Overview of the Colorado Office of Behavioral Health

& the State Behavioral Health System

Patrick K. Fox, M.D.

Chief Medical Officer, CDHS

Facts

• US spends $3.5 trillion annually on health care

• Expected to be $5.5 trillion, or 20% of the US economy by 2025

• Medicaid is 22% of national market

• 23% of the Colorado population and 27% of the state’s budget

Colorado’s public mental health system is comprised of the

community-based mental health programs overseen by the

Office of Behavioral Health, and the State’s Medicaid,

capitated waiver program, which the Colorado Department

of Health Care Policy and Financing (HCPF) administers.

HCPF manages the Medicaid-eligible population and the

Office manages the non-Medicaid population.

Governor John Hickenlooper

Department of Healthcare Policy and Financing

Department of Public Health and Environment

Department of Human Services

Colorado Government Organizational Structure

Department of Regulatory Agencies, Division of Insurance

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Community Behavioral Health Services

Federal Fiscal Year Award

MH Block Grant $6,900,325

SA Block Grant $25,467,833

Mental Health Institute Appropriated Funds

Colorado Mental Health Institute at Pueblo (CMHIP)

Overview

● Operates a total of 449 psychiatric beds

(104 beds in the Admissions Program, 116 in the Cognitive-Behavioral

Program, 157 in the Psych-Social Program, and 72 in the Restoration

Program), treating adolescent, adult and geriatric patients.

● Employs 959.0 FTE (Long Bill appropriated)

● Serves a patients with a range of commitment types:

o 30% Incompetent to Proceed/Restoration (forensic)

o 30% Not Guilty by Reason of Insanity (forensic)

o 1% Department of Corrections Transfer (forensic)

o 11% Court Ordered Evaluation (forensic)

o 10% Voluntary Civil

o 18% Involuntary Civil

Colorado Mental Health Institute at Fort Logan (CMHIFL)

Overview

Operates 94 civil adult inpatient psychiatric beds.

o Primary referrals are individuals referred from the community mental

health centers under C.R.S. 27-65.

Employs 216.4 FTE (Long Bill appropriated)

For fiscal year 2016-17, CMHIFL operated at an Average Daily Census of

91.3 (97%) patients.

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Community Behavioral Health ServicesIn accordance with Colorado statute, oversees community behavioral health providers

of services, including:

● 17 community mental health centers.

● 14 community mental health clinics or psychiatric specialty clinics. (Clinics serve

special populations such as members of racial, ethnic or linguistic minority

groups.)

● 48 designated facilities (involuntary mental health treatment, 1,445 psychiatric

beds, including the two state psychiatric institutes).

● 4 designated managed service organizations across seven sub-state purchasing

areas that contract with 41 funded substance use disorder treatment providers 184

sites of service.

● 6 acute treatment facilities.

● 40 residential facilities providing residential mental health services for children

(psychiatric residential treatment facilities and therapeutic residential child care

facilities).

● 698 licensed substance use disorder treatment provider agencies.

● 44 prevention providers (94 statewide programs/strategies).

Community Mental Health Centers

Managed Service Organizations

Office of Behavioral Health RoleSubstance Use Disorder Services

Substance Use Disorder Oversight Description

● Title 27, Article 80, 81, and 82 Colorado Revised Statute primarily

governs these programs.

● Contract for the provision of community prevention, intervention,

treatment and recovery services.

● Ensure timely access to a continuum of services including

outpatient, residential, and detoxification services

● Assure expedited access and specialized services for priority

populations

● Contract for prevention services to strengthen local initiatives to

reduce risk factors for substance use at the individual, family and

community levels.

Office of Behavioral Health FundingSubstance Use Disorder Services

Substance Use Disorder Oversight Description

Program Cost: Total appropriated funding for Substance Use

Disorder, Prevention and Treatment Services total funding for FY

2015-16 is $46,139,364.

● $15,436,902 is General Fund

● $3,957,954 is from various cash funds

● $3,092,634 is from reappropriated funds (including Medicaid)

● $23,651,874 is federal funding (Substance Abuse Prevention and

Treatment Block Grant and other federal discretionary grants)

Office of Behavioral Health –Mental Health Services

Categories of Mental Health Services Designations and

Licenses:

❏ Community Mental Health Center

❏ Community Mental Health Clinic (Psychiatric Specialty Clinic)

❏ Psychiatric Hospital

❏ Seventy-two-Hour Treatment and Evaluation

❏ Acute Treatment Unit

❏ Short-Term Treatment Facility

❏ Long-Term Treatment Facility

❏ Therapeutic Residential Child Care Facility

❏ Psychiatric Residential Treatment Facility

Office of Behavioral Health Funding Mental Health Services

Mental Health Oversight Description

Program Cost: Total appropriated funding for Mental Health Services

for FY 2015-16 is $49,352,996.

