CBHC's 2016 Legislative Agenda & Colorado Budget Cycle

1. Doyle Forrestal CEO Coral Cosway Director of Policy & Government Affairs Frank Cornelia, MS, LPC Associate Director of Policy & Government Affairs Gil Romero, Esq Capitol Success Group CBHC’s 2015 Legislative Update

2. 2015 Legislative Session Recap

3. Budget • 1.7% COLA for behavioral health providers • Early Childhood Mental Health Services Program footnote • Additional $1.5M for Health Service Corps loan repayment • Other budget footnotes: • Special Connections program rate increase • Continue to support MHFA • Stop withholding contract dollars

4. Policy • APRN Rx (SB 197) • Psychologist CE (HB 1067) • Telehealth (HB 1029) • Harm reduction/criminal justice reform (SB 053, 116, & 124) • Safe Schools Interim Committee (SB 214) • Felony DUI (HB 1043) • Retail marijuana tax revenue (HB 1367)

5. What Lies Ahead……

6. Proposition BB • What does Prop BB do? • Why is it needed? • Why should I vote YES on Proposition BB? • Where can I get more information? www.voteyesonbb.org

7. CBHC 2016 Legislative Agenda • Maintain state funding for behavioral health, including for: • Medicaid (HCPF) • Indigent care (OBH) • Crisis services (OBH) • Mental Health First Aid (OBH) • Health Service Corps loan repayment (CDPHE) • Jail-based Behavioral Health Services (Marijuana tax revenue) • Marijuana tax revenue dollars for the ATR program • Health care alignment • Workforce

8. Budget Focus • The Big 3 Budget Items: • TABOR • Negative factor • Hospital provider fee

9. The Colorado Budget Cycle

10. What is TABOR? • In 1992, Colorado voters approved a measure which amended the Colorado Constitution that restricts revenues for all levels of government (state, local, and schools).  • Under TABOR “Taxpayer Bill of Rights”, state and local governments cannot raise tax rates without voter approval and cannot spend revenues collected under existing tax rates without voter approval if revenues grow faster than the rate of inflation and population growth. • Revenue in excess of the TABOR limit, commonly referred to as the "TABOR surplus", must be refunded to taxpayers, unless voters approve a revenue change as an offset in a referendum.

11. What is the Negative Factor?

12. Hospital Provider Fee What is it? • Hospitals pay a fee based on their occupied beds and outpatient charges- the money is kept briefly in a state account. There, it attracts matching funds from the federal government. • Most of the money, plus the federal match, goes back to hospitals. Some of it is used to pay for the expanded Medicaid and CHP+ eligibility. The fee also helps people who previously had not qualified for public insurance. How is affects the state budget? • Revenue collected from the fee counts toward the limit established by the Taxpayer’s Bill of Rights (TABOR). • The fee brought in $528.8 million in 2014-15 and is estimated to bring in $805.8 million in 2015-16. (Leg Council September Revenue Forecast) What are Legislators proposing to do? • Last year, Legislators introduced a bill during the last week of session to take the Hospital Provider Fee out of the General Fund and make it what is known as an “enterprise fund” Thus, shifting it out from under the General Fund/TABOR limit would eliminate the need for taxpayer refunds. However, the bill was killed in the last days of the session. • We expect to see similar legislation introduced in the beginning of the 2016 session; however, it is not yet known if Democrats have enough votes to pass it through the Senate.

13. Overall Budget Impact • Due to a change in the way K-12 education is funded (referred to as the “K-12 negative factor”), $3 out of every $4 in the state budget will go toward K-12 education. That leaves only one-quarter of the budget to support every other state priority • We have heard that any program/line item that doesn’t use all of their funding this year cannot expect to have that funding redirected for other purposes within their program/line item next year. Those monies will be directed toward filling the state budget gap instead. • A decrease of just 0.15 percentage points, or $15.0 million, in revenue subject to TABOR would result in SB09-228 transfers doubling. This amount is well within the amount of typical forecast error. This would cause the budget shortfall in FY 2015-16 to potentially increase by a further $100 million from the current level of $34.3 million, requiring larger budget balancing actions. (According to the OSPB Forecast) “As we assess the impact of the TABOR limit, the potential transfers under Senate Bill 09-228, and the expected cost of maintaining the negative factor at its current level, the available new revenue for the General Fund are potentially severely limited.” -OSPB September Revenue Forecast

14. 2016 Potential (state) Legislation • 27-65 Emergency Holds • Hospitals’ role • Expanding providers who can terminate a hold • Network adequacy/transparency • Suicide training for school and mental health professionals • School Safety and Youth in Crisis Committee • Parole Reform

15. Federal Issues: 2016 Hill Day • Issues: • Mental Health First Aid Act • Comprehensive Addiction and Recovery Act • Mental Health Access Improvement Act • Comprehensive mental health and addiction reform • FY16 appropriations

16. CBHC 2016 Legislative Agenda • Maintaining Funding • Healthcare alignment • Workforce (behavioral health licensure process) • Access to Recovery (ATR)

17. What’s on the Horizon? • Tax Revenue from Retail Marijuana • State Budget Picture • Healthcare Alignment • Shifting State Block Grant Priorities • State Innovation Model (SIM) • CCBHCs • 2703 Health Homes • ACC Phase II

18. Questions? Comments? Frank Cornelia Associate Director of Policy & Government Affairs fcornelia@cbhc.org| 303-832-7594 x206