 

 

You can also talk to us about your needs. Call us at:

  • Adult Community Services at 801-373-7394, or
  • Youth Case Management at 801-377-1213 

 

Non-Traditional Medicaid Members

You do not get help with rides for services that are not an emergency.

 

Interpreter Services

What if I need an interpreter?

We know it can be hard to talk with your provider if your first language is not English or you are hard of hearing.  We might have providers who speak or sign your language.  You can ask to get services from them, or you can ask for an interpreter.  Interpreters are free and available in all languages, including sign language.  An interpreter can help you over the phone or be with you at your mental health visits.  They will help you talk with and understand what your provider is telling you.  To ask for an interpreter or a provider who can speak or sign your language, call: Adult Services at 801-373-9656; Youth Services at 801-377-1213; or Wasatch Mental Health’s main office at 801-373-4760 or 1-866-366-7987.  If you will need an interpreter for your mental health services, during your first appointment, the intake worker will also talk with you  more about this.

 

What if I want to call Wasatch Mental Health and I am deaf, hard of hearing or have a hard time speaking?

You can call Relay Utah at 711. If you have a hard time speaking, you can also call Speech-to-Speech Relay Utah at     1-888-346-5822 and a trained person will help you. If you speak Spanish and are deaf, hard of hearing or have a hard time speaking, call Spanish Relay Utah at 1-888-346-3162.

 

For more information about Relay Utah, go to their website at www.connectutah.com  If you need a telecommunications device (TTY), call Sprint Relay Customer Service at 1-800-676-3777, or TTY at 1-800-346-4128.  In some cases, the TTY device might be available at little or no cost to you.

Servicios de intérpretes

¿Qué sucede si necesito un intérprete?

Sabemos que puede ser difícil hablar con su terapeuta si su primera lengua no es el inglés o si tiene problemas auditivos. Wasatch Mental Health cuenta con terapeutas que hablan otros idiomas que incluyen el lenguaje de señas. Puede solicitar que ellos le brinden servicios o puede solicitar un intérprete. Los intérpretes son gratuitos y están disponibles en todos los idiomas, incluyendo el lenguaje de señas. Un intérprete puede ayudarlo por teléfono o puede acompañarlo a sus citas de salud mental. Esto le ayudará a hablar con su terapeuta y comprender lo que le está diciendo. Para solicitar un intérprete o un terapeuta que pueda hablar otro idioma o el lenguaje de señas, llame a Servicios para Adultos al 801-373-9656, Servicios para jóvenes al 801-377-1213 ó 1-866-366-7987. 

 

¿Qué sucede si quiero llamar al a Wasatch Mental Health y soy sordo, no oigo bien o tengo problema en hablar?

Si es usted sordo o tiene dificultad para oír, llame  a Relay Utah al 711.  Si tiene discapacidad del habla, llame a Comunicación oral Relay Utah al 1-888-346-5822 y una persona especialmente calificada le ayudará. Si usted habla Español y está sordo o tiene dificultad para oír o impedimento en el habla, llame  a Español Relay Utah al 1-888-346-3162.

 

Para obtener más información sobre Relay Utah, visite su sitio Web en www.connectutah.com. Si necesita un teléfono de texto (TTY) de atención al cliente de Sprint Relay al 1-800-676-3777 o TTY al 1-800-346-4128. Si habla español, llame al 1-888-346-3162. En algunos casos el dispositivo TTY puede estar disponible a un bajo precio o de forma gratuita.

 

Services Not Covered by Wasatch Mental Health

What services are covered by Medicaid but not by Wasatch Mental Health?

Wasatch Mental Health does not provide medical care, dental care, or substance abuse services, for example.  Medical care includes medical detoxification in a hospital for a substance abuse problem. If you have questions about these or other services that might be covered by Medicaid, call your physical health plan, or Medicaid at 1-800-662-9651.  Call aDDAPT at 801-851-7128 or 844-773-7128 for questions about substance abuse services they cover.

 

Payment for Services

 

Hospital Emergency Room Services

Will I have to pay for services in a hospital emergency room?

 

You will not have to pay for emergency services in a hospital emergency room. However, there is a co-payment if you use the emergency room when it is not an emergency.

 

Mental Health Care in a Hospital

Will I have to pay for mental health care in a hospital?

 

You will not have to pay for mental health care in a hospital if you are:

  • On Medicaid under the CHEC program
  • Living in a nursing home
  • American Indian/Alaska Native
  • Getting hospice care
  • On Medicaid under the Medicaid Cancer program
  • On Medicaid due to being pregnant

 

If you are not in one of these groups, the hospital can charge you $75 for each hospital stay.  Hospitals cannot charge more than the co-payment.

 

Will I ever have to pay for mental health services?

