Click here for a printable version of the guide! 

Centennial Mental Health Center (Centennial) serves a ten-county region, providing Mental Health and Substance Abuse treatment for the residents of Northeastern Colorado.  Services include Individual Therapy, Group Education and Group Therapy, Couples and Family Therapy, Case Management, Club House Services, Residential Services, Transitional Services, Day Treatment, Intensive Out-Patient Services, Psychiatric Assessment and Medication Management.  Not all services are available in all locations.  Talk with your clinician to find out the services in your county. 

Centennial staff members are dedicated to providing the best treatment in the least restrictive setting at a reasonable cost to the residents of our service area.  We are regulated by the State of Colorado through Mental Health Services and the Alcohol and Drug Abuse Division.

This handbook contains the information necessary for you to understand your rights and to weigh the benefits and risks you may face with your treatment.  This information will be explained to you, and you will be asked to sign verification that you have received this information.  This booklet is used to inform all consumers of the Center of information regardless of the types of treatment received.  Some of the information may not directly relate to your treatment.  Ask your therapist if you have questions. 

Centennial operates on a sliding fee basis.  You are eligible to apply for a reduced fee based on your gross income and the number of people in your family.  To get a reduced fee you will need to show us some proof of income, such as a pay stub or a tax return.  We are Medicaid providers and can accept many other types of insurance.  You should check with your insurance company first to see if we are providers for your plan.  Most fees are due at the time of service.  In some instances, intake fees must be paid at the time the appointment is made. 

Centennial’s product is time.  Late cancellations and No-shows waste our staff time and take away from our ability to see other people who need our help. 

CANCELLATION.  To cancel an appointment, you must advise the Center that you will not attend at least 24 hours before your appointment time.

NO SHOW.  If you do not cancel your appointment, you will be considered a “No Show”.  If you arrive under the influence or without proper payment, you will be considered a “No Show.”

If you no-show, you may be required to pay for services when you make an appointment.  If you no-show for a prepaid appointment, Centennial will keep your money and reschedule only if you pay for your next appointment when it is scheduled. 

Medical Records at Centennial are held in the strictest confidence in accordance with state and federal laws about the maintenance of Mental Health and Substance Abuse records.  

We will not acknowledge that a person is receiving services or disclose any information identifying that person as a consumer of the agency or as having a mental health or substance abuse issue unless:

1.The consumer consents in writing, or

2.The disclosure is allowed by a court order, or

3.The disclosure is made to medical personnel in a medical emergency, or

4.The disclosure is necessary for audit or program evaluation. 

Violation of these confidentiality laws is a crime.  Suspected violations may be reported to appropriate authorities in accordance with federal and state regulations.

The guarantee of confidentiality has only a few exceptions:

·                     If the consumer is suspected of committing a crime at the facility or against a staff member, the authorities will be notified.

·                     If child abuse or neglect is suspected, the authorities will be notified.

·                     If the consumer presents an imminent risk to him/her self or others, or is gravely disabled due to a mental illness, information will be disclosed to ensure the safety of all concerned.

Our consumers have the right:

1.      To be treated with respect and dignity.

2.      To have a service plan established for your treatment with your participation.

3.      To have the service plan reviewed every 6 months by the professional clinical staff assigned to supervise and implement your plan.

4.      To receive a second opinion (at no cost for Medicaid consumers).

5.      To have the professional person in charge of your treatment explain the procedures and medications that will be used, including the benefits, risks and side effects.  To be given information about other treatment procedures that are available.

6.      To refuse the services offered to you, unless an emergency exists or a court order is in effect.

7.      To have your treatment and medical records kept confidential except when release of this information is authorized by law.

8.      To see your records or have them shown to any person that you designate in writing according to Colorado law and applicable Federal law, including HIPAA.

9.      To file a complaint about the services you are receiving or about the denial of services or treatment rights.  No retaliation can be made against you for complaining.

10.  To receive assistance from a Consumer Services Representative or Parent/Family Advocate in making complaints or grievances and to receive copies of the complaint/grievance procedure. 

11.  To have a staff person, the Consumer Service Representative or Parent/Family Advocate explain these rights to you in a language you understand best.

12.  To receive appropriate services that are available and accessible when medically necessary, including crisis care 24 hours a day, 7 days a week.

