First Regular Session Sixty-seventh General Assembly STATE OF COLORADO INTRODUCED LLS NO. 09-0111.02 Kristen Forrestal SENATE BILL 09-011 SENATE SPONSORSHIP Boyd, Morse HOUSE SPONSORSHIP Frangas, Green, Riesberg Senate Committees House Committees Health and Human Services A BILL FOR AN ACT Concerning the creation of the behavioral health commission for the purpose of guiding the development of an integrated behavioral health system in Colorado, and, in connection therewith, requiring a post-enactment review of the implementation of this act. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Health Care Task Force. Creates the behavioral health commission (commission) within the department of human services for the purpose of guiding the development and implementation of an integrated behavioral health system in Colorado. Requires the commission to exercise its powers and duties as if transferred by a type 1 transfer. Requires members of the commission to include representatives of each executive department involved in behavioral health care services, a representative of the judicial branch, a representative from the governor's office, and members of the community involved in behavioral health issues. Requires the commission to perform duties in order to implement a behavioral health system. Allows the commission to contract out services, develop and implement demonstration projects, and promulgate rules. Repeals the commission on July 1, 2019. Requires a post-enactment review of the implementation of the act. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. 24-1-120, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBSECTION to read: 24-1-120. Department of human services - creation - repeal. (10) The powers, duties, and functions of the behavioral health commission, created in part 5 of article 1 of title 26, C.R.S., are transferred by a type 1 transfer to the department of human services. SECTION 2. Article 1 of title 26, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PART to read: PART 5 BEHAVIORAL HEALTH COMMISSION 26-1-501. Legislative declaration. (1) The general assembly hereby finds that: (a) Behavioral health is integral to overall health care; (b) There is no single behavioral health system in Colorado, leaving consumers with behavioral health disorders and their families to rely on receiving services from a number of public systems, including behavioral health, child welfare, juvenile and criminal justice, education, higher education, and others; (c) Adult, youth, and child consumers and their families need quality behavioral health care that is individualized and coordinated to meet their changing needs through a comprehensive, integrated system; (d) Timely access through multiple points of entry to a full continuum of culturally responsive services, including prevention, early intervention, crisis response, treatment, and recovery is needed in an integrated system; (e) The independent processes that each Colorado department undertakes to create separate budget requests to the joint budget committee of the general assembly results in competition for dollars to oversee and provide behavioral health services and leads to further fragmentation of the behavioral health system; (f) State-level leadership supporting an integrated behavioral health system helps to ensure that the system is streamlined and cost-effective and that funding is maximized; (g) The use of evidence-based and promising practices, when possible, results in favorable outcomes for Colorado's adult, youth, and child consumers and their families and the communities in which they live; and (h) Lack of public awareness regarding behavioral health issues creates a need for public education to emphasize the importance of behavioral health as part of overall health and wellness and to create the will to invest in and support an integrated behavioral health system in Colorado. (2) The general assembly therefore determines that it is in the best interest of the state to create a behavioral health commission to analyze, guide, develop, and implement an integrated behavioral health system in Colorado. (3) The general assembly further determines that in order to ensure the proper implementation of the intent of the general assembly and the behavioral health commission and its duties as set forth in this part 5, the legislative service agencies of the general assembly shall conduct a post- enactment review of the implementation of this part 5 in accordance with section 2-2-1201, C.R.S. 26-1-502. Definitions. As used in this part 5, unless the context otherwise requires: (1) "Behavioral health" means an integrated approach to mental health and substance use care. (2) "Blend" means to combine revenues into a single pool from which they can be allocated to providers without discerning their source and specific requirements. (3) "Braid" means to use revenues from various sources to pay for a service package where the tracking and accountability for each pot of money is maintained at the administrative level. (4) "Commission" means the behavioral health commission created in section 26-1-503. 26-1-503. Behavioral health commission - creation - members - appointment. (1) (a) There is hereby created within the department of human services the behavioral health commission, the head of which shall be the chair of the commission. The chair of the commission shall be appointed and assisted by the members of the commission. The commission shall exercise its powers and duties as if transferred by a type 1 transfer. (b) The purpose of the commission is to develop and implement a set of shared outcomes across key systems to enable joint accountability and to improve the lives of persons in Colorado with behavioral health issues, their families, and the communities in which they live. (2) The commission shall consist of twenty-seven members to be appointed, on or before September 1, 2009, as follows: (a) A representative of the judicial branch of government to be appointed by the chief justice of the supreme court; (b) A representative of the governor's office to be appointed by the governor; (c) A representative with specialized involvement in behavioral health services and funding from each of the following departments, who shall be appointed by the executive director of the department: (I) The department of corrections; (II) The department of education; (III) The department of health care policy and financing; (IV) The department of human services; (V) The department of public health and environment; and (VI) The department of public safety; (d) A representative of the department of law appointed by the attorney general; (e) A representative of each of the following, to be appointed by the governor: (I) Health plans; (II) The membership organization representing Colorado's community mental health centers; (III) Psychiatrists; (IV) Behavioral health organizations; (V) Behavioral health professional associations; and (VI) A consumer advocacy organization; (f) A representative of each of the following, to be appointed jointly by the majority leader of the senate and the majority leader of the house of representatives: (I) Consumers in urban areas of Colorado; (II) Consumers in rural areas of Colorado; (III) The membership organization representing Colorado's substance abuse providers; (IV) A statewide family organization; (V) County commissioners in Colorado; and (VI) A veterans service organization with experience working with veterans with substance abuse and mental health disorders; (g) A representative of each of the following, to be appointed jointly by the minority leader of the senate and the minority leader of the house of representatives: (I) An association representing physicians; (II) An association representing community health centers; (III) A mental health advocacy organization; (IV) A substance abuse advocacy organization; (V) A statewide association of psychologists or licensed clinical social workers; and (VI) Professionals who work with individuals with developmental disabilities who also have co-occurring disorders. (3) All members of the commission shall be paid necessary travel expenses, and members of the commission who are not employed by the state shall be paid a reasonable per diem and expenses. 26-1-504. Behavioral health commission - powers and duties - rules. (1) The commission shall: (a) Develop and implement a set of shared outcomes across key systems to enable joint accountability; (b) Identify and implement cross-system collaborations and joint financing strategies at the state and local level with the goal of allowing access to a full continuum of appropriate and timely behavioral health services; (c) Extend the use of joint auditing across systems that could include fiscal or programmatic audits, taking into consideration that each system has different contractual reporting requirements to state, federal, and other funding sources; (d) Design and implement a multi-year joint budget and strategic planning process across departments to support long-term and cross-system needs; (e) Address the barriers created by state and federal funding requirements; (f) Develop and implement a financing reform plan and structure that supports the full continuum of behavioral health services statewide, minimizes the barriers and effects of funding silos, maximizes the use of cross-system funding, reduces barriers that currently hinder the state's ability to braid and blend funding sources, and recognizes that new and additional funding will be needed, as well as looking at shifting existing funding, for the planning and initial stages of implementation; (g) Make legislative recommendations to the general assembly regarding state general funds that are saved by implementing a collaborative system at the local and state level to ensure that the savings are reinvested in behavioral health to provide services to people who are uninsured in that local region or community; (h) With other appropriate partners, such as the office of information technology created in section 24-37.5-103, C.R.S., investigate and develop recommendations for utilization of an electronic, cross-system data collection, sharing, and evaluation system; (i) Develop and implement cultural competency standards, definitions, and requirements, including training and reporting, to provide equitable treatment of culturally diverse adult, youth, and child consumers with behavioral health issues and their families; (j) Develop and implement standards for the meaningful involvement of adult, youth, and child consumers and their families at both the system and service delivery levels and address barriers to involvement, such as reimbursement for travel and other expenses related to participating in policy-making efforts; (k) Develop and maintain a plan to ensure work force capacity to meet the behavioral health needs of Coloradans across the state that includes, but is not limited to, consideration of standards for co-occurring disorder training curricula and cross-training on mental health and substance abuse, the use of telemedicine, the availability of consultation services for primary care physicians, addressing compensation levels, and providing tuition reimbursement for needed behavioral health specialists in underserved areas of the state; and (l) Coordinate with the Colorado governor's behavioral health coordinating council and other behavioral health organizations deemed appropriate by the commission. (2) (a) The commission may contract out services in order to implement the provisions of this part 5. (b) The commission may develop and implement demonstration projects in order to carry out its duties pursuant to this part 5. (3) In carrying out its duties, the commission shall consult the January 2008 report of the behavioral health interim task force created by House Joint Resolution 07-1050; the May 2008 report titled "Transforming Colorado's Behavioral Health System" from the Colorado behavioral healthcare council and the Colorado association of alcohol and drug service providers; the studies and work product of the Colorado prevention leadership council, Colorado LINKS for mental health, and the center for systems integration; and any other material deemed necessary by the commission for background and guidance. (4) The commission may promulgate rules as necessary to implement this part 5 pursuant to the "State Administrative Procedure Act", article 4 of title 24, C.R.S. The rules may include, but shall not be limited to, rules regarding an integrated behavioral health system. (5) On or before January 30 of each year, the commission shall report its progress and findings to the health and human services committees of the senate and the house of representatives or their successor committees. The first report to the committees shall include timelines for implementing the duties of the commission. 26-1-505. Repeal. This part 5 is repealed, effective July 1, 2019. Prior to such repeal, the commission shall be reviewed as provided for in section 24-34-104, C.R.S. SECTION 3. 24-34-104 (50), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read: 24-34-104. General assembly review of regulatory agencies and functions for termination, continuation, or reestablishment. (50) The following agencies, functions, or both, shall terminate on July 1, 2019: (c) The behavioral health commission created in part 5 of article 1 of title 26, C.R.S. SECTION 4. Accountability. Five years after this act becomes law and in accordance with section 2-2-1201, Colorado Revised Statutes, the legislative service agencies of the Colorado general assembly shall conduct a post-enactment review of the implementation of this act using information contained in the legislative declaration in section 2 of this act. SECTION 5. Effective date. This act shall take effect July 1, 2009. SECTION 6. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.