BHA Provider Rules: Chapter 15

June 21, 2023

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American Sign Language (ASL) Interpreters

• We have two ASL interpreters that will alternate throughout session
• If you want interpretation, “Pin” these boxes to your main screen:
• ASL Interpreter - Elisa
• ASL Interpreter - Kristen
• To pin the interpreters:
• Select “Gallery View” from the upper right corner of your screen
• Click on the ASL interpreter screen, select the “More” button or the three dots
• Select “Pin Video”
• Repeat this process for the second ASL interpreter
• Thank you to Elisa and Kristen for their assistance today!

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BHA Values

• Truth
• Equity
• Collaboration
• Community-Informed Practice
• Generational Impact

Housekeeping

• Introductions
• Two (2) hours booked today
• Video will be recorded and posted on the BHA’s YouTube channel
• BHA’s YouTube channel link may be found on the BHA website and in chat
• BHA staff will have access to chat/transcript to ensure comments are captured
• Share whatever you are comfortable with in this venue
• Ways to share input
• Chat
• Email: cdhs_bharulefeedback@state.co.us
• Google Form/survey response
• Raise your (virtual) hand
• Please reach out through email or Google Form if we do not get to your concern

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Today’s Town Hall

• Provide information about Chapters 15: Designation of Facilities for the Care and Treatment of Individuals with Mental Health Disorders (Title 27, Article 65, C.R.S.)
• This was formerly Chapter 17
• More presentation and content heavy than other stakeholder events
• Visit our website for upcoming events
• https://bha.colorado.gov/resources/laws-rules
• A *NEW WAY* to stay informed
• Register for the new Quality and Standards newsletter
• http://eepurl.com/isj-PA
• First newsletter was sent yesterday!

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HB 22-1256

• Significant changes to involuntary mental health treatment in Colorado,
• Expansion of patient rights,
• Required discharge planning, and
• Expansion of who can place and remove an involuntary mental health hold

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• Specific changes to 27-65 C.R.S. regarding the significant transformation to the 72-hour hold process will be discussed along with upcoming changes to CH15: 27-65 Designation Rules.

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HB 22-1256

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Effective August 2022:

• New “intervening professional” definition to remove peace officer and add APRN & PA
• RNs must complete a BHA-identified training to initiate mental health holds
• Voluntary hospitalizations of minors
• Respondent’s right to an attorney
• New Transportation Hold (M0.5) provisions
• New requirements for terminations of certifications including notification to BHA
• Long-term certification petitions must include inpatient/outpatient recommendation
• New discharge requirements
• BHA must promulgate rules and develop/distribute forms
• BHA must train providers, facilities, counties, judges/magistrate, intervening professionals and certified peace officers

HB 22-1256

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• New emergency procedure statutory language: “emergency mental health hold”
• Discharge instructions (with required components) must be provided to people on emergency MH holds prior to release
• BHA standardized evaluation form must be used
• The BHA will begin assisting emergency medical services facilities in finding solutions for difficult-to-place folks
• Subsequent involuntary mental health holds are allowable in both designated and non-designated emergency medical services facilities if appropriate placement cannot be found
• New patient rights specific to STC/LTC inpatient

Effective ***July 2023 NOW January 2024***:

HB 22-1256

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• The BHA is responsible for providing case coordination for certified individuals (as identified by the facility and the BHA)
• Outpatient certification (short-term & long-term) provisions:
• OP facility must proactively reach out to clients to engage the individual in treatment
• If the person refuses treatment, the court may order transport to a designated facility to receive tx and COM; the individual does not need to be imminently dangerous to self/others
• Liability limited for designated facilities (cert terminated despite the person meeting criteria, for example)
• New certification provisions: anyone may contest treatment regimen at any court proceeding (including COM)
• New provisions for termination of short-term & long-term certifications

Effective July 2024:

House Bill 23-1236: BHA Implementation Update Bill

• Behavioral Health Entity (BHE) and Safety Net Rule

Extension 7/1/23 → 1/1/24

• Behavioral Health Administrative Service Organization (BHASO)

Extension 7/1/24 → 7/1/25

• 27-65 Extensions

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27-65 Designation Updates

• HB 23-1236 extended implementation timelines for how services are provided to individuals on an involuntary hold (7/1/23 → 1/1/24)
• New data reporting requirements for emergency departments (7/1/23 → 7/1/24)

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Key Provisions: HB22-1256

• Updates with additions to patient rights in every involuntary procedure in CRS 27-65
• Updates who can place a transportation hold
• Major updates to involuntary mental health holds
• Creates first ever statutory section dedicated to outpatient certifications
• New data reporting
• New responsibilities for the BHA, including more staff to support 27-65 program
• Three different implementation timelines

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August 9, 2022 – What reforms are in effect now?

