Rule-making#: / 13-3-4-1
Office/Division or Program: Office of Behavioral Health/ Community Programs / Rule Author: Susan Drown / Phone: 303-866-7514
Email:
STATEMENT OF BASIS AND PURPOSE
Summary of the basis and purpose for the rule or rule change. (State what the rule says or does, explain why the rule or rule change is necessary and what the program hopes to accomplish through this rule.)
The proposed rule changes are intended to consolidate and clarify the six existing volumes of rules that will become one volume of behavioral health rules, and to establish new rules for the Integrated System of Care Family Advocacy Programs for Mental Health Juvenile Justice Populations pursuant to House Bill 11-1193 and Section 27-69-101, et seq., C.R.S.
In 2010, Senate Bill 10-175 was signed into law and recodified the state substance abuse and mental health statutes under one section of the Colorado Revised Statutes: Title 27. This set the framework for re-evaluation and integration of the corresponding community behavioral health rules. In response to S.B. 10-175 and Executive Order D 2011-005, the Department initiated a rule reduction review.
Promulgation of these proposed rules into one integrated volume creates effective, efficient, and elegant behavioral health rules by streamlining processes, eliminating inconsistency, and providing clarification and technical clean-up to outdated standards for all programs licensed and or designated by the Community Behavioral Health unit. Many of the current rules are repeated throughout the six existing volumes due to being promulgated when there were separate behavioral health divisions: Alcohol and Drug Abuse Division, Division of Mental Health, Mental Health Services, and Institutes Division. Now, all of these divisions are consolidated under one office: the Office of Behavioral Health, and therefore require consolidation of rules.
The proposed rule changes will introduce new rules for the Family Advocacy Programs pursuant to Section 27-69-101, C.R.S, and consolidate the following eight volumes of current rules:
2 CCR 501-1, Ability to Pay
2 CCR 502-1 (Volume 19), Care and Treatment of the Mentally Ill
2 CCR 502-2, Colorado Public Mental Health System
2 CCR 502-3 (Volume 20), Child Mental Health Treatment
2 CCR 502-4 (Volume 21), Competency Evaluations in Criminal Cases
6 CCR 1008-1 (Volume 15), Alcohol and Other Drug Abuse/Dependence treatment Standards
6 CCR 1008-2 (Volume 22), Licensing of Addiction Programs Using Controlled Substances
6 CCR 1008-3 (Volume 14), Addiction Counselor Certification and Licensure
It is proposed that these Code of Colorado Regulations be repealed, and the revised and consolidated set of rules entitled Behavioral Health, Volume 21, be adopted as 2 CCR 502-1, which will accurately reflect the incorporation of the state mental health and substance abuse rules into one Code of Colorado Regulations.
Initial Review / 08/02/2013 / Final Adoption / 09/06/2013Proposed Effective Date / 11/07/2013 / EMERGENCY Adoption / N/A
DOCUMENT 6
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STATEMENT OF BASIS AND PURPOSE (continued)
An emergency rule-making (which waives the initial Administrative Procedure Act noticing requirements) is necessary:
to comply with state/federal law and/orto preserve public health, safety and welfare
Explain:
Authority for Rule:
State Board Authority:
26-1-107, C.R.S. (2012) - state board of human services to promulgate rules for programs administered and services provided by the state department; governing program scope and content, requirements, obligations, and rights of clients and recipients. Specifically, 26-1-107(6)(g), C.R.S., provides that the state board shall adopt rules concerning mental health and alcohol and drug abuse programs;
26-1-109, C.R.S. (2012) - state board rules to coordinate with federal programs;
26-1-111, C.R.S. (2012) - state department to promulgate rules for public assistance and welfare activities;
26-1-111(5), C.R.S. (2012) - state department, through the unit in the state department that administers behavioral health programs and services, including those related to mental health and substance abuse, shall administer alcohol and drug abuse programs set forth in articles 80, 81, and 82 of title 27, C.R.S.;
27-67-106 - 27-67-107, C.R.S. (2012) - state board to promulgate rules regarding sliding scale for child mental health treatment act services and dispute resolution;
27-80-108, C.R.S. (2012) - state board of human services has the power to promulgate rules governing the requirements for substance abuse providers, managed service organizations, and addiction counselors;
27-90-103, C.R.S. - the state board of human services is authorized to adopt “board rules” as is necessary to implement the behavioral health programs.
