Lawmakers want to transform Colorado’s behavioral health care system
Federal funding provides one-time boost, but problems run deep
Kim Bimestefer, the executive director of the Colorado Department of Health Care Policy and Financing, speaks at a news conference April 7, 2022, at the Colorado State Capitol building. (Faith Miller/Colorado Newsline)
State lawmakers, community leaders and Gov. Jared Polis met at the Colorado Capitol on Thursday to drum up support for three high-dollar policies that would expand access to mental health and substance use treatment. Coupled with legislation setting up the new Behavioral Health Administration, these federally-funded investments are supposed to transform behavioral health in Colorado.
“This will boost access to substance use disorder treatment, residential and outpatient services, and ensure that more Coloradans have access to the care that they need to thrive,” House Assistant Majority Leader Serena Gonzales-Gutierrez, a Denver Democrat, said at the news conference.
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But the state has a long way to go: National nonprofit Mental Health America ranks Colorado in last place overall for adult mental health. In 2020, 1,294 people died by suicide in Colorado, according to the Colorado Department of Public Health and Environment. While that represents a slight decrease from the year prior, Colorado had the seventh-highest suicide rate in the nation in 2020, according to the Centers for Disease Control and Prevention.
As of March, preliminary data from CDPHE showed that 1,757 people died of drug overdose in Colorado last year. That’s the highest number in recent history, and it represents a 19% increase from 2020, when 1,477 died of drug overdose.
Filling gaps in services
House Bill 22-1281, sponsored by Gonzales-Gutierrez and Rep. Naquetta Ricks, would provide $90 million in grant funds to local governments and community-based organizations. Sens. Faith Winter, a Westminster Democrat, and Bob Rankin, a Carbondale Republican, are the bill’s Senate sponsors.
The grants could be used to implement programs that would help fill gaps in services for various regions of Colorado.
This money would come from the coronavirus relief funding that Congress sent to Colorado in 2021 through the American Rescue Plan Act. State lawmakers set up a task force last year that discussed how to spend $450 million of the federal ARPA funding on improving behavioral health in the state.
“The pandemic has exacerbated longstanding issues in our system,” said Gonzales-Gutierrez, who served as vice chair of the Behavioral Health Transformational Task Force. “In some cases, this is an urgent matter of life or death, just as we’ve heard countless times from folks coming to testify. This problem will not be solved overnight, but we have a unique opportunity before us.”
Mental Health America’s 2022 State of Mental Health in America report, which used data from 2018-2019, ranked Colorado in last place overall for adult mental health. The ranking accounted for a variety of factors related to the prevalence of mental illness and access to care.
Colorado had the sixth-highest prevalence of mental illness among adults and the second-highest prevalence of adults with substance use disorders.
Colorado had the fourth-highest percentage of adults (31.8%) with a mental illness who reported they were not able to receive the treatment they needed.
The task force recommended spending at least $45 million on grants to “evidence-based programs” that fill gaps across the continuum of mental health and substance use needs — ranging from addiction prevention to supportive housing and recovery homes — and another $45 million for grants to help make youth- and family-oriented behavioral health services available within two hours’ drive of every Colorado community. Both of those recommendations are included in HB-1281, which passed the House Committee on Public and Behavioral Health and Human Services by unanimous vote Tuesday.
School-based mental health care
Sens. Chris Kolker, a Centennial Democrat, and Jerry Sonnenberg, a Republican from Sterling, are sponsoring Senate Bill 22-147, along with Reps. Mary Young, a Greeley Democrat, and Rod Pelton, a Cheyenne Wells Republican.
The bill directs $11.1 million to three separate programs aimed at improving access to mental health and substance use treatment within public schools. Of that, $5 million would go to an existing program in the Colorado Department of Education that provides matching grants to schools to help them hire and retain behavioral health workers, provide training and resources for school staff, and serve students suffering from mental illness or addiction. Another $1.5 million would go to the Colorado Department of Public Health and Environment’s grant program to fund school-based health centers where children and youth can receive medical care.
SB-147 would also set up the Colorado Pediatric Psychiatry Consultation and Access Program within the University of Colorado system and seed it with $4.6 million. The program would help supply primary care providers with the resources they need to begin identifying and treating mild to moderate behavioral health conditions in children and youth.
The behavioral health task force recommended spending at least $11.5 million on these priorities, without going into detail about how much should be allocated to each program.
SB-147 won unanimous approval in the Colorado Senate on Monday. Next, the bill heads to the House for consideration.
Integrating primary care, behavioral health
House Bill 22-1302 — sponsored by Reps. Perry Will, a New Castle Republican, and Chris Kennedy, a Lakewood Democrat, along with Sens. Sonya Jaquez Lewis, a Boulder County Democrat, and Kevin Priola, a Republican from Henderson — would invest $35 million into better integrating physical health care with treatment for mental illness and substance use disorders, mostly by providing grants to primary care practices. The goal of this legislation is to increase access to screening and treatment for mental illness and addiction before these issues become severe enough to lead to a crisis.
The behavioral health task force recommended putting at least $35 million toward this priority. According to a report from the task force, providers could use the grants to improve health information technology; address social determinants of health, such as economic stability and education access, for their patients; expand telehealth resources like virtual appointments; and better coordinate care for patients with various physical and behavioral health needs.
Mental Health America’s latest report ranked Colorado 13th overall for youth mental health.
Among young people, Colorado had the 18th-lowest rate of severe depression and the sixth-highest rate of substance use disorders.
