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In 2017, the Colorado General Assembly passed Senate Bill (SB) 17-019 to improve access to effective medications for people who transfer in and out of criminal justice and mental health facilities, including institutes, jails and prisons. By having continuous access to the same set of effective medications, including psychotropic medications, individuals are more likely to maintain mental wellness and be successful transitioning between the criminal or juvenile justice system and mental health service providers.
The State is working to strengthen medication consistency across settings through the following efforts:
Program DescriptionIssued December 2018
A medication formulary is a continually updated list of both generic and brand-name prescription medications and related cost information, representing the approved recommendations of pharmacists, physicians, and other experts. Using a medication formulary ensures that all patients can access the medication that works for them.
Switching medications can cause a patient or inmate to escalate or have new symptoms. Maintaining consistency across providers saves costs related to urgent and emergency mental health needs, crisis care, transportation and staff time.
The State medication formulary is comprised of specific psychotropic medications that, if used appropriately, can increase medication continuity for individuals with behavioral health disorders in the criminal and juvenile justice systems. Click on the green button to access the Formulary.
The medication formulary is updated and reviewed annually and lists both generic and brand-name prescription medications and related cost information. It represents the approved recommendations of pharmacists, physicians, and other experts. The medications listed on this formulary comprise the preferred formulary used in community provider settings, including community mental health centers, and is available through the Medicaid benefit for individuals released from criminal justice systems. This specific medication formulary was created for the sole purpose of ensuring medication consistency for persons with mental health disorders in the criminal and juvenile justice systems in Colorado.
The Office of Behavioral Health understands that correctional institutions provide care to people with chronic conditions including serious mental illnesses and need access to a complete range of medications available. The formulary is not intended to restrict medications when a patient’s needs warrant a different pharmaceutical. The formulary is a minimum set of medications that should be available, but does not encompass all medications that may be available to an individual in custody. The formulary is not designed to change the prescriber/patient relationship; rather, it is to promote a statewide approach to ensure individuals have the standardized protocols and medications to support their recovery to ensure a safe and successful return into the community.
This medication formulary should be kept and easily accessible to prescribers at federally qualified health care centers, clinics, community mental health centers, substance use treatment settings, institutions, acute treatment units and crisis stabilization units designated by the Office of Behavioral Health. All facilities designated by the Office of Behavioral Health are statutorily required to use the medication formulary when prescribing medications and are encouraged to leverage the standardized medications listed on the formulary to patients if the patients are already prescribed a medication.
Per Colorado Revised Statutes, §27-70-103 (2), this formulary will be regularly updated.
Facilities can leverage opportunities to reduce costs of purchasing medications on the formulary and are able to participate in Colorado cooperative purchasing opportunities for medications and other pharmacy products and services. All Colorado county facilities, including jails and other local government entities are authorized to participate in cooperative purchasing. Purchases are made by using State Price Agreements.
MMCAP has national account status with all of the major brand name and generic pharmaceutical manufacturers ensuring much lower prices to participating facilities. Overall, by becoming an MMCAP Member, your facility will save money on purchases of required formulary medications.
Buying other products and services as an MMCAP Member will further reduce the costs associated with providing healthcare to inmates. MMCAP members receive access to a full range of other healthcare products and services, such as medical supplies, influenza vaccines, dental supplies, and drug testing products and services.
To participate in the MMCAP, contact Amy Risley (contact information above). She will explain how the jail can become an MMCAP member, how to make purchases using the State Price Agreements and answer any other related questions you may have.
Amy Risley, MBA, CPPB
State Procurement Administrator
State Purchasing & Contracts Office
Colorado Department of Personnel and Administrationamy.firstname.lastname@example.org | 303.866.5663
Technology and health are intersecting as more efforts are being made to create meaningful and improvement-driven strategies around behavioral health care. An integral component of this initiative includes the secure transmission of health information so that providers can better access and use patient information to achieve improved outcomes for this vulnerable population.
Primary care providers, specialists, and behavioral health professionals lack critical information about a person’s diagnosis and relevant treatment history that can lead to delays in a treatment - or even create harmful consequences for the client... People with chronic physical and behavioral health treatment needs often suffer needlessly due to a lack of coordination and access to information from treatment providers.
OBH is piloting solutions to support jail health care provider’s access to relevant health information and coordination of treatment across various treatment settings. Technology and Health Information Exchange (HIE) helps provider’s better coordinate care for individuals by facilitating safe and secure transmission of health information — making information available when and where it's needed for medical care. HIE equips providers with a better understanding of the whole health of an individual so they can provide the safest and most effective treatment recommendations.
At the national level, the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (ONC) is charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The demand for electronic health information exchange among care professionals is growing along with nationwide efforts to improve the quality, safety and efficiency of health care delivery.
