Sen. Judy Amabile

Legislative Oversight Committee Concerning the Treatment of Persons with Behavioral Health Disorders in the Criminal and Juvenile Justice Systems. The bill prohibits the department of health care policy and financing from imposing prior authorization, step therapy, and fail first requirements for medicaid coverage of a prescription drug, as indicated on federally approved labels, to treat serious mental health disorders.(Note: This summary applies to this bill as introduced.)

The act updates provisions of the existing article 1.9 of title 18, Colorado Revised Statutes, concerning the treatment of persons with mental health disorders in the criminal and juvenile justice systems. Substantive changes include: Broadening the name and scope of the legislative oversight committee (committee) and associated task force (task force) from concerning the treatment of "persons with mental health disorders" to "persons with behavioral health disorders"; Allowing the task force to research topics for members of the committee upon request; Adjusting task force membership and creating term limits for task force members; Further defining issues for the task force to study; and Extending the repeal date to July 1, 2027. The act appropriates $108,131 to the legislative department from the general fund to implement the provisions of the act. (Note: This summary applies to this bill as enacted.)

If the trier of fact finds a defendant not guilty by reason of insanity (NGRI) for a crime that is not a class 1 or class 2 felony, resulted in another person suffering serious bodily injury or death, involved the defendant using a deadly weapon, or involved felony unlawful sexual behavior, the act authorizes the court, at the request of the defendant, to allow the defendant to remain at liberty or set a hearing to modify the bond and delay final disposition, delay formal entry of the finding of NGRI, and stay the commitment of the defendant to the custody of the department of human services (state department) until the conclusion of the initial release hearing. If the defendant is on bond, the act requires the court to order the state department to conduct a release examination on an outpatient basis. Upon an initial commitment following a finding of NGRI, or upon delaying the final entry of the finding of NGRI, the act requires the court to schedule an initial release hearing no later than 120 days after the initial commitment. The act requires the court to conduct the initial release hearing. The act requires the court to order the state department to complete a release examination no later than 30 days prior to the initial release hearing. The act authorizes the court to continue the hearing beyond 120 days upon a finding of good cause or if necessary to conduct a second evaluation of the defendant. Beginning September 1, 2022, the act requires the chief officer of the institution at which the defendant is committed to annually submit a release examination report to the court certifying whether the defendant continues to meet the criteria for ongoing inpatient hospitalization or meets the applicable test for release. The act describes what must be included in the release examination report. The act appropriates $868,271 to the state department from the general fund for use by the office of behavioral health. (Note: This summary applies to this bill as enacted.)

