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March 9, 2022 HB 22-1256
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 22-0257
Rep. Amabile; McCluskie
Sen. Moreno; Gardner
Date:
Bill Status:
Fiscal Analyst:
March 9, 2022
House HHS
Erin Reynolds | 303-866-4146
Erin.Reynolds@state.co.us
Bill Topic: MODIFICATIONS TO CIVIL INVOLUNTARY COMMITMENT
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☒ Local Government
☐ Statutory Public Entity
The bill makes numerous changes to the state’s involuntary commitment system.
It will increase state expenditures beginning in FY 2022-23.
Appropriation
Summary:
For FY 2022-23, the bill requires appropriations totaling $143.7 million to the
Department of Human Services and the Judicial Department.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under HB 22-1256
Budget Year
FY 2022-23
Out Year
FY 2023-24
Out Year
FY 2024-25
Out Year
FY 2025-26
Revenue
- - - -
Expenditures General Fund $143,778,255 $144,474,344 $201,601,390 $108,123,456
Centrally Approp. - - $19,374 $72,491
Total Expenditures $143,778,255 $144,474,344 $201,620,764 $108,195,947
Total FTE 218.1 FTE 237.3 FTE 239.0 FTE 240.6 FTE
Transfers - - - -
Other Budget Impacts GF Reserve $21,566,738 $21,671,152 $30,240,208 $16,218,518
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March 9, 2022 HB 22-1256
Summary of Legislation
The bill transfers duties relating to the care and treatment of persons with mental health disorders
from the Office of Behavioral Health to the Behavioral Health Administration (BHA) in the
Department of Human Services (DHS). It creates new procedures relating to 72-hour treatment and
evaluation of a person appearing to have a mental health crisis, as well as procedures to certify short-
term or long-term care and treatment of a person who has a mental health crisis. The bill also outlines
processes for engaging with an individual that may be experiencing a behavioral health crisis
including transport, oversight, care, and access to legal representation. These provisions are detailed
below.
Effective ninety days after signing, the administration for Article 65 of Title 27 is transferred to the
Behavioral Health Administration from the Office of Behavioral Health. The bill expands the list of
professionals that can place a mental health hold; updates the involuntary transportation hold; and
requires court petitions to include recommendations for inpatient or outpatient services.
Effective July 1, 2023, the bill:
subjects a person who files a malicious or false petition for an evaluation of a respondent to
criminal prosecution;
authorizes a certified peace officer to transport a person to an emergency medical services facility
(EMS facility), even if a warrant has been issued for the person's arrest, if the certified peace officer
believes it is in the best interest of the person;
authorizes a secure transportation provider to take a respondent into custody and transport the
person to an EMS facility or designated facility for an emergency mental health hold;
expands the list of professionals who may terminate the emergency mental health hold;
requires evaluations to be completed using a standardized form approved by the BHA
commissioner;
expands who can initiate a certification to include an advanced practice registered nurse with
training in psychiatric nursing and prescriptive authority;
requires an EMS facility to immediately notify the BHA if a person is evaluated and the evaluating
professional determines that the person continues to meet the criteria for an emergency mental
health hold and the initial emergency mental health hold is set to expire before an appropriate
placement is located;
requires the BHA to support the EMS facility in locating an appropriate placement option; and if
an appropriate placement option cannot be located, the bill authorizes the EMS facility to place
the person under a second emergency mental health hold and requires the court to immediately
appoint an attorney; and
requires the facility to provide the person with a discharge summary and a copy of the completed
evaluation; facilitate a follow-up appointment within 7 calendar days after discharge, attempt to
follow up with the person 48 hours after discharge, and encourage the person to designate a family
member, friend, or lay person to participate in the person's discharge planning.
