Colorado § 27-50-403 - Behavioral health administrative services organizations - contract requirements - individual access - care coordination.

§ 27-50-403. Behavioral health administrative services organizations - contract requirements - individual access - care coordination.

(1) The BHA shall develop a contract for designated behavioral health administrative services organizations, which must include, but is not limited to, the following:

(a) Requirements to establish and maintain a continuum of care and network adequacy in the service area consistent with part 3 of this article 50, including but not limited to providing all behavioral health safety net services described in section 27-50-301;

(b) Expectations for subcontracting with behavioral health safety net providers and other providers, consistent with part 3 of this article 50, including prioritization of comprehensive community behavioral health providers;

(c) Expectations for adherence to the universal contracting provisions developed pursuant to section 27-50-203 and use of the universal contracting provisions with all relevant subcontractors;

(d) Reporting requirements related to claiming federal funding for eligible services and programs;

(e) Prohibitions on denying or prohibiting access to any medically necessary behavioral health service, including medication-assisted treatment, as defined in section 23-21-803, for a substance use disorder;

(f) Requirements to serve all individuals in need of services and a specific prohibition on denial of services for any of the reasons provided in section 27-50-301 (4);

(g) Agreements on data collection and reporting, including any provisions necessary to implement section 27-50-201;

(h) Procedures related to corrective actions pursuant to section 27-50-402;

(i) Any provisions necessary to ensure the behavioral health administrative services organization fulfills the functions provided in subsection (2) of this section;

(j) Requirements for calculating and reporting the annual administrative costs. The BHA shall establish and enforce the maximum allowable administrative cost ratios for the behavioral health administrative services organizations and report the actual performance of each behavioral health administrative services organization annually.

(k) A requirement that the behavioral health administrative services organization perform appropriate fiscal management and quality oversight of providers in its network within the scope of the provider's contract, including, but not limited to, the behavioral health administrative services organization directly engaging in audits and corrective action plans with providers in its network to ensure compliance with the contract.

(l) Requirements for the behavioral health administrative services organizations to collaborate with diversion programs, statewide criminal justice programs, and the bridges wraparound care program created pursuant to article 8.6 of title 16 when the programs are available in the behavioral health administrative services organization's region.

(2) A behavioral health administrative services organization shall:

(a) Proactively engage hard-to-serve individuals with adequate case management and care coordination throughout the care continuum;

(b) Implement trauma-informed care practices;

(c) Accept and provide behavioral health safety net services to individuals outside of the behavioral health administrative services organization's region;

(d) Promote competency in de-escalation techniques;

(e) Through network adequacy and other methods, ensure timely access to treatment, including high-intensity behavioral health treatment and community-based treatment for all individuals including children, youth, and adults;

(f) Require collaboration with all local law enforcement and county agencies in the service area, including county departments of human or social services and local collaborative management programs within the service area;

(g) Triage individuals who need alternative services outside the scope of the behavioral health safety net system;

(h) Promote patient-centered care, cultural awareness, and coordination of care to appropriate behavioral health safety net providers;

(i) Collaborate with schools and school districts in the service area to identify gaps in services and to promote student access to behavioral health services at school and in the contracting with providers to build the network of behavioral health safety net services, inclusion of relevant programs or services eligible for federal grants or reimbursement, including relevant programs or services identified in the federal Title IV-E prevention services clearinghouse;

(j) Update information as requested by the BHA about available treatment options and outcomes in each region of the state;

(k) Utilize evidence-based or evidence-informed programming to promote quality services;

(l) Consider, when contracting with providers to build the network of behavioral health safety net services, inclusion of relevant programs or services eligible for federal grants or reimbursement, including relevant programs or services identified in the federal Title IV-E prevention services clearinghouse; and

(m) Meet any other criteria established by the BHA.

Source: L. 2022: Entire article added, (HB 22-1278), ch. 222, p. 1466, § 1, effective July 1. L. 2023: (1)(i) amended and (1)(k) added, (HB 23-1236), ch. 206, p. 1061, § 30, effective May 16; (2)(f) amended, (HB 23-1249), ch. 287, p. 1730, § 10, effective August 7. L. 2024: (1)(l) added, (HB 24-1355), ch. 471, p. 3315, § 16, effective August 7.

Cross references: For the legislative declaration in HB 23-1249, see section 1 of chapter 287, Session Laws of Colorado 2023.