Current law sets forth emergency procedures to transport a person for a screening and to detain a person for a 72-hour treatment and evaluation if the person appears to have a mental health disorder, and as a result of the mental health disorder, appears to be an imminent danger to the person's self or others or appears to be gravely disabled. Current law also sets forth procedures to certify a person for short-term or long-term care and treatment if the person has a mental health disorder, and as a result of the mental health disorder, is a danger to the person's self or others or is gravely disabled. The act modifies these procedures by: Transferring duties of the executive director of the department of human services to the commissioner (commissioner) of the behavioral health administration (BHA); Limiting who can take a person into protective custody and transport the person to an outpatient mental health facility, a facility designated by the commissioner (designated facility), or an emergency medical services facility (EMS facility) if the person has probable cause to believe a person is experiencing a behavioral health crisis; Requiring the facility where the person is transported to require an application, in writing, stating the circumstances and specific facts under which the person's condition was called to the attention of a certified peace officer or intervening professional; Requiring an intervening professional to screen the person immediately or within 8 hours after the person's arrival at the facility to determine if the person meets the criteria for an emergency mental health hold; Establishing certain rights for a person being transported, which must be explained prior to transporting the person; Effective July 1, 2023: Subjecting a person who files a malicious or false petition for an evaluation of a respondent to criminal prosecution; Authorizing a certified peace officer to transport a person to an EMS facility even if a warrant has been issued for the person's arrest, if the certified peace officer believes it is in the best interest of the person; Authorizing an intervening professional or certified peace officer to initiate an emergency mental health hold at the time of screening the respondent; Authorizing a secure transportation provider to take a respondent into custody and transport the person to an EMS facility or designated facility for an emergency mental health hold; Expanding the list of professionals who may terminate the emergency mental health hold; Requiring the evaluation to be completed using a standardized form approved by the commissioner; Requiring an EMS facility to immediately notify the BHA if a person is evaluated and the evaluating professional determines that the person continues to meet the criteria for an emergency mental health hold and the facility cannot locate appropriate placement; Requiring the BHA to support the EMS facility in locating an appropriate placement option. If an appropriate placement option cannot be located, the act authorizes the EMS facility to place the person under a subsequent emergency mental health hold and requires the court to immediately appoint an attorney. Authorizing a designated facility to place the person under a subsequent emergency mental health hold if the person has been recently transferred from an EMS facility to the designated facility and the designated facility is unable to complete the evaluation before the initial emergency mental health hold is set to expire; and Requiring the facility to provide the person with discharge instructions; facilitate a follow-up appointment within 7 calendar days after discharge; attempt to follow up with the person 48 hours after discharge; and encourage the person to designate a family member, friend, or lay person to participate in the person's discharge planning. Effective January 1, 2024: Authorizing the BHA to delegate physical custody of the respondent to a designated facility; Requiring an extended certification to be filed with the court at least 30 days prior to the expiration of the original certification; Establishing requirements for a short-term or long-term certification on an outpatient basis; and Requiring the outpatient treatment provider, in collaboration with the BHA, to develop a treatment plan for the respondent and requiring the BHA to create a one-step grievance process for the respondent related to the respondent's treatment plan or provider. The act establishes a right to an attorney for a person certified for short-term or long-term care and treatment, regardless of income. The act establishes certain rights for a person transported or detained for an emergency mental health hold or certified on an outpatient basis. The act modifies current rights for a person certified for short-term or long-term care and treatment on an inpatient basis. Beginning January 1, 2025, the act requires the BHA to annually submit a report to the general assembly on the outcomes and effectiveness of the involuntary commitment system, disaggregated by region, including any recommendations to improve the system and outcomes for persons involuntarily committed or certified. The act appropriates $522,433 to the department of human services, $177,426 to the department of law, and $86,700 to the judicial department. (Note: This summary applies to this bill as enacted.)

The act creates the legislative oversight committee (committee) concerning Colorado jail standards and the Colorado jail standards commission (commission) in the legislative branch. The committee consists of 6 members of the General Assembly and oversees the commission. The committee may introduce up to 3 pieces of legislation in the 2024 session based on recommendations from the commission. The commission recommends standards for the operation of Colorado's county jails (jails). The commission consists of the following 22 members: 5 sheriffs or senior jail administrators; 2 county commissioners; 3 people with lived experience of being incarcerated or having a family member who is or was incarcerated in a jail; One mental health professional with experience working in a jail; One person representing competency services; One person representing the behavioral health administration; One person representing police officers; One person representing a lesbian, gay, bisexual, transgender, or queer advocacy organization; One person representing an organization advocating for the rights of people with disabilities; One person representing an organization advocating for the rights of communities of color; One person representing an organization advocating for the rights of persons with mental or physical disabilities; One non-law-enforcement person with experience working in a jail; The state public defender or the state public defender's designee; One district attorney; and One person representing the department of public safety with expertise in jail operations. The commission shall recommend standards for all aspects of jail operations as follows: Reception and release; Classification of inmates; Security; Housing; Sanitation and environmental conditions; Communication; Visitation; Health care, mental and behavioral health care, and dental care; Food service; Recreation and programming; Inmate disciplinary processes; Restrictive housing; Inmate grievances; Staffing; and Inmates' prerogatives. The commission shall complete a report that includes its recommendations regarding the feasability of jails of various sizes and their ability to implement the recommendations and present it to the committee for approval by November 15, 2023. The act repeals the committee and commission on July 1, 2024. The act appropriates $96,039 from the general fund to the legislative department. (Note: This summary applies to this bill as enacted.)

