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5As a member of CDPHP, you will also have a Health Home CareManager who will work with all your physical and behavioralhealth providers to pay special attention to your whole healthcare needs. The Health Home Care Manager will help make sureyou get the medical, behavioral health and social services youmay need, such as help to get housing and food assistance.You may be using your Medicaid card to get a behavioral healthservice that is now available through CDPHP. To find out if aservice you already get is now provided by CDPHP, contactMember Services at (518) 641-3800 or 1-800-388-2994. You and your health care team will work together to makesure you enjoy the best physical and emotional healthpossible. You can get special services for healthy living,such as nutrition classes and help to stop smoking. CDPHP has a contract with the New York State Departmentof Health to meet the health care needs of people withMedicaid. In turn, we choose a group of health care, mentalhealth and substance use providers to help us meet yourneeds. These doctors and specialists, hospitals, clinics,labs, case managers, and other health care facilities makeup our provider network. You will find a list in our providerdirectory. If you do not have a provider directory, call MemberServices at (518) 641-3800 or 1-800-388-2994 to get acopy or visit our website at CDPHP.com. When you join CDPHP, one of our providers will take careof you. Most of the time that person will be your PrimaryCare Provider (PCP). You may want to choose a PCP fromyour mental health or substance use clinic. If you need tohave a test, see another specialist, or go into the hospital,your Primary Care Provider will arrange it. Your Primary Care Provider is available to you every day,day and night. If you need to speak to him or her afterhours or weekends, leave a message and how you can bereached. Your Primary Care Provider will get back to you assoon as possible. Even though your Primary Care Provideris your main source for health care, in some cases, you canself-refer to certain doctors for some services. See page 8for details. You may be restricted to certain plan providers if you are: getting care from several doctors for the same problem getting medical care more often than needed using prescription medicine in a way that may be dangerous to your health allowing someone other than yourself to use your planID cardConfidentialityWe respect your right to privacy. CDPHP recognizes the trustneeded between you, your family, your doctors and other careproviders. CDPHP will never give out your medical or behavioral health history without your written approval. The onlypersons that will have your clinical information will be CDPHP,your Primary Care Provider, your Health Home Care Managerand other providers who give you care and your authorizedrepresentative. Referrals to such providers will always be discussed with you in advance by your Primary Care Providerand/or Health Home Care Manager. CDPHP staff have beentrained in keeping strict member confidentiality.HOW TO USE THIS HANDBOOK This handbook will tell you how your new health care planwill work and how you can get the most from CDPHP. Thishandbook is your guide to health and wellness services. Ittells you the steps to take to make the plan work for you. The first several pages will tell you what you need to knowright away. The rest of the handbook can wait until you needit. Use it for reference or check it out a bit at a time. When youhave a question, check this handbook or call our MemberServices department at (518) 641-3800 or 1-800-388-2994.You can also call the New York Medicaid Choice Helpline at1-800-505-5678.HELP FROM MEMBER SERVICESThere is someone to help you at Member ServicesMonday through Friday8:00 AM–6:00 PMCall (518) 641-3800 or 1-800-388-2994(TTY/TDD 711)If you need help at other times, call the crisis line directly at1-888-320-9584 You can call Member Services to get help any time youhave a question. You may call us to choose or change yourPrimary Care Provider (PCP for short), to ask about benefitsand services, to get help with referrals, to replace a lost IDcard, to report that you are pregnant, the birth of a new babyor ask about any change that might affect your benefits. We offer free sessions to explain our health plan and howwe can best help you. It’s a great time for you to ask questionsand meet other members. If you’d like to come to one of thesessions, call us to find a time and place that is best for you. If you do not speak English, we can help. We want you toknow how to use your health care plan, no matter whatlanguage you speak. Just call us and we will find a way totalk to you in your own language. We have a group of people who can help. We will also help you find a PCP (PrimaryCare Provider) who can speak to you in your language. For people with disabilities: If you use a wheelchair, or areblind, or have trouble hearing or understanding, call us if youneed extra help. We can tell you if a particular provider’soffice is wheelchair accessible or is equipped with specialcommunications devices. Also, we have services like: TTY/TDD machine (Our TTY phone number is 711) Information in large print Case Management Help in making or getting to appointments Names and addresses of providers who specialize inyour disabilityCDPHP (518) 641-3800 or 1-800-388-2994, TTY/TDD 711. Behavioral Health Crisis 1-888-320-9584.

