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July 28, 2022 HB 22-1256
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Final Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 22-0257
Rep. Amabile; McCluskie
Sen. Moreno; Gardner
Date:
Bill Status:
Fiscal Analyst:
July 28, 2022
Signed into Law
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 includes appropriations totaling $0.6 million to multiple state
agencies.
Fiscal Note
Status:
The fiscal note reflects the enacted 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
Revenue
- - -
Expenditures General Fund $609,133 $1,383,607 $2,297,665
Centrally Appropriated $72,638 $177,308 $181,260
Total Expenditures $681,771 $1,560,915 $2,478,925
Total FTE 5.5 FTE 12.8 FTE 12.6 FTE
Transfers - -
Other Budget Impacts General Fund Reserve $91,370 $207,541 $344,650
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July 28, 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 (CDHS). It modifies procedures for 72-hour emergency mental health
holds, and outlines processes related to transport, oversight, care coordination, and access to legal
representation. These provisions are detailed below.
Effective August 9, 2022, the bill:
transfers the administration for Article 65 of Title 27 to the BHA;
modifies 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 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 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;
requires the evaluation to be completed using a BHA-approved standardized form;
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. 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;
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; and
allows grievance filings related to mental health holds to be filed with the Department of Public
Health and Environment (CDPHE), in addition to the BHA and the Office of the Ombudsman for
Behavioral Health Access to Care.
Effective July 1, 2024, the bill:
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; Page 3
July 28, 2022 HB 22-1256
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 requires 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 provide periodic updates to the BHA advisory board related to the bill’s
implementation from January 1, 2023, through July 1, 2025;
requires the BHA to annually submit a report to the legislature beginning January 1, 2025, on the
outcomes and effectiveness of the involuntary civil commitment system, including
recommendations for improvement; 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. Visit leg.colorado.gov/fiscalnotes for more information about criminal justice costs in
fiscal notes.
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July 28, 2022 HB 22-1256
State Expenditures
The bill increases state General Fund expenditures in the CDHS and the Judicial
Department by the amounts shown in Table 2. These costs are explained further below.
Table 2
Expenditures Under HB 22-1256
Cost Components FY 2022-23 FY 2023-24 FY 2024-25
Department of Human Services
Personal Services $307,257 $527,186 $544,640
Operating Expenses $6,750 $13,635 $13,635
Capital Outlay Costs $31,000 $31,000 -
Legal Services $177,426 $177,426 $88,713
Care Coordination - $350,000 $1,400,000
Centrally Appropriated Costs
1
$72,638 $144,421 $149,992
FTE – Personal Services 4.5 FTE 9.7 FTE 10.1 FTE
FTE – Legal Services 1.0 FTE 1.0 FTE 0.5 FTE
CDHS Subtotal $595,071 $1,243,668 $2,196,980
Department of Public Health and Environment
Personal Services - $132,155 $125,277
Operating Expenses - $3,105 $2,700
Capital Outlay Costs - $12,400 -
Travel Costs - $50,000 $36,000
Centrally Appropriated Costs
1
- $32,887 $31,268
FTE – Personal Services - 2.1 FTE 2.0 FTE
CDPHE Subtotal - $230,547 $195,245
Judicial Department
Court-appointed Attorneys $86,700 $86,700 $86,700
Judicial Subtotal $86,700 $86,700 $86,700
Grand Total $681,771 $1,560,915 $2,478,925
Total FTE 5.5 FTE 12.8 FTE 12.6 FTE
Department of Human Services. The bill requires the BHA to provide oversight and notifications
related to involuntary civil commitments, care coordination for individuals and coordination
assistance to emergency medical services facilities, technical training on emergency transportation
holds, and evaluation and reporting, as detailed below.
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July 28, 2022 HB 22-1256
Program management and coordination. The BHA requires 1.0 FTE Program Manager
responsible for the direct oversight of involuntary civil commitments, including rule development
and enforcement, staff management, contract oversight, and determinations of when sufficient
treatment was received. The BHA also requires 1.0 FTE Program Coordinator to provide
notification upon discharge; track and evaluate certifications for treatment; and review and
determine whether to file a petition with the court for long-term certifications.