The act requires the department of health care policy and financing (department) to prepare a behavioral health rates report of medicaid reimbursement rates for community mental health providers and independent mental health and substance use treatment providers. The department shall hire an independent auditor to prepare the behavioral health rates report. The department shall, in coordination with the behavioral health rates report, prepare recommendations to create equitable payment models between providers of community mental health centers and independent mental health and substance use treatment providers providing comparable behavioral health services. The department shall present the behavioral health rates report and recommendations to the house of representatives public and behavioral health and human services committee. The audit conducted must reflect data from state fiscal year 2020-21 and include a determination and recommendations on the adequacy of reimbursement rates paid to medicaid mental health providers. The department shall present an action plan to implement changes to reimbursement rates based on the findings of the audit to the joint budget committee before November 15, 2022. The department shall also prepare an annual progress report on the state's progress in implementing the action plan and provide an update at the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing on or before August 1, 2023, and annually thereafter through August 1, 2025. The act requires the department to fully implement the action plan no later than December 31, 2025. The department shall publish an annual cost report on or before March 15, 2023, and each year thereafter. The department shall establish a cost report template and cost reporting schedule to assist community mental health centers in relaying cost information to the state department. The department shall establish a transparency report that translates the cost report data into meaningful and actionable information to ensure equity in provider compensation and adequate access to care for medicaid members. The department shall redact certain information from the cost reports to ensure compliance with state and federal privacy laws. The department shall create a publicly accessible website providing information on the behavioral health rates reports and information to assist the public, medicaid providers, and medicaid members in understanding the published information. (Note: This summary applies to this bill as enacted.)

The act requires, on or before January 1, 2023, the department of labor and employment (department), in partnership with the business experiential-learning commission in the department, the office of economic development, the state work force development council, local district colleges, the departments of education and higher education, the state board for community colleges and occupational education, and area technical colleges, to provide incentives to eligible employers to create high-quality, work-based learning opportunities for adults and youth (incentive program). The department is required to select at least 2 work-based learning intermediaries (intermediaries) to coordinate employers, schools, youth, and adults participating in the incentive program to establish work-based learning opportunities and select employers to participate in the incentive program. The department is required to provide monetary incentives to the selected intermediaries and employers for the implementation of work-based learning opportunities. The department is required to compile data concerning the incentive program and submit a report to the business committees of the senate and house of representatives during the "SMART Act" hearings held each legislative session. On or before January 1, 2023, the office of future work in the department and its partners are required to create a digital navigation program and employ digital navigators to: Reach out to youth and adults who have been historically excluded or disengaged from work-based learning opportunities and connect them with available opportunities; Address digital inequities, including access to digital technology and computer and technology skills training, cybersecurity, and affordable internet service; Refer youth and adults to career navigation services; and Provide a one-stop service that includes: Making referrals to work-based learning programs; facilitating enrollment in digital literacy classes, workshops, and upskilling and work-based learning opportunities; and assisting with digital skill development, job applications, and access to other benefits and services. The act authorizes the executive director of the department to promulgate rules to implement the incentive program and the digital navigation program. The office of new Americans in the department is required to: By September 1, 2022, convene a global talent task force to study the pathways for obtaining certain in-demand occupational licenses, look at international credentials, and take advantage of the global pool of skilled workers; and By January 1, 2023, establish a virtual, career-aligned English as a second language program to provide tools for new Americans and English language learners to enter into work-based learning programs to improve language and skills development for specific occupations and careers. $6,100,000 is appropriated from the general fund to the department for use in the 2022-23 state fiscal year for: State operations and program costs; The office of future work; and The office of new Americans. If the department does not expend the appropriated amount by July 1, 2023, the money ir further appropriated to the department for use in the 2023-24 state fiscal year. $11,319 is appropriated from the general fund to the legislative department for use by the general assembly. (Note: This summary applies to this bill as enacted.)