6 If you are getting care in your home now, your nurse or attendant may not know you have joined our plan. Call us right awayto make sure your home care does not stop unexpectedly.YOUR HEALTH PLAN ID CARDAfter you enroll, we will send you a Welcome Letter. Your CDPHPID card should arrive within 14 days after your enrollmentdate. Your card has your PCP’s (Primary Care Provider’s) nameand phone number on it. It will also have your Client Identification Number (CIN). If anything is wrong on your CDPHP IDcard, call us right away. Your ID card does not show that youhave Medicaid or that CDPHP is a special type of health plan.Carry your ID card at all times and show it each time you gofor care. If you need care before the card comes, your WelcomeLetter is proof that you are a CDPHP member. You should alsokeep your Medicaid benefit card. You will need your Medicaidcard to get services that CDPHP does not cover.PART I—First ThingsYou Should KnowHOW TO CHOOSE YOUR PRIMARY CAREPROVIDER (PCP) You may have already picked your PCP (Primary Care Provider).If you have not chosen a PCP, you should do so right away.If you do not choose a doctor within 30 days, we willchoose one for you. Member Services (518) 641-3800 or1-800-388-2994) can check to see if you already have aPCP or help you choose a PCP. You may also be able tochoose a PCP at your behavioral health clinic. CDPHP provides an online list of all doctors, clinics, hospitals,pharmacies and others who work with us in the Find a Docsection of www.CDPHP.com. You can also ask to receive aprinted book with this information. If you would like onemailed to you, please call Member Services or you can fillout and return the post card on the back of your memberinformation packet. The provider directory will show which doctors and providersare taking new patients. You should call their offices tomake sure that they are taking new patients at the timeyou choose a PCP. You can also get a list of providers onour website at www.CDPHP.com.You may want to find a doctor that: you have seen before, understands your health problems, is taking new patients, can speak to you in your language, is easy to get to, is at a clinic you go to. Women can also choose one of our OB/GYN doctors for withwomen’s health care. Women do not need a PCP referral tosee a plan OB/GYN doctor. They can have routine check-ups,follow-up care if needed, and regular care during pregnancy. We also contract with several FQHCs (Federally QualifiedHealth Centers). All FQHCs give primary and specialty care.Some consumers want to get their care from FQHCs becausethe centers have a long history in the neighborhood. Maybeyou want to try them because they are easy to get to. Youshould know that you have a choice. You can choose oneof our providers. Or you can sign up with a PCP in one ofthe FQHCs that we work with. Just call Member Services(518) 641-3800 or 1-800-388-2994) for help. In almost all cases, your doctors will be CDPHP providers.There are four instances when you can still see anotherprovider that you had before you joined CDPHP. In thesecases, your provider must agree to work with CDPHP. Youcan continue to see your provider if: You are more than 3 months pregnant when you joinCDPHP and you are getting prenatal care. In that case,you can keep your doctor until after your deliverythrough post-partum care. At the time you join CDPHP, you have a life threateningdisease or condition that gets worse with time. In thatcase, you can ask to keep your provider for up to 60 days. If you are being treated by a provider licensed by theOffice of Mental Health or certified by the Office of Alcohol and Substance Abuse Services for a behavioral healthcondition that began before July 1, 2016, you can ask tokeep your provider for treatment for up to 2 years fromJuly 1, 2016. At the time you join CDPHP, regular Medicaid paid foryour home care and you need to keep getting that carefor at least 120 days. In that case, you can keep yoursame home care agency, nurse or attendant, and thesame amount of home care, for at least 90 days. CDPHPmust tell you about any changes to your home care before the changes take effect. If you have a long-lasting illness, like HIV/AIDS or otherlong term health problems, you may be able to choose aspecialist to act as your PCP (primary care provider). YourPCP, after speaking with the CDPHP medical director and aspecialist, may issue a referral/authorization to a specialistwith experience in treating your condition. That specialistwill be able to provide and assist with your primary andspecialty care. A referral/authorization will be made, alongwith a treatment plan approved by CDPHP after talkingwith your PCP, the specialist, and you. The specialist shallbe able to treat you without a referral/authorization fromyour PCP, under the terms of the treatment plan. If you need to, you can change your PCP in the first 30 daysafter your first appointment with your PCP. After that, youcan change once every six months without cause, or moreoften if you have a good reason. You can also change yourOB/GYN or a specialist to which your PCP has referred you. If your provider leaves CDPHP, we will tell you within 15 daysfrom when we know about this. If you wish, you may be ableto see that provider if you are more than three months pregnant or if you are receiving ongoing treatment for a condition.If you are pregnant, you may continue to see your doctorthrough post-partum care. If you are seeing a doctor regularly for a special medical problem, you may continue yourCDPHP (518) 641-3800 or 1-800-388-2994, TTY/TDD 711. Behavioral Health Crisis 1-888-320-9584.