 

Non-Emergency Outpatient Services

 

You might have to pay your provider for a service if:

  • You get a service that is not covered by Wasatch Mental Health or Medicaid; or
  • You get a service that is not pre-approved by Wasatch Mental Health (the provider or you tried to get approval but we denied the request or approved less than what was asked for); or
  • You do not go to a Wasatch Mental Health provider.

 

If any of the above happens, your provider might ask you to pay for the service.You should only be billed for the service if all four things below are met:

  • The provider has a written policy for billing all patients for services that are not covered, not just Medicaid patients;
  • The provider tells you before you get the service that you will have to pay for the service;
  • You agree to pay for the service; and
  • There is a written agreement signed by you and the provider that says what the service is and how much you will have to pay.

 

You might also have to pay your provider for a non-emergency outpatient mental health service if:

  • You ask for and get services during an appeal with or during a Medicaid state fair hearing.  You would only have to pay if the appeal or state fair hearing decision is not in your favor.
  • You are not on Medicaid when you get the service.

Emergency Outpatient Services       

You will not have to pay for emergency outpatient services.

 

 

Ambulance Services for Emergency Care

Will I have to pay for ambulance services for emergency care?

You will not have to pay for ambulance services for emergency care.

 

 

Getting Mental Health Services

How do I get mental health services?

Call the clinic nearest your home. (See Service Locations below)  If you have questions, call Wasatch Mental Health’s main office at 801-373-4760 or 1-866-366-7987.

 

Where do I go for mental health services?

Service Locations

 

Adult Services

  • Westpark Family Clinic

750 North Freedom Blvd (200 West), Provo, UT,

801-373-4760

  • Provo Family Clinic

1165 East 300 North, Provo, UT, 801-377-1213

  • North Utah County American Fork Family Clinic  578 East 300 South, American Fork, UT, 801-763-5010
  • South Utah County Payson Family Clinic

285 North 1250 East Payson, UT, 801-852-3805

 

Youth Services

  • Provo Family Clinic

     1165 East 300 North, Provo, UT, 801-377-1213

  • North Utah County American Fork Family Clinic

     578 East 300 South, American Fork, UT, 801-763-5010

  • South Utah County Payson Family Clinic

     285 North 1250 East Payson, UT, 801-852-3805

  •  Westpark Family Clinic

     750 North Freedom Blvd (200 West), Provo, UT,

801-373-4760

Evaluations and some therapy services are provided during the evenings.  Let us know if you need services in the evening.

 

How quickly can I be seen?

If you need emergency care, you will be seen right away. (See Emergency Services, page 10).  We will give you urgent care for conditions that need to be taken care of right away, but that are not considered emergencies.  If you need urgent care, we will see you within 5 working days. 

 

If you do not have an urgent need for care, we will see you within 15 working days.  If your condition changes and you think you need to be seen sooner, please call us.  We’ll talk about your needs again.

 

Are there other programs I can go to directly?

Yes.  Wasatch Mental Health has the following programs for children and youth that you can go to directly.

 

GIANT Steps Program – Autism Services

This is a pre-school for children with autism living in Alpine, Nebo, or Provo School Districts. The pre-school is located at Foothill Elementary School, 921 North 1240 East, Orem, Utah.  If your child has autism, you should call us at 801-226-5437 as soon as your child is diagnosed.  We will put your child on our list to start pre-school when he/she is three years old.

 

Vantage Point Youth Service Center

This is a 24-hour crisis management services for families who have out-of-control or runaway youth ages 12 to 18.  You can get services by calling 801-373-2215, or you can take your child to Vantage Point, located at 1189 East 300 North, Provo, Utah.

 

 

Services From Providers

Can I choose my Wasatch Mental Health provider?

You can talk to the Intake Worker about your choice of prescriber, therapist, or case manager who is right for your needs.

 

Intake Workers can be reached weekdays, 8:00 a.m.–5:00 p.m. Call 801-373-9656 for Adult Services, or 801-377-1213 for Youth Services, or call our main office at 801-373-4760 or

1-866-366-7987.

 

 

 

 

Can I get a second opinion?

Yes.  You have the right to get a second opinion about your mental health problem or services.  If you would like a second opinion by another provider, call us at 801-373-4760 or 1-866-366-7987. There is no cost for a second opinion.

 

Can I change my Wasatch Mental Health provider?

Yes. You can talk to your current provider about a change or you can call Wasatch Mental Health at 801-373-4760 or 1-866-366-7987 about your request.

 

Services From Other Providers

Can I get mental health services from someone outside of 

Wasatch Mental Health?

In some situations, you can go to a provider outside Wasatch Mental Health.  You and the provider must get approval before you get the service.  For more information, call our Program Manager who oversees contracts with outside providers weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987.

 

You do not need approval before you get emergency services.  (See Emergency Services, page 10).

 

When will I be told if I can see someone outside of Wasatch Mental Health?