13.  To receive culturally appropriate and competent services, including the availability of interpreter services if you have a communication disability or if you don’t speak English.

14.  To choice, according to your individual needs, about a specific provider in terms of gender, location, hours, ethnicity, etc., in keeping with available resources.

15.  To understand the risks and benefits of experimental programs or research and to refuse to participate in such programs.

Additional Rights for Individuals with Medicaid

State of Colorado Insurance Regulations and Medicaid Rules provide additional rights and protections for individuals who have Medicaid.  Medicaid consumers also have the right to:

1.      Receive written information on available services and network providers.

2.      Choose a provider from the provider network.

3.      Request that a specific provider be considered for inclusion in the network.

4.      Express an opinion about NBH’s services to regulatory agencies, legislative bodies or the media without NBH causing any adverse effects upon the provision of services. 

5.      Have an independent advocate. 

6.      Receive prompt notification of termination or changes in services or provider. 

7.      Know why if you are denied access to your records and appeal the denial. 

8.      Any other rights guaranteed by statute or regulation. 

This Notice Describes How Medical [Including Mental Health] Information About You May Be Used And Disclosed And How You Can Get Access To This Information.  Please Review Carefully.

During the process of providing services to you, Centennial Mental Health Center will obtain, record, and use mental health and medical information about you that is protected health information.  Ordinarily that information is confidential and will not be used or disclosed, except as described below. 

Uses and Disclosures of Protected Information

General Uses and Disclosures Not Requiring the Consumer’s Consent.  The Center will use and disclose protected health information in following ways. 

Treatment.  Treatment refers to the provision, coordination, or management of health care [including mental health care] and related services by one or more health care providers. For example, Center staff involved with your care may use your information to plan your course of treatment and consult with other staff to ensure the most appropriate methods are being used to assist you.

Payment.  Payment refers to the activities undertaken by a health care provider [including a mental health provider] to obtain or provide reimbursement for the provision of health care.  For example, the Center will use your information to develop accounts receivable information, bill you, and with your consent, provide information to your insurance company for services provided.  The information provided to insurers and other third party payors may include information that identifies you, as well as your diagnosis, type of service, date of service, provider name/identifier, and other information about your condition and treatment.  If you are covered by Medicaid, information will be provided to the State of Colorado's Medicaid program, including but not limited to your treatment, condition, diagnosis, and services received. 

Health Care Operations.  Health Care Operations refers to activities undertaken by the Center that are regular functions of management and administrative activities.  For example, the Center may use your health information in monitoring of service quality, staff training and evaluation, medical reviews, legal services, auditing functions, compliance programs, business planning, and accreditation, certification, licensing and credentialing activities.

Contacting the Consumer.  The Center may contact you to remind you of appointments and to tell you about treatments or other services that might be of benefit to you. 

Required by Law.  The Center will disclose protected health information when required by law or necessary for health care oversight.  This includes, but is not limited to: (a) reporting child abuse or neglect; (b) when court ordered to release information; (c) when there is a legal duty to warn or take action regarding imminent danger to others; (d) when the consumer is a danger to self or others or gravely disabled; (e) when required to report certain communicable diseases and certain injuries; and (f) when a Coroner is investigating the consumer’s death. 

Health Oversight Activities.  The Center will disclose protected health information to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the health care system, government health care benefit programs, and regulatory programs or determining compliance with program standards.

Crimes on the premises or observed by Center personnel.  Crimes that are observed by Center staff, that are directed toward staff, or occur on the Center’s premises will be reported to law enforcement. 

Business Associates.  Some of the functions of the Center are provided by contracts with business associates.  For example, some administrative, clinical, quality assurance, billing, legal, auditing, and practice management services may be provided by contracting with outside entities to perform those services.  In those situations, protected health information will be provided to those contractors as is needed to perform their contracted tasks.  Business associates are required to enter into an agreement maintaining the privacy of the protected health information released to them.

Research.  The Center may use or disclose protected health information for research purposes if the relevant limitations of the Federal HIPAA Privacy Regulation are followed. 

Involuntary Consumers.  Information regarding consumers who are being treated involuntarily, pursuant to law, will be shared with other treatment providers, legal entities, third party payers and others, as necessary to provide the care and management coordination needed. 

