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our proposed "Roadmap" for CO Medicaid's Volume 8

When things Start to go "South" for the patient -- & Providers & Others are not aware of "real" Alternatives that are out there -- Including "Reasonable accommodations" &/or Outpatient certification

                     One of our BIG pet peeves is that providers, law enforcement and media are sometimes NOT clear on Colorado's Mental Health Certification Law* -- and their answer to our Mental Health Crisis for a long time was to amend the Civil Commitment Statutes.
                     That really changed in a BIG way with this Legislative Session -- really trying to get @ the Systemic Problems.
                     We created a breakdown of 72-Hour Holds & Court-Ordered Mental Health Evaluations:  THEY ARE 2 DIFFERENT THINGS.   We were providing that @ $10 -- it is now on sale:  FREE. 
                
                      SO why are we doing this?  We  want to get everybody certified, right?  WRONG.  We want providers & their attorneys to understand  that in most cases they are making the WRONG CHOICE when they call the cops when they have every ability to make REASONABLE ACCOMMODATIONS &/or seek Mental Health Certification.

                       So what is the "ROADMAP" that we would like to see in Volume 8, and really is already in the LAW but is NOT as clear as it needs to be:
  • Low  Level Behavioral/Status Issues that are not dangerous.
    • ​Reasonable Accomodations: 
      • Could include calling in an EXPERT for advice 
      • Additional Staffing
      • Etc.
    • ​​Proposing a Higher or Different Level of Care in the Community
      • ​Intensive Case Management
      • Assertive Community Treatment
      • CO Medicaid Mental Health Residential Services -- provider is certified as an Assisted Living Residence
                               [These levels of care should consider Reasonable     
                               Accommodations when necessary & appropriate as well.]
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  • Medium to High Behavioral/Status Issues:  dangerousness - gravely disabled​​
    • ​Put on a 72-Hour Hold [imminent danger to self or others  or gravely disabled] or Seek Court-Ordered Evaluation [danger to self or others or gravely disabled]  IF necessary, meaning the person will not voluntarily accept treatment, which can include treatment in the community --
    • MANY people @ this Stage will ACCEPT help -- in fact may be BEGGING FOR IT -- BUT because of their significant mental disabilities they will need SIGNIFICANT, SIGNIFICANT ASSISTANCE -- don't expect individuals @ this level of Behavioral Need/Status or DISABILITY to COORDINATE ANYTHING.
    • Reasonable Accommodations are legally required here as well.
    • Proposal for a voluntary acceptance of a higher level of care.
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  • High Behavioral/Status Issues:  including imminent danger, danger & gravely disabled
    • ​If someone is in imminent danger -- SAFETY FIRST.
    • Providers --if you've got time to file a petition for restraining order you've got time for a 72-Hold or a Petition for a Court-Ordered Evaluation.
    • Reasonable Accommodations are legally required here as well -- obviously what is "reasonable" may be different in exigent circumstances.
    • Proposal for voluntary acceptance of a  higher level of care.
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  • Finally, we need an INCLUSIVE after the fact "Root Cause" analysis of every situation in which a Medicaid provider:
    • ​filed a restraining order
    • filed criminal charges, 
    • called the police, or
    • a Medicaid recipient ended up homeless or incarcerated.
                   [Our contention is that not only are most of these situations preventable, BUT many of the tools we need to do that -- WE ALREADY HAVE -- but we are NOT utilizing them to the extent necessary and in some cases as legally required.]   

NOTE:
* State Mental Health Certification laws are independent of Medicaid -- but many people who may be subject to them are on Medicaid.  So State Medicaid agencies really need a clear policy on certification because their members are more likely to be subject to such proceedings. 

Further, the need for such proceedings or resort to even less desirable alternatives often implicate the need to make reasonable accommodations in policy, practice and procedure for people with mental illness.          
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As one therapist with Denver's St. Francis Center said,



​"You need a caseworker, to get a caseworker."
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​Orchid:

& sometimes it takes an Attorney to get an Intensive Case Manager