The State of Colorado is at the forefront of national efforts and has been able to create innovative and meaningful initiatives that align with the national landscape. More importantly, Colorado is paving the way for our vulnerable populations to be offered the same health benefits as others through the use of technology and health information exchange practices across public and private providers. This momentum continues to demonstrate a need to engage providers and other entities that can benefit from the interoperability enhancements within the health IT system.
The State of Colorado has two HIEs: CORHIO (Colorado Regional Health Information Organization) and QHN (Quality Health Network). These entities house information that can be essential when individuals make the critical transition in or out of criminal justice settings by standardizing how their health information is shared and mitigating the potential for gaps in critical treatment opportunities. The goal of the HIE is to provide the technology to support the flow of health information between providers and other healthcare organizations, which will allow delivery of the right information to the right place at the right time, providing safer, more timely, efficient, patient-centered care.
CORHIO serves Denver and many of the surrounding geographical locations. QHN serves the western slope of Colorado and many of the surrounding geographical locations. You can find more information on the CORHIO website or the QHN website.
Starting in early 2019, CORHIO and QHN will implement a "query-based" exchange pilot so that jails healthcare provider’s caregivers) can access clinical health information data for individuals being booked into jails. In general this information would include information on recent hospital or emergency room admissions and recent providers that are connected to the HIE. The outcome of the pilot will inform future efforts to broadly roll out access to query the HIE’s for all remaining jails in the state.
CORHIO & QHN improve the quality of healthcare by:
Both QHN and CORHIO are valuable partners in the Medication Consistency Pilot. By leveraging resources between the two HIE’s, OBH will support delivery of interoperability features across the criminal justice system to allow for more secure data sharing, improved care transitions and ultimately better health outcomes for this vulnerable population.
Jails interested in having access to query the information in the HIEs should contact Danielle Culp with the Office of Behavioral Health at email@example.com or at 303.866.7110.
HIE participation must comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, a federal privacy law that sets a baseline of protection for protected health information (PHI).
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The Office of the National Coordinator for Health Information Technology (ONC) offers the following guidance for ensuring HIE compliance. Visit the ONC website for more information. Or contact CORHIO or QHN for assistance.
Health care providers and other covered entities that create, maintain or transmit PHI must follow the HIPAA regulations. HIPAA generally permits disclosure of PHI without consent for treatment, payment and health care operations.
While it is not required, health care providers may decide to offer patients a choice as to whether their health information may be exchanged electronically, either directly or through a Health Information Exchange Organization (HIE). That is, they may offer an “opt-in” or “opt-out” policy or a combination.
The U.S. Department of Health and Human Services (HHS) does not set out specific steps or requirements for obtaining a patient’s choice whether to participate in an HIE. However, adequately informing patients of these new models for exchange and giving them the choice whether to participate is one means of ensuring that patients trust these systems. Providers are therefore encouraged to enable patients to make a “meaningful” consent choice rather than an uninformed one.
You can read more about patient choice and HIE in guidance released by the Office for Civil Rights (OCR): the HIPAA Privacy Rule and Electronic Health Information Exchange in a Networked Environment.
Yes. There are additional federal and state privacy laws that govern the disclosure of PHI. Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2 requires health care providers to obtain patients’ written consent before they disclose their health information to other people and organizations, even for treatment and payment purposes. Many of these privacy laws protect information that is related to health conditions considered “sensitive” by most people.
The HIEs review the data in their network and the processes to ensure high quality standards are being met. CORHIO has a Security Team, which consists of a Compliance Officer, a Privacy Officer and a Security Officer. They work together to review both privacy and security policies, train employees, review new security technologies, enforce the CORHIO security program and act as first responders to breaches and/or suspected breach notifications.
If you have any questions about the HIE security procedures or data monitoring, please contact CORHIO representative or the Help Desk at firstname.lastname@example.org. You can also request a copy the CORHIO Security Overview document from CORHIO, which includes more details.
(Click on the presentation image below to view the webinar.)
Q: What is the Medication Consistency Program?
A: The Colorado State Legislature recently passed Senate Bill (SB) 17-019 calling for enhanced medication consistency solutions and health information exchange. Strengthening the medication practices of jail staff is a key priority for Colorado, and the legislation has potential to positively impact the quality of care provided to individuals within Colorado’s jail system.
Q: What is an HIE (Health Information Exchange)?
A: Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care. Colorado has two HIEs (CORHIO- Colorado Regional Health Information Exchange Organization) and QHN (Quality Health Network).
Q: Do we have to be in the CORHIO territory to be selected for the pilot program?
A: No, both QHN (Quality Health Network) and CORHIO will be participating in this program.
