2021 Legislative Wrap-Up
The 2021 session of the Colorado General Assembly ended June 8, following a packed calendar that saw the session draw to a close later than usual because of COVID-19 precautions.
This year was a successful one for funding the continuum of services addressing substance use, particularly compared to last year, when budgetary cuts reduced fiscal measures on several bills and required state departments to cut existing programs.
The Opioid and other Substance Use Disorder Study Committee took a break last summer; therefore, there were no interim committee bills this year. Regardless, lawmakers worked on a number of bills related to addressing the opioid and substance use crisis and proposed funding for services and programs for prevention, harm reduction, treatment, and recovery support.
$112 Million for Behavioral Health in FY21-22 in SB21-137 Behavioral Health Recovery Act of 2021
One major bill the Consortium followed was SB21-137, referred to as the Behavioral Health Recovery Act of 2021. Among this bill’s initial provisions were continuing the medication-assisted treatment program and providing funding for behavioral health programs and services in frontier and rural communities. It also continues funding for efforts of the Colorado Consortium in response to the opioid and substance use crisis.
The number of behavioral health programs funded by SB21-137 was greatly expanded in May when American Rescue Plan Act (ARPA) federal stimulus funds became accessible to state governments. The American Rescue Plan Act is federal legislation that delivers $350 billion nationwide to eligible state, local, territorial, and tribal governments to respond to the COVID-19 emergency. The state was allocated $3.9 billion of these funds for use by the Colorado General Assembly. Local city and county jurisdictions are also receiving separate ARPA funds directly.
Sen. Brittany Pettersen, the bill sponsors, and many of you championed inclusion of American Rescue Plan Act (ARPA) federal stimulus dollars in this bill. An agreement was made with the House and Senate leadership and the Governor’s office to allocate funds from ARPA to behavioral health in this bill and through 2024. The high attendance at the Governor’s Office Build Back Stronger listening tours, which many of you participated in, was touted as one factor lending weight to the decision of addressing behavioral health with these funds.
SB21-137 creates the Behavioral Health and Mental Health Cash Fund with an appropriation of $550 million from federal American Rescue Plan Act (ARPA) dollars available through Dec. 31, 2024. Approximately $100 million in appropriations from SB21-137 for fiscal year 2021-22 will be drawn from this cash fund, leaving approximately $450 million for consideration by the Colorado General Assembly in funding “mental health treatment, substance misuse treatment, and other behavioral health services.” While SB21-137 specifies use for approximately $100 million of these funds for fiscal year 2021-22, the remaining $450 million for fiscal years 2022-2024 will be discussed in a behavioral health task force meeting this summer.
See the SB21-137 bill summary for the included items through FY2021-22. Major items funded include $26 million for care coordination and $18 million for workforce development, which are two recommendations from the Governor’s Behavioral Health Task Force. In addition, $10 million will go to managed service organizations for substance use treatment and recovery services, and $9 million will go to a matching grant for local jurisdictions that allocate funds to behavioral health. Information about this matching grant can be found in Section 15 of the bill. Additional major items include the following: crisis services for children and youth, a pilot program for residential placement of youth, jail-based behavioral health services and funding for community mental health services. Please see the bill summary for information on all items funded.
While several suggestions were included in the bill from stakeholder feedback, many more still need to be addressed to respond in a sustained manner to the opioid and other substances crisis. To understand those issues, a new Behavioral Health Task Force will meet this summer.
Legislative Council Behavioral Health Task Force to Convene to Address Remaining Federal Stimulus Behavioral Health Funds through 2024
We will share information about the Behavioral Health Task Force and how to become involved as we receive additional information. Below is a description of the Task Force as described in statute.
- The Executive Committee of the Legislative Council is charged with creating a Behavioral Health Task Force that will meet in the 2021 interim that will “issue a report with recommendations to the General Assembly and the Governor on policies to create transformational change” related to behavioral health and for use of the designated cash funds.
- The Task Force membership may include non-legislative members and may have working groups to assist in the work of the Task Force.
- The Executive Committee is also charged with hiring a facilitator to guide the work of the Task Force.
- The Task Force will only submit recommendations on policies and funding and will not prepare bill drafts.
- In light of the creation of the Behavioral Health Task Force, SB21-137 amended the statue of the Opioid and Other Substance Use Disorder Study Committee. The Opioid and Other Substance Use Disorder Study Committee will not convene this summer. Instead, the Study Committee will meet in the interim of 2022 and 2023. This will allow stakeholders the opportunity to concentrate on providing input related to the work of the 2021 Behavioral Health Task Force.
SB21-137 passed and awaits being sent to the Governor for signature.
Last Year’s Vetoed Prevention Bill Returns in HB21-1276
Another important bill was related to the prevention of substance use disorders (HB21-1276). This bill was a resurrection of last year’s prevention bill (HB20-1085) coming out of the Opioid and Other Substance Use Disorder Committee that was vetoed by Governor Jared Polis. The bill sponsors worked with the Governor’s office on details of the bill to avoid a veto.