Family Members.  Except for certain minors, incompetent consumers, or involuntary consumers, protected health information cannot be provided to family members without the consumer’s consent.  In situations where family members are present during a discussion with the consumer, and it can be reasonably inferred from the circumstances that the consumer does not object, information may be disclosed in the course of that discussion.  However, if the consumer objects, protected health information will not be disclosed. 

Fund Raising.  The Center, or its fund raising Foundation, may contact consumers as a part of its fund raising activities. 

Emergencies.  In life threatening emergencies Center staff will disclose information necessary to avoid serious harm or death. 

Consumer Authorization or Release of Information.  The Center may not use or disclose protected health information in any other way without a signed authorization or release of information.  When you sign an authorization, or a release of information, it may later be revoked, provided that the revocation is in writing.  The revocation will apply, except to the extent the Center has already taken action in reliance thereon. 

Your Rights as a Consumer

Access to Protected Health Information.  You have the right to inspect and obtain a copy of the protected health information the Center has regarding you, in the designated record set. There are some limitations to this right, which will be provided to you at the time of your request, if any such limitation applies.  To make a request, ask Center staff for the appropriate request form. 

Amendment of Your Record.  You have the right to request that the Center amend your protected health information.  The Center is not required to amend the record if it is determined that the record is accurate and complete.  There are other exceptions, which will be provided to you at the time of your request, if relevant, along with the appeal process available to you.  To make a request, ask Center staff for the appropriate request form. 

Accounting of Disclosures.  You have the right to receive an accounting of certain disclosures the Center has made regarding your protected health information.  However, that accounting does not include disclosures that were made for the purpose of treatment, payment, or health care operations.  In addition, the accounting does not include disclosures made to you, disclosures made pursuant to a signed Authorization, or disclosures made prior to April 14, 2003.  There are other exceptions that will be provided to you, should you request an accounting.  To make a request, ask Center staff for the appropriate request form.  

Additional Restrictions.  You have the right to request additional restrictions on the use or disclosure of your health information.  The Center does not have to agree to that request, and there are certain limits to any restriction, which will be provided to you at the time of your request.  To make a request, ask Center staff for the appropriate request form. 

Alternative Means of Receiving Confidential Communications.  You have the right to request that you receive communications of protected health information from the Center by alternative means or at alternative locations. For example, if you do not want the Center to mail bills or other materials to your home, you can request that this information be sent to another address.  There are limitations to the granting of such requests, which will be provided to you at the time of the request process.  To make a request, ask Center staff for the appropriate request form. 

Copy of this Notice.  You have a right to obtain another copy of this Notice upon request. 

Additional Information

Privacy Laws.  The Center is required by State and Federal law to maintain the privacy of protected health information.  In addition, the Center is required by law to provide consumers with notice of its legal duties and privacy practices with respect to protected health information.  That is the purpose of this Notice. 

Terms of the Notice and Changes to the Notice.  The Center is required to abide by the terms of this Notice, or any amended Notice that may follow.  The Center reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all protected health information that it maintains.  When the Notice is revised, the revised Notice will be posted in the Center’s service delivery sites and will be available upon request. 

Complaints Regarding Privacy Rights.  If you believe the Center has violated your privacy rights, you have the right to complain to Center management.  To file your complaint, call:

You also have the right to complain to the United States Secretary of Health and Human Services by sending your complaint to:

Office for Civil Rights Regional Manager
%Office for Civil Rights
U.S. Department of Health & Human Services
1961 Stout Street ‑ Room 1426
Denver, CO 80294

It is the policy of the Center that there will be no retaliation for your filing of such complaints.

Additional Information.  If you desire additional information about your privacy rights at the Center, please call any of the Consumer Services Representatives listed above. 

Effective Date.  This Notice is effective April 14, 2003.

Your satisfaction with our services is very important to us.  We want you to be treated fairly and respectfully.  If you feel for any reason that you haven’t been treated fairly, we want to hear from you.

How You Can Make A Complaint

We strongly urge you to first bring up any concern or complaint with the person that provides treatment for you or your loved one.  If that is not successful for you, Centennial has a simple process to work out complaints.  We have Consumer Service Representatives (CSR) for adult services and Parent/Family Advocates (PFA) for children and family services to help you get your complaint answered. 

Your CSR or PFA can be contacted at:

Even though the CSR’s and the PFA’s are employed by Centennial, it is their job to represent and protect your interest.