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March 9, 2022 HB 22-1256
Effective January 1, 2025, the bill:
authorizes the court to certify a respondent for not more than 3 months for short-term treatment
and place the respondent in the BHA's custody without the need for an 72-hour emergency mental
health hold upon a petition of certain individuals;
requires the court to commit the respondent to the custody of the BHA if the court finds that
grounds for certification for short-term treatment have been established;
authorizes the judge or magistrate who certified the respondent for short-term treatment to sign
the notice of certification;
requires the notification of certification to include a recommendation whether the certification
should take place on an inpatient or outpatient basis;
authorizes the BHA to delegate physical custody of the respondent to a designated facility;
requires an extended certification to be filed with the court at least 30 days prior to the expiration
of the original certification;
establishes requirements for a short-term or long-term certification on an outpatient basis; and
requires the outpatient treatment provider, in collaboration with the BHA, to develop a treatment
plan for the respondent and requiring the BHA to create a one-step grievance process for the
respondent related to the respondent's treatment plan or provider.
Additionally, the bill:
establishes a right to an attorney for a person certified for short-term or long-term care and
treatment, regardless of income;
requires the BHA to annually submit a report to the legislature every January 1 on the outcomes
and effectiveness of the involuntary commitment system, disaggregated by region, including any
recommendations to improve the system and outcomes for persons involuntarily committed or
certified; and
makes conforming amendments.
Comparable Crime Analysis
Legislative Council Staff is required to include certain information in the fiscal note for any bill that
creates a new crime, changes the classification of an existing crime, or creates a new factual basis for
an existing crime. This section outlines data on crimes comparable to the offense in this bill and
discusses assumptions on future rates of criminal conviction for those offense.
Prior conviction data and assumptions. This bill creates a new offense of retaliating or discriminating
against any person or entity involved in a grievance procedure, an unclassified misdemeanor subject
to a fine of not more than $1,000. The bill also subjects persons filing a malicious or false petition for
an evaluation subject to criminal prosecution. To form an estimate on the prevalence of these new
crimes, the fiscal note analyzed the existing offense of violating confidentiality of public health records
as a comparable crime. From FY 2018-19 to FY 2020-21, zero offenders have been sentenced and
convicted for this existing offense; therefore, the fiscal note assumes that there will be minimal or no
additional case filings or convictions for the new offense under the bill. Because the bill is not expected
to have a tangible impact on criminal justice-related expenditures or revenue at the state or local levels,
these potential impacts are not discussed further in this fiscal note. Visit leg.colorado.gov/fiscalnotes
for more information about criminal justice costs in fiscal notes. Page 4
March 9, 2022 HB 22-1256
State Expenditures
The bill increases state General Fund expenditures in the DHS and the Judicial
Department by the amounts shown in Table 2. For costs in the DHS, the fiscal note groups them into
three parts—parts A through C—based on their effective dates. These costs are explained further
below.
Table 2
Expenditures Under HB 22-1256
Cost Components FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26
Part A – Statewide Technical Training, Individual Care Coordination, Facility Designation
Personal Services $372,871 $689,156 $774,050 $780,181
Operating Expenses $7,965 $16,335 $17,685 $17,685
Capital Outlay Costs $43,400 $31,000 $6,200 -
Legal Services $177,426 $177,426 $88,713 $88,713
Insurance/Supplemental Retirement
1
$86,540 $178,990 $199,626 $201,178
FTE – Personal Services 5.3 FTE 11.7 FTE 13 FTE 13.1 FTE
FTE – Legal Services 1.0 FTE 1.0 FTE 0.5 FTE 0.5 FTE
Part A Subtotal $688,202 $1,092,907 $1,086,274 $1,087,757
Part B – Short-term Certification and Community-based Treatment
Personal Services $18,927,395 $20,164,730 $20,164,730 $20,164,730
Operating Expenses $297,810 $303,210 $303,210 $303,210
Capital Outlay Costs $1,395,000 - - -
Contracted Community Beds $4,999,040 $4,999,040 $4,999,040 $4,999,040
Contracted Hospital Beds $8,760,000 $8,760,000 $8,760,000 $8,760,000
Housing Assistance $2,830,750 $2,830,750 $2,830,750 $2,830,750
Transitional Services $7,576,200 $7,576,200 $7,576,200 $7,576,200
ACT Team Overhead $724,640 $724,640 $724,640 $724,640
Insurance/Supplemental Retirement
1
$3,892,518 $4,136,167 $4,136,167 $4,136,167
FTE – Personal Services 211.8 FTE 224.6 FTE 224.6 FTE 224.6 FTE
Part B Subtotal $49,403,353 $49,494,737 $49,494,737 $49,494,737
Part C – Mental Health Institute Inpatient Services for Long-term Certifications
Bed Construction $93,600,000 $93,600,000 $93,600,000 -
Information Technology - $200,000 $25,000 $25,000
Bed Operating Costs - - $56,940,000 $56,940,000
Part C Subtotal $93,600,000 $93,800,000 $150,565,000 $56,965,000
DHS Subtotal $143,691,555 $144,387,644 $201,146,011 $107,547,494
Total DHS FTE 218.1 FTE 237.3 FTE 237.9 FTE 238.2 FTE
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March 9, 2022 HB 22-1256
Table 2
Expenditures Under HB 22-1256 (Cont.)
