Additional COVID-19 Guidance for Behavioral Health Providers
Behavioral Health Providers:
As we respond to Colorado’s COVID-19 outbreak, the Colorado Department of Human Services, Office of Behavioral Health (OBH) is committed to providing you additional guidance and resources. We recognize that these are difficult times, and our staff is on duty and available to support you.
In this email:
- Continuing Emergency Services
- Reminder on Facility Closures
- Updates on Using Telehealth During a State of Emergency
- Waiver of Face-to-Face Requirements for DUI, Criminal Justice and Children and Youth Mental Health Treatment Act Programs
- Contract Updates, including Emergency Funding Flexibility
- Additional Guidance from Managed Service Organizations and Administrative Services Organizations
- Using State Opioid Grant Dollars for COVID-19 Response
- CAC Clinical Training Program
Previous OBH Guidance
- Provider Guidance - March 12, 2020
- Additional Guidance for Colorado Opioid Treatment Programs - March 15, 2020
- DUI Face-to-Face Waiver - March 19, 2020
Our priority during this time is to continue to serve Coloradans in need. To help providers prioritize services, OBH is sharing the following expectations:
- OBH considers the following to be critical services that should be continued during this time:
- Colorado Crisis Services, including the statewide hotline, walk-in centers, CSUs and mobile crisis services
- Withdrawal management programs
- Residential programs and services provided in facilities (jails, Youth Services etc.)
- Opioid Treatment Programs
- Medication-assisted treatment
- Outpatient services should be maintained if at all possible including use of telehealth
- People need access to emergency behavioral health services and providers should continue to provide services whenever possible. OBH would like to avoid unnecessary emergency room visits and wants to ensure Coloradans have access to behavioral health treatment.
- If you are struggling with staffing due to illness or other COVID-19-related issues, please notify your OBH program staff or let us know via this form prior to closure so we can preemptively develop an appropriate solution that enables law enforcement and other community partners to know where to find alternative resources.
- All providers working with clients face-to-face should implement a screening protocol like this to ensure that providers are safe and should follow CDC guidelines for appropriate distance.
- For programs that serve individuals who are vulnerable or at-risk populations such as Intensive Outpatient Programs and Assertive Community Treatment (ACT), we recommend that providers identify necessary service accommodations to ensure adequate service delivery, including telehealth.
- OBH encourages providers to review your caseload and identify those folks who may need additional support and proactively reach out to them to develop safety and risk plans. Ensure that they know the crisis number, 844.493.TALK, and walk-in center locations (coloradocrisisservices.org).
By OBH rule, all licensed and designated facilities must notify OBH of any closures immediately. Please contact your program manager as soon as possible to help us determine service gaps and potential referrals.
Certified Opioid Treatment programs (OTPs) cannot close without approval from OBH, the Drug Enforcement Agency and Substance Abuse and Mental Health Services Administration (SAMHSA). If you are considering closing, please contact State Opioid Treatment Authority Amy Cooper at firstname.lastname@example.org.
This week, the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency. Read more.
In response to the pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) now allows for the disclosure of health needs to another health provider without written consent under the medical emergency exception under 42 CFR, part 2. Providers should document such disclosures and why they are being made. Read more.
For more guidance on Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency, please see this U.S. Department of Health and Human Services memo.
For most services (excluding exceptions noted in the next session), OBH rule does not limit the use of telemedicine and telehealth options at licensed and designated facilities. Telemedicine and telehealth should be used with clients when appropriate. For best practices in telehealth and telemedicine, please see this HealthIT.gov guide.
Statute does not limit the use of telehealth for the following circumstances:
- Placing individuals on 72-hour mental health hold procedures (M1s)
- Administering involuntary psychiatric medications
- Providing medical services to individuals in jail
Billing for Telehealth: During this period, our providers may document these encounters and submit billing to OBH contracts as they would otherwise for an in-office, in-person service. Please use 02 for place of service to represent that these services were provided or received through a telecommunication system. No special modifiers for telehealth are required in these cases. Although the Uniform Service Coding Manual may not otherwise allow for telehealth, OBH will not enforce that criteria, starting now through the end of May, at which time we will reassess. If providers have issues with submitting data to OBH, which is used for billing support, please have them contact OBH Senior Data Compliance Manager Sharon Pawlak at email@example.com.