• New and updated statutory sections
• 27-65-103 (treatment of minors), now 104
• New intervening professionals (who can place a hold or terminate a hold) definition
• Transportation hold (M-0.5), 27-65-107 C.R.S.
• Peace Officers, EMS
• MH clinicians can no longer place M-0.5
• New rights (NEW M FORM)
• Screening within must occur immediately upon arrival to designated facility, if professional person unavailable-within 8 hours (does not apply to EDs)
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Updated Reforms: New Practice Now

• All people who are certified (ST/LT) have the right to an attorney and respondents can only waive counsel in front of a judge.
• All individuals terminated from certification must be reported to BHA
• BHA website: Resources->Involuntary Mental Health Treatment
• Bottom of page: Certification Termination Reporting

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72-hour Hold-> Emergency Mental Health Hold

• Outlines that law enforcement has the discretion to ignore a warrant and take someone to a treatment facility on an M1 hold, unless otherwise required by law, if the certified peace officer believes it is in the best interest of the person.
• Separates certified peace officer from the definition of intervening professional. And subsequently creates two separate pathways for placing an M1 in the community

One pathway that is specific for law enforcement

One pathway that is specific for intervening professionals (clinical professionals)

• Changes language from “admitted” to “detained” and “presented” so the subsection applies to people in an ED (current language says "admitted").
• Clearly states an emergency mental health hold ends 72-hours after the hold is placed or ordered, includes EMTALA mention.
• Subsequent holds criteria (1/1/24)
• Placement cannot be located
• Continues to meet emergency mental health hold criteria (M-1)
• Contacting BHA and placement coordination efforts (TBD)

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EMH Holds (con’t)

• If any person, voluntary or involuntary, has been waiting for placement at a facility for longer than 72 hours, the BHA must be notified. The BHA shall support the facility in locating an appropriate placement option.
• Bill provided BHA with sufficient funding to provide this support to facilities 24/7/365
• If the person is in an ED and appropriate placement cannot be located at a designated facility, the ED can place the person on a subsequent 72-hour hold if they continue to meet criteria if they do the following:
• Notify the court and the court (not the facility) shall appoint counsel
• Notify the person’s lay person
• Notify the BHA
• If the person has recently transferred from an ED to a designated facility and the designated facility can demonstrate that they do not have time to evaluate the person for a certification before the hold expires, they can place a subsequent mental health hold if the BHA and the person’s lay person are notified.
• BHA shall maintain data on all of this.

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Emergency Mental Health Evaluation

• Evaluations may be completed by: Professional person, Psych APRN or PA, LCSW, LPC, LMFT with 2 years of experience in behavioral health safety and risk assessment working in a health-care setting.
• Clarifies that the person in charge of the evaluation may drop the hold
• Evaluations must be done using a standardized form approved by the BHA (to be created and stakeholder feedback by end of 2023)- implementation 1/1/24
• Separate from crisis assessment

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July 1, 2024 Reforms

• Certification Changes: Outpatient certifications and provider immunity
• Requires the BHA to create a one-step grievance process
• Allows the respondent or their identified lay person or guardian to contest the treatment regimen (including court-ordered meds) at any court hearing related to the certification
• Outlines the provider must proactively outreach to the respondent before asking for a court order for a certified peace officer or secure transportation provider to assist in transporting the individual.
• Outlines judicial process if the person is placed in a more restrictive setting
• Limitations on liability for provider
• Adds patient rights specific to a person certified on an outpatient basis
• Adds that the Court can order a secure transportation provider, not just a peace officer to pick someone up
• BHA will provide care coordination for all individuals on a certification

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BHA Implementation of HB22-1256

BHA implementation of this bill requires the following:

