(1) No later than July 1, 2024, the BHA, in collaboration with the department of health care policy and financing and the department of public health and environment, shall establish a comprehensive and standardized behavioral health safety net system throughout the state that must include behavioral health safety net services for children, youth, and adults, including adults who have a serious mental illness and children and youth who have a serious emotional disturbance, along a continuum of care.
(2) The BHA shall ensure that all Coloradans have access to the behavioral health safety net system, which must:
(a) Proactively engage priority populations with adequate case management and care coordination throughout the care continuum;
(b) Promote competency in de-escalation techniques;
(c) Develop, maintain, and utilize adequate networks for timely access to treatment, including high-intensity behavioral health treatment and community-based treatment for children, youth, and adults;
(d) Require collaboration with all state and local law enforcement jurisdictions and counties in the service area, including judicial districts and county departments of human or social services;
(e) Triage individuals who need services outside the scope of the behavioral health safety net system;
(f) Incorporate and demonstrate trauma-informed care practices;
(g) Promote patient-centered care and cultural awareness;
(h) Update information as requested by the BHA about available treatment options and outcomes in each region of the state;
(i) Prioritize relevant programs or services eligible for federal grants or reimbursement, including relevant programs or services identified in the federal Title IV-E prevention services clearinghouse;
(j) Utilize evidence-based or evidence-informed programming to promote quality services; and
(k) Meet any other criteria established by the BHA.
(3) In establishing the standardized and comprehensive behavioral health safety net system, the BHA shall:
(a) In collaboration with state agencies and the advisory council created pursuant to section 27-50-701, establish and routinely assess what types of behavioral health services are provided on a community, regional, and statewide basis for children, youth, and adults. The BHA shall ensure that, at a minimum, the following behavioral health safety net services are available for children, youth, and adults statewide:
(I) Emergency or crisis behavioral health services;
(II) Mental health and substance use outpatient services;
(III) Behavioral health high-intensity outpatient services;
(IV) Behavioral health residential services;
(V) Withdrawal management services;
(VI) Behavioral health inpatient services;
(VII) Mental health and substance use recovery supports;
(VIII) Integrated care services;
(IX) Care management;
(X) Outreach, education, and engagement services;
(XI) Outpatient competency restoration;
(XII) Care coordination;
(XIII) Hospital alternatives;
(XIV) Screening, assessment, and diagnosis, including risk assessment, crisis planning, and monitoring to key health indicators; and
(XV) Additional services that the BHA determines are necessary in a region or throughout the state.
(b) When routinely assessing the services available regionally and statewide, as required in subsection (3)(a) of this section, assess adequacy of funding and resources necessary to implement the behavioral health system plan pursuant to section 27-50-204;
(c) Set clinical and practice standards and health, safety, and welfare standards, including standards specific to children and youth, when appropriate, through the licensing of behavioral health entities and the approval of behavioral health safety net providers;
(d) Establish statewide, regional, and local behavioral health network adequacy standards, including standards specific to children and youth, when appropriate; and
(e) Implement a behavioral health administrative services organization structure pursuant to part 4 of this article 50.
(4) Except as provided in section 27-50-303, behavioral health safety net providers shall not refuse to treat an individual based on the individual's:
(a) Insurance coverage, lack of insurance coverage, or ability to pay;
(b) Clinical acuity level related to the individual's behavioral health condition or conditions, including whether the individual has been certified for short-term treatment or long-term care and treatment pursuant to article 65 of this title 27;
(c) Readiness to transition out of the Colorado mental health institute at Pueblo, the Colorado mental health institute at Fort Logan, or any other mental health institute or licensed facility providing inpatient psychiatric services or acute care hospital providing stabilization because the individual no longer requires inpatient care and treatment;
(d) Involvement in the criminal or juvenile justice system;
(e) Current involvement in the child welfare system;
(f) Co-occurring mental health and substance use disorders, physical disability, or intellectual or developmental disability, irrespective of primary diagnosis, co-occurring conditions, or if an individual requires assistance with activities of daily living or instrumental activities of daily living, as defined in section 12-270-104 (6);
(g) Displays of aggressive behavior, or history of aggressive behavior, as a symptom of a diagnosed mental health disorder or substance use disorder;
(h) Clinical presentation or behavioral presentation in any previous interaction with a provider;
(i) Place of residence; or
(j) Disability, age, race, creed, color, sex, sexual orientation, gender identity, gender expression, marital status, national origin, ancestry, or tribal affiliation.