The act establishes new coverage requirements for homeowners insurance policies issued or renewed in Colorado, which requirements apply in the event of a total loss of an owner-occupied residence as a result of a wildfire disaster that is declared by the governor. The act also establishes new requirements for insurers who issue or renew homeowners insurance policies, which requirements concern an insurer's handling of policy claims after such a total loss occurs. For the 2022-23 state fiscal year, the act appropriates $66,781 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance as follows: $59,231 for personal services; and $7,550 for operating expenses.(Note: This summary applies to this bill as enacted.)

Under current law, in a dispute over a defendant's competency, a party may request a second evaluation of the defendant. The act requires that if a second evaluation is completed and restoration is ordered, the court shall make the second evaluation available to the department of human services (department). If the court finds that the competency report provided by the department does not meet statutory requirements, the act permits a defendant to be placed in the department's custody for an inpatient competency evaluation. Under current law, when a defendant is in custody on a misdemeanor, petty offense, or traffic offense and the defendant is found incompetent to proceed, there is a presumption that the court will enter a personal recognizance bond. The act also creates a presumption that the court will order outpatient restoration services. If the court denies a personal recognizance bond, the court shall notify the department of the specific facts and findings it relied upon in the order for restoration treatment. The department is allowed to offer assistance to an out-of-state provider providing restoration services to a defendant living outside Colorado. The requirement to opine on whether there is a substantial probability that the defendant will be restored to competency and remain competent with the use of medication or not remain competent without the use of forced medication is eliminated. After the court has conducted at least 4 competency reviews, the act requires the court to conduct a competency review every 91 days. The court is required to dismiss the defendant's case if there is not a substantial probability that the defendant will be restored to competency in the reasonably foreseeable future. The act appropriates: $28,562,828 from the economic recovery and relief fund cash fund to the department for use by the office of behavioral health for inpatient bed capacity; and $800,000 from the behavioral and mental health cash fund to the department to contract for a feasibility study of renovating a facility in Adams county to provide inpatient beds for competency services.(Note: This summary applies to this bill as enacted.)

The act requires the department of human services (department) to renovate a building at the mental health institute at Fort Logan to create at least 16 additional inpatient beds for persons in need of residential behavioral health treatment. The act authorizes the new beds to be used for persons needing competency services until the backlog of such persons is eliminated, and at that point the beds may begin to serve civil patients. The act also directs the department and the department of health care policy and financing to create, develop, or contract to add at least 125 additional beds at mental health residential facilities (mental health facilities) throughout the state for adults in need of ongoing supportive services. For the new beds, the act requires the department, in collaboration with the behavioral health administration, the department of health care policy and financing, and relevant stakeholders, to establish criteria for admissions and discharge planning, quality assurance monitoring, appropriate length of stay, and compliance with applicable federal law. The act requires mental health facilities to be licensed by the department of public health and environment as an assisted living facility or by the department as a behavioral health entity during the 2022-23 state fiscal year. Starting in the 2023-24 state fiscal year, the mental health facilities must be licensed by the behavioral health administration. The act appropriates to the department from the behavioral and mental health cash fund: $728,296 for use by administration and finance; $39,854,179 for use by the office of behavioral health for contract beds and renovations in mental health residential facilities, costs associated with additional beds in department facilities, and oversight of the additional beds; $6,578,266 for costs associated with the operation of additional beds at the Colorado mental health institute at Fort Logan; $6,991,567 for capital construction at the mental health institute at Fort Logan; and $3,692,111 for capital construction at three existing department facilities to create mental health residential facilities. The act also appropriates $91,938 to the department of health care policy and financing. (Note: This summary applies to this bill as enacted.)