Cost Components FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26
Judicial Department
Personal Services - - $93,089 $223,412
Operating Expenses - - $2,470 $5,130
Capital Outlay Costs - - $13,120 $720
Court-appointed Attorneys $86,700 $86,700 $86,700 $86,700
Guardians Ad Litem - - $156,000 $156,000
Mental Health Evaluations - - $104,000 $104,000
Centrally Appropriated Costs
1
- - $19,374 $72,491
FTE – Personal Services - - 1.1 FTE 2.4 FTE
Judicial Subtotal $86,700 $86,700 $474,753 $648,453
Grand Total $143,778,255 $144,474,344 $201,620,764 $108,195,947
Total FTE 218.1 FTE 237.3 FTE 239.0 FTE 240.6 FTE
1
Centrally appropriated costs are not included in the bill's appropriation, unless the bill requires 20 FTE or more.
Department of Human Services—Part A. Part A of the bill requires the DHS to provide technical
training on emergency transportation holds, individual care coordination for individuals experiencing
a mental health crisis, a one-step grievance process, facility-level designation, and reporting, as
detailed below.
Technical training. The DHS requires 2.0 FTE to develop, oversee, and administer
profession-specific trainings for peace officers and emergency medical services personnel and
provide technical assistance to facilities, programs, and counties regarding emergency
transportation holds.
Individual care coordination. The DHS will require a total of 6.1 FTE to implement individual
care coordination. This includes 1.0 FTE to facilitate individual care coordination, including
providing tracking and notifications at all steps in the process as well as evaluating an individual's
long-term certification for treatment and managing the related court petitioning process. Starting
in FY 2023-24, 5.1 FTE is required to respond to notifications from emergency medical services
facilities 24/7 and support the emergency medical services facility in locating an appropriate
placement option on an inpatient or outpatient basis.
These costs assume that the BHA will not maintain patient treatment records nor patient specific
forms, instead it will create a form template to be maintained in an individual’s treatment record
at a facility. Any records requests pursuant to this provision would be a responsibility of the
facility or program providing the hold services.
One-step grievance process. The DHS requires 1.0 FTE to create and oversee the one-step
grievance process.
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March 9, 2022 HB 22-1256
Facility designation. The DHS will require 3.0 FTE to provide facility-level annual tiered
designation, compliance checks, and technical assistance for 147 facilities. This assumes a ratio of
one staff per 50 facilities.
Reporting. Starting in FY 2024-25, 1.0 FTE is required to collect and report program data, and
make recommendations to the legislature.
