Code of Colorado Regulations
500 - Department of Human Services
502 - Behavioral Health
2 CCR 502-1 - BEHAVIORAL HEALTH
Chapter 12 - Behavioral Health Safety Net Provider Approval
Section 2 CCR 502-1-12.4 - Essential Behavioral Health Safety Net Providers
Universal Citation: 500 CO Code Regs 2 CCR 502-1-12.4
Current through Register Vol. 48, No. 6, March 25, 2025
12.4.1 Requirements
A. Essential behavioral health safety net providers shall provide at least one of the following services.
1. Emergency and/or crisis behavioral health services;
2. Behavioral health outpatient services;
3. Behavioral health high-intensity outpatient services;
4. Behavioral health residential services;
5. Withdrawal management services;
6. Behavioral health inpatient services;
7. Integrated care services;
8. Hospital alternatives; and/or
9. Additional services that the BHA determines are necessary in a region or throughout the state.
B. For services which a BHA endorsement exists in Chapters 3 through 10 of these rules, services shall be provided in conformity with the rules of the endorsement.
C. When providing services to children and families, essential behavioral health safety net providers shall provide services to children and families in conformity with the standards set forth in Chapter 8 of these rules.
D. The essential behavioral health safety net provider shall provide clinical services during times that ensure accessibility and meet the needs of the individual population to be served, including evening and/or weekend hours.
1. These extended hours may include services provided via telehealth, if appropriate.
E. Essential behavioral health safety net providers offering outpatient behavioral health services must have in-person service offerings in addition to any telehealth services the agency may elect to provide.
12.4.2 Priority Populations
A. Essential behavioral health safety net providers must serve all priority populations as defined in Section 27-50-101(17), C.R.S., unless:
1. The agency's approval limits the agency's scope and responsibility to a specific subset of priority population(s); and
2. The provisions in the agency's contract with the BHA or its designee limit the agency's scope and responsibility to a specific subset of priority populations.
B. When an essential behavioral health safety net provider is approved to serve a subset of priority populations, the agency shall ensure that corresponding admission and exclusion criteria are:
1. Outlined in the agency's policy developed pursuant to part 12.3.2.B.2 of this Chapter;
2. Approved by the BHA or its designee;
3. Publicly available on the provider's website; and
4. Applied uniformly.
C. The essential behavioral health safety net provider shall have personnel with scope of practice and training to meet the needs of priority populations within the scope of the services and priority populations that the essential behavioral health safety net provider is approved to provide.
12.4.3 Screening, Triage, and Care Coordination in Alignment with No Refusal Requirements
A. When an individual attempts to initiate treatment with an essential behavioral health safety net provider, the essential behavioral health safety net provider shall complete an initial screening and triage process to identify the needs of the individual, and to determine the urgency and appropriateness of care with the essential behavioral health safety net provider.
B. Screenings must collect at least the following information from an individual seeking services:
1. Identifying information;
2. Primary complaint/reason for seeking services;
3. Current behavioral health symptoms, including severity, duration, mental status, and changes or impairments in functioning due to symptoms;
4. Medical concerns/chronic health issues, including pregnancy and postpartum status; and,
5. Evaluation of imminent risk, including:
a. Suicide risk;
b. Danger to self or others;
c. Urgent or critical medical conditions, including withdrawal or overdose risk; or
d. Other immediate risks, including threats from another person.
6. Preliminary determination of level of care needed;
7. Health-related social needs and associated risk factors related to social determinants of health, including but not limited to:
a. Food security;
b. Housing stability and security;
c. Personal safety;
d. Access to health services including preventative health care;
e. Physical health concerns for which the individual is not receiving adequate treatment.
8. Whether an individual is part of an identified priority population and which one.
C. The essential behavioral health safety net provider shall use these standard criteria for determining whether an agency's clinical scope of practice or treatment capacity are appropriate to meet the needs of the individual, or if the agency will instead provide care coordination to support the individual in accessing alternate services. These criteria are:
1. The individual's presenting problem or behavioral health diagnosis is outside the scope of practice of the agency and its personnel, including the age range with which the agency works, or the modalities and interventions in which personnel are trained in.
2. The agency is approved pursuant to part 12.4.2 of this Chapter to serve a subset of priority populations, and the individual does not fall within the priority population(s).
3. The individual presents with the need for a level of care the agency does not provide.
4. The agency cannot provide services within an appropriate time frame per the individual's needs and the agency's capacity.
