Questions remain about who is ultimately responsible for preventing the most vulnerable Coloradans from falling through the cracks.
DENVER — State lawmakers will determine in the coming weeks the role of a soon-to-be-launched behavioral health agency and the extent to which it will reform Colorado’s tattered mental health safety net system.
A bill introduced on Wednesday aims to place responsibilities on the Behavioral Health Administration and private contractors who pay hundreds of millions of dollars in federal and state taxes each year to provide mental health and addictions care across the state.
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Dr. Morgan Medlock, the crisis care psychiatrist Governor Jared Polis has hired in Washington D.C. to lead the new cabinet-level agency set to launch in July, has promised to help drive “a comprehensive transformation of a system that we know is failing so many of our families, friends and neighbors.
The Colorado News Collaborative detailed these failures in a survey published in December.
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“The people of Colorado have spoken. And they’re demanding change,” Medlock said at a news conference on Friday. “Today we begin to deliver on that promise.”
One of the most far-reaching reforms in the 232-page bill would prohibit publicly funded mental health safety net providers from refusing to treat clients based on their insurance status, level of aggressiveness, their involvement in the criminal justice system or the complexity of their cases. . The need for the rule stems from a pattern established by some of Colorado’s 17 Regional Community Mental Health Centers (CMHCs) of “firing” hard-to-treat or indigent clients with impunity from state regulators. State. The centers received higher rates than other providers because they were expected to serve as caregivers of last resort.
But the bill does not make it clear that the centers would, in fact, be subject to the no-rights-to-refusal rule.
“We’re looking for clearer — much clearer — language around this,” says Lauren Snyder, vice president of government affairs at Mental Health Colorado, the state’s leading advocacy group.
The bill also directs the new agency to contract with regional organizations that would coordinate behavioral health care for clients with complex needs. But the current language is vague about whether these organizations or existing community mental health centers would take responsibility for preventing the most vulnerable from falling through the cracks. It’s also unclear what impact these new regional organizations would have on the higher Medicaid reimbursement rates long granted to the centers, which have had a virtual monopoly on safety net care.
- Develop for the first time a set of comprehensive statewide standards for quality of care, including timeliness of service (although the details of these standards will be decided later).
- Ensure regional mobile crisis teams respond to those in need within two hours. Currently, response times range from five minutes to half a day, and some teams don’t show up at all.
- Improve data collection and analysis to identify gaps in services and improve treatments and outcomes
- Reduce bureaucracy by using a “one-size-fits-all contract” rather than several different contracts for state mental health and addictions providers
- Update payment models so that provider compensation reflects their performance and quality of care, and does not reflect unreasonable administrative costs
- Improve reimbursement to non-CMHC safety net providers based on access and quality of care
- Work to diversify and expand Colorado’s behavioral health workforce
By 2024, the bill aims to make it easier for the public to file complaints against care providers. Again, the details of how this would work are missing. Among those missing details: whether dedicated investigative staff would handle complaints and routinely inspect and audit state mental health providers — including community mental health centers — for issues of quality of care, compliance with contracts, failure to serve indigent customers or accept sliding scale payment, and possible fraud.
With such language in the bill, enforcement would depend on the culture Medlock or his successors create within the new agency and their willingness to insist on adherence to the new standards. The Colorado Department of Human Services (and its Office of Behavioral Health) and the Department of Health Care Policy and Funding bowed for decades to pressure from community mental health centers to avoid stricter rules in transparency and accountability, and failed to enforce existing rules. .
The centers’ lobbying group, the Colorado Behavioral Health Council, did not respond to a survey this week about its views on the bill.
Advocates for people with mental health issues and their families generally praise the measure, but say it needs to articulate more clearly that the priority of care should go to people in crisis and with chronic mental health issues rather than to the so-called “well-worried,” ie people with less acute cases.
“We need language that says people with the most severe cases can’t be fired by CMHC until (another provider) agrees to work with them,” says Mental Health’s Snyder. of Colorado.
The bill does not say how much the new agency will cost, or whether it will hire more staff than those who worked in the Department of Human Services’ Office of Behavioral Health. A tax note is expected in the coming week.
Under the measure, Medlock must appoint 15 to 20 people to an advisory board that reflects Colorado’s demographics. More than half must have experience with behavioral health issues personally or in their family. This structure, she said, will ensure those who need services have a better chance of being heard.
Medlock and others acknowledged what Senator Pete Lee, a sponsor of the bill, called the “fractured and disintegrated” nature of Colorado’s mental health system. But the bill says nothing about the main reason for these divides: the majority of funding for safety net services comes from Medicaid, and that those funds have been — and will continue to be — administered by the Department of Politics. and funding Colorado’s health care. , a separate agency headed by another cabinet member. The split between an agency that holds the purse strings and one that sets service expectations has created a lack of transparency and accountability, and deep frustrations among the public.
Late last year, a staff member and a member of the state’s joint budget committee questioned the need for the new behavioral health administration, saying it would be just another layer. of bureaucracy.
Medlock addressed those concerns on Friday, saying the bill grants him the power to convene other agencies and cabinet members “to create a cohesive vision that makes a difference for people…”
“It’s actually a totally different way of thinking for our state,” she said.
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