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The Child Mental Health Treatment Act (CMHTA) (CRS 27-67-101, et seq.) was enacted into Colorado law in 1999 through House Bill 99-1116. The act allows families to access community, residential, and transitional treatment services for their child without requiring a dependency and neglect action, when there is no child abuse or neglect. To be eligible, a child must have a mental illness, be under the age of 18, and be at risk of out-of-home placement or at risk of further involvement with a county department of human/social services. The act applies to both Medicaid-eligible and non-Medicaid-eligible children, although the application and payment processes differ. Local and state-level appeal processes are available if services are denied, and for local interagency disputes.
Transition services provided to children served through the act include case management and post-discharge services provided by a Community Mental Health Center (CMHC) to children admitted to a residential facility, in collaboration with families, community supports and agencies, and the residential facility. Community-based services include, but are not limited to, therapeutic foster care, intensive in-home treatment, intensive case management, and day treatment. Families interested in accessing these services should discuss this with the CMHTA liaison at their local CMHC.
For additional questions or assistance regarding the Child Mental Health Treatment Act, please contact the CMHTA Program Manager, Andrew Gabor, at 303.866.7422 or firstname.lastname@example.org.
Non-Medicaid eligible children apply through the local CMHC. If the CMHC determines that residential treatment is needed, the family must apply for disability benefits through their local Social Security office. The residential treatment costs for non-Medicaid eligible children are covered through private insurance, if available, or a parental fee based on the Colorado child support guidelines; Supplemental Security Income (SSI) benefits; Medicaid; and CMHTA funds when needed. If the CMHC determines that community-based treatment is needed, costs are covered by the act and a parental fee not to exceed 50 percent of the residential fee. Families of non-Medicaid eligible children should contact their local CMHC for more information or to apply for services under the act. The links at the bottom and side of the page also contain information about this program.
Families of Medicaid-eligible children apply for residential treatment through their Behavioral Health Organization (BHO). The BHO is responsible for residential treatment costs for Medicaid-eligible children determined to require this level of care. Families of Medicaid-eligible children should contact their local BHO for more information or to apply for this program. The BHO phone number is located on the back of the child’s Medicaid card.
Visit the Frequently Asked Questions Page and expand the CMHTA FAQs section.
The online versions of these behavioral health regulations are the most current versions available. However, these are not the official versions. For official publication of these and all State of Colorado regulations, please consult the Code of Colorado Regulations (CCR) or contact Lexis-Nexis at 800.227.9597 or the Secretary of State, Information Center at 303.894.2200, x6418.
A child who is not categorically eligible for Medicaid at the time that residential treatment in a Therapeutic Residential Child Care Facility or Psychiatric Residential Treatment Facility is required must become eligible for Supplemental Security Income (SSI) in order to qualify for benefits through the Child Mental Health Treatment Act beyond the first 30 days of residential treatment. The SSI Eligibility is essential because if the child qualifies for SSI, the child will also become eligible for Medicaid. Medicaid eligibility is necessary for the State to contribute to residential treatment costs beyond the first 30 days. In order to gain SSI eligibility, certain criteria must be met. Financial and medical requirements are two main parts of the SSI eligibility determination.
The family should apply for SSI benefits for their child through their local Social Security Administration (SSA) office. The Community Mental Health Center (CMHC) is available to assist the family in the application process.
In order to meet SSI financial eligibility criteria, the child must have limited income and assets. For children who will be in a residential treatment facility and out of the home for longer than a temporary absence, the parents' income is not considered, only the income and assets that the child possesses.
Disability Determination Services, which is part of the Colorado Department of Human Services, is responsible for disability determination based on the SSI criteria outlined by the Social Security Administration (SSA). In order for a child to meet SSI disability eligibility criteria, the mental illness must be determined to be a disabling condition that has lasted, or is expected to last for a year. This determination will rely heavily upon documentation of the disability and the level to which it impacts life functioning. The family will be required to submit comprehensive documentation from the child's providers and as much supporting information as possible, including prior treatment reports, school reports and IEPs, records from hospitalizations and former therapists, etc.
An SSI Checklist in the Child Disability Starter Kit developed by the Social Security Administration can help in the application process.
If SSI eligibility is determined, the child is eligible for benefits beginning with the month following the month of eligibility. This first benefits payment may be retroactive. Medicaid eligibility will begin the first day of the month following the calendar month of placement. Provider reimbursement will be retroactive to the date of Medicaid eligibility. If the child is determined not eligible for SSI, the parent is liable for the cost of care beyond the first 30 days of residential treatment.
An eligible child will lose SSI and Medicaid eligibility upon returning home, unless the parent's financial status has changed and the family income is low enough to qualify for SSI.
CMHTA authorizes the state (through the Office of Behavioral Health) to assist families with the costs of care for children who are not categorically eligible for Medicaid and who are eligible for community, residential or transitional treatment services. Families are also required to participate in the costs of care for their children. The following information outlines the potential costs for families at various stages of the program.
