Tracking# 2007-01435
FA/P 2/1/08, eff. 4/1/08

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[I:07101101.doc]

(2 CCR 502-3)

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Revisions to the Child Mental Health Treatment Act rules, Sections 20.000 through 20.800, were final adoption following publication on 2/1/2008 by the State Board of Human Services, with an effective date of 4/1/2008 (Rule-making# 07-10-11-1).  Statement of Basis and Purpose, Regulatory Analysis, and specific statutory authority for these revisions were incorporated by reference into the rule.  These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Boards and Commissions Division, State Board Administration. 
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20.100  INTRODUCTION [Rev. eff. 4/1/08]
These rules are intended to implement the mental health treatment services defined in the Child Mental Health Treatment Act, Sections 27-10.3-101 through 27-10.3-107, C.R.S., subject to available appropriations, to ensure the maximum use of appropriate least restrictive treatment services and to provide access to the greatest number of children. The purpose of the Child Mental Health Treatment Act is to provide access to mental health treatment for eligible children who are Medicaid eligible as well as those who are at risk of out-of-home placement, as defined below. In addition, the rules are intended to provide a sliding fee scale for responsible parties to offset the cost of care not covered by private insurance or Medicaid provided under the Child Mental Health Treatment Act. Grievance procedures for denial of residential mental health treatment are established in the rules as well as a dispute resolution process for county departments and mental health agencies.
20.200  DEFINITIONS [Rev. eff. 4/1/08]
“Ability to Pay” is the amount of income and assets of the legally responsible person(s) available to pay for the individual cost of mental health treatment and room and board for a child in residential treatment.
“Care Management” means arranging for continuity of care and the array of service necessary for treating the child, and the authority to rescind authorization for any treatment services with proper notice. 
“Child at Risk of Out-of-Home Placement” means a child who, although not otherwise categorically eligible for Medicaid, meets the following criteria: 
A.  Has been diagnosed as having a mental illness, as defined in Section 27-10-102 (8.5), C.R.S.; 
B.  Requires a level of care that is provided in a residential child care facility pursuant to Section 25.5-5-306, C.R.S., or that is provided through in-home or community-based programs and who, without such care, is at risk of out-of-home placement; 
C.  If determined to be in need of placement in a residential child care facility, is determined to be eligible for Supplemental Security Income; and, 
D.  For whom it is inappropriate or unwarranted to file an action in dependency or neglect pursuant to Article 3 of Title 19, C.R.S. 
“Children who are Medicaid Eligible” means a child who, with a covered mental health diagnosis, is eligible for services through the Medicaid Mental Health Capitation Program. 
“Community-Based Services” includes, but is not limited to, therapeutic foster care, intensive in-home treatment, intensive case management, and day treatment. 
“Community Mental Health Center” means either a physical facility or a group of services under unified administration or affiliated with one another, and includes at least the following services for the prevention and treatment of mental illness in persons residing in a particular community in or near the community mental health center or group so situated: 
A.  Inpatient services;
B.  Outpatient services;
C.  Partial hospitalization;
D.  Emergency services; and, 
E.  Consultative and educational services.
“Cost of Care” includes mental health treatment not covered by private insurance or Medicaid, and room and board.
“County Department” means the county or district department of human/social services.
“Mental Health Agency” means the community mental health center serving children in a particular geographic area and authorized by the Colorado Department of Human Services pursuant to the Rules and Regulations for the Colorado Public Mental Health System (2 CCR 502-2), or the Behavioral Health Organization, serving children in a particular geographic area who are receiving Medicaid. 
“Resident” means a child receiving residential mental health treatment under the Child Mental Health Treatment Act. 
“Residential Treatment” means services provided by a therapeutic residential child care facility or psychiatric residential treatment facility licensed as a residential child care facility pursuant to Section 26-4-527, C.R.S., which has been approved by the State Department to provide mental health treatment.
“Responsible Persons” means parent(s) or legal guardian(s) of a minor.
