I_OpioidSubstance_2019A 08/13/2019 09:38:19 AM Committee Summary

Senator Pettersen called the meeting to order.  An agenda was distributed to the committee (Attachment A).

Representative Kennedy discussed the stakeholder process and the mailing list for the stakeholders.  He invited members of the public to email him at repchriskennedy@gmail.com if they wish to be included in the stakeholder email list.

Senator Pettersen explained the stakeholder process.

Dr. Robert Valuck, Colorado Consortium for Prescription Drug Abuse Prevention, presented on stakeholder recommendations around treatment and provided a handout  (Attachment B).  He discussed gaps in treatment options under private insurance coverage and Medicaid.  He discussed recommendations to redirect federal grant block funding to include low-income individuals who do not qualify as "indigent."

Dr. Valuck continued his presentation and discussed recommendations to enhance the continuum of care, such as align statutory language addressing the education, prevention, and treatment of alcohol and other substances.  He discussed recommendations to increase access to treatment, including increasing evidence-based withdrawal management, treatment, and recovery capacity.

Dr. Valuck discussed recommendations regarding improving the quality of treatment and medication assisted treatment (MAT). Dr. Valuck responded to questions.

Kim McConnell, Department of Health Care Policy and Financing, provided an update on the application process for the Medicaid wavier for inpatient and residential treatment under Medicaid and distributed a handout (Attachment C).  She discussed the department's collaboration with stakeholders to develop the waiver; the expansion of services under the waiver; and provider capacity. She responded to questions.

Lisa Gawenus, Center for Addiction Medicine at Denver Health, presented on Denver Health's substance use disorder treatment services and the coordination of these services and distributed a handout (Attachment D). She spoke about various MAT services.

Ms. Gawenus discussed the evolution of Narcotic Treatment Program admissions. She responded to questions.

Ms. Gawenus spoke about the success the treatment on demand program has had in retaining patients.

She discussed the mission, vision and values of the Center for Addiction Medicine. She responded to questions.  Ms. Gawenus discussed the center's five year strategic goals.  She discussed the partnerships the center has across the region including training and telehealth consultations with rural providers.  She discussed the disparity between the cost of care provided to opioid-related hospitalizations and the reimbursement received.  She discussed the difference between the reimbursement rates for services provided to a patient with a diagnosis of substance use disorder and the reimbursement rate for services provided to a patient with a mental health diagnosis.

Ms. Gawenus discussed the treatment of comorbid substance use disorders and bolstering non-opioid treatment services provided to persons with other substance use disorders.

Camille Harding, Office of Behavioral Health (OBH), Colorado Department of Human Services (DHS), updated the committee on House Bill 19-1287.  She discussed the bed capacity tracker, the rural grants, and incorporation in the Crisis Hotline Contract. Ms. Harding responded to questions.

Ms. Harding discussed the Population in Need Study required under federal block grant funding.  She discussed the funding related to providing a continuum of treatment services.  Ms. Harding provided information on the federal grants received by OBH.  She explained the Managed Service Organization (MSO) system in OBH to provide treatment.

Frank Cornelia, Colorado Behavioral Healthcare Council, discussed recommendations related to substance use disorders (SUD) treatment. He described a recommendation to align state statutes regarding civil commitments for persons with SUD and mental health disorders. Mr. Cornelia discussed other changes to statutory requirements and language regarding persons with SUD. Mr. Cornelia responded to questions. Ms. Harding responded to questions.

Daniel Darting, Signal Behavioral Health, presented on the partnership between OBH and MSOs to provide a statewide safety net for the treatment of SUD.  He spoke about the expanded treatment that his organization has been able to provide as the result of recent state legislation.  He explained that the MSO system advocates for strategies focused on the entire continuum of care for SUD. Mr. Darting discussed some recommendations for the committee to consider, including expanding funding for more family services, intensive outpatient programs, transitional residential treatment, and employment supports. He also recommended that the involuntary commitment process be improved and suggested providing expanded funding for technology and telehealth.

Brad Sjostrom, Colorado Providers Association (COPA), discussed the priorities of COPA, including coordination across the continuum of care, funding expansion areas, statute modernization, and support for education around medical responsibility for SUD clients. 

Steve Holloway, Colorado Department of Public Health and Environment (CDPHE) presented on the state's efforts to develop additional workforce of treatment providers and distributed a handout (Attachment E).  He explained how CDPHE estimated the demand for care across the state and the treatment reply.  He discussed the areas of the state with a shortage of health professionals and the expansion of the Colorado Health Service Corps Program.

Brad Sjostrom, COPA, commented on CDPHE's efforts to expand the health provider workforce.  Mr. Holloway responded to questions.

Senator Pettersen recessed the meeting.

Senator Pettersen reconvened the meeting.

Commissioner Byron Pelton provided the committee with statistics regarding methamphetamine use in Colorado, and Logan County specifically.  A packet of handouts were distributed to the committee (Attachment F).