Local Behavioral Health Organizations (BHOs) serve as the point of access for children who are categorically eligible for Medicaid. Families interested in accessing residential treatment for their Medicaid-eligible child should contact their local BHO. The BHO will provide an assessment to determine the need for services including, but not limited to, residential treatment services. If the assessment determines that the child needs residential treatment, the BHO will be financially responsible for the cost of care.
Local Community Mental Health Centers (CMHCs) serve as the point of access for children who are not categorically eligible for Medicaid and are at risk of out-of-home placement as defined in the Act. The CMHC will conduct an evaluation to determine if treatment is necessary. Families may be assessed a fee, based on a sliding scale, for this evaluation. If private insurance is not available to pay the fee, the family may be responsible for this cost. The local CMHC will provide specific information about the cost for this service.
Community-based services include, but are not limited to, therapeutic foster care, intensive in-home treatment, intensive case management, and day treatment. The CMHC will determine the parental fee based on reported income. This fee is not to exceed 50 percent of what the residential fee would be. The remainder of the treatment costs would be covered by CMHTA.
A monthly child support payment will be determined for each child, based on the family's gross monthly income and the "Schedule of Basic Child Support Obligations" in Section 14-1-115, C.R.S. The residential facility determines the support payment based on this schedule, and the family pays the child support payment directly to the residential facility to cover room and board (also called child maintenance) costs. Families who do not cooperate in making income information available may be billed for the full cost of care.
Subject to available appropriations, the state will pay for the first 30 days of room and board (child maintenance) and treatment for eligible children, minus any private insurance available and the monthly child support payment. The residential facility will submit an invoice to the Office of Behavioral Health for reimbursement of these costs. The invoice must identify the amount billed to the family for the monthly child support payment and any amount paid by private insurance. Families who do not make income information or insurance benefits available may be billed for the full cost of care.
A child who is not categorically eligible for Medicaid at the time that placement in a residential facility is required must become SSI eligible in order to qualify for state funding through the act, beyond the first 30 days of residential treatment. The SSI application is essential because if the child qualifies for SSI, the child will also be eligible for Medicaid. SSI and Medicaid eligibility are necessary for the state to contribute to the residential costs beyond the first 30 days.
If SSI eligibility is determined, benefits will be assigned on behalf of the child. Although these benefits will likely be assigned to the family as the representative payee for the child, the monthly benefit payments (minus a $30 needs allowance that should be held for the child's needs) must be given to the residential facility to cover the room and board costs. In addition to providing the residential facility with the monthly SSI benefits, the family must continue to pay the monthly child support payment that was determined.
If SSI eligibility is denied, the family will be financially responsible for all costs (room and board and treatment) beyond the first 30 days of residential treatment.
Once SSI eligibility is determined, Medicaid will pay for the residential treatment costs retroactive to the first day of the second calendar month of care, until the completion of the residential treatment. Subject to available appropriations, the State will continue to participate in the remaining costs of care, if necessary. The State's share of the ongoing costs of care is the portion of the expenses not covered by private insurance, Medicaid, the monthly Child Support Payment, and the SSI award, minus the personal needs allowance. The residential facility will submit monthly invoices to the Office of Behavioral Health for reimbursement of costs not covered by these other sources. The invoice must completely identify the amount paid by Medicaid, private insurance, the SSI award, and the amount billed to the family for the Child Support Payment.
Two types of dispute resolution processes are included in the rules for the CMHTA. One covers disputes between parents/guardians and mental health agencies concerning the denial of residential treatment. The other pertains to disputes between local mental health agencies and county departments of social services about responsibility for providing residential treatment. The following briefly describes each of these processes.
Under this process, parents may file an appeal with the local mental health agency and, if unresolved at that level, with the state. This process includes timelines for providing the assessment based on the child's needs, and for the appeals at the local and state levels.
Key aspects are:
The outcome of the state-level review constitutes final agency action for non-Medicaid eligible children. For Medicaid-eligible children, the parent/guardian or the BHO may appeal the state-level decision.
The following describes the process for resolving, at the state level, disputes between county departments and local mental health agencies under the Child Mental Health Treatment Act. The state dispute resolution process is used only after locally established resolution processes have been exhausted. The state dispute resolution committee will include members who represent a mental health agency, a county department, and the Colorado Department of Human Services.
Within five (5) days of either agency recognizing a dispute exists and the local established processes have been exhausted, one or both of the agencies will request that the dispute resolution process be conducted. The request must be made in writing and directed to:
Office of Behavioral Health
3824 W. Princeton Circle
Denver, CO 80236
CMHTA recognizes the essential need for services within the child’s own community. These services are designed to reduce the risk of out-of-home placement and to reduce the severity of symptoms. Community-based services include, but are not limited to:
Transitional services are available to children served through CMHTA funds and are broadly defined to include supports provided prior to admission to residential treatment, during the child’s stay in care, and following discharge from the facility. It is essential for parents to discuss transitional service needs at the earliest point possible in the placement process. Transition services include, but are not limited to:
Advance planning can ensure that treatment is a successful experience for all, and that positive outcomes are sustained beyond discharge from residential care. Parents are encouraged to ask questions, make suggestions, and fully participate in all aspects of residential treatment, including transition services. The Community Mental Health Center liaison is the main point of contact in this regard.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)