“State Department” means the Colorado Department of Human Services.
20.300  CHILD MENTAL HEALTH TREATMENT ACT PROGRAM DESCRIPTION [Eff. 4/1/08]
The Child Mental Health Treatment Act allows parents or guardians to apply to a mental health agency on behalf of their minor child for mental health treatment services whether the child is categorically eligible for Medicaid under the capitated mental health system, or whether the parents or guardians believe his or her child is at risk for out-of-home placement, as defined in Section 20.200. 
A.  The mental health agency is responsible for clinically assessing the child and providing care management and necessary treatment services, including any in-home family mental health treatment, other family preservation services, residential treatment or any post-residential follow-up service that may be appropriate for the child’s or family’s needs. A dependency or neglect action pursuant to Article 3 of Title 19, C.R.S., shall not be required in order to allow a family access to residential mental health treatment services for a child.
B.  The Child Mental Health Treatment Act provides appeal processes for parents or guardians when residential services are denied, and to resolve disputes between mental health agencies and county departments. 
C.  The Act authorizes funding for services for children at risk of out-of-home placement, which are not covered by private insurance, Medicaid, or the family’s share. 
20.400  APPLICATION FOR MENTAL HEALTH TREATMENT FOR CHILDREN [Rev. eff. 4/1/08]
A.  A parent or guardian may apply to a mental health agency on behalf of his or her minor child for mental health treatment.
B.  The mental health agency will evaluate the child and clinically assess the child’s need for mental health services. When warranted, treatment services will be provided as may be necessary and in the best interests of the child and the child’s family. 
C.  Subject to available appropriations, the mental health agency shall be responsible for the provision of care management and necessary treatment services, including any in-home family mental health treatment, other family preservation services, residential treatment, or any pre- or post-residential services that may be appropriate for the child’s or family’s needs. 
D.  A face to face assessment and decision regarding requests for treatment shall be performed by the mental health agency within the following time periods after a request for mental health treatment has been made by a parent or guardian. 
1.  Emergency situations, defined as a condition that appears to require unscheduled, immediate or special mental health intervention in response to a crisis situation involving the risk of imminent harm to the person or others. Emergency situation evaluations shall be completed within six (6) hours of the initial assessment request. 
2.  Urgent situation, defined as a condition that appears to, if not addressed within twenty-four (24) hours, be likely to escalate to an emergency situation. Urgent situation evaluations shall be completed within twenty-four (24) hours of the initial assessment request. 
3.  Routine situations, defined as all other situations, shall be completed within three (3) business days of the initial assessment request. 
4.  If the mental health agency requires additional time to make a decision following an assessment and the parent agrees, then the mental health agency may take up to, but no more than, fourteen (14) calendar days to provide a decision. If the parent does not agree, the notification timelines referenced above remain in effect. 
E.  The mental health agency decision shall be communicated orally and in writing to the parent or guardian within the time allowed for the completion of the evaluation. Oral notice shall be face to face with the parent or guardian when possible. 
The written decision shall contain notice of the applicable criteria for mental health treatment, the factual basis for the decision, the grievance procedures, and a statement for the parent or guardian to sign, indicating that they agree with the decision, or that they disagree and wish to file a grievance.
20.500  PROCESS OF DETERMINING ABILITY TO PAY AND ADJUSTED CHARGE FOR TREATMENT SERVICES PROVIDED TO CHILDREN AT RISK OF OUT-OF-HOME PLACEMENT [Rev. eff. 4/1/08]
A.  The community mental health center shall determine the cost of care for children in this program. Insurance and other benefits shall be applied first to the cost of care. Medicaid is the payor of last resort and will be provided, if the child is eligible, if other insurance coverage is not available. Insurance and other benefits for any resident shall be billed at the full cost of care. A  responsible person(s) who fails to cooperate in making existing insurance and other benefits available for payment will nevertheless be considered as having benefits available for payment.