Colorado had the 12th-highest percentage of children (9.6%) with private insurance that did not cover mental or emotional problems.
HB-1302 would also provide $3 million in funding for the state to develop a new universal contract for all behavioral health providers it contracts with — another recommendation of the task force. This will apply to providers that contract with the state Medicaid program as well as other types of contracted behavioral health providers. The requirements of this universal contract are included in another bill moving through the Legislature, House Bill 22-1278.
The House Committee on Public and Behavioral Health and Human Services Committee approved HB-1302 on March 29 by a vote of 10-1, with Rep. Dave Williams, a Colorado Springs Republican, opposed.
Building out the Behavioral Health Administration
The $450 million that lawmakers had to spend from the American Rescue Plan Act represents a “historic investment,” a phrase that’s been frequently repeated by policy makers this year. However, it must be obligated for a very specific purpose by 2025 and spent by 2027. That means more is needed to transform Colorado’s behavioral health care system for the long run.
Young, the Greeley Democrat, hopes House Bill 22-1278 will help with that. The 232-page legislation — which also counts Rep. Pelton, Democratic Sen. Pete Lee of Colorado Springs and Republican Sen. Cleave Simpson of Alamosa as sponsors — would build out the state’s new Behavioral Health Administration.
In 2020, members of an earlier task force unanimously recommended the state establish the Behavioral Health Administration as one of several strategies for reforming the state’s behavioral health care system. The goal was to centralize management of the state’s myriad mental health and substance use programs, improving access to care and outcomes for patients.
A bipartisan bill that Polis signed into law in April laid the groundwork for the new government agency. Sponsored by Young and Pelton along with Sens. Rhonda Fields, an Aurora Democrat, and Bob Gardner, a Colorado Springs Republican, House Bill 21-1097 declared that the Behavioral Health Administration would be part of the Department of Human Services until at least November 2024, after which it could become a separate department in the state government.
This year’s bill would permanently house the BHA under the Department of Human Services and have it take over most of the programs currently run by the department’s Office of Behavioral Health. It would establish a commissioner to head the BHA and give that commissioner, along with the State Board of Human Services, the authority to set rules for Colorado’s behavioral health safety-net system.
“The overarching goal is that people in the state of Colorado can access the behavioral health care they need, the right care, and when they need it,” Young said in an interview.
The BHA would centralize behavioral services, which are currently housed under separate departments, making it difficult for people suffering from mental health issues or addiction to navigate the system.
By July 1, 2024, the BHA would need to establish:
- A system for addressing complaints and grievances with behavioral health care
- A system for monitoring the performance of behavioral health providers
- A comprehensive behavioral health safety-net system, including emergency care, outpatient services and case management
- A new system for licensing behavioral health organizations and providers
- An advisory council to provide feedback to the BHA
HB-1097 would also transfer community intervention and early intervention programs from the Department of Human Services to the Department of Public Health and Environment.
New safety-net system
In creating a new safety-net system, the bill would define several types of behavioral health organizations, including:
- Behavioral health entity: “a facility or provider organization engaged in providing community-based health services” outside of a hospital, psychiatric hospital or nursing home. These services might include treatment for behavioral health disorders such as alcohol or drug addiction, depression, anxiety, bipolar disorder or schizophrenia. As defined in the bill, behavioral health entities don’t include residential child care facilities or licensed mental health care professionals operating a private practice.
- Comprehensive behavioral health safety net provider: a licensed behavioral health care entity approved by the BHA to provide a list of safety-net services to a county or region, either directly or by contracting with other providers. Those safety-net services would include:
- emergency and crisis behavioral health services
- mental health and substance use outpatient services
- behavioral health high-intensity outpatient services
- clinical case management
- outreach, education and engagement services
- mental health and substance use recovery supports
- care coordination
- outpatient competency restoration
- Essential behavioral health safety net provider: a licensed behavioral health care entity approved by the BHA to provide at least one of the safety-net services defined above.
Currently, Young explained, “someone with an intellectual and developmental disability with a co-occurring mental health disorder could go to (a mental health provider) and be told, ‘No, you can’t come here for services, because your primary disorder is intellectual and developmental.'”
Establishing expectations for comprehensive and essential providers would prevent that from happening, Young said. Ideally, the BHA will ensure that “safety net services are provided across the state to everyone, that everyone can get them, and that high-priority populations that are the ones who had the greatest difficulty accessing it up to this point in time, the barriers that have occurred for them are addressed.”
Community mental health centers controversy
The original version of HB-1278 struck the existing legal definition of organizations that are supposed to deliver the safety-net services described in the bill: community mental health centers, of which there are 17 in Colorado. The state’s Office of Behavioral Health contracts with community mental health centers to provide treatment for uninsured or underinsured people.
An investigation last year by the Colorado News Collaborative found these mental health centers operate with little state oversight, receive non-compete contracts and are paid higher rates than other types of safety-net providers. The reporting prompted calls for systemic change from state officials.
But during HB-1278’s first committee hearing, representatives of several community mental health centers urged lawmakers to approve a change that would include them in the bill, warning that vulnerable people could slip through the cracks without their continued presence in Colorado communities.
The House Public and Behavioral Health and Human Services Committee ultimately passed an amendment, which incorporated a new definition for community mental health centers and stated they could apply to be licensed as a comprehensive or essential safety-net provider.
HB-1278 was subsequently approved on a vote of 10-1, with Williams opposed. It’s scheduled for a second hearing Friday morning before the House Appropriations Committee.
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