Legal services. The DHS requires 1800 hours of legal services in FY 2022-23 and FY 2023-24, and
900 hours per year starting in FY 2024-25. Legal services are provided by the Department of Law
at a cost of $98.57 per hour. The Department of Law will use 1.0 FTE in the first two years and
0.5 FTE in third and subsequent years for this work.
Department of Human Services—Part B. Part B of the bill establishes a new procedure that allows
the court to certify a respondent for up to three months for short-term treatment in the custody of the
BHA without a petition, which is assumed to require the BHA to provide custodial oversight of these
certified individuals. Costs to provide custodial oversight are detailed below.
Case managers. In CY 2019, there were 6,587 short-term certifications. Using the substance use
disorder involuntary commitment system caseload as a proxy, each BHA staff can manage
62 cases per year, resulting in a need of 106.2 FTE case managers.
Assertive Community Treatment teams. Assuming that the Assertive Community Treatment
(ACT) model will be used to provide treatment to individuals under short-term certification; that
about half of short-term certifications, or 3,294, will require their services per year, which is
824 individuals at any given time assuming three month certification; the DHS requires eight ACT
teams of 14.8 FTE per team.
Contracted beds. Further, some individuals will require direct treatment. There were 7,189 total
certifications (short-term and long-term certifications) in CY 2019. Assuming the state must create
a system of stable mental health services for this population while in its custody, and that up to
one percent of individuals will require a bed over the course of each year, the DHS requires
32 contracted community beds at a cost of $156,220 per bed per year; and 20 contracted hospital
beds at a cost of $438,000 per bed per year.
Housing assistance. In addition, the bill requires a treatment plan to be developed for each
individual in BHA custody. Assuming that housing will be part of treatment plans for individuals
that are unhoused and/or transitioning from inpatient care, and that the average length of stay
will be six months, the DHS requires 60 beds in transitional housing. Costs assume $100 per bed
day, plus one contracted case manager per 20 beds, a supervisor, and contract administrator costs.
Transitional services. Using the DHS transitional specialist program as a proxy, the DHS requires
$2,300 per individual, assuming 3,294 per year, for individually based wrap-around services.
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March 9, 2022 HB 22-1256
Medicaid reimbursement. Some persons served by the BHA will be eligible for Medicaid and
services provided under the bill will qualify for Medicaid reimbursement. However, an estimate
of the amount of potential Medicaid reimbursements is not available at this time. To the extent
Medicaid reimbursement is available, the amount of General Fund required will decrease and be
offset by an increase in federal funds. It is assumed that this funding shift will be addressed
through the annual budget process.
Department of Human Services—Part C. In CY 2019, there were 602 long-term certifications. It is
assumed that individuals on long-term certification will require institute level of care, and will receive
treatment services for approximately four months and then transition to long-term care in a
community setting, equating to 1,806 individuals served per fiscal year at the Mental Health Institutes.
To serve this population, a new facility with 120 beds is required. It is assumed the new facility will
be built over three years at the cost of $2.3 million per bed, which is the 2017 cost to build beds at
MHI-Fort Logan plus 30 percent to account for changes in construction prices and labor since that
previous project. Operating bed costs of $1,300 per day starting in FY 2024-25, plus IT costs to support
system modifications for the civilly committed population estimated at $200,000 in FY 2023-24 and
$25,000 in FY 2024-25 and ongoing.
Judicial Department. The Judicial Department will have costs for court-appointed attorneys and
guardians, as well as increased workload in the trial courts.
Court-appointed attorneys. Beginning in FY 2022-23, costs for court-appointed attorneys are
expected to increase due to the bill's absolute right to counsel. Costs are estimated based on the
difference between the number of short-term mental health cases filed in FY 2020-21, 6,957 cases,
and mental health cases where court-appointed counsel was provided, 6,718 cases, which equates
to 221 appointments per year at an average rate of $340 per appointment, or $75,140 per year. In
addition, the bill requires the court to immediately appoint an attorney in cases where an
appropriate placement option cannot be located and the person continues to meet the criteria for
an emergency mental health hold. Assuming 34 cases receive a second emergency hold, the cost
is $11,560 per year.