B.  The responsible person(s)’ ability to pay for residential treatment shall be calculated using the “Colorado Child Support Guideline” and the “Schedule of Basic Child Support Obligations,” as found in Section 14-10-115, C.R.S., and the Department’s Child Support Enforcement rules (9 CCR 2504-1). 
C.  The fee for community-based services shall be based on the income of the “responsible persons” defined in Section 20.200, using the “Uniform Method of Determining Ability to Pay” (2 CCR 501-1). The cost of home and community based services shall not exceed fifty percent (50%) of that which would have been charged to the “responsible persons” for residential treatment. 
D.  The charge to the responsible person(s) shall be the balance of the cost of care after insurance and other benefits have been deducted, or the ability to pay, whichever is less. If the responsible person(s) does not cooperate in making insurance and other benefits available, the  responsible person(s) will be billed for the amount equal to the dollar value of the insurance or benefits in addition to the lesser of the balance of the cost of care or the ability to pay. If the dollar value of insurance and other benefits cannot be determined, the legally responsible person(s) will be billed the full cost of care. 
20.600  DISPUTE RESOLUTION FOR DENIAL OF MENTAL HEALTH TREATMENT [Rev. eff. 4/1/08]
A.  Except as provided below, the mental health agency shall use the formalized grievance process that the agency has established pursuant to the requirements of the Mental Health Services Clients Rights and Advocacy Rules, Sections RA.1 and RA.2 (2 CCR 502-2) if the child is at risk of out-of-home placement as defined in Section 20.200 or the Capitated Medicaid Mental Health Care “Recipient Appeals” process found at Section 8.057 of the Colorado Department of Health Care Policy and Financing’s Medical Assistance Manual (10 CCR 2505-10) if the child has Medicaid. 
B.  If the parent or guardian requests a grievance of a denial of treatment or a recommendation that a child be discharged from services, either in writing or orally, the mental health agency shall have two (2) working days within which to complete the internal grievance review process and communicate a decision to the parent in writing and orally, in person when possible. Said notice shall contain the information required in Section 20.400, E, along with the process for clinical review in Section 20.600, C-E, below.  If the mental health agency requires more than two (2) working days to complete its internal review and the parent is in agreement, then the mental health agency may take up to but no more than five (5) working days to complete the review. If the parent is not agreeable, the two (2) working day timeline discussed above remains in effect.
C.  Within five (5) working days after the mental health agency’s final denial of requested residential services or recommendation that the child be discharged from treatment, a parent or guardian may request a clinical review of the need for residential services by an objective third party, at the State Department, who is a professional person as that term is defined in Section 27‑10-102(11), C.R.S., to review the action of the mental health agency. Such a request may be oral or in writing, but if oral must be confirmed in writing, and shall be made to the Director of Behavioral Health Services, Colorado Department of Human Services. 
D.  Unless waived by the parent or guardian, said clinical review shall include: 
1.  A review of the mental health agency denial of residential services; 
2.  A face to face evaluation of the child, so long as the parent or guardian arranges transportation of the child for the evaluation; and, 
3.  A review of the evidence provided by the parent or guardian. The parent or guardian shall be advised of the name and credentials of the reviewing professional, as well as any mental health agency affiliations of the reviewing professional. The parent or guardian shall have an opportunity to request an alternate reviewing professional at the state department at that time, so long as any delay caused by the request is waived by the parent or guardian as described below.
E.  Within three (3) working days of the receipt of the request for clinical review a decision shall be communicated orally and in writing by the professional person to the parent or guardian, Behavioral Health Services, and the mental health agency. The written decision shall include the relevant criteria and factual basis. If the clinical review finds residential treatment to be necessary, the mental health agency shall provide residential treatment to the child within 24 hours of said decision. If the residential treatment is not available within 24 hours and placement in residential treatment is recommended, the state level review must recommend appropriate alternatives including emergency hospitalization, if appropriate, if the child is in need of immediate placement out of the home. The decision shall contain a notice that a Medicaid recipient may appeal further pursuant to Section 8.057 of the Colorado Department of Health Care Policy and Financing’s Medical Assistance Manual (10 CCR 2505-10).
F.  If the professional person requires more than three (3) working days to complete the face to face evaluation, or if the parent or guardian requires more time to obtain evidence for the clinical review, the parent or guardian may waive the three day deadline above, so long as said waiver is confirmed in writing.  In any event, the face to face evaluation and the clinical review shall be completed within six (6) working days.
G.  The State Department review shall constitute final agency action for non-Medicaid eligible children. 
20.700  DISPUTE RESOLUTION FOR COUNTY DEPARTMENTS AND MENTAL HEALTH AGENCIES [Rev. eff. 4/1/08]

A.  If a dispute exists between a mental health agency and county department regarding whether mental health services should be provided under the Child Mental Health Treatment Act or by the county department, one or both may request the Director of the Division of Field Administration, Colorado Department of Human Services, to provide dispute resolution. 
B.  The request to invoke the dispute resolution process shall be in writing and submitted within five (5) calendar days of either agency recognizing that a dispute exits. 
C.  The written request for dispute resolution shall include, at a minimum, the following information: 
1.  The county department and mental health agency involved in the dispute, including a contact person at each;
2.  The child’s name, age, and address; 
3.  The parent or guardian address, phone number, and e-mail address;
4.  Pertinent information regarding the child including, but not limited to, medical or mental health status/assessment; 
5.  The reason for the dispute, any efforts to resolve the matter locally, and any pertinent information regarding the child; 
6.  Information about the child’s mental health status pertaining to the dispute; and, 
7.  The parent or guardian’s perspective on the matter, if known. 
D.  Within ten (10) calendar days of receiving the dispute resolution request, the Division of Field Administration shall convene a committee in order for each side to present their position. 
E.  The committee shall consist of, at a minimum, members who represent a third party mental health agency and county department of human/social services, the Division of Mental Health, the Division of Child Welfare, and the Department of Health Care Policy and Financing. 
F.  The Division of Field Administration shall provide notice to both agencies that the State Department will resolve the dispute. 
G.  Each side will have an opportunity to present its position to the committee.  Interested parties will be allowed to present written or oral testimony at the discretion of the committee. 
H.  After both agencies present their positions, and other parties present as appropriate, the committee will have five (5) working days to issue its determination in writing to the disputing agencies.  The committee’s decision shall constitute final agency action, which binds the agency determined responsible for the provision of necessary services. 
20.800  RESPONSIBILITIES OF COMMUNITY MENTAL HEALTH CENTERS [Eff. 4/1/08]
Subject to the availability of state appropriations, the community mental health center shall provide Child Mental Health Treatment Act services to youth who are eligible as defined in Sections 20.100 and 20.200. 
A.  Child Mental Health Treatment Act services include, but are not limited to: 
1.  Mental health assessments; 
2.  Community based services;
3.  Care management services; 
4.  Residential treatment services; and, 
5.  Non-residential mental health transition services for youth. 
B.  The community mental health center shall provide to the State Department necessary Child Mental Health Treatment Act eligibility, service, and financial information in an agreed upon format. 
C.  The community mental health center shall provide or coordinate treatment services in collaboration with youth and families, and community based and residential care providers. 
D.  If a child has been determined eligible under the Child Mental Health Treatment Act and necessary services are not immediately available, the community mental health center shall submit an alternative plan of care and provide interim services as appropriate. 
E.  The community mental health center shall maintain a comprehensive clinical record for each child receiving services through Child Mental Health Treatment Act funding and make such records available for review by the State Department. The service plan in the clinical record plan shall reflect any services provided directly by the center (e.g., case management). The goal of those case management services may be, at least in part, to oversee the delivery of services by third party providers to assure that adequate progress is achieved, and may reference the state plan of care and the providers clinical treatment plan.