The Department of Health Care Policy and Financing is sharing changes to their telemedicine policy here.
The Department of Regulatory Agencies’ Division of Professions and Occupations has Emergency Licensing Measures for Healthcare Professionals here.
By OBH rule, DUI, Criminal Justice and CYMHTA programs must deliver services face-to-face in the same room; however:
- Due to overwhelming demand, OBH has issued a blanket waiver to allow all DUI programs to use telehealth in lieu of face-to-face meetings. DUI programs can begin using telehealth services immediately without submitting a waiver until July 1, 2020.
- Under the state of emergency declared by Governor Polis, criminal justice and CYMHTA programs can deliver services without meeting the in-person, face-to-face requirement if face-to-face puts patients and staff at considerable risk. Please inform your program staff that you are doing so or let us know via this form.
Contract Updates, Including Emergency Funding Flexibility
OBH has received many questions about contracts. Here how we plan to assist you:
- Continue normal service to the extent possible: We understand that safety measures like social distancing may disrupt traditional programming. We encourage you to explore strategies like telehealth to modify services that are core to your contract. See this website for general OBH guidance for COVID-19.
- Fill out the questionnaire on program challenges and disruptions: We recognize that your response to COVID-19 may preclude or delay you from meeting contract deliverables. We are sending this questionnaire to all direct service providers on Thursday, March 19, to gather input from our contractors who need to request accommodations from OBH to sustain critical services. The questionnaire must be filled out by noon on Monday, March 23. Providers will collaborate with respective OBH Program Managers to develop solutions.
- Inform us of any closures: Per OBH rule, you must contact your program manager as soon as possible when closing a facility or suspending any services. This will help us identify service gaps in regions and programs.
- Emergency Funding Flexibility: We understand that to continue to deliver direct services, providers may require supplies and tools that were not anticipated at the time of contract budgeting, such as personal protective equipment, additional cleaning supplies, technology/devices for telehealth, etc. Providers can include these costs within operating supplies and/or clients costs, as appropriate, as funding remains available within the contact. Providers can also take advantage of the flexibility within contracts, as allowed, to reallocate expenses between categories to capture the necessary and reasonable costs incurred to comply with guidelines for care providers from the Centers for Disease Control and the Colorado Department of Public Health and Environment.
OBH staff are available to help you navigate contract issues. As we work with you individually, please see this website to stay up to date on OBH’s guidance.
Signal Behavioral Health, a Managed Service Organization (MSO) and Administrative Services Organization (ASO), released this guide with additional recommendations for providers. OBH is sharing this guidance, as it’s useful for providers in maintaining service delivery.
During this time, OBH has authorized expanded use of State Opioid Grant dollars to support OTPs in the purchase of the following items:
- Personal Protective Equipment for staff (PPE)
- Lockboxes for additional take-home doses
- Hand sanitizer and soap
- Methadone take-out bottles
- Additional items as approved by OBH and MSOs
To access these funds, OTPs, purchasers and MSOs will follow these steps:
- OTPs will keep receipts for any MAT Access during COVID-19, including expenses necessary to provide MAT services (see above for examples).
- Purchasers will submit these receipts as supporting documentation for reimbursement to their MSO, as currently contracted, along with their documents for medications.The best practice is to include a summary sheet of these expenses in front of the receipts.
- MSOs will include this documentation, along with any supporting documentation, falling under the MAT or OMAT budget line. MSOs will include a grand total of all MAT Access related expenses during the COVID-19 crisis on the front page of the invoice in the Notes section.
We encourage OTPs to reach out to Signal Behavioral Health to receive additional NARCAN kits to keep clients and those around them safe. Kits can be requested from Troy Bowman at firstname.lastname@example.org or 303-870-4482.
The OBH Approved Trainer, CAC Clinical Training Program is granting temporary approvals for the delivery of CAC courses (CAC I, CAC II and CAC III) using an online platform.
Please send Mary.McMahon@state.co.us an email for the skills-based courses that are scheduled through the end of May, with the dates of the training. If you are unable to offer the CAC course using an on-line platform, please cancel and reschedule the course until a later date (past the end of May).
Thank you for all the work you are doing to ensure Coloradans receive the services they need.
Robert Werthwein, Director
Department of Human Services, Office of Behavioral Health