7present course of treatment for up to 90 days. Your doctormust agree to work with CDPHP during this time. If any ofthese conditions apply to you, check with your PCP or callMember Services at (518) 641-3800 or 1-800-388-2994.HEALTH HOME CARE MANAGEMENTCDPHP is responsible for providing and coordinating yourphysical health care and your behavioral health services. Weuse Health Homes to coordinate services for our members. It isyour choice if you want to join a Health Home, and we encourage you to join a Health Home for your Care Management.CDPHP can help you enroll with a Health Home that will assignyour personal Health Home Care Manager. Your Health HomeCare Manager can help you make appointments, help you getsocial services, and keep track of your progress.Your Health Home is responsible for giving you an assessmentto see what Behavioral Health Home and Community BasedServices you may need. Using the assessment, you and yourHealth Home Care Manager will work together to make a Planof Care that is designed especially for you.Your Health Home Care Manager can: Work with your PCP and other providers to coordinate allof your physical and behavioral health care; Work with the people you trust, like family members orfriends, to help you plan and get your care; Support you getting social services, like SNAP (food stamps)and other social service benefits; Develop a plan of care with you to help identify your needsand goals; Help with appointments with your PCP and other providers; Help you manage ongoing medical issues like diabetes,asthma, and high blood pressure; Help you find services to help with weight loss, healthyeating, exercise and to stop smoking; Support you during treatment; Identify resources you need that are located in your community; Help you with finding or applying for stable housing; Help you safely return home after a hospital stay; and Make sure you get follow up care, medications and otherneeded services.Your Health Home Care Manager will be in touch with you soonafter you enroll to find out what care you need and to helpyou with appointments. Your Health Home Care Manager orsomeone from your Health Home provider is available to you24 hours a day, 7 days a week. Call CDPHP Members Servicesat (518) 641-3800 or 1-800-388-2994.If you are in crisis and need to talk to someone right away,call 1-888-320-9584. If you don’t choose to enroll in a HealthHome, all these services will be provided to you by CDPHP casemanagers. To find out more about CDPHP case management,call 1-888-94CDPHP.REGULAR HEALTH CARE Your health care will include regular check-ups for all yourhealth care needs. We provide referrals to hospitals or specialists. We want new members to see his or her PrimaryCare Provider for a first medical visit soon after enrolling inCDPHP. This will give you a chance to talk with your PrimaryCare Provider about your past health issues, the medicinesyou take, and any questions that you have. Day or night, your PCP is only a phone call away. Be sureto call your PCP whenever you have a medical question orconcern. If you call after hours or weekends, leave a messageand where or how you can be reached. Your PCP will callyou back as quickly as possible. Remember, your PCP knowsyou and knows how the health plan works. You can call CDPHP twenty-four (24) hours a day, seven (7)days a week at (518) 641-3800 or 1-800-388-2994, if youhave questions about getting services or if for some reason you cannot reach your Primary Care Provider. Your care must be medically necessary—the services youget must be needed: to prevent, or diagnose and correct what could causemore suffering, or to deal with a danger to your life, or to deal with a problem that could cause illness, or to deal with something that could limit your normal activities. Your PCP will take care of most of your health care needs.You should have an appointment to see your PCP. If everyou can’t keep an appointment, call to let your PCP know. As soon as you choose a PCP, call to make a first appointment. If you can, prepare for your first appointment. YourPCP will need to know as much about your medical historyas you can tell him or her. Make a list of your medical background, any problems you have now, any medications youare taking, and the questions you want to ask your PCP. Ifyou have the need for treatment over the coming weeks,make your first appointment in the first week of joiningCDPHP. For non-urgent, preventive care, your PCP shouldbe able to see you within four weeks. If you need a baseline or routine physical, your PCP should see you withintwelve weeks. Your Health Home Care Manager can helpyou make and get ready for your first appointment. If you need care before your first appointment, call yourPCP’s office to explain your concern. He or she will giveyou an earlier appointment for this concern. (You shouldstill keep your first appointment to discuss your medicalhistory and ask questions.) Use the following list as a guide for the longest time youmay have to wait after you ask for an appointment. Your CareManager can also help you make or get appointments. urgent care: within 24 hours non-urgent sick visits: within 3 days routine, preventive care: within 4 weeksCDPHP (518) 641-3800 or 1-800-388-2994, TTY/TDD 711. Behavioral Health Crisis 1-888-320-9584.