Trial courts. Beginning January 1, 2025, the bill allows anyone to directly petition the court for
certification, allows the respondent to request a jury trial, and requires the court to appoint a
guardian ad litem to represent the respondent in certain cases, largely within 10-day timeframes.
In FY 2020-21, there were 6,957 short-term mental health cases filed statewide. Assuming
30 percent of the 6,957 short-term cases, or approximately 2,087 cases, will petition the courts, and
the district court standard for mental health cases is 4,880 cases per judicial officer, an additional
0.4 FTE judicial officer and 1.2 FTE support staff is required.
Further, the bill's one-step grievance process, the allowance for anyone to contest a respondent’s
treatment regimen, a respondent's right to judicial review on restrictive placements and to file
motions to contest certification, and right to waive counsel will all increase hearing time.
Assuming that 45 minutes of additional hearing time will be required in 5 percent of cases
(353 cases) and assuming that 15 minutes of additional hearing time will be required in 3 percent
of cases where the right to counsel has been waived, 209 cases, an additional 0.2 FTE judicial officer
and 0.6 FTE support staff is required.
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March 9, 2022 HB 22-1256
Guardian Ad Litem appointments. Beginning January 1, 2025, assuming about 2,000 cases are
filed as a result of the legislation, and that 5 percent of cases will have a GAL appointed, the
Judicial Department requires 104 new appointments at an average cost of $1,500 per appointment.
Mental health evaluations. Beginning January 1, 2025, and using the same assumption for GAL
appointments, the Judicial Department requires 104 mental health evaluations ordered at an
average cost of $1,000 per evaluation.
The fiscal note assumes the Judicial Department will use the annual budget process to account for
other provisions of the bill or outcomes that differ from these assumptions. The fiscal note also
anticipates that the DHS and the Judicial Department will be in consultation about guardian ad litem
and mental health evaluation costs.
Other state agencies. Impacts to other state agencies—including, but not limited to, the Departments
of Higher Education, Public Safety, and Regulatory Agencies—have not been estimated and will be
addressed through the annual budget process as needed.
Centrally appropriated costs. Pursuant to fiscal note and Joint Budget Committee policy, centrally
appropriated costs for bills involving more than 20 FTE are appropriated in the bill, rather than
through the annual budget process. Employee insurance and supplemental employee insurance costs
for new staff under the bill are shown in Table 2 above.
Other Budget Impacts
General Fund reserve. Under current law, an amount equal to 15 percent of General Fund
appropriations must be set aside in the General Fund statutory reserve beginning in FY 2022-23. Based
on this fiscal note, the bill is expected to increase the amount of General Fund held in reserve by
amounts shown in Table 1, which will decrease the amount of General Fund available for other
purposes.
Local Government
County attorneys. County attorneys are required to handle civil commitments in court when the
respondent lives in a county with a population less than 50,000. These costs have not been estimated.
Local law enforcement. Workload will increase for local law enforcement to provide support and
transportation services in emergency mental health matters. This involvement may also increase
officer liability related to use of force in a civil matter, which will increase litigation costs. These costs
have not been estimated.
Technical Note
The Behavioral Health Administration is in the process of being established, initially through
House Bill 21-1097, and further through House Bill 22-1278.
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March 9, 2022 HB 22-1256
Effective Date
The bill has the following effective dates:
sections 2, 5, and 40 of this act take effect July 1, 2023;
sections 27-65-108 and 27-65-111, as enacted in section 1 of this act, and sections 3 and 4 of this act
take effect January 1, 2025; and
the remainder of this act takes effect 90 days following adjournment of the General Assembly
sine die, assuming no referendum petition is filed.
State Appropriations
For FY 2022-23, the following General Fund appropriations are required:
$143,691,555 to the Department of Human Services and 211.8 FTE; of this amount, $177,426 is
reappropriated to the Department of Law and with an additional 1.0 FTE.
$86,700 to the Judicial Department.
State and Local Government Contacts
Counties District Attorneys Higher Education
Human Services Information Technology Judicial
Law Public Safety Regulatory Agencies
Sheriffs
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.