Program Authority:
26-1-105.5(6), C.R.S. (2012) - all rules, regulations, and orders adopted prior to July 1, 1994, in conjunction with powers, duties and functions were transferred to the department of human services;
26-1-108(1.8), C.R.S. (2012) - grants rule-making authority to the state department as established consistent with the powers and the distinction between board rules and executive director rules as provided in statute;
27-65-128, C.R.S. (2012) - the department shall make such rules as will consistently enforce the provisions of care and treatment of persons with mental illness;
27-66-102(2), C.R.S. (2012) - the department may adopt reasonable and proper rules to implement community mental health services in this article in accordance with the provisions of section 24-4-103, C.R.S., and consistent with sections 27-90-102 and 27-90-103, C.R.S.;
27-69-101 through 104,C.R.S. (2012) - the department to promulgation of rules and standards for Family Advocacy Programs for Mental Health Juvenile Justice Populations;
27-81-106, C.R.S. (2012) - the unit in the department that administers treatment of alcoholism shall establish standards for approved treatment facilities that receive public funds;
27-82-103(1), C.R.S. (2012) - the unit shall establish standards for approved treatment facilities that receive public funds or that dispense controlled substances or both;
27-92-102, C.R.S. (2012) –the department shall periodically determine the cost of care and an individual’s ability to pay;
STATEMENT OF BASIS AND PURPOSE (continued)
42 CFR Part 8 - Use of narcotic drugs in maintenance and detoxification treatment. The Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration (SAMHSA) are issuing final regulations for the use of narcotic drugs in maintenance and detoxification treatment of opioid addiction.
X / Yes / NoYes / X / No
Does the rule incorporate material by reference?
Does this rule repeat language found in statute?
If yes, please explain.
References are made to the following federal citations: Title 42 Code of Federal Regulations Part 2 (Public Health, Confidentiality of Alcohol and Drug Abuse Patient Records); the Health Insurance Portability and Accountability Act (HIPAA); Title 28 Code of Federal Regulations Part 31 (Judicial Administration, Office of Juvenile Justice and Delinquency Prevention grant program definitions).
The program has sent this proposed rule-making package to which stakeholders?
Colorado Department of Public Health and Environment (CDPHE); Colorado Department of Health Care Policy and Financing (HCPF); Colorado Department of Regulatory Agencies (DORA); CDHS Colorado Mental Health Institutes; CDHS Division of Child Welfare; Colorado Behavioral Healthcare Council; community mental health centers; mental health clinics; Colorado Designated Managed Service Organizations; Colorado Hospital Association; consumer and family advocacy agencies; designated mental health facilities; and, substance abuse treatment providers; Policy Advisory Committee and Child Welfare Sub-PAC.
Attachments:
Regulatory Analysis
Overview of Proposed Rule
Stakeholder Comment Summary
REGULATORY ANALYSIS
1. List of groups impacted by this rule:
Which groups of persons will benefit, bear the burdens or be adversely impacted by this rule?
Community mental health centers, behavioral health clinics, substance use disorder providers, hospitals, residential child care facilities that are licensed or designated by the Office of Behavioral Health will benefit from aligned processes, elimination of redundancies, and clarified timeframes. Licensed substance use disorder agencies will be impacted by the shift in moving from a three year license to a two year licensing period.
Children, adults, and families receiving behavioral health services will benefit from rules that protect individual rights and provide consistent minimum standards of care.
2. Describe the qualitative and quantitative impact:
How will this rule-making impact those groups listed above? How many people will be impacted? What are the short-term and long-term consequences of this rule?
Overall, the short-term impact to agencies will be a learning curve of where to find regulations that have been in six different volumes. The long-term impact of the proposed rules will be elimination of redundancies and aligning processes across program areas for consistency. Language is updated to reflect person-centered practice. Additionally, technical clean-up has been provided throughout the rules.
Section 21.120, Behavioral Health Licensure and Designation: Rules regarding substance use disorder licensing and mental health designation were integrated to provide consistency in language and procedures. Short and long-term impacts are alignment of processes regardless of program area and clarification of licensing and designation requirements. Licensing and designation expectations and timeframes have been clarified. Agencies that are both licensed and designated by the Office of Behavioral Health will benefit from procedures being aligned with consistent time frames. The licensing (currently three years) and designation (currently one year) period will be aligned to two (2) years. This will provide agencies with the opportunity for coordinated licensing and designation visits. This will benefit agencies licensed to provide substance use disorder services by having technical assistance more frequently during site reviews. Longer-term impact will be providers paying the $200 licensing fee every two years instead of every three (3) years.
Persons receiving services will benefit from a new licensing status, limited license, which the Office may issue to prevent or address a perceived conflict of interest and/or a dual relationship within the agency that may negatively impact individuals in treatment.
Section 21.130 Data Requirements: No significant content changes to this section. Providers will continue to submit data via the Drug and Alcohol Coordinated Data Systems (DACODS) and the Colorado Client Assessment Record (CCAR).
Section 21.140 Critical Incident Reporting: This section aligns the requirements for critical incident reporting across all licensed and designated agencies. All agencies will use the same critical incident reporting form, which providing clear guidelines on what information to report.
REGULATORY ANALYSIS (continued)
Section 21.150 Quality Improvement: This section aligns the requirements for quality improvement planning across all licensed and designated agencies. For substance use providers who are not contracted with a Managed Services Organization (MSO), they will now incorporate at least bi-annual clinical reviews of records into their practice, if they are not doing so currently. This will require additional administrative coordination and planning for the agencies. Long term impact for agencies will be the determination of whether services are achieving desired outcomes and people with behavioral health disorders are receiving the quality care they need.
Section 21.160 Personnel: Requirements clarifying that staff be assigned duties that are commensurate with their experience and have training specific to the particular needs of persons being served provide short and long-term guidance on impacting service quality.
Section 21.170 Records Care and Retention: The retention time of substance use disorder treatment records is aligned with current mental health requirements pursuant 27-65-121(4)(b) and (c), C.R.S. This will be in increase from five to seven years for agencies providing outpatient substance use disorder services and five to ten (10) years for inpatient/residential treatment. This may have a long-term impact on agencies’ storage capacity. The short-term impact is to bring these providers into compliance with Department of Regulatory Agency (DORA) behavioral health practitioner rules.
The timeframe for releases of information increased from one to two years for agencies designated to provide mental health services. The timeframe for many licensed substance use disorder providers is shorter. This will result in less paperwork for mental health agencies, more for substance use disorder providers. For persons receiving behavioral health services, this protects and responds to their best interests and keeps them informed of whom the agency is sharing their information.
Section 21.180 Grievances: This section brings substance use disorder rules into alignment with current mental health grievance requirements. This is of benefit to the protection of persons receiving behavioral health services and accountability of the agencies to document and respond to complaints.
Section 21.190 Documentation in Records: Timeframes for assessment have been aligned for consistency across all program areas and levels of care. The “within seven days” timeframe for outpatient services also aligns with Medicaid requirements. An updated assessment allows the flexibility of being completed when there is a change in level of care or functioning and at minimum is required every six months.
Time frames for service planning are aligned for consistency across all program areas and levels of care. An initial service plan to be completed within twenty-four hours of admission is added to address immediate needs, safety and stabilization of persons receiving services. Timeframes for comprehensive service plans are clarified and updated. Service plan reviews are to be completed when there is a change in the individual’s level of care or functioning along with minimum frames.
REGULATORY ANALYSIS (continued)
Requirements for discharge planning, summaries, and information provided to the individual at discharge have been clarified. This benefits persons receiving behavioral health services in receiving continuity of care and clear discharge information. Some agencies will be impact by an increase in paperwork.
The current rule has been revised to add adjusted annual timeframes for assessment and service plan reviews for persons receiving medication only services.
Section 21.200 Care and Treatment of Children, Youth, and Families: This provides a consolidated section within behavioral health rules to focus on children, youth and families. Currently there is no substance use disorder rule on a minimum age of consent. Consent is clarified to mean that youth fifteen years of age and older may consent to treatment. This is not a change within mental health providers. The majority of all programs are already involving parents (unless contraindicated) and obtaining consent and will be minimally impacted. This section strengthens family/other supportive individuals engagement in assessment, service planning, and interventions when appropriate.
Minor in Possession (MIP): This is a new section to address a licensing modality that providers have been preparing and asking for more direction from the Office of Behavioral Health regarding the education and treatment requirements for MIP citations. Youth will benefit from the delivery of age and developmentally appropriate services that target individual needs.