Lauren Snyder, Mental Health Colorado, described the history of methamphetamine use in the U.S. and its chemical and physical effects on the body. She discussed the long term effects of methamphetamine use on brain functions. Ms. Snyder provided data on the prevalence of methamphetamine admissions for treatment.

Ms. Snyder discussed barriers to treatment for methamphetamine use, including lack of approved MAT treatments and long-term services, and stigma toward methamphetamine users. She described the need for intensive outpatient treatment programs, utilization of the matrix model, and for treatment programs to address other mental and physical health needs. Ms. Snyder and Commissioner Pelton responded to committee questions.

Ms. Snyder and Dave Long, Logan County Department of Human Services, continued to respond to questions regarding funding for methamphetamine treatment and the use of funds for different SUDs.  

Mr. Long presented on the resurgence of methamphetamine use in Northeast Colorado and the gaps in SUD funding.  He discussed the county's inability to reimburse treatment providers effectively.  Mr. Long described the increases in open child welfare cases in Logan County due to parental SUD issues.  He discussed possible solutions, including aligning Regional Accountable Entities, adjusting the distribution of funds to MSOs, utilizing a Medicaid waiver for inpatient services, and increasing treatment workforce salaries and reimbursement for providers.

Commissioner Pelton discussed allowing community colleges to award four year degrees in counseling.  Ms. Snyder and Mr. Long responded to committee questions.  

Jose Esquibel, Colorado Consortium for Prescription Drug Abuse Prevention, distributed a handout to the committee (Attachment G).  He discussed stakeholder recommendations regarding recovery from SUDs.  The recommendations include payment reform for recovery services and providers, increasing housing availability for persons in recovery, and increasing access to recovery supports.  

Mr. Esquibel described the Consortium recommendations, including data collection to access and monitor recovery and increased funding opportunities for existing and new services.

Jalyn Ingalls, Colorado Health Institute, presented on the State Strategic Plan for Substance Use Recovery and distributed a handout (Attachment H).  Ms. Ingalls described the elements of the strategic plan, including a whole person health approach, recovery in the continuum of care, integrating community voices, and understanding best practices for recovery.

Ms. Ingalls discussed strategic objectives for the plan.  The objectives include creating a recovery-oriented system of care and equipping local communities with recovery services.  

Rourke Weaver, Colorado Consortium for Prescription Drug Abuse Prevention, discussed sustained funding for recovery services and collection of data on recovery services outcomes.  Nancy VanDeMark, Mental Health Colorado, discussed the lack of prevalence and variety of recovery homes in Colorado, connecting treatment and recovery services, and reimbursing peer recovery services.  

Senator Pettersen recessed the meeting.

Senator Pettersen reconvened the meeting.

Ryan Templeton, DHS, presented on recommendations for improving recovery support services and provided a handout (Attachment I).  He discussed the structure and activities of the Behavioral Health Planning and Advisory Council (BHPAC).  He described the membership and experience of BHPAC members.

Julie Corbett, DHS, described tenancy support for persons in recovery and supporting employment through the Individual Placement and Support (IPS) program.  Mr. Templeton described the IPS program and discussed expanding the program to all community mental health centers and other behavioral health providers.  Mr. Templeton responded to committee questions about the IPS program.  Ms. Corbett discussed supporting and encouraging recovery-ready activities and communities.  

Mr. Templeton responded to committee questions on affordable housing.

Megan Marx-Varela, Colorado Coalition for Parity, presented on relapse, which is a return to substance use after recovery, and distributed handouts to the committee (Attachment J).  She discussed negative stigma and perception of relapse.  Ms. Marx-Varela recommended that a comprehensive review of SUD services statewide be conducted.  

Frank Cornelia, Colorado Behavioral Healthcare Council, discussed the gaps in the continuum of care of recovery services. He described the benefits of recovery support services and discussed the successes of the Jefferson Center Mental Health Recovery House.  Mr. Cornelia and Ms. Marx-Varela responded to committee questions.

Nicholas Petrucelli, Stout Street Foundation, discussed his experience working with persons in recovery, and as a peer recovery coach. He described efforts to prevent relapse, and gaps in services to do so. Mr. Petrucelli discussed encouraging and providing a variety of recovery services and experiences. He responded to committee questions.

Mr. Petrucelli further discussed studying recovery best practices in other states, analyzing the impact of stigma, and measuring standards of care. He told the committee about overdose deaths after relapse. Committee members commented.

Senator Pettersen and committee members discussed their interest in the topic areas of treatment and recovery.  The committee discussed the focus of future meeting dates, stakeholder meetings, and outstanding topics for the committee to discuss.  

Yelana Love, Office of Legislative Legal Services, commented on the committee's schedule.

Senator Pettersen commented on future meetings.

Judy Salano, representing herself, testified regarding local public health SUD efforts.  

Thomas Hernandez, Tribe Recovery Homes, testified regarding recovery support services.