If the provider has a written agreement with Wasatch Mental Health, we can usually decide within 14 calendar days.  Sometimes we might need more time to make a decision.  We will let you know about this in writing.  If we need to take more time, you can file a grievance if you are unhappy about this.  (See Complaints /Grievances, page 14). 

 

Also, you or your provider might want us to take more time for some reason.  If so, let us know.  If you, or your provider, think it is important to make a decision quickly for health or safety reasons and we agree, we will do so, generally in 3 working days.  We will give you our decision about your request in writing and we will contact the provider. 

If the provider does not have a written agreement with Wasatch Mental Health, we will always make a decision within 14 calendar days.

 

Emergency Services

What is a mental health emergency?

  • When you think your life is in danger.
  • When you believe you might harm yourself or others.
  • When your safety or others’ safety is at risk.

 

What are emergency services?

These are mental health services given to treat your emergency.

 

How do I get emergency services?

Wasatch Mental Health has 24-hour telephone emergency services seven days a week.  Call 801-373-7393 or 1-866-366-7987 anytime to talk to a crisis worker. 

Weekdays, 8:00 a.m.–5:00 p.m., if you want to talk to a crisis worker in person, call or go to the clinic nearest your home (See Service Locations, page 7). Tell the receptionist you want to see a crisis worker.

 

Also, day or night, you can go to any hospital emergency room in or outside Utah County.   You do not need approval from Wasatch Mental Health before you get emergency services.

 

Mental Health Care in a Hospital

How do I get mental health care in a hospital?

Mental health care in a hospital after an emergency is usually called post stabilization care services. 

 

Wasatch Mental Health uses:

Utah Valley Regional Medical Center 

1034 North 500 West, Provo, UT 

 

Mountain View Hospital

1000 East 100 North, Payson, UT

 

Provo Canyon Behavioral Hospital

1350 East 750 North, Orem, UT

If a hospital wants to admit you after treating your emergency, the hospital must call us for pre-approval. It’s important to let the hospital know that Wasatch Mental Health is your Medicaid mental health provider so they can call before they admit you.  We might have you stay at the hospital or send you to another hospital.  Hospitals can call us at 801-373-7393 or 1-866-366-7987.

 

Actions

What are actions?

Actions are when we:

  • Deny (turn down) or approve fewer services than you wanted.
  •  Reduce or stop a service that has been previously approved.  If you agree with the change, it is not an action.  It is only an action if you tell us you don’t want the change.
  • Deny payment to an outside provider for a service that you might have to pay for.
  • Do not offer your first appointment within the required amount of time for emergency, urgent or non-urgent care, and you are not happy with this. (See Getting Mental Health Services, page 6).
  • Do not settle an appeal or grievance you have filed with us as soon as we are supposed to.
  • Do not make a decision about getting services from a Wasatch subcontractor as soon as we are supposed to.

 

How will I know if Wasatch Mental Health is taking an action?

We will send you a letter called a Notice of Action.  You have the right to appeal our action if you disagree.

 

Appeals

What is an appeal?

An appeal is when you ask us review our action to see if we made the best decision.

 

 

 

Who can file an appeal?

You, your legally authorized representative or your provider can file an appeal.  You must tell us in writing if you want your provider to file the appeal.

 

When do I file an appeal?

Your Notice of Action letter will give complete information on the appeal process.  It will also tell you how soon you must tell us you want to appeal the action.  In most situations, you must tell us you want to file an appeal within 30 days from the date on the Notice of Action letter.

How do I file an appeal?

The Notice of Action letter will tell you how to file an appeal. 

 

What if I need help filing an appeal?

If you need help filing your appeal, call our Customer Service Representative weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987. 

 

Can I keep getting services if I file an appeal?

If our action was to reduce or stop services we have previously approved, you file your appeal in the time frame required, and you ask that the services be continued, we will keep giving you these services.  You might have to pay for the services if the appeal decision is not in your favor.  If you are appealing any other kind of action and have questions about services during your appeal, call the Customer Service Representative weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987.

 

When will Wasatch Mental Health tell me the decision on my appeal?

We will usually be able to give you a written decision within 15 calendar days after we get your appeal.  Sometimes we might need more time to make the decision.  We will let you know about this in writing. Also, you might want us to take more time for some reason.  If so, let us know.

 

When you, or your provider, think it is important to make a decision on your appeal quickly due to health or safety reasons, we will do so, generally within 3 working days. 

Medicaid Fair Hearings

What can I do if I am unhappy with the appeal decision?

If you are unhappy with our decision on your appeal, or we cannot make a decision on your appeal as soon as Medicaid wants us to, this is what you can do: 

You, your legally authorized representative, or your provider can ask for a fair hearing with Medicaid.  In these situations, we will tell you in our decision letter that you can ask for a fair hearing.  The letter will tell you how and when to ask for the fair hearing.  We will also give you the fair hearing request form to send to Medicaid.  You must ask for a fair hearing in writing using the form that we give you.  If you have questions or need help filling out the fair hearing form, call the Customer Service Representative weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987.