● $38,592,553 is General Fund

● $4,243,407 is from various cash funds

● $283,467 is from reappropriated funds (including Medicaid)

● $6,233,569 is federal funding (MH block grant and other federal

discretionary grants)

Strengthening Colorado’s Mental Health System-

Colorado’s Crisis Response System

GOALS:

● Expand early access to support and services for individuals with

behavioral health needs and their families

● Promote ongoing recovery through linkage with community resources

● Decrease the number of unnecessary involuntary civil commitments,

hospital emergency room visits, jail stays, and reduce episodes of

homelessness for individuals experiencing a behavioral health emergency

● Increase the availability of community and natural supports to prevent

behavioral health crisis

Community Mental Health Contracting

OBH

MSO CMHC

HCPF

BHO RCCO

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Department of Health Care Policy and Financing

Behavioral Health Community Programs

Provides mental health services through five regional Behavioral Health

Organizations (BHOs), that provide or arrange for the provision of

medically necessary mental health services to Medicaid-eligible clients.

Since January 1, 2014, BHOs have provided medically necessary substance

use disorder services to Medicaid-eligible clients.

FY 2014-15 Medicaid Mental Health Community Programs

Total $489,392,205 including $165,279,696 in General Funds.

Total FY 2014-15 HCPF Budget: ~$7Billion

Total FY 2017-18 HCPF Budget: $10Billion

Due to ACA expansion of the Medicaid population to include

Adults without Dependent Children, there are 1.3 million

Medicaid enrollees in Colorado20

HCPF Funding

60%

29%

7% 4%

Federal

State

Hospital Provider Fee

Cash Funds

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Calendar Year 2016 Data

Who Gets Paid for Services?

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Total Budget: $10 Billion • $5.8 billion federal

• $2.8 billion state + cash funds and hospital provider fee

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Calendar Year

2016 Data

Enrollment & Costs Overview

Enrollment Expendituresby Population by Population

*Age 20 & younger and qualifying former foster care youth

*

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ACA Expansion in Colorado

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DORA-Division of Insurance The Division of Insurance is housed within the Department of

Regulatory Agencies and provides requirements for private health

insurance carriers

Acts to ensure adequacy of available services and to promote

health parity

70% of Coloradans receive health coverage through

private/employer provided insurance

Approximately 6% of Coloradans remain uninsured

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Improving Population Management

American Lifestyle Behaviors that Drive Spend:

Tobacco Use

American Diet and Weight

Poor Stress Management

Addiction

Sexual Behavior

80-90% of disease is preventable, if we modify our lifestyle

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THE SIM APPROACH

Publi

c

Healt

h

Behavi

oral

Health

Provid

ers

Consumers

Practice

Transformation

Payment

ReformPopulation

HealthHIT

Access

to integrated care in coordinated

systems supported by value-based payment

Support for

practices as

they accept

new payment

models and

integrate

behavioral

and physical

healthcare.

Engaging

communities

in

prevention,

education,

and improving

access to

integrated

care.

Implement

value-based

payment

models that

incentivize

integration

and improve

quality of

care.

Secure and

efficient use

of technology

across health

and non-

health sectors

in order to

advance

integration

and improving

health.

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PAYMENT REFORM

Enhanced Financial Support

Data Sharing

Aligning Quality

Measures

Common Approach to

Accountability

• Colorado Medicaid

• Anthem Blue Cross Blue Shield

• Cigna

• Colorado Choice Health Plans

• Kaiser Permanente

• Rocky Mountain Health Plans

• United Healthcare

Resources OBH Needs Analysis by WICHE (April 2015):

http://www.ahpnet.com/AHPNet/media/AHPNetMediaLibrary/White%20Papers/OB

H-Needs-Analysis-Report2015-pdf.pdf

OSPB Behavioral Health Funding Study (Nov. 2016)

https://drive.google.com/file/d/0B0TNL0CtD9wXM21GVXZuclhLUVE/view

CHI Exploring Options for Residential and Inpatient Treatment of

Substance Use Disorder in Health First Colorado (Nov. 2017):

https://www.colorado.gov/pacific/sites/default/files/HCPF%202017%20Inpatient%20S

UD%20Treatment%20Report.pdf

CHI Statewide Needs Assessment of Prevention for Substance Abuse

https://coag.gov/sites/default/files/contentuploads/oce/Substance_Abuse_SA/SATF_Mt

g_Handouts/02.02.18_snaps_for_ags_substance_abuse_task_force_jan2018_nn.pdf

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