July of 2024 brought new laws impacting Colorado’s behavioral health system. While Colorado has continuously made some improvements and investments in behavioral health programs, the fundamental definitions of safety net services and providers were more than 60 years old. New Colorado reform laws expand these definitions to include more services and reflect the significant advancements in behavioral health care in the modern age with the goal of improving patient access to quality care and improving provider payments.
Even though Colorado has historically been one of the most physically healthy states in the nation, behavioral health data shows that we have work to do. In 2021, Colorado had the sixth highest suicide rate in the nation, and as of 2023, it ranked in the bottom half of states with a higher prevalence of mental illness and lower access to care for adults and children. As a state, the mounting, complex behavioral health needs of our population require structural reform. Within Colorado’s larger roadmap of transformation, an immediate priority is modernizing how we define, pay for, and set outcome expectations for behavioral health safety net services.
“To achieve BHA’s mission of transforming Colorado’s behavioral health system, it’s crucial that we understand and address the specific needs of the people of Colorado,” said Dannette R. Smith, BHA Commissioner. “We are grateful for the collaboration with our communities in shaping these rule changes. As a state, we are committed to fulfilling our promise of expanding access to care as outlined in these new laws.”
The wave of system reforms that took effect on July 1st is an important step in a transformative effort to acknowledge the mission-critical role of behavioral health safety net providers. Colorado’s behavioral health system includes prevention, treatment, and recovery services funded through the Department of Health Care Policy and Financing (HCPF), which administers the state Medicaid program, the Behavioral Health Administration (BHA), which oversees the regulatory and policy ecosystem, and regional entities which administer and oversee local providers on the state’s behalf. The state’s Medicaid program has instituted a new payment system that is connected to the new BHA licensing structure and regulations that ensure access for underserved and high-need Coloradans. Together, these changes prioritize whole-person care for mental health & substance use disorders by supporting providers who offer essential, comprehensive care to high-needs and priority populations.
The value-based payment system ensures that patients have increased access to a system which rewards providers who agree to serve people with complex social and behavioral health needs. These payments are based on the cost of providing care. For example, providing housing navigation, case management, care coordination with health clinics, and day programs for an individual facing homelessness with multiple health conditions and no family support costs more than a small practice providing only psychotherapy. This type of payment model creates predictability, consistency, and sustainability of payments for BHA-approved safety net providers to support these providers in successfully helping patients achieve improved outcomes through less intensive and more community-based care.
“Historically, the behavioral health safety net in Colorado has been held together largely by a non-profit, mission mentality—and that is incredibly impactful,” said Daniel Darting, CEO of Signal Behavioral Health Network, which oversees crisis behavioral health and substance use prevention, treatment, and recovery services in 37 Colorado counties. “But it’s predominantly funded on a grant mindset, so services are often in flux in communities. Enhanced payments create stability. If we want a functional behavioral health system, we need to invest in it as a true health care system.”
The updated reimbursement model strengthens and expands the reach of our safety net by supporting providers in expanding access to critical community-based services. This is especially transformative in our many rural and frontier communities where the safety net is largely composed of small to medium-sized providers. Additionally, Colorado’s new reforms allow smaller providers to collaboratively apply for safety net designations through the BHA by taking on additional care coordination responsibilities, making them eligible for enhanced reimbursement. Multiple providers can pool services and jointly apply as comprehensive safety net providers or essential providers of select safety net services to access this funding stream.
“These designations demolish the idea of having to exclusively be a sole, comprehensive provider and replace it with a more inclusive and expansive approach,” said Breeah Kinsella, Executive Director of the Colorado Providers Association (COPA). “A lot of providers are doing this work in their communities already, but there was never a path, a structure for them to achieve the same level of sustainable funding from the state that was available to larger providers.”
While these reforms significantly update the long-established definitions, procedures, and ways of operating for safety net providers, achieving their intended outcomes requires commitment.
Every computer operating system that’s ever been created needs updates after it’s launched. The same is true of Colorado’s behavioral health system transformation. At the state level, both HCPF and the BHA continue to work closely with providers to identify and resolve the myriad of questions that come with these new policies, designations, and quality of care standards.
“We want more providers to step up and get into the space,” said Chris Lindley, Chief Population Health Officer of Vail Health, a Colorado Community Mental Health Center and a comprehensive safety net provider. “Everybody wants to see changes to this system, but it’s a behemoth, and there are still an enormous number of regulatory hurdles to work through.”
“For the everyday individual, there’s more access and better services than there were ten years ago,” said Charles Davis, CEO of Crossroads’ Turning Points, a provider based in Pueblo, CO. “I’m hopeful the work being done now will continue on that trajectory, but this field is one of the most complicated disciplines I’ve ever been around.”
To help community partners better understand system changes and meet new reform requirements, HCPF has worked to create a series of technical assistance and resources to help providers and their workforce prepare for and navigate the opportunities created in this transformation. That effort rolled out earlier this year and will continue to evolve as we learn more about where barriers remain for providers and how those barriers can best be navigated, mitigated, or, ideally, removed.
The stigmas of behavioral health aren’t just social—in many respects, they have been codified into policy and into funding and infrastructure over decades. Colorado’s reforms seek to remove that dynamic and reflect the equity, dignity, and community-building value our behavioral health providers deliver, in addition to increasing the access Medicaid members have to a full continuum of quality behavioral health services.
Cristen Bates, MPH, is the Office Director of the Office of Medicaid and CHP+ Behavioral Health Initiatives and Coverage for the Colorado Department of Health Care Policy and Financing. Additional information on Colorado’s behavioral health reform efforts can be found at https://hcpf.colorado.gov/bhreform.
