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May 24, 2023 HB 23-1236
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Final Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 23-0853
Rep. Young; Amabile
Sen. Kolker; Simpson
Date:
Bill Status:
Fiscal Analyst:
May 24, 2023
Signed into Law
Erin Reynolds | 303-866-4146
erin.reynolds@coleg.gov
Bill Topic: IMPLEMENTATION UP DATES TO BEHAVIORAL HEALTH ADMI NISTRATION
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 shifts appropriations
between the DHS and BHA and may increase state workload and future costs.
Appropriation
Summary:
The bill requires and includes the reallocation of a $2.2 million appropriation.
Fiscal Note
Status:
The fiscal note reflects the enacted bill.
Table 1
State Fiscal Impacts Under HB 23-1236
Budget Year
FY 2023-24
Out Year
FY 2024-25
Revenue - -
Expenditures
1
General Fund $0 $0
Transfers - -
Other Budget Impacts - -
1
The bill requires the reallocation of a $2.2 million appropriation from the BHA to the DHS, resulting in no net change
in state expenditures. See State Appropriations section.
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May 24, 2023 HB 23-1236
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 (OCFMH) 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 as part of the behavioral health
administrative services organization;
clarifying the role of the BHA and OCFMH in jail-based behavioral health services, including that
the OCFMH is responsible for competency restoration and the BHA is the central organizing
structure and responsible entity for the remaining jail-based behavioral health services;
requiring the BHA to provide, directly or through contract, care navigation services and align the
services with the care coordination infrastructure;
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;
adding BHA representatives to serve on certain boards and commissions;
requiring the BHA to allocate funding to community-based behavioral health providers;
modifying timelines for licensing behavioral health entities; and
authorizing the BHA to revoke or not renew a behavioral health entity's license in certain
circumstances.
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.
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May 24, 2023 HB 23-1236
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
The bill makes several clarifications and adjustments to the authority of the DHS and the BHA. Most
of these changes, other than for jail-based competency services, do not require a change in
appropriations, and overall there is no net change in state expenditures. These changes are described
below.
Behavioral Health Administration. The bill makes the following programmatic clarifications and
modifications in BHA, which do not require an adjustment in appropriations:
rolls care navigation services into care coordination;
makes the 988 Crisis Hotline Cash Fund continuously appropriated and removes the repeal date;
and
requires funding to be allocated to community-based behavioral health providers in rural areas,
which will utilize the BHA's discretionary direct-to-agency stimulus funding.
Department of Human Services. The bill’s delineation of authority for various programs codifies
existing practice; no change in appropriations is required for these changes.
Jail-based competency services (DHS and BHA). The bill’s clarification that the Competency
Enhancement Program services are provided by the OCFMH requires a reallocation of $2,250,400
General Fund from the Jail-based Behavioral Health Services line item in the Behavioral Health
Administration budget to the Jail-based Competency Restoration Program line item in the OCFMH
budget, which results in no net change in expenditures.
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. The bill
also gives the BHA the ability to summarily suspend a behavioral health entity’s license to operate;
which will require legal resources. These will be addressed through the annual budget process as
suspension activity is known.
Department of Public Health and Environment. The CDPHE is currently in its wind-down period
of licensing of behavioral health entities; however, the bill extends this period. As such, it is assumed
that CDPHE will be required to inspect, license, and enforce 20 facilities at an estimated cost of $67,300
in FY 2023-24, and $7,600 in FY 2024-25. The BHA will continue to provide financial support with
Behavioral Health Entity Cash Fund and federal funding to CDPHE through the bill’s adjusted
timeline within existing appropriations. Additionally, 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.
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May 24, 2023 HB 23-1236
Department of 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 was signed into law by the Governor on May 16, 2023, and takes effect August 7, 2023,
assuming no referendum petition is filed.
State Appropriations
For FY 2023-24, the bill requires and includes an increase of $2,250,400 General Fund to the Jail-based
Competency Restoration Program line item in the Office of Civil and Forensic Mental Health in the
DHS and a corresponding decrease in General Fund appropriations to the Jail-based Behavioral
Health Services line item in the Behavioral Health Administration.
Departmental Difference
The CDPHE assumes it requires $67,289 in FY 2023-24, including spending authority of $51,500 from
the Behavioral Health Entity Cash Fund and $15,789 from the General Fund, as well as $7,596 in
FY 2024-25 from the cash fund, to manage behavioral health entity licensing. As discussed in the State
Expenditures section, the fiscal note assumes that the BHA will continue to provide support to the
CDPHE within its existing appropriations and no adjustment to state expenditures is required.
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.