 

At a fair hearing, you can speak for yourself, or you can have a relative, friend, lawyer or anyone else speak for you. Before and during the fair hearing, you, and any person helping you, can present documents. Also, you, and any person helping you, can look at all of the documents that will be used at the fair hearing.

 

Can I keep getting my services if I file a request for a Medicaid Fair Hearing?

If the Medicaid fair hearing is about our decision to reduce or stop services we have previously approved, you need to check the box on the fair hearing form asking that the services continue. If you ask for a fair hearing in the required time frame, and ask that we keep giving you the services, we will do so.

 

You might only have to pay for these services if the fair hearing decision is not in your favor.  If the fair hearing is about any other kind of action, you can discuss your services during the fair hearing.

 

 

Complaints/Grievances

What if I have a complaint about Wasatch Mental Health?

If you have a complaint about anything other than an action, this is called a grievance. Examples of grievances are complaints about the quality of care or services given to you, rudeness of a provider, or a provider not respecting your rights.

 

Who can file a grievance?

You, your legally authorized representative or your provider can file a grievance. 

 

How do I file a grievance?

  • You can tell your grievance to any staff member. 
  • You can call our Customer Service Representative weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or       1-866-366-7987. Tell the representative you want to file a grievance. 
  • You can give us your grievance in writing.  Give it to your provider or any staff member, put it in the suggestion box located in waiting rooms, or mail it to: Wasatch Mental Health, Customer Service Representative, 750 North Freedom Blvd. (200 West), Suite 300, Provo, UT 84601.

 

If you don’t want to talk to us about your grievance, you can call Medicaid weekdays, 8:00 a.m.–5:00 p.m., at 1-877-291-5583.

 

What if I need help filing my grievance?

Any staff member can help you or call the Customer Service Representative weekdays, 8:00 a. m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987.

 

When will Wasatch Mental Health tell me the decision on my grievance?

We will give you our decision within 45 calendar days after we get your complaint, unless you ask us to take more time.

Sometimes, we might need more time to make a decision. If we need more time, we'll let you know in writing. Once we make a decision, we'll either talk to you about our decision or send you a letter.

 

Client Rights and Responsibilities

What are my rights as a client?

You have the right to:

  • Get mental health care regardless of your race, color, national origin, disability (mental or physical), sex, reli­gion, or age.  If you have been treated unfairly or discriminated against for any reason, please call any of the numbers listed below:
  • Wasatch Mental Health Customer Service Representative at 801-373-4760 or

1-866-366-7987.

  • Medicaid’s Constituent Services at

1-877-291-5583.

  • The Federal Office for Civil Rights at 1-303-844-2024, e-mail contact: ocrmail@hhs.gov. Web site: www.hhs.gov/ocr.
  • Get information on the Prepaid Mental Health Plan in a way that is easily understood, be treated with respect and dignity.
  • Have your privacy protected.
  • Get information on other types of treatment in a way that is easily understood.
  • Take part in decisions about your mental health care, including the right to refuse treatment.
  • Be free from restraint or seclusion if it is used to coerce (force), discipline, or is used as a reaction (to retaliate), or for convenience, as specified in federal regulations on the use of restraint and seclusion.
  • Get a copy of your mental health record.  You can also ask that it be amended or corrected, when allowed by federal law.
  • Get mental health covered services in the amount you need and when you need them.
  • Get a second opinion at no cost to you.
  • Use your rights at any time and not be treated badly if you do.

What are my responsibilities as a client?

You are responsible to:

  • Keep scheduled appointments.
  • Cancel appointments 24 hours in advance.
  • Be on time for your appointments.
  • Participate with your provider in your treatment plan and care.
  • Tell the secretary and your Medicaid case worker of changes in your address, phone number, or insurance.
  • Tell medical staff all medications you are taking, including medical and mental health prescriptions, over-the-counter medications, herbs, etc.
  • Complete any surveys Wasatch Mental Health gives you.
  • Respect the property, comfort, and confidentiality of clients and staff.
  • Notify your treatment provider when you want to stop getting services.

 

 

Advance Health Care Directive

What if I am ill and can’t make health care decisions?

You can give others instructions about your decisions for your health care. This is called an Advance Healthcare Directive. This will tell us, in writing, what health care choices you want made if you get very sick and can’t decide for yourself.