• Updates to M-forms including new patient rights (by July 1, 2023)
• Updates to 2 CCR 502-1, the state Behavioral Health Rules (In effect Jan 1, 2024)
• Process for notification to BHA regarding certification termination
• Creation of and stakeholder process for standardized evaluation form (Jan 1, 2024)
• Process for supporting placement of individuals (January 1, 2024)
• Creation of one-step grievance process (July 1, 2024)
• Process for BHA care coordination for individuals on certifications (July 1, 2024)
• Training and technical assistance

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Process for supporting placement of individuals

• As part of HB22-1256, the BHA will be provided with funding to hire additional FTE to provide support for emergency medical services facilities to place individuals when no appropriate beds can be found
• Although this bill did not include funding for additional beds, the BHA will provide support to EDs if they are struggling with placement
• Information about seeking BHA support will be posted on the involuntary treatment page of the BHA website

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Creation of one-step grievance process (7/1/24)

• With the creation of the BHA, a team of folks devoted to complaints and grievances will be hired in the coming months
• The BHA will create a special webpage for people receiving services and their loved ones to make the complaint/grievance process as straightforward as possible
• Updates about this process will be posted on the involuntary treatment page of the BHA website prior to July 2024: https://bha.colorado.gov/resources/involuntary-mental-health-treatment

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Process for BHA care coordination for individuals on certifications (7/24)

• With the creation of the BHA, an entire process for care coordination is being developed; this will either live within the BHA or be contracted out to the BHASOs or RAEs
• All individuals on certifications who require additional care coordination support will have access to these services
• Updates about this process will be posted on the involuntary treatment page of the BHA website

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Training

• HB22-1256 provided funding for additional FTEs to develop and implement community trainings specific to involuntary mental health procedures
• Trainings will be targeted toward peace officers, EMT professionals, providers, facilities, counties, judges, magistrates, intervening professionals, & professional persons (who oversee certifications)
• Some trainings will be online and always available on the BHA website; others will occur in-person and as needed virtually

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Chapter 15: Designation of Facilities for the Care and Treatment of Individuals with Mental Health Disorders (Title 27 Article 65, C.R.S.)

Main Sources:

• 2 CCR 502-1
• HB 22 1256
• HB 23 1236
• Stakeholder feedback

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Person-Centered Summary:

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If you are in danger of hurting yourself or others, you may be placed on an emergency mental health hold. 27-65 designated facilities refer to facilities that are capable of providing services to you should this happen. Services may be provided on an inpatient or outpatient level of care depending on your ability to take care of yourself or your risk of harm to self or others. Emergency mental health holds are placed on people that are:

• A danger to themselves (participating in self-harm, thoughts of suicide, or a recent suicide attempt) and are unable to remain safe
• A danger to others (threatening to hurt someone else), or
• Gravely disabled. This means your mental health has gotten so severe you are incapable of basic self-care (not showering, brushing your teeth, missing work, staying in bed all day, not eating or drinking etc.)

If you find yourself placed on an emergency mental health hold, this means you must be involuntarily taken to treatment in order to keep you or others safe. There are patient rights in place that the emergency medical services facility and/or the inpatient/outpatient facility must adhere to. During treatment, you will be stabilized and gain tools and resources to better your mental health. Once you are able to keep yourself safe again, your hold will be discontinued.

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15.2 Definitions

Definitions have been updated to reflect:

• Additional statutory definitions from HB 22-1256
• Feedback from stakeholders to not exclude appropriate providers of assessments and services
• Some of the terms from this section are found in Chapter 1
• Example: “Authorized practitioner” means the person (A) authorized by law to  prescribe treatment, medication or medical devices, (B) who holds a current unrestricted license to practice, and (C) is acting within the scope of such authority. this person may also be registered with the drug enforcement administration (DEA) to prescribe controlled substances. This includes, but is not limited to: 

A. A physician, psychiatrist, medical doctor, or doctor of osteopathy licensed pursuant to Article 240 of Title 12, C.R.S.,

B. A physician assistant licensed pursuant to Part 113 of Article 240 of Title 12, C.R.S., and,

C. An advanced practice registered nurse (APRN), licensed pursuant to Part 255 of Title 12, C.R.S. 

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Definitions Continued:

• "Intervening professional" means an individual who is statutorily permitted to enact an emergency mental health hold. Intervening professionals must be one of the following:
• A professional person as defined in this chapter;
• A physician assistant licensed pursuant to Section 12-240-113, C.R.S.;
• An advanced practice registered nurse, as defined in Section 12-255-104 (1), C.R.S.;
• A registered professional nurse, as defined in Section 12-255-104 (11), C.R.S., who has specific mental health training as identified by the BHA;
• A clinical social worker licensed pursuant to 12-245-401, C.R.S.;
• A marriage and family therapist licensed pursuant to 12-245-501, C.R.S.;
• A professional counselor licensed pursuant to 12-245-601, C.R.S.;
• An addiction counselor licensed pursuant to 12-245-801, C.R.S.
• Note: Certified peace officers were removed from this definition but are still able to initiate a mental health hold.

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Definitions Continued:

• "Professional person" means a person licensed to practice medicine in this state (this includes Advanced Practice Registered Nurses), a psychologist licensed to practice in this state, or a person licensed and in good standing to practice medicine in another state or a psychologist licensed to practice and in good standing in another state who is providing medical or clinical services at a treatment facility in this state that is operated by the armed forces of the United States, the United States public health service, or the United States department of veterans affairs.
• "Physician" means an individual licensed to practice medicine in this state not including advanced practice registered nurses (APRNs).
• "Lay Person" means an individual identified by another individual who is detained on an involuntary emergency mental health hold, certified for short-term treatment, or certified for long-term care and treatment, who is authorized to participate in activities related to the individual’s involuntary emergency mental health hold, short-term treatment, or long-term treatment, including court appearances, discharge planning, and grievances. The individual may rescind the lay person’s authorization at any time.

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27-65 Designation Requirements

• All agencies providing involuntary treatment services pursuant to Article 65 of Title 12, C.R.S. shall meet the standards in Chapter 15.
• Any facility licensed by a state agency including CDPHE or the Division of Child Welfare within the Colorado Department of Human Services providing involuntary mental health services whether inpatient or outpatient, shall seek a 27-65 designation.
• If the facility is also a BHE, they must comply with CH2 and if Safety Net Providers, CH3.
• A designated facility must also comply with regulations specific to the involuntary services it provides, which includes:
• Involuntary emergency services (Part 15.16)
• Involuntary short-term and long-term inpatient care and treatment (Part 15.17); and/or
• Involuntary outpatient care and treatment (Part 15.18).

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Designation Procedures

Facilities providing twenty-four (24) hour inpatient or acute crisis care, must apply for a separate designation based on the unique physical address of each site. IF TWO OR MORE BUILDINGS SHARE A PHYSICAL ADDRESS, EACH BUILDING MUST BE DESIGNATED SEPARATELY FOR 27-65 SERVICES. If a medical hospital applies for 27-65 designation, the specific units/floors to be designated must be specified on the application.

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Updates to 27-65 Designation

• Data Requirements: 27-65 designated facilities must now submit disaggregated data (previously aggregated data). Data needed for emergency mental health holds:
• Information on the individual receiving care
• Who initiated the hold
• Reason(s) for the hold
• Disposition information
• Placement challenges
• Reason(s) for subsequent hold (if applicable)
• Involuntary transportation hold information (how many the facility received) & outcomes
• Disaggregated data also needed for long term and short term certifications, voluntary patients (only individuals info), involuntary medications/treatment, ECT procedures, and from emergency medical services facilities (EDs), whether designated or not.

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27-65 Data Reporting Requirements

Most Notable Changes

• Client-Level Data: the BHA requires, as of 07/01/2024, that both 27-65 Designated Facilities and ED/Non-Designated Facilities submit client-level data regarding 27-65 services.
• Placement Data: the BHA requires 27-65 service providers to submit data related to client placement and any issues related to placing individuals in the appropriate level of care; subsequent hold data
• Certification Data: increased demographic data for individuals on short and long-term certifications; track the services an individual received DURING the certification.
• Annual Reporting: The BHA will once again develop an annual report.

27-65 Data Reporting Requirements

Why All the Changes?

• Who are we serving?
• The BHA is committed to understanding the communities we serve as well as those communities we are currently undeserving or missing entirely.
• Service Provision
• How and where are services being provided?
• State Budgeting
• Strategically planning for the future with projected needs analysis.
• Annual Reporting
• A full annual report will once again be provided by the BHA.

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27-65 Data Reporting Requirements

How to Report Data

• The BHA will give a template to both 27-65 Designated and Non-Designated facilities in which they will enter data for the reporting period.
• It is currently being drafted.
• Please ensure that 27-65 staff are well versed in the changes outlined by the statute.

27-65 Data Reporting Requirements

27-65 Training

• Technical Assistance
• How to Video for the new data collection template
• Office Hours

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Data Requirements Questions

General Standards

Leadership Personnel Requirements: Minimum leadership staff requirements to both short and long-term facilities must now have both a Facility Director and Clinical Director. One qualified individual to administer medications at all times Qualified Medication Administration Person (QMAP) now included in medication administration).

Individual Records section added: All professional persons and/or facilities providing an evaluation, care, and/or treatment shall keep records detailing all care and treatment received by the individual, and the records must be made available, upon the individual’s written authorization, to the individual’s attorney or the individual’s personal physician.

Discharge Summary Requirements

Discharge summary and care coordination instructions must contain the following:

• A summary of why the individual was detained or evaluated for an emergency mental health hold;
• Detailed information as to why the evaluating professional determined the individual no longer meets the criteria for an emergency mental health hold or certification;
• Whether the individual may receive services on a voluntary basis;
• If the individual’s medications were changed or the individual was newly prescribed medications during the emergency mental health hold, a clinically appropriate supply of medications, as determined by the judgment of a licensed health-care provider, for the individual until the individual can access another provider or follow-up appointment;
• A safety plan for the individual and, if applicable, the individual’s lay person where indicated by the individual’s mental health disorder or mental or emotional state;
• Notification to the individual’s primary care provider, if applicable;
• A referral to appropriate services, if such services exist in the community, if the individual is discharged without food, housing, or economic security those referrals and linkages must be documented in the individual’s record;

Discharge Summary Requirements Continued

• The phone number to call or text the Colorado Crisis Services hotline and information on the availability of peer support services;
• Information on how to establish a psychiatric advance directive if one is not presented;
• A list of any screening or diagnostic tests conducted during the emergency mental health hold, if requested;
• A summary of therapeutic treatments provided during the emergency mental health hold, if requested;
• Any laboratory work, including blood samples or imaging that was completed or attempted, if requested;
• A copy of any psychiatric advance directive presented to the facility, if applicable; and,
• How to contact the discharging facility if needed.

Follow-up Requirements

• Follow up for all facilities discharging an individual from an emergency mental health hold:
• Regardless of discharge status (release/voluntary/certified)
• Regardless of type of facility and designation status, must attempt follow-up contact with individual/lay person/guardian at least 48 hrs post discharge
• May contract with community-based behavioral health providers or the crisis hotline
• 988 phone call alone is NOT sufficient to meet this requirement
• Must receive authorization from individual to share information
• This does not apply to individuals with Medicaid (RAEs to follow up with pts - facility to contact RAE regarding member’s mental health hold)

Updates Continued

• Therapy or Treatment Using Special Procedures: Procedures such as Transcranial Magnetic Stimulation (TMS), ECT, and the use of feeding tubes for eating disorder treatment will require special procedures for consent.
• Requirements for Placement Facilities: Agencies that use placement facilities will need to send placement facility contracts at least biennially. Contracts will be submitted to the BHA at same time as BHE license renewal.
• Subsequent Emergency Mental Health Holds: Subsequent involuntary mental health holds are allowable in both designated and non-designated emergency medical services facilities if appropriate placement cannot be found
• Facility must notify the court (so attorney may be appointment), the BHA, and the individuals’s lay person (if the individual desires)

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Seclusion, Restraint, & Physical Management

• Further details on when these interventions can and cannot be used and policies/procedures needed by the agency
• Increased personnel training and demonstration of knowledge/application
• Added standards of care at time of admission including:
• Collaborating with the individual strategies that may minimize the potential for a behavioral health emergency event that requires these interventions
• Assessing for assault, trauma, and S/R/PM history, and any additional risk factors
• Timelines for orders has changed to match federal regulations and standards of a maximum of 4 hours for an order (was previously 24 hours)

Seclusion, Restraint, & Physical Management

• Increased regulations for protecting and monitoring individuals including:
• Personnel may not be more than 10 feet away
• Maintain continuous line of sight and consistent efforts to interact throughout the episode
• Personnel ensure for individuals in restraint that blood circulation and airways are not restricted/obstructed
• Increased regulations for relief periods
• Must debrief with the individual and assess for trauma
• Specific documentation requirements of intervention episodes
• Additional regulations added on seclusion, restraint, and physical management of a minor�

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Transportation Holds (M.05)

Procedures for Involuntary Transportation Holds:

• Involuntary transportation holds can no longer be initiated by an “intervening professional”, only by an “EMS provider” or “certified peace officer”
• Individuals may not be transported for longer than 6 hours
• Once the individual is presented to an outpatient mental health facility or facility designated by the commissioner, an intervening professional shall screen the individual immediately. If an intervening professional is not immediately available, the individual must be screened as soon as possible but no later than 8 hours after the individual’s arrival at the facility to determine if the individual meets criteria for an emergency mental health hold.

NOTE: This does not apply to EDs

• Rights must be explained to the individual prior to transporting them involuntarily and provided in written form

Transportation Rights

• To not be detained under an emergency transportation hold pursuant to this section for longer than fourteen (14) hours, to not be transported for longer than six (6) hours, and to receive a screening immediately but within no more than eight (8) hours after being presented to the receiving facility.
• Subsection 27-65-107 (4)(a)(i), C.R.S., does not prohibit a facility from holding the individual as authorized by state and federal law, including the federal “emergency medical treatment and labor act,” 42 u.s.c. sec. 1395dd, or if the treating professional determines that the individual's physical or mental health disorder impairs the individual’s ability to make an informed decision to refuse care and the provider determines that further care is indicated.
• To request a phone call to an interested party prior to being transported. If the certified peace officer or ems provider believes access to a phone poses a physical danger to the individual or someone else, the receiving facility shall make the call on the individual’s behalf immediately upon arrival at the receiving facility.

Transportation Rights Continued

• To wear the individual’s own clothes and keep and use personal possessions that the individual had in the individual’s possession at the time of detainment. A facility may temporarily restrict an individual’s access to personal clothing or personal possessions until a safety assessment is completed.
• If the facility restricts an individual’s access to personal clothing or personal possessions, the facility shall have a discussion with the individual about why the individual’s personal clothing or personal possessions are being restricted. A licensed medical professional or a licensed mental health professional shall conduct a safety assessment as soon as possible. The licensed professional shall document in the individual’s medical record the specific reasons why it is not safe for the individual to possess the individual’s personal clothing or personal possessions.

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Transportation Rights Continued

• To keep and use the individual’s cell phone, unless access to the cell phone causes the individual to destabilize or creates a danger to the individual’s self or others, as determined by a provider, facility personnel , or security personnel involved in the individual’s care.
• To have appropriate access to adequate water and food and to have the individual’s nutritional needs met in a manner that is consistent with recognized dietary practices.
• To be treated fairly, with respect and recognition of the individual’s dignity and individuality.
• To file a grievance with the BHA, the Department of Public Health and Environment (CDPHE), or the office of the ombudsman for behavioral health access to care established pursuant to 27-80-3, C.R.S.

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An individual’s rights may only be denied if access to the item, program, or service causes the individual to destabilize or creates a danger to the individual’s self or others, as determined by a licensed mental health provider or professional person involved in the individual’s care or transportation.

M Forms & Patient Rights

• M 1 & M 0.5 Forms
• Final edits by end of week
• Ready for dissemination 7/1/23
• Patient Rights
• Transportation Rights- All ages
• 72 hr hold Rights- All ages
• Certification Rights- Adults
• Certification Rights- Minors
• Voluntary Hospitalization- Minors
• Patient Rights- translation and beautification

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M-Forms Questions

Additional Procedures for Minors

• A minor who is 15 years of age or older may receive mental health services from a facility with/or without consent from a parent or legal guardian
• Rights of a Minor include (in addition to the rights listed in 15.14.5):
• To refuse to sign the admission consent form
• To revoke consent at a later date (this will trigger a review of need for hospitalization)
• Seek to be released from the facility
• Services are suited to the individual’s needs, delivered in the least restrictive environment, and delivered with an opportunity for family members to be involved, when appropriate

Additional Procedures for Minors Cont.