(5) The BHA may promulgate rules or determine other appropriate processes to approve behavioral health providers as behavioral health safety net providers. Behavioral health providers that do not hold a license from the BHA but are otherwise licensed or authorized to provide behavioral health services in the state of Colorado are eligible to be approved as behavioral health safety net providers.
Source: L. 2022: Entire article added, (HB 22-1278), ch. 222, p. 1459, � 1, effective July 1. L. 2023: (1) amended, (HB 23-1236), ch. 206, p. 1059, � 22, effective May 16.
27-50-302. Requirement to serve priority populations - screening and triage for individuals in need of behavioral health services - referrals. (1) Except as provided in this section, comprehensive community behavioral health providers must provide the safety net services listed in section 27-50-101 (11) to priority populations.
(2) Except as provided in section 27-50-303, essential behavioral health safety net providers shall provide the safety net service or services that they contract with the behavioral health administrative services organization or managed care entity to provide to priority populations.
(3) Notwithstanding any other provision of this section to the contrary, emergency and crisis services must be available to any individual who is experiencing a behavioral health crisis, regardless of whether the individual is a priority population.
(4) (a) When a priority population client initiates treatment with a behavioral health safety net provider, prior to the intake the provider shall complete an initial screening and triage process to determine urgency and appropriateness of care with the provider.
(b) The behavioral health safety net provider shall use standard criteria, as determined by the BHA, for determining whether a client's needs exceed the clinical expertise of the provider.
(c) If a priority population client's needs exceed the treatment capacity or clinical expertise of an essential behavioral health safety net provider, the provider shall refer the client to another appropriate provider.
(d) If a priority population client's needs exceed the treatment capacity or clinical expertise of a comprehensive community behavioral health provider, the provider must ensure that the client has access to interim behavioral health services in a timely manner until the client is connected to the most appropriate provider for ongoing care. This may include use of providers within the network of the behavioral health administrative services organization or the regional managed care entity.
(e) The comprehensive community behavioral health provider shall obtain approval from the behavioral health administrative services organization under which the provider is operating, or the regional managed care entity for medicaid clients, prior to referring a priority population client to alternative services; except that an individual experiencing a behavioral health crisis may be referred to emergency or crisis services without prior approval.
(f) A behavioral health safety net provider shall include services that address the language, ability, and cultural barriers, as necessary, to serve communities of color and other underserved populations.
(5) When referring a client to alternative services, a behavioral health safety net provider shall assist the client in identifying and initiating services with an appropriate provider for ongoing care. As appropriate, the behavioral health safety net provider shall use the behavioral health administrative services organization or, for medicaid clients, the regional managed care entity for care coordination.
(6) (a) Behavioral health safety net providers shall track the following information for all individuals who were referred to alternative services pursuant to this section:
(I) Client demographics;
(II) Standardized descriptions of the needs of the client that could not be met and require the client to be referred to another provider;
(III) The outcome and timeliness of the referral; and
(IV) Any other information required by the BHA.
(b) The provider shall provide the report at regular intervals to the BHA and to either the behavioral health administrative services organization under which the provider is operating or, for medicaid clients, to the managed care entity.
Source: L. 2022: Entire article added, (HB 22-1278), ch. 222, p. 1462, � 1, effective July 1. L. 2023: (4)(f) added, (HB 23-1236), ch. 206, p. 1059, � 23, effective May 16.