8 first pre-natal visit: within 3 weeks during 1st trimester(2 weeks during 2nd, 1 week during 3rd) first family planning visit: within 2 weeks follow-up visit after mental health/substance use ER orinpatient visit: 5 days non-urgent mental health or substance use specialistvisit: within 1 week. adult baseline and routine physicals: within 12 weeksplan explaining why you need an out-of-network referral.We will assess the treatment plan and consult with yourPCP and the out-of-network provider and make a decisionwithin three work days. When a decision is made, you willreceive a letter from a CDPHP medical director telling youwhether your request has been approved or denied. Specificinformation needed to file an appeal will be explained in adenial letter. If your PCP or CDPHP refers you to a provideroutside our network, you are not responsible for any of thecosts except any copayments as described in this handbook.BEHAVIORAL HEALTH CARE AND HOME ANDCOMMUNITY BASED SERVICES (BHHCBS) Sometimes we may not approve an out-of-network referralbecause we have a provider in CDPHP that can treat you.If you think our plan provider does not have the right trainingor experience to treat you, you can ask us to check if yourout-of-network referral is medically needed. You will needto ask for a plan appeal. See page 17 to find out how.Behavioral health care includes mental health and substanceuse treatment services. You have access to services that canhelp you with emotional health. You can also get help withalcohol or other substance use issues.If you need help to support your living in the community,CDPHP provides additional services, called Behavioral HealthHome and Community Based Services (BHHCBS). These servicescan help you stay out of the hospital and live in the community.Some services can help you reach life goals for employment,school, or for other areas of your life you may like to work on.To be eligible for these services, you will need to get an assessment. To find out more, call us at (518) 641-3600/1-888320-9584 or ask your Health Home or CDPHP Care Managerabout these services.See pages 12–13 of this Handbook for more information aboutthese services and how to get them.HOW TO GET SPECIALTY CAREAND REFERRALS Sometimes, we may not approve an out-of-network referralfor a specific treatment because you asked for care that is notvery different from what you can get from a CDPHP provider.You can ask us to check if your out-of-network referral forthe treatment you want is medically needed. You will needto ask for a plan appeal. See page 17 to find out how. You may need to see a specialist for ongoing care of amedical or behavioral health condition. Your PCP may beable to refer you for a specified number of visits or length oftime (a standing referral). If you have a standing referral, youwill not need a new referral for each time you need care. If you have a long-term disease or a disabling illness thatgets worse over time, your PCP may be able to arrange for: your specialist to act as your PCP; or a referral to a care center that specializes in the treatment of your illness. If you need care that your PCP cannot give, he or she willrefer you to other specialists who can. If your PCP refersyou to another doctor, we will pay for your care. Most ofthese specialists are CDPHP providers. Talk with your PCPto be sure you know how referrals work.GET THESE SERVICES FROM OUR PLANWITHOUT A REFERRAL If you think the specialist does not meet your needs, talkto your PCP. Your PCP can help you if you need to see a different specialist.You do not need a referral from your PCP to see one of ourproviders IF you are pregnant, or you need OB/GYN services, or you need family planning services, or you want to see a mid-wife, or you need to have a breast or pelvic exam. There are some treatments and services that your PCP mustask CDPHP to approve before you can

Health and Recovery Plan We are glad that you enrolled in CDPHP. CDPHP's Health and Recovery Plan, or HARP, is approved by New York State. HARPs are a new kind of plan that provide Medicaid members with their health care, plus care for behavioral health. In this hand - book, behavioral health means mental health, substance use