Page 1 March 24, 2023 HB 23-1236 Legislative Council Staff Nonpartisan Services for Colorado’s Legislature Fiscal Note Drafting Number: Prime Sponsors: LLS 23-0853 Rep. Young; Amabile Date: Bill Status: Fiscal Analyst: March 24, 2023 House Public & Behavioral Health Erin Reynolds | 303-866-4146 erin.reynolds@coleg.gov Bill Topic: IMPLEMENTATION UPDATES TO BEHAVIORAL HEALTH ADMIN ISTRATION Summary of Fiscal Impact: ☐ State Revenue ☒ State Expenditure ☐ State Transfer ☐ TABOR Refund ☐ Local Government ☐ Statutory Public Entity This bill delineates certain administrative responsibilities between the recently created Behavioral Health Administration and the Department of Human Services, and makes clarifications and modifications to the administration’s statute. It may increase state workload and future costs. Appropriation Summary: No appropriation is required. Fiscal Note Status: The fiscal note reflects the introduced bill. Summary of Legislation This bill delineates certain administrative responsibilities between the recently created Behavioral Health Administration (BHA) and the Department of Human Services (CDHS). The bill also formally repeals the Office of Behavioral Health, which is now functioning as the recently renamed Office of Civil and Forensic Mental Health in CDHS. Additionally, the bill makes the following clarifications and modifications, including but not limited to: authorizing the BHA to seek, accept, and expend gifts, grants, or donations for the purpose of administering any behavioral health program and service; requiring a behavioral health safety net provider to include services that address the necessary language and cultural barriers to serve communities of color and other underserved populations; requiring the BHA to create a regional subcommittee structure of the advisory council that is not limited by the behavioral health administrative services organization region; requires the BHA to provide, directly or through contract, care navigation services and align the services with the care coordination infrastructure; Page 2 March 24, 2023 HB 23-1236 continuously appropriating funding to the 988 crisis hotline cash fund; expanding the rights of a person detained by a certified peace officer or emergency medical services provider and transported to an outpatient mental health facility or other facility to any person detained, whether or not the person is transported to a facility; codifying that the BHA is a health oversight agency charged with overseeing the behavioral health-care system in Colorado and discharging the BHA's duties; and adding BHA representatives to serve on certain boards and commissions. Background House Bill 21-1097 required the CDHS to submit a plan for the creation of the BHA. The BHA was established in July 2022 within the Department of Human Services (DHS) upon the passage of House Bill 22-1278. Assumptions The fiscal note assumes that any necessary budget adjustments related to the establishment of the BHA will occur through the annual budget process. State Revenue The bill may increase state revenue to the BHA from gifts, grants, and donations. This funding is not subject to TABOR. State Expenditures Behavioral Health Administration. While no change in appropriations is required, the bill makes the following programmatic clarifications and modifications in BHA: rolls care navigation services into care coordination, which might necessitate the creation of a care coordination line item; and makes the 988 Crisis Hotline Cash Fund continuously appropriated and removes the repeal date. Department of Human Services. The bill’s delineation of authority for various programs codifies existing practice. No change in appropriations is required. Department of Law. To the extent that the bill’s codification of the BHA as a health oversight agency as defined by federal law generates the need for legal support, those resources will be provided by the Department of Law. The fiscal note assumes existing BHA legal resources are sufficient. Page 3 March 24, 2023 HB 23-1236 Public Health and Environment. The bill minimally increases CDPHE workload to add a BHA representative to the Health Equity Commission, which is staffed by the Office of Health Equity. Health Care Policy and Financing. The bill may increase workload and potential costs in HCPF from the bill’s requirement to provide services that address the necessary language and cultural barriers to serve communities of color and other underserved populations, as well as data reporting on the usage of navigation services. Resources will be addressed through the annual budget process as potential cost drivers are known. Effective Date The bill takes effect 90 days following adjournment of the General Assembly sine die, assuming no referendum petition is filed. State and Local Government Contacts Behavioral Health Administration Counties Health Care Policy and Financing Human Services Information Technology Law Personnel Public Health and Environment Regulatory Agencies 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.