You may ask anyone, at anytime, to help you pursue your complaint or concern.  However, this helper does not take the place of the Consumer Service Representative in the Complaint Process. 

Note: No person receiving services may be terminated from services during the time the Complaint Resolution Process is occurring or during appeal of a decision, unless continuation of services presents a risk to that person or others.

What We Will Need From You

To make sure we have all the information we need to help with your complaint, please be prepared to tell us the following at the time you call or write:

1.      Personal information so we can get in touch with you (name, phone number, address, birth date, Medicaid number if you have Medicaid.)

2.      Who the complaint is about

3.      What the complaint/problem is (date, what happened people involved, etc.)

4.      How you would like the situation resolved

5.      What you have already done to try to resolve the issue

Individuals with Medicaid

Consumers receive the Consumer Handbook when enrolled in the NBH Medicaid Mental Health Program.  Please review that information.  If you no longer have a copy, request a copy from your provider or receptionist.  The information in this Help Guide summarizes the information you may need if you have a problem with your mental health service provider.  In addition to the complaint process for adverse events outlined on the next page, other protective procedures are available to you.

General Procedure

This is the procedure you should use to complain about access to services, satisfaction, mental health treatment, substance abuse treatment, individual staff, quality of service, or rights violation.  (If you receive Medicaid, please also see the section “Adverse Service Determination” for complaints about a notification of denial, suspension or lower level of service based on utilization review.) 

To start the process, please:

1.      Report your complaint within 30 days of the incident to the local CSR or PFA in person, in writing, or by telephone/TDD.  Individuals with Medicaid may contact the NBH Director of Consumer and Family Affairs to initiate complaints about NBH.

2.      The Consumer Service Representative or Parent Family Advocate will call you to confirm the details of the complaint.  Any written documentation you submit will be attached to the written record.  If you have some idea of how you want the complaint resolved, please inform the CSR or PFA when you talk to them.  (For urgent situations, a faster investigation and resolution may occur.)

3.      The CSR or PFA or Director of Consumer and Family Affairs will investigate and provide you a written response with a proposed resolution to your complaint within fifteen (15) calendar days of receipt of your complaint. The letter will include information about the appeal process to Colorado Mental Health Services.

4.      If you are not satisfied with the resolution, you can appeal to

·         For Mental Health Consumers: The Consumer Representative at Colorado Mental Health Services (MHS) at 1-800-811-7648.

·         For Substance Abuse Consumers: The SSPA1 Field Representative at the Colorado Alcohol and Drug Abuse Division (ADAD) at 303-866-7480. 

For people without Medicaid, the process stops with a decision from MHS or ADAD.  If you do have Medicaid and are still not satisfied after receiving the decision of MHS, you can appeal before an administrative law judge through Health Care Policy and Financing. 

Denial of Residential Placement (Children and Adolescents Only)

This is the procedure you should use to complain if your child, Medicaid recipient or not, has been denied access to residential placement.  This process allows for another local clinical evaluation as a second opinion with a strict set of procedures.  The time frames are shorter than for regular complaints and appeals processes.

1.      If your child’s provider has not explained these procedures, call, write or visit the PFA or NBH Director of Consumer and Family Affairs about your complaint.

2.      This person will explain the HB1116 process and available alternatives and will assist you in requesting the local appeal evaluation if you wish. 

3.      This person will immediately notify the local HB1116 Coordinator, who will arrange for the appeal evaluation and conduct the appeal process.  The local HB1116 Coordinator has two days to complete the appeal evaluation and notify parents.

4.      The local HB1116 Coordinator will send notices and give information about the additional appeals process, if necessary.

5.      If dissatisfied with the outcome of the local appeal evaluation, a parent may contact the office of Colorado Mental Health Services at 1-800-811-6748 to request a Clinical Review by the State.  In this case, the parent must be prepared to take the child to the Colorado Mental Health Institute at Fort Logan (located in Denver) for the evaluation.  The law specifies that the State has 3 days to conduct the evaluation unless parents approve an extension. 

6.      The local PFA or Director of Consumer and Family Affairs will assist parents in this process, monitor progress and keep a complaint log for reporting.