Hospitalization Procedures for Minors

• Application process and independent review
• Minor may be admitted voluntarily or involuntarily
• For applications an independent professional conducts an investigation
• Unless minor is 15 + and is seeking voluntary admission

Objection to Hospitalization

• Objection process for when a minor does not consent to or objects to continued hospitalization
• Need for continued hospitalization must be reviewed within 10 days
• Process with review and courts if continued objection after review

New Individual Rights for Emergency Mental Health Holds

• To request a change to voluntary status;
• To have reasonable access to telephones or other communication devices (including cell phones) and to make and to receive calls or communications in private;
• To keep and use the individual's cell phone, unless access to the cell phone causes the individual to destabilize or creates a danger to the individual's self or others, as determined by a provider, facility personnel member, or security personnel involved in the individual's care;
• An individual’s rights may be denied for good cause only by the professional person providing treatment. Denial of any right must in all cases be entered into the individual’s treatment record. Information pertaining to a denial of rights contained in the individual’s treatment record must be made available, upon request, to the individual, or the individual’s attorney.

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New Individual Rights for Emergency Mental Health Holds

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• To wear the individual’s own clothes, keep and use the individual’s own personal possessions, and keep and be allowed to spend a reasonable sum of the individual’s own money.
• A facility may temporarily restrict an individual’s access to personal clothing or personal possessions, until a safety assessment is completed;
• If the facility restricts an individual’s access to personal clothing or personal possessions, the facility shall have a discussion with the individual about why the individual’s personal clothing or personal possessions are being restricted;
• A licensed medical professional or a licensed mental health professional shall conduct a safety assessment as soon as possible. The licensed professional shall document in the individual’s medical record the specific reasons why it is not safe for the individual to possess the individual’s personal clothing or personal possessions.
• The facility shall periodically conduct additional safety assessments to determine whether the individual may possess the individual's personal clothing or personal possessions, with the goal of restoring the individual’s rights established pursuant to this section.

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Emergency Department Facilities

• Involuntary Emergency Services Designation: New designation that is OPTIONAL for all emergency services (emergency departments). This will allow for the designated facilities to place individuals on a medical unit while on a hold or certification when needed.
• Must be in compliance with:
• Parts 2.9 (dispute resolution), 2.17 (critical incident reporting), & 2.25.5 (right to appeal)
• Data requirements from Part 15.5.9 (exempt from all other data requirements), 15.7.3 (documentation in individuals records), & 15.14 (procedures for emergency mental health holds)

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Involuntary Short-Term and Long-Term Care and Treatment Designation (Inpatient Services)

• Previously combining ATU and CSU, based on stakeholder feedback, ATU and CSU to remain current state (rules adapted from CDPHE 6 CCR 1011-1 CH3)
• Outlined procedures for how facilities are to initiate and discontinue long-term and short-term certifications
• New staffing requirements for all short- and long-term designated facilities
• When going to court for certifications, a recommendation of appropriate level of care (inpatient vs. outpatient) must be specified
• Must have policies and procedures for therapeutic programming being offered and documented in individual’s treatment plan
• Programming can include the following, but is not limited to:
• Intensive case management;
• Assertive community treatment;
• Peer recovery support services;
• Other therapeutic activities.

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Involuntary Outpatient Care and Treatment

• Involuntary Outpatient Care & Treatment Designation (Entirely new section!):
• New set of patient rights
• This designation specifies that facilities must possess a comprehensive safety net approval to provide involuntary outpatient care and treatment
• Individual may receive involuntary treatment at outpatient status if:
• They are assessed as appropriate to place in an outpatient setting
• Outpatient is better suited to the individual needs and welfare
• Designated facility holding the outpatient certification has documentation of a recent physical examination
• Additional requirements for treatment planning emphasizing finding/sustaining recovery and safety

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Outpatient Certification Cont.

• How will Outpatient Certification be enforced if the individual refuses treatment and/or medication?
• The facility is responsible for providing services and will “proactively” reach out to engage individuals in treatment
• If the individual refuses treatment or court-ordered medication and is decompensating psychiatrically, the court may order a certified peace officer or secure transportation to transport the individual to an appropriate designated facility
• Does not need to be imminently dangerous to self or others for provider to request transportation intervention with the individual
• Outpatient Certification Individual Rights (Not all rights are listed):
• Request to change to voluntary status;
• Treated fairly and with respect while receiving treatment appropriate to their needs and having a collaborative voice on what those needs are; and,
• Within 48 hours from request to be able to receive services of a patient representative, which includes a peer specialist

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Thank You

https://bha.colorado.gov/resources/laws-rules

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Contact:

CDHS_BHARuleFeedback@state.co.us

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BHA Newsletter: bha.colorado.gov

under “How can I be involved?”

bha.colorado.gov

@BHAConnect