Care coordination for emergency medical services facilities. Starting in FY 2023-24, the BHA
requires 5.1 FTE to respond to notifications from emergency medical services facilities 24 hours a
day and support the emergency medical services facility in locating an appropriate placement
option on an inpatient or outpatient basis.
Technical training. The BHA 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.
Evaluation and reporting. Starting in FY 2022-23, the BHA requires 1.0 FTE to collect and report
program data. Beginning January 1, 2025, this position will also make program improvement
recommendations to the legislature.
Legal services. The BHA 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.
Care coordination for certified persons. Beginning in the last three months of FY 2023-24, the
BHA requires contracted services estimated at $200,000 for each of the seven regions to provide
care coordination services to certified individuals, or $1.4 million per year. FY 2023-24 are
prorated for three months, assuming contracts will be hired in advance of the section going into
effect on July 1, 2024.
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 Public Health and Environment. The CDPHE require staff to address its new
responsibility address grievances related to facilities, which take effect FY 2023-24. Grievances related
to transport, which take effect FY 2022-23, are expected to be minimal.
Staff. Assuming that the CDPHE receives approximately 0.8 percent complaints from each
hospital (116) and behavioral health facility (18), based on the average hospital-related complaint
rate from the past four years, and that each complaint requires 40 hours to investigate, the
department requires 2.3 FTE in FY 2023-24, prorated for the General Fund pay date shift. In Page 6
July 28, 2022 HB 22-1256
FY 2024-25, when the CDPHE no longer has oversight over behavioral health facilities, the FTE is
reduced to 2.0 FTE. After FY 2024-25, if CDHPE has received more grievances than anticipated,
additional resources will be sought through the annual budget process.
Travel. Travel costs assume half of the complaint investigation surveys will be outside the Denver
metro area and that overnight travel will be needed, requiring travel day and full day per diem
payments and hotel costs at an assumed three nights per trip.
Judicial Department. Costs will increase for the Judicial Department to provide court-appointed
representation to respondents in certain cases, estimated at $86,700 per year. Workload will also
increase related to potential new caseloads established in the bill. These impacts are detailed below.
Court-appointed counsel. 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 additional 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.
Respondent rights. Trial court workload may increase from engaging the respondent proactively
in their treatment and affording various respondent rights that may be challenged in court. In
FY 2020-21, there were 6,957 short-term and 109 long-term mental health cases filed in the trial
courts. Based on the avenues created in the legislation, and assuming additional hearing time is
required in 5 percent of cases, this would create the need for 0.1 FTE Magistrate and support staff.
This increase can be absorbed by trial courts.
Other potential caseload increases. Additional provisions of the bill may result in caseload
increases for the trial courts, including criminal prosecution for any person who files a malicious
or false petition for a respondent evaluation or for facilities who violate whistleblower protections.
As discussed in the Comparable Crime section, these impacts can be absorbed by the trial courts.
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 CDHS and the Judicial Department will be in consultation about any guardian ad
litem and mental health evaluation costs.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs associated
with this bill are addressed through the annual budget process and centrally appropriated in the Long
Bill or supplemental appropriations bills, rather than in this bill. These costs, which include employee
insurance and supplemental employee retirement payments, are shown in Table 2 above.
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July 28, 2022 HB 22-1256
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 decreases 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.
Effective Date
The bill was signed into law by the Governor on June 8, 2022, and has the following effective dates:
sections 2 and 5 take effect July 1, 2023;
sections 27-65-108 and 27-65-111 as enacted in section 1, and sections 3 and 4 take effect
July 1, 2024; and
the remainder of this act takes effect August 9, 2022, assuming no referendum petition is filed.
State Appropriations
For FY 2022-23, the following General Fund appropriations are required and included:
$522,433 to the Department of Human Services and 5.5 FTE;
of this amount, $177,426 is reappropriated to the Department of Law and with an additional
1.0 FTE; and
$86,700 to the Judicial Department.
State and Local Government Contacts
Counties District Attorneys Higher Education
Human Services Information Technology Judicial
Law Public Health and Environment 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/fiscalnotesFinal Fiscal Note