HB21-1276: Prevention of Substance Use Disorders
- Requires a health benefit plan to align cost-sharing amounts for non-pharmacological treatment of pain for a minimum of six physical therapy visits, six occupational therapy visits, six chiropractic visits, and six acupuncture visits
- Requires a drug benefits carrier to provide coverage for at least one atypical opioid for treatment of acute or chronic pain at the lowest tier of the carrier’s formulary and not require step therapy or prior authorization
- Establishes a requirement of a carrier to not prohibit or penalize a contracted physical therapist, occupational therapist, chiropractor, or acupuncturist from providing a covered person with information on the person’s financial responsibility for services provided
- Reinstates the seven-day supply limit of an opioid to a patient who has not obtained an opioid within the last twelve months from that prescriber
- Limits the supply of a benzodiazepine to a patient who has not obtained a benzodiazepine prescription in the last twelve months, except the limit does not apply for the treatment of epilepsy or a seizure disorder, alcohol withdrawal, or a neurological condition
- Requires appropriate tapering of benzodiazepines and avoiding abrupt discontinuation or withdrawal of benzodiazepines
- Requires development of competency-based health-care provider training on prescribing opioids, the potential harm of inappropriately limiting prescriptions to chronic pain patients and best practices for prescribing benzodiazepines
- Requires the enabling of integration of the Prescription Drug Monitoring Program with electronic medical records
- Mandates the query of the PDMP before prescribing a benzodiazepine unless prescribed for epilepsy, a seizure disorder, alcohol withdrawal or a neurological condition
- Creates the Colorado Substance Use Disorders Prevention Collaborative with institutions of higher education, nonprofit agencies and state agencies
HB21-1276 passed and awaits being sent to the Governor for signature.
In addition to the Behavioral Health Recovery Act of 2021 (SB21-137) and the prevention bill (HB21-1276), the Consortium followed several other bills pertaining to naloxone prescribing, medication-assisted treatment, the Prescription Drug Monitoring Program, the Naloxone Bulk Purchase Fund, and peer support services.
SB21-011: Pharmacist Dispensing of Naloxone
The bill requires a pharmacist who dispenses an opioid to an individual to inform the individual of the potential dangers of a high dose of opioid and offer to prescribe the individual an opioid antagonist, such as naloxone, at least one time per year, if:
- The individual is, at the same time, prescribed a benzodiazepine, a sedative hypnotic drug, carisoprodol, tramadol, or gabapentin; or
- The opioid prescription being dispensed is at or in excess of 90 morphine milligram equivalent
- This does not apply to a pharmacist dispensing an opioid prescription to a patient who is in hospice or palliative care or a resident in a veteran’s living center
This bill was signed by the Governor into law on June 4, 2021.
SB21-098: Continuation of the Prescription Drug Monitoring Program (PDMP)
- Continues the Colorado Prescription Drug Monitoring Program through 2028
- Allows a deputy coroner acting on behalf of the coroner to access and query the PDMP
This bill passed and was sent to the Governor on June 16, 2021.
SB21-122: Naloxone Bulk Purchase and Standing Orders
The intent of the bill is to align statute related to standing orders for opiate antagonists with eligibility for use of the Opiate Antagonist Bulk Purchase Fund.
- Specifies a unit of local government as an eligible entity for standing orders related to the dispensing of an opiate antagonist by a pharmacist
- Extends immunity for administration of an opiate antagonist to a unit of local government
- Specifies as an eligible entity for the opiate antagonist bulk purchase fund: a harm reduction organization, a law enforcement agency, and a first responder
The bill clarifies language proposed by the Colorado Department of Public Health and Environment based on the experience with administering the Bulk Purchase Fund.
This bill was signed by the Governor into law on April 15, 2021.
HB21-1021 Peer Support Professional Behavioral Health
- Defines in statute peer support professionals
- Defines recovery support services organization
- Defines services offered by peer-run organizations
- Includes recovery community organizations as peer-run organizations
- Authorizes the Department of Health Care Policy and Finance to promulgate rules establishing minimum standards for recovery support service organizations
- Adds peer support professional services provided through recovery support organizations as eligible for Medicaid reimbursement
- Based on available appropriations, requires investment in recovery services by managed service organizations (MSOs), including peer-run recovery support services and specialized services for underserved populations
- Adds recovery services as authorized use of funding for various state programs
This bill passed and was sent to the Governor on June 9, 2021.
HB21-1012 Expand Prescription Drug Monitoring Program
- Allows for tracking of all prescription drugs as determined through rule making and for justified exclusions.
This bill passed and awaits being sent to the Governor for signature.
The Colorado Consortium for Prescription Drug Abuse Prevention wants to thank all of the Consortium partners for your hard work in providing feedback on these bills.
For information about other bills more broadly related to behavioral health, please visit our partner Mental Health Colorado for additional summaries.
We’d also like to thank the bill sponsors:
Chair, Senator Brittany Pettersen (Jefferson): SB137, SB98, HB1012
Senator Rhonda Fields (Arapahoe): SB11
Senator Joann Ginal (Larimer): SB122, HB1275
Senator Dennis Hisey(Clear Creek, El Paso, Fremont, Park, Teller): HB1021
Senator Sonya Jaquez-Lewis (Boulder): SB98
Senator Barbara Kirkmeyer (Broomfield, Larimer, Weld): HB1275
Senator Kevin Priola (Adams): HB1276
Senator Faith Winter (Adams): HB1276, SB137
Senator Rachel Zenzinger (Jefferson): HB1021
Chair, Representative Chris Kennedy (Jefferson): HB1276, SB137
Representative Yadira Caraveo (Adams): HB1021
Representative Don Coram (Archuleta, Dolores, La Plata, Montezuma, Montrose, Ouray, San Juan, San Miguel): HB1012
Representative Meg Froelich (Arapahoe): SB122
Representative Leslie Herod (Denver): HB1276
Representative Susan Lontine (Denver, Jefferson): HB1275
Representative Dafna Michaelson Jenet (Adams): SB137
Representative Kyle Mullica (Adams): SB11, SB98, HB1012
Representative Rod Pelton (Cheyenne, Kit Carson, Logan, Morgan, Phillips, Sedgwick, Yuma): SB11, HB1021
Representative Janice Rich (Mesa): SB98, HB1012
Representative Perry Will (Garfield, Moffat, Rio Blanco): HB1275