D. In accordance with Section 27-50-301(4), C.R.S., unless it is determined, pursuant to the criteria in part 12.4.3.c of this Chapter, that an individual's needs fall outside the scope and capacity of the essential behavioral health safety net provider, the essential behavioral health safety net provider shall not refuse to treat an individual based on the individual's:
1. Insurance coverage, lack of insurance coverage, or ability to pay;
2. Clinical acuity level related to the individual's behavioral health condition or conditions, including whether the individual has been certified for short-term treatment or long-term care and treatment pursuant to Article 65 of Title 27, C.R.S.;
3. Readiness to transition out of the Colorado Mental Health Hospital at Pueblo, the Colorado Mental Health Hospital at Fort Logan, or any other mental health institute or licensed facility providing inpatient psychiatric services or acute care hospital providing stabilization because the individual no longer requires inpatient care and treatment;
4. Involvement in the criminal or juvenile justice system;
5. Current involvement in the child welfare system;
6. Co-occurring mental health and substance use disorders, physical disability, or intellectual or developmental disability, irrespective of primary diagnosis, co-occurring conditions, or if an individual requires assistance with activities of daily living or instrumental activities of daily living, as defined in Section 12-270-104(6), C.R.S.;
a. Essential behavioral health safety net providers shall not deny services to individuals who exhibit inappropriate sexual behaviors.
7. Displays of aggressive behavior, or history of aggressive behavior, as a symptom of a diagnosed mental health disorder or substance use disorder;
8. Clinical presentation or behavioral presentation in any previous interaction with a provider;
9. Place of residence; or
10. Disability, age, race, creed, color, sex, sexual orientation, gender identity, gender expression, marital status, national origin, ancestry, or tribal affiliation.
E. If the individual's needs exceed the treatment capacity or clinical scope of practice needed to serve the individual, the essential behavioral health safety net provider shall provide a warm handoff to a provider or entity able to provide care for the individual that is within its scope of service, which may include the BHA or its designee.
1. Essential behavioral health safety net providers must also provide warm handoffs for individuals who have health-related social needs that require alternative services outside the scope of the behavioral health safety net system, such as services for housing, food insecurity, and transportation. The essential behavioral health safety net provider shall connect the individual to appropriate resources to initiate those services.
2. When referring an individual to an alternative provider, entity, or service, geographic location and the individual's ability to access the service location shall be considered.
F. The essential behavioral health safety net provider shall track the following information for all priority population individuals who were referred to alternative services pursuant to this part. This information must be maintained in a single report that must be made available upon request by the BHA or its designee. This report shall include:
1. Individual demographics, including to which priority population the individual belongs;
2. Standardized descriptions of the needs of the individual that could not be met and require the individual to be referred to another provider;
3. The outcome and timeliness of the referral, i.e., the date of the referral and response from the receiving agency; and
4. Whether the individual was discharged from a higher level of care to a lower level of care and, if so, what level of care the referring provider was seeking to discharge the individual from.
G. These processes must apply at the time of initial screening, and any time reassessment indicates the individual's needs have changed and fall outside of the scope of the agency.
1. When an essential behavioral health safety net provider initiates a transition in care for an individual or family under the care of the agency, whether the transition is to an alternate agency or an alternate level of care within the agency, the essential behavioral health safety net provider must notify the individual or family via a live conversation and then ensure that appropriate steps are taken to transition the individual or family.
2. Requirements to not refuse care based on these criteria apply to essential behavioral health safety net providers as a whole. Refusal does not include transferring an individual to an alternative level of care within an essential behavioral health safety net provider or identifying new personnel to support the individual.
12.4.4 Governance
A. Overall responsibility for the administration of an essential behavioral health safety net provider shall be vested in a director who is a physician or a member of one of the licensed mental health professions unless the essential behavioral health safety net provider is only providing recovery support services. If the director is not a licensed physician or licensed mental health professional, the essential behavioral health safety net provider shall employ or contract with at least one (1) authorized practitioner or licensee to advise the director on clinical decisions.
B. Each essential behavioral health safety net provider from which services may be purchased shall:
1. Be under the control and direction of a county or local board of health, a board of directors or board of trustees of a corporation, a for-profit or not-for-profit organization, a regional mental health board, tribal organization, or a political subdivision of the state;
2. Enter into a contract developed pursuant to Section 27-50-203, C.R.S. and accept publicly funded individuals.
Disclaimer: These regulations may not be the most recent version. Colorado may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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