Q: Is there a cost associated with participating in the Cooperative Purchasing Agreement?
A: No, there is no cost involved with a membership with MMCAP (Minnesota Multistate Contracting Alliance for Pharmacy).
Q: Do we need to have a medical vendor in our jail to participate in the program?
A: No, there is no requirement that a jail have a contract with a medical vendor for participation in the program.
Q: Is the toolkit going to be available and where?
A: Yes, the Medication Toolkit has been posted to www.colorado.gov/pacific/cdhs/medication-consistency.
Q: How will pilot sites be selected? Are there applications?
A: Once the contract is approved with the State HIEs (CORHIO and QHN), the jails will be selected and contracts will be established. There is no application process.
Q: Are performance measures tied to this work?
A: Yes, there are performance measures included in this project and a report will include the outcomes by June 30, 2019.
Q: Are all medications included in the formulary?
A: No, the formulary and Medication Consistency project focuses on psychotropic medications.
Q: What is the purpose of participating in the Colorado Cooperative Purchasing?
A: Participation is free. Jails will have access to medications at reduced costs, in a more timely fashion, and will have the opportunity to buy in bulk.
Q: Is our jail health information safeguarded by sharing with the HIE?
A: Yes, the HIEs have these safeguards in place and will train appropriate staff on accessibility to data sharing platforms and review existing security technologies. Also, the HIEs follow laws, regulations, and guidance on HIPAA compliant data exchange. HIEs must comply with HIPAA privacy rules according to federal law.
Q: Are there privacy laws that require each inmate’s consent?
A: Yes, there are laws in place that govern the disclosure of PHI (Personal Health Information). Patient consent will be in place prior to any data exchange.
Q: Will this pilot program include data exchange with DOC (Department of Corrections)?
A: The Medication Consistency Pilot program (based on Senate Bill 17-019), does not currently include funding for data exchange with DOC. However, there are other statewide initiatives that are happening concurrently that include DOC.
In 2017, the Colorado General Assembly passed Senate Bill (SB) 17-019 to improve access to effective medications for people who transfer in and out of criminal justice and mental health facilities, including institutes, jails and prisons. By having continuous access to the same set of effective medications, individuals are more likely to maintain mental wellness and be successful transitioning between the criminal or juvenile justice system and mental health service providers.
The legislation, sponsored by Senator Beth Martinez Humenik and Representative Jonathan Singer, was requested by the Legislative Oversight Committee on the Treatment of Persons with Mental Illness in the Criminal and Juvenile Justice System. This toolkit fulfills part of SB 17-019 requirements.
The bill declared the following:
In addition, SB 17-019 requires:
“Medication formulary” means the Required Formulary Psychotropic Medications: 2018, which is hereby incorporated by reference. No later editions or amendments are incorporated. The medication formulary is available at no cost from the Colorado Department of Human Services at https://www.colorado.gov/pacific/cdhs/behavioral-health-laws-rules.
The medication formulary is a list of minimum medications, established pursuant to 27-70-103, C.R.S., that may be used by service providers to increase the likelihood that a broad spectrum of effective medications are available to individuals to treat behavioral health disorders, regardless of the setting or service provider. The medication formulary may not contain a complete list of medications, and providers may prescribe and/or carry any additional medications they deem necessary.
21.120.36 Medication Consistency in Designated Facilities*
A. Designated facilities shall ensure all clinical staff are aware of and have access to the medication formulary.
B. Designated facilities shall ensure their providers have access to the medications on the medication formulary when prescribing medications to treat behavioral health disorders
*jails are NOT considered designated facilities
SB 17-019 requires OBH to develop the medication formulary in collaboration with “departments, agencies and providers” (§ 27-70-103 (1)(a)) In November and December 2017, OBH worked with the Departments of Corrections, Public Safety and the Colorado Jail Association (CJA) to administer two surveys to their members - one for jail administrators and one for health providers in criminal justice systems. (Access the survey HERE.) The survey gathered information to help implement the legislation and to determine the best ways to support local jurisdictions as they work to improve coordination and outcome for people with mental health conditions involved in the criminal justice system.
In an effort to support the implementation of the Medication Consistency Pilot project, we analyzed the results of the surveys to determine our approach. The health services administrator (HSA) survey contained 48 questions. Thirty-three counties responded. Respondents reflected jail sizes statewide (small rural, medium-size and large county jails).
Table 1: Number of Health Services Administrators Responding
*Source: Colorado County Designations, 2016 Colorado Rural Health Center
Survey Findings (read the official summary of the findings HERE)
Mental Health Screening
Danielle Culp, Health Information Technology Exchange Coordinator
Office of Behavioral Health
email@example.com | 303.866.7110