Adverse Service Determination

For Medicaid recipients, this procedure should be used to complain if you received a notice to deny, reduce, suspend or terminate clinical services, and you don’t agree with the decision of your service provider:

1.      Report your complaint to your CSR, PFA or the Director of Consumer and Family Affairs, by telephone or in person.

2.      That person will immediately explain the procedures to appeal the denial of services so that you can take appropriate action, including a reconsideration request, which will take one day and will not be considered a complaint.  The steps for urgent and emergent situations are different from those for a routine situation.  (Review the complete procedures in your Consumer Handbook). 

3.      The CSR, PFA or Director of Consumer and Family Affairs will immediately notify the appropriate Clinical Supervisor or Utilization Manager to begin the appeals process for an Adverse Service Determination and will explain what you need to do.  You will need to provide some documentation in this process.

4.      The Utilization Manager will arrange the FIRST LEVEL APPEAL REVIEW to be completed within 10 days (and a SECOND LEVEL APPEAL REVIEW to be completed within 25 days, if you want one.)  The Utilization Manager will keep you informed about these processes. 

5.      The CSR, PFA or Director of Consumer and Family Affairs will help you prepare for these processes, but will not conduct them.

6.      If you still are denied services after the Second Level Appeal Review, you can request an Independent External Review through the Colorado Division of Insurance or appeal to Colorado Mental Health Services and then to an Administrative Law Judge through Health Care Policy and Finance.  The CSR or PFA will help you with these processes.

7.      In all cases, the CSR or PFA and Director of Consumer and Family Affairs will maintain records of complaints for reporting purposes.

If the time frame for the appeals process for Adverse Service Determination would be life or health threatening to you or threaten your ability to regain maximum function, you can request an EXPEDITED APPEALS PROCESS.  In this case, a review will be arranged and notification made to you within 72 hours.

OMBUDS Program (MHOPC) 

This independent advocacy group is available to assist mental health consumers and family members who are not comfortable using the local CSR, PFA, or NBH Director of Consumer and Family Affairs with complaints.  Call 1-877-317-9900 toll free.

NBH Office of Consumer And Family Affairs 

This office solicits feedback about services, provides education and empowerment activities and facilitates consumer and family participation in NBH policy and planning activities.  To become involved in an educational workshop, focus group, or an advisory committee to Northeast Behavioral Health or its individual local mental health centers, please contact your Consumer Service Representative, Parent/Family Advocate or NBH Director of Consumer and Family Affairs at 1-888-296-5827 or 970-353-3686 ext. 136.

The Secretary of Health and Human Services

If you believe your privacy rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) have been violated, you also may complain to:

Office for Civil Rights Regional Manager

% Office for Civil Rights

U.S. Department of Health & Human Services

1961 Stout Street ‑ Room 1426

Denver, CO 80294

(303) 844‑2024; (303) 844‑3439 (TDD)

(303) 844‑2025 FAX

Centennial Mental Health Center, Inc.
211 W. Main
Sterling, CO 80751
(970) 522-4549

Disclosure Statement

Except in emergency situations or when psychotherapy is being administered as the result of a court order, every unlicensed psychotherapist or licensee shall provide the information below in writing to each consumer during the initial consumer contact.  In residential, institutional, or other settings where multiple providers may provide psychotherapy, the primary therapist shall make the disclosure. 

 12.43.214 (1) (C) CRS: The practice of licensed, certified and unlicensed persons in the field of psychotherapy is regulated by the Department of Regulatory Agencies.   

12.43.214 (1) (d) CRS: A consumer is entitled to receive information about the methods of therapy; the techniques used; the duration of therapy (if known); and the fee structure.  A consumer may seek a second opinion from another therapist/case manager and may terminate therapy at any time.  In a professional relationship, sexual intimacy is never appropriate and should be reported to the grievance board.

12.43.214 (1) (d) CRS: PRIVILEGED COMMUNICATIONS.  The information provided by a consumer during therapy sessions is legally confidential in the case of licensees, except as provided in section 12.43.218 and except for certain legal exceptions, which will be identified by the licensee should any such situation arise during therapy.

12.43.214 (3) CRS: A consumer is entitled to information (upon request) concerning any psychotherapist/case manager in the employ of this agency who is providing psychotherapy services to that consumer.  Such information includes the therapist/case manager’s name, educational degrees, licenses, and credentials.

 Questions or complaints may be addressed to:

 Credentials of Centennial Mental Health Staff: