As used in this part 8, unless the context otherwise requires:
(1) At risk of out-of-home placement means a child or youth who is eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5 and the child or youth:
(a) Has been diagnosed as having a mental health disorder, as defined in section 27-65-102 (11.5), or a behavioral health disorder; and
(b) May require a level of care that is provided in a residential child care facility, inpatient psychiatric hospital, or other intensive care setting outside of the child's or youth's home. At risk of out-of-home placement includes a child or youth who:
(I) Is entering the division of youth services; or
(II) Is at risk of child welfare involvement.
(2) Behavioral health disorder means a substance use disorder, mental health disorder, or one or more substantial disorders of the cognitive, volitional, or emotional processes that grossly impair judgment or capacity to recognize reality or to control behavior, including serious emotional disturbances. Behavioral health disorder also includes those mental health disorders listed in the most recent versions of the diagnostic statistical manual of mental health disorders, the diagnostic classification of mental health and developmental disorders of infancy and early childhood, and the international statistical classification of diseases and related health problems.
(3) Behavioral health services or behavioral health system means the child and youth service system that encompasses prevention and promotion of emotional health, prevention and treatment services for mental health and substance use conditions, and recovery support.
(4) Child and youth means a person who is twenty-six years of age or younger.
(5) Managed care entity means an entity that enters into a contract to provide services in the statewide managed care system pursuant to articles 4, 5, and 6 of this title 25.5.
(6) Mental health professional means an individual licensed as a mental health professional pursuant to article 245 of title 12 or a professional person as defined in section 27-65-102 (17).
(7) Out-of-home placement means a child or youth who is eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5 and the child or youth:
(a) Has been diagnosed as having a mental health disorder, as defined in section 27-65-102 (11.5), or a behavioral health disorder; and
(b) May require a level of care that is provided in a residential child care facility, inpatient psychiatric hospital, or other intensive care setting outside of the child's or youth's home. Out-of-home placement includes a child or youth who:
(I) Has entered the division of youth services; or
(II) Is at risk of child welfare involvement.
(8) Wraparound means a high-fidelity, individualized, family-centered, strengths-based, and intensive care planning and management process used in the delivery of behavioral health services for a child or youth with a behavioral health disorder, commonly utilized as part of the system of care framework.
Source: L. 2019: Entire part added, (SB 19-195), ch. 190, p. 2098, � 2, effective August 2.
Cross references: For additional definitions applicable to this part 8, see � 25.5-4-103.
25.5-5-803. High-fidelity wraparound services for children and youth - federal approval - reporting. (1) Subject to available appropriations, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide wraparound services for eligible children and youth who are at risk of out-of-home placement or in an out-of-home placement. Prior to seeking federal authorization, the state department shall seek input from relevant stakeholders including counties, managed care entities participating in the statewide managed care system, families of children and youth with behavioral health disorders, communities that have previously implemented wraparound services, mental health professionals, the behavioral health administration in the department of human services, and other relevant departments. The state department shall consider tiered care coordination as an approach when developing the wraparound model.
(2) Upon federal authorization, and subject to available appropriations, the state department shall require managed care entities to implement wraparound services, which may be contracted out to a third party. Subject to available appropriations, the state department shall contract with the department of human services and the behavioral health administration in the department of human services to ensure care coordinators and those responsible for implementing wraparound services have adequate training and resources to support children and youth who may have co-occurring diagnoses, including behavioral health disorders and physical or intellectual or developmental disabilities. Attention must also be given to the geographic diversity of the state in designing this program in rural communities.
(3) Upon implementation of the wraparound services, the state department, the department of human services, and the behavioral health administration in the department of human services shall monitor and report the annual cost savings associated with eligible children and youth receiving wraparound services to the public through the annual hearing, pursuant to the State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act, part 2 of article 7 of title 2. The state department shall require managed care entities to report data on the utilization and effectiveness of wraparound services.
(4) Subject to available appropriations, the state department shall work collaboratively with the department of human services, the behavioral health administration in the department of human services, counties, and other departments, as appropriate, to develop and implement wraparound services for children and youth at risk of out-of-home placement or in an out-of-home placement. The behavioral health administration in the department of human services shall oversee that the wraparound services are delivered with fidelity to the model. As part of routine collaboration, and subject to available appropriations, the state department shall develop a model of sustainable funding for wraparound services in consultation with the department of human services and the behavioral health administration in the department of human services. Wraparound services provided to eligible children and youth pursuant to this section must be covered under the Colorado Medical Assistance Act, articles 4, 5, and 6 of this title 25.5, subject to available appropriations. The state department may use targeting criteria to ramp up wraparound services as service capacity increases, or temporarily, as necessary, to meet certain federal financial participation requirements.
Source: L. 2019: Entire part added, (SB 19-195), ch. 190, p. 2100, � 2, effective August 2. L. 2020: (1), (2), and (4) amended, (HB 20-1384), ch. 172, p. 789, � 2, effective June 29. L. 2022: Entire section amended, (HB 22-1278), ch. 222, p. 1516, � 77, effective July 1. L. 2023: (1) amended, (HB 23-1236), ch. 206, p. 1054, � 15, effective May 16.