 

There is one form with instructions. You must use this form. Once you have filled out the form, be sure to give a copy to all your health care providers. You should also keep a copy and give one to your family members. If you have questions about the Advance Directive or would like the Advance Healthcare Directive form, talk to your provider or call Wasatch Mental Health at 801-373-4760 or 1-866-366-7987. You can also download an Advance Directive Form at www.aging.utah.edu/utah_coa/directives/

If you have an Advance Directive and there is a problem with it being followed, call the Utah survey and certification agency at 801-538-6158 or 1-800-662-4157. 

Privacy

Will my mental health record be protected?

Wasatch Mental Health follows federal laws about the privacy of your mental health record.  We do not use or share any of your protected health information, except as federal law allows.  When allowed by federal law, only the minimum necessary information will be shared.  We will talk to you more about your privacy rights on your first visit. 

 

You can also ask about your privacy rights any time. Talk to your provider or call Wasatch Mental Health at 801-373-4760 or 1-866-366-7987.

 

 

Wasatch Mental Health Center Operations

What if I want to know how Wasatch Mental Health is set up and works?

We will answer any questions you have about how we are set up, including questions about our grievance system, billing practices, confidentiality policy, or how we choose providers and what is required of them.  If you ask, we will give you a copy of our Preferred Practice Guidelines for mental health care. Call our Customer Service Representative weekdays, 8:00 a.m.–5:00 p.m., at 801-373-4760 or 1-866-366-7987.

 

 

Section 2

Medicaid Substance Use Disorder Services– Utah County Department of Drug and Alcohol Prevention and Treatment

 

Utah County Department of Drug and Alcohol Prevention and Treatment (aDDAPT) is the Medicaid provider of substance use disorder services for adults, youth and children.  If you need substance use disorder services, call aDDAPT at 801-851-7128 or at 844-773-7128.

 

Covered Substance Use Disorder Services

What substance use disorder services are covered?

Outpatient services for substance use problems include:

  • Evaluations
  • Psychological Testing
  • Individual and Group Therapy
  • Family Therapy
  • Individual and Group Therapeutic Behavioral Services
  • Medication Management
  • Individual Skills Training and Development
  • Psychosocial Rehabilitation Services (Day Treatment)
  • Peer Support Services
  • Targeted Case Management Services

 

 

We will give you the services you need after we meet with you to talk about your needs.

 

Services are provided by licensed mental health professionals, including doctors, nurses, psychologists, social workers, professional counselors, licensed substance use disorder counselors,  case managers, etc.  If you want more information on any of these services, call aDDAPT at 801-851-7128 or at 844-773-7128.

 

 

 

Are any other services covered?

Yes, other services are:

  • Interpreter Services

 

Transportation

How can I get help with transportation to my substance use disorder services?

 

Traditional Medicaid Members

You may be able to get help with rides to your substance use disorder services.  If you do not have a ride, call the Department of Workforce Services to get a bus pass:

 

  • DWS:  801-526-0950 or 866-435-7414

 

Logisticare may be able to help with non-emergency rides if you cannot ride the bus:

 

  • Logisticare: 855-563-4403

 

UTA Flex Trans is a special bus service that might be able to help:
 

  • Flex Trans:  877-882-7272, ext. 6

 

To learn about help with rides, see the Medicaid Member Guide.  You can find the guide online or call Medicaid with questions:

  • Medicaid Member Guide at Medicaid.utah.gov or
  • Call Medicaid at 1-800-662-9651

You can also talk to us about your needs. Call us at 801-851-7128.

 

Non-Traditional Medicaid Members

You do not get help with rides for services that are not an emergency.

 

Interpreter Services

What if I need an interpreter?

We know it can be hard to talk with your provider if your first language is not English or you are hard of hearing.  We might have providers who speak or sign your language.  You can ask to get services from them, or you can ask for an interpreter.  Interpreters are free and available in all languages, including sign language.  An interpreter can help you over the phone or be with you at your mental health visits.  They will help you talk with and understand what your provider is telling you. 

To ask for an interpreter or a provider who can speak or sign your language, call aDDAPT at 801-851-7128 or 844-773-7128.

 

What if I want to call aDDAPT and I am deaf, hard of hearing or have a hard time speaking?

You can call Relay Utah at 711. If you have a hard time speaking, you can also call Speech-to-Speech Relay Utah at     1-888-346-5822 and a trained person will help you. If you speak Spanish and are deaf, hard of hearing or have a hard time speaking, call Spanish Relay Utah at 1-888-346-3162.

 

For more information about Relay Utah, go to their website at www.connectutah.com  If you need a telecommunications device (TTY), call Sprint Relay Customer Service at 1-800-676-3777, or TTY at 1-800-346-4128.  In some cases, the TTY device might be available at little or no cost to you.

 

Servicios de intérpretes

¿Qué sucede si necesito un intérprete?

