Colorado Gov. Jared Polis signed House Bill 1236 into law on May 16th, which applies a series of administrative modifications to the state’s Behavioral Health Administration (BHA).
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Under the bill, the BHA will continue as the regulatory oversight agency for the behavioral healthcare system, and continue to serve as the central body for managing jail-based behavioral health services. This includes regulating community-based providers and developing a system of care coordination.
The bill clarifies administrative and programmatic responsibilities between the Colorado Department of Human Services (CDHS) and the BHA, as the Office of Behavioral Health has been dissolved.
The law also extends the deadlines for issuing licenses to behavioral health entities and mental health residential facilities to January 1, 2024.
The BHA was established last year to lead the work on six areas of system reform to the state’s behavioral health system, but program delays and reports of administrative difficulties have brought the agency’s effectiveness into question.
Dr. Morgan Medlock resigned from her post as the agency’s commissioner in April due to conflicts with the governor’s chief of staff over administrative authority. CDHS Executive Director Michelle Barnes immediately took over as interim commissioner of the BHA.
In an interview with State of Reform, bill sponsor Rep. Mary Young (D – Greeley) said the legislation was initially introduced as a technical cleanup bill that addressed the delays in improving behavioral health access and equity but was modified during the session in light of recent changes to leadership.
“My belief is that the change in leadership will work very well for the administration,” Young said. “Commissioner Barnes has led the [Behavioral Health Task Force], and she saw what the task force produced and understands [the issues].
Obviously, in the transition in working with the BHA as the leader of CDHS, she also saw what was happening—she was aware of some of the gaps that were occurring in leading to the successful development of a BHA. I know it’s always difficult to have these kinds of changes, but I think it will be a positive one.”
The new changes authorize the BHA Commissioner to serve on the state’s health equity commission, appoint a member to the government data advisory board, and pursue fundraising efforts.
Young, a member of the House Public and Behavioral Health and Human Services Committee, said HB 1236 was a response to lawmakers not getting answers to critical questions surrounding investment and planning.
The technical changes address how individuals may formally engage with and inform the behavioral health administrative service organizations (BHASO) and BHA on regionally-based services including care coordination. The bill clarifies that the BHA establishes a regionally-informed structure for a BHASO to operate.
Legislators were receiving conflicting information from regional subcommittees about how that coordination would be taking place, according to Young—whether BHASOs would have a physical presence in their regions, and what their main functions would be.
Young will be looking to Barnes to get answers to those questions as the BHA coordinates with local leadership on the technical changes, yet it remains to be seen how those changes will impact service issues.
Colorado ranks among the worst states for adult mental health, facing a higher prevalence of mental illness and lower rates of access to care than many other states. Despite lawmakers approving $450 million last year to improve behavioral health access and workforce capacity, the state has seen little progress.
CDHS requested $3.2 billion for FY 2023-2024 at the start of this year’s legislative session to help meet its staffing needs. CDHS officials reported then that internal and state mental hospital staffing shortages impacted the department’s ability to comply with a 2019 federal consent decree over ongoing failures to provide court-ordered services and competency evaluations for criminal defendants in state custody.
Lawmakers reduced the appropriation for CDHS from the previous year’s allocation of $2.6 billion to $2.3 billion for the upcoming fiscal year.
HB 1236 will also require safety net providers to address cultural competency and other barriers to health access and equity.
“One of the critical pieces for me in this [legislation was] the data monitoring because when we looked back, we didn’t have a good handle on which patients will be turned away [and] why they will be turned away,” Young said. “This is going to require data monitoring to make sure we’re really providing what we’ve committed to. In other words, no closed door.”
Young remains committed to ensuring Coloradans can access behavioral health services in their preferred and primary languages, and says she is excited about the BHA’s work to build cultural and linguistic competency among providers.
Another key piece of behavioral health reform to emerge from the session was HB 1153, which authorizes CDHS to conduct a feasibility study on establishing new pathways to behavioral healthcare. The aim will be to create a structure of support for individuals with serious mental illness through collaboration between the state’s behavioral health and judicial systems.
Young said she and her colleagues have been focusing on policies that maximize the state’s federal match for Medicaid and Medicare services, which are critical to her constituents. She intends to work through new policies and ensure community behavioral health needs are met.
“I know there’s going to be productive ongoing discussions because communities have been saying that they wanted investments in behavioral health,” Young said. “I’m hoping that [work] is going to [have] a positive outcome—that we will be able to work with our hospital partners and return some of that [community benefit] revenue either into programming or in some other ways of supporting behavioral healthcare and communities.”