27-50-303. Essential behavioral health safety net providers - approval to serve limited priority populations. (1) Essential behavioral health safety net providers must serve all priority populations unless the universal contracting provisions with the behavioral health administrative services organization limit the provider's scope and responsibility to a specific underserved population pursuant to subsection (2) of this section.
(2) Behavioral health administrative services organizations may contract with an essential behavioral health safety net provider to provide a safety net service or services, including those determined necessary pursuant to section 27-50-301 (3)(a)(XV), to only one or more specific underserved populations within the priority populations.
Source: L. 2022: Entire article added, (HB 22-1278), ch. 222, p. 1463, � 1, effective July 1.
27-50-304. Behavioral health safety net provider network - incentives - preferred status - rules. (1) The BHA shall ensure that each region in the state includes a network of behavioral health safety net providers that collectively offer a full continuum of behavioral health services.
(2) The BHA shall provide statewide technical assistance specific to strengthening and expanding the behavioral health safety net system and increasing provider participation within the publicly funded behavioral health safety net provider network.
(3) The BHA and state agencies, through the behavioral health administrative services organizations established pursuant to part 4 of this article 50 and managed care entities as defined in section 25.5-5-403, shall:
(a) Subject to performance and available funds, provide behavioral health safety net providers with opportunities for quality incentives, value-based payment, or other enhanced payments or preferred contract statuses;
(b) Prioritize comprehensive community behavioral health providers in awarding contracts for behavioral health services; and
(c) Consider, upon application, behavioral health safety net providers for state-administered and county-administered grant funds related to the prevention, treatment, recovery, and harm reduction for behavioral health services.
(4) To be eligible for enhanced service payments, behavioral health safety net providers must meet specific BHA licensing or approval standards, pursuant to part 5 of this article 50.
(5) To meet the requirement in subsection (1) of this section, the behavioral health administrative services organizations and managed care entities may contract with potential and existing approved safety net providers to expand service capacity in a specific region of the state.
(6) Nothing in this section limits the ability of state agencies to award contracts or grants for the procurement of behavioral health services directly to any county, city and county, municipality, school district, health service district, or other political subdivision of the state or any county, city and county, district, or juvenile court, or to any nonprofit or for-profit organization in accordance with applicable law.
(7) The BHA may promulgate rules as necessary to implement this section.
Source: L. 2022: Entire article added, (HB 22-1278), ch. 222, p. 1463, � 1, effective July 1.
27-50-305. Resources to support behavioral health safety net providers - independent third-party contract. (1) No later than July 1, 2025, the BHA shall contract with an independent third-party entity to provide services and supports to behavioral health providers seeking to become a behavioral health safety net provider with the goal of the provider becoming self-sustaining.
(2) The independent third-party entity shall assist behavioral health providers in accessing alternative payment models and enhanced reimbursement rates through the BHA and medicaid by providing:
(a) Support to providers in completing the annual cost reporting to inform medicaid rate-setting;
(b) Analysis of current accounting practices and recommendations on implementing new or modified practices to support the soundness of cost reporting;
(c) Administrative support for enrolling in different payer types, including, but not limited to, medicaid, medicare, and commercial insurance;
(d) Billing and coding support;
(e) Claims processing;
(f) Data analysis;
(g) Compliance and training on policies and procedures;
(h) Shared purchasing for technology;
(i) Assistance in building provider capacity to become a behavioral health safety net provider; and
(j) Any other service and support approved by the BHA.
(3) The independent third-party entity shall prioritize providing services and supports to a behavioral health provider that has not previously used the state cost report process to set medicaid rates.
(4) The independent third-party entity shall be nonpartisan and shall not lobby, personally or in any other manner, directly or indirectly, for or against any pending legislation before the general assembly.
Source: L. 2024: Entire section added, (HB 24-1045), ch. 470, p. 3290, � 27, effective August 7.