Sabemos que puede ser difícil hablar con su terapeuta si su primera lengua no es el inglés o si tiene problemas auditivos. aDDAPT cuenta con terapeutas que hablan otros idiomas que incluyen el lenguaje de señas. Puede solicitar que ellos le brinden servicios o puede solicitar un intérprete. Los intérpretes son gratuitos y están disponibles en todos los idiomas, incluyendo el lenguaje de señas. Un intérprete puede ayudarlo por teléfono o puede acompañarlo a sus citas de salud mental. Esto le ayudará a hablar con su terapeuta y comprender lo que le está diciendo. Para solicitar un intérprete o un terapeuta que pueda hablar otro idioma o el lenguaje de señas, llame aDDAPT al 801-851-7128  o al numero gratiuto 888-773-7128.

 

¿Qué sucede si quiero llamar al a aDDAPT y soy sordo, no oigo bien o tengo problema en hablar?

Si es usted sordo o tiene dificultad para oír, llame  a Relay Utah al 711.  Si tiene discapacidad del habla, llame a Comunicación oral Relay Utah al 1-888-346-5822 y una persona especialmente calificada le ayudará. Si usted habla Español y está sordo o tiene dificultad para oír o impedimento en el habla, llame  a Español Relay Utah al 1-888-346-3162.

Para obtener más información sobre Relay Utah, visite su sitio Web en www.connectutah.com. Si necesita un teléfono de texto (TTY) de atención al cliente de Sprint Relay al 1-800-676-3777 o TTY al 1-800-346-4128. Si habla español, llame al 1-888-346-3162. En algunos casos el dispositivo TTY puede estar disponible a un bajo precio o de forma gratuita.

 

Services Not Covered by ADDAPT

What services are covered by Medicaid but not aDDAPT?

aDDAPT does not provide medical care, dental care, vision care or pharmacy. Medical care includes medical detoxification in a hospital for a substance use disorder problem.

 

If you have questions about these or other services that might be covered by Medicaid, call your physical health plan, or Medicaid at 1-800-662-9651. 

 

Also, methadone maintenance services for substance use disorder problems are not covered by aDDAPT.  If you need this service, you can get it from a Medicaid methadone maintenance service provider.  If you have questions, call Medicaid at 1-800-662-9651. If you are getting methadone maintenance services, and you want to get additional substance use disorder services paid for by Medicaid, you must get them through aDDAPT. 

Payment for Services

Will I ever have to pay for substance use disorder services?

 

Hospital Emergency Room Services

You will not have to pay for emergency services in a hospital emergency room.

 

Non-Emergency Outpatient Services

You might have to pay your provider for a service if:

  • You get a service that is not covered by aDDAPT or Medicaid; or
  • You get a service that is not pre-approved by aDDAPT(the provider or you tried to get approval but we denied the request or approved less than what was asked for); or
  • You do not go to an aDDAPT provider.

 

If any of the above happens, your provider might ask you to pay for the service.You should only be billed for the service if all four things below are met:

 

  • The provider has a written policy for billing all patients for services that are not covered, not just Medicaid patients;
  • The provider tells you before you get the service that you will have to pay for the service;
  • You agree to pay for the service; and
  • There is a written agreement signed by you and the provider that says what the service is and how much you will have to pay.

 

  •  

 

You might also have to pay your provider for a non emergency outpatient mental health service if:

  • You ask for and get services during an appeal with or during a Medicaid state fair hearing.  You would only have to pay if the appeal or state fair hearing decision is not in your favor.
  • You are not on Medicaid when you get the service.

Emergency Outpatient Services       

You will not have to pay for emergency outpatient services.

Getting Substance Use Disorder Services

How do I get substance use disorder services?

Call aDDAPT at 801-851-7128 or at 844-773-7128.   

 

Where do I go for substance use disorder services?

aDDAPT is located at:

151 South University Avenue, Provo, Utah

 

aDDAPT will meet with you to see what services you need.  When we meet with you, we will talk with you about appropriate providers, whether they are taking new clients and the non-English languages they speak. 

 

We might provide your substance use disorder services or send you to one of our other providers.  ADDAPT has several providers in Utah County.

 

Evaluations and some therapy services can be provided during the evenings.  Let us know if you need services in the evening.

 

How quickly can I be seen?

If you need emergency care, you will be seen right away. (See Emergency Services, page 25).  We will give you urgent care for conditions that need to be taken care of right away, but that are not considered emergencies.  If you need urgent care, we will see you within 5 working days.

 

 

 

If you do not have an urgent need for care, we will see you within 15 working days.  If your condition changes and you think you need to be seen sooner, please call us.  We’ll talk about your needs again.

 

Services From Providers

Can I choose my substance use disorder provider?

Yes,  you can talk to us about your choice of provider when we meet with you to talk about your needs. During the assessment process, the appropriate providers, whether they are accepting new clients, and the non-English languages spoken by the providers will be discussed. 

 

Additional ADDAPT providers are:

House of Hope

1726 South Buckley Lane

Provo, Utah 84606

Phone: (801) 373-6562

 

Institute for Cognitive Therapy, Inc.

560 South State St. Suite G1

Orem, Utah 84058

Phone: 801-802-8608

 

New Road’s Behavioral Health

230 West Towne Ridge Pkwy, Suite 225

Sandy, Utah 84070

Phone: 801-669-5088

 

Odyssey House

340 East 100 South

Spanish Fork, Utah 84660

Phone: 801-623-4770

 

Project Reality

151 South University Ave, Suite 1400

Provo, Utah 84111

Phone: 801-851-7118

 

Rocky Mountain Addiction Center

151 South University Ave. Ste. 1500

Provo, Utah 84601

Phone: 801-851-7128

 

Depending on your service needs, aDDAPT may have other providers available to serve you.

 

Can I change my substance abuse provider?

You might be able to.  If you want to change your provider, call aDDAPT at 801-851-7128 or 844-773-7128 to talk about your request.

 

Services From Other Providers

Can I get substance use disorder services from a provider who is not an aDDAPT provider?

This might be possible.  It depends on your needs and the services our providers can offer.  You and the provider must get prior approval.  For more information, call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128.

 

When will I be told if I can see someone outside of aDDAPT?

We will make a decision within 14 calendar days.

 

Can I get a second opinion?

Yes.  You have the right to get a second opinion about your substance use disorder problems or services.  If you would like a second opinion by another provider, call us at 801-851-7128 or 844-773-7128.   There is no cost for a second opinion.

 

Emergency Services

What is a substance abuse emergency?

  • When you think your life is in danger.
  • When you believe you might harm yourself or others.
  • When your safety or others’ safety is at risk.

 

 

What are emergency services?

These are substance use disorder services given to treat your emergency.

 

How do I get emergency services?

aDDAPT has 24-hour telephone emergency services seven days a week through Foothill Residential Treatment. Call Foothill Residential Treatment at 801-851-7652.

 

Also, if you are getting substance use disorder services from one of our providers, you can call your providers on weekdays. 

 

If your provider is not available, call Foothill Residential Treatment at 801-851-7652.

 

Also, day or night, you can go to any hospital emergency room in or outside Utah County.  A prior-authorization is not required.

 

Actions

What are actions?

Actions are when we:

  • Deny (turn down) or approve fewer services than you wanted.
  •  Reduce or stop a service that has been previously approved.  If you agree with the change, it is not an action.  It is only an action if you tell us you don’t want the change.
  • Deny payment to an outside provider for a service that you might have to pay for.
  • Do not settle an appeal or grievance you have filed with us as soon as we are supposed to.
  • Do not make a decision about getting services from a aDDAPT provider as soon as we are supposed to.

 

How will I know if aDDAPT is taking an action?

We will send you a letter called a Notice of Action.  You have the right to appeal our action if you disagree.

 

Appeals

What is an appeal?

An appeal is when you ask us review our action to see if we made the best decision.

 

Who can file an appeal?

You, your legally authorized representative or your provider can file an appeal. 

 

When do I file an appeal?

Your Notice of Action letter will give complete information on the appeal process.  It will also tell you how soon you must tell us you want to appeal the action.  In most situations, you must tell us you want to file an appeal within 30 days from the date on the Notice of Action letter.

 

 How do I file an appeal?

The Notice of Action letter will tell you how to file an appeal. 

 

What if I need help filing an appeal?

If you need help filing your appeal, call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128.    

 

Can I keep getting services if I file an appeal?

If our action was to reduce or stop services we have previously approved, you file your appeal in the time frame required, and you ask that the services be continued, we will keep giving you these services.  You might have to pay for the services if the appeal decision is not in your favor. 

 

If you are appealing any other kind of action and have questions about services during your appeal, call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128 to talk about your services.

 

When will aDDAPT tell me the decision on my appeal?

We will usually be able to give you a written decision within 15 calendar days after we get your appeal.  Sometimes we might need more time to make the decision.  We will let you know about this in writing. Also, you might want us to take more time for some reason.  If so, let us know.   When you, or your provider, think it is important to make a decision on your appeal quickly due to health or safety reasons, we will do so, generally within 3 working days. 

 

Medicaid Fair Hearings

What can I do if I am unhappy with the appeal decision?

If you are unhappy with our decision on your appeal, or we cannot make a decision on your appeal as soon as Medicaid wants us to, this is what you can do:

You, your legally authorized representative, or your provider can ask for a fair hearing with Medicaid.  In these situations, we will tell you in our decision letter that you can ask for a fair hearing.  The letter will tell you how and when to ask for the fair hearing.  We will also give you the fair hearing request form to send to Medicaid.  You must ask for a fair hearing in writing using the form that we give you.  If you have questions or need help filling out the form, call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128. 

 

At a fair hearing, you can speak for yourself, or you can have a relative, friend, lawyer or anyone else speak for you. Before and during the fair hearing, you, and any person helping you, can present documents. Also, you, and any person helping you, can look at all of the documents that will be used at the fair hearing.

 

Can I keep getting my services if I ask for a fair hearing?

If the fair hearing is about our decision to reduce or stop services we have previously approved, you need to check the box on the fair hearing form asking that the services continue. If you ask for a fair hearing in the required time frame, and ask that we keep giving you the services, we will do so.  You might only have to pay for these services if the fair hearing decision is not in your favor.  If the fair hearing is about any other kind of action, you can discuss your services during the fair hearing.

 

Complaints/Grievances

What if I have a complaint about aDDAPT or my provider?

If you have a complaint about anything other than an action, this is called a grievance. Examples of grievances are complaints about the quality of care or services given to you, rudeness of a provider, or a provider not respecting your rights.

 

Who can file a grievance?

You, your legally authorized representative or your provider can file a grievance. 

How do I file a grievance?

  • You can tell your grievance to your provider or any staff member. 
  • You can call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128.  Tell us you want to file a grievance. 
  • You can give us your grievance in writing.  Give it to your provider or any staff member, or mail it to:

 

ADDAPT

151 South University Avenue, Suite 3200

Provo, UT 84601

 

If you don’t want to talk to us about your grievance, you can call Medicaid weekdays, 8:00 a.m.–5:00 p.m., at 1-877-291-5583.

 

What if I need help filing my grievance?

Your provider or any staff member can help you.  You can also call aDDAPT weekdays, 8:00 a. m.–5:00 p.m., at 801-851-7128 or 844-773-7128 and ask for help.

 

When will aDDAPT tell me the decision on my grievance?

We will give you our decision within 45 calendar days after we get your complaint, unless you ask us to take more time.

Sometimes, we might need more time to make a decision. If we need more time, we'll let you know in writing. Once we make a decision, we'll either talk to you about our decision or send you a letter.

Client Rights and Responsibilities

What are my rights as a client?

You have the right to:

  • Get substance use disorder care regardless of your race, color, national origin, disability (mental or physical), sex, reli­gion, or age.  If you have been treated unfairly or discriminated against for any reason, please call any of the numbers listed below:
  • aDDAPT at 801-851-7128 or 844-773-7128.
  • Medicaid’s Constituent Services at 1-877-291-5583.
  • The Federal Office for Civil Rights at 1-303-844-2024,      e-mail contact: ocrmail@hhs.gov. Web site: www.hhs.gov/ocr.
  • Get information on the Prepaid Mental Health Plan in a way that is easily understood.
  • Be treated with respect and dignity.
  • Have your privacy protected.
  • Get information on other types of treatment in a way that is easily understood.
  • Take part in decisions about your substance use disorder services including the right to refuse treatment.
  • Be free from restraint or seclusion if it is used to coerce (force), discipline, or is used as a reaction (to retaliate), or for convenience, as specified in federal regulations on the use of restraint and seclusion.
  • Get a copy of your substance use disorder record.  You can also ask that it be amended or corrected, when allowed by federal law.
  • Get substance use disorder services in the amount you need and when you need them.
  • Get a second opinion at no cost to you.
  • Use all these rights without being poorly treated by the Utah County, its staff, and its contract treatment providers.

 

What are my responsibilities as a client?

You are responsible to:

  • Keep scheduled appointments.
  • Cancel appointments 24 hours in advance.
  • Be on time for your appointments.
  • Participate with your provider in your treatment plan

and care.

  • Tell the secretary and your Medicaid case worker of changes in your address, phone number, or insurance.
  • Tell medical staff all medications you are taking, including medical and mental health prescriptions,

over-the-counter medications, herbs, etc.

  • Complete any surveys aDDAPT or your provider gives you.
  • Respect the property, comfort, and confidentiality of clients and staff.
  • Notify your treatment provider when you want to stop getting services.

 

Privacy

Will my substance use disorder record be protected?

aDDAPT follows federal laws about the privacy of your substance use disorder record.  We do not use or share any of your protected health information, except as federal law allows.  When allowed by federal law, only the minimum necessary information will be shared.  We will talk to you more about your privacy rights on your first visit.  You can also ask about your privacy rights any time. Talk to your provider or call aDDAPT weekdays, 8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128. 

 

ADDAPT Operations

What if I want to know how aDDAPT is set up and works?

We will answer any questions you have about how we are set up, including questions about our grievance system, billing practices, confidentiality policy, or how we choose providers and what is required of them.  If you ask, we will give you a copy of our Preferred Practice Guidelines for substance use disorder services.  Call aDDAPT weekdays,   8:00 a.m.–5:00 p.m., at 801-851-7128 or 844-773-7128.