Bill Summary

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The bill removes an exception that previously allowed private treatment facilities to operate without approval from the Behavioral Health Administration (BHA) if they accepted only private funds and did not dispense controlled substances.

It establishes universal safety procedures for all licensed health care facilities, hospitals, behavioral health entities, and recovery residences that treat individuals with substance use or co-occurring mental health disorders. These procedures must ensure access to evidence-based treatment and FDA-approved medications, safe discharge and transfer practices, and continuity of care.

The bill imposes a statutory duty on behavioral health entities to prioritize patient safety and provide care consistent with prevailing clinical standards, including the ASAM Criteria. It prohibits liability waivers for breaches of this duty and allows regulatory enforcement for violations.

Behavioral health entities must implement enhanced discharge protocols, including documented safety plans, overdose education, naloxone access, and coordination with authorized supports. If a patient discharges against medical advice, the entity must conduct a safety evaluation and take crisis intervention steps if needed.

The bill requires use of peer recovery specialists during transitions of care and mandates documentation of interactions. It also requires prescribers to consult the prescription drug monitoring program and coordinate with other providers when multiple medications are involved.

Health insurers and Medicaid must provide coverage for treatment consistent with ASAM standards. The Division of Insurance may issue guidance and review compliance with parity laws.

Full Revised Bill Text

SECTION 1. Short title.

The short title of this act is the “Safe Patient-centered, Ethical, and Needs-based Care for Effective Recovery Act,” also known as “Spencer’s Law.”

 

SECTION 2. Legislative declaration.

(1) The general assembly finds that:

(a) The drug overdose crisis continues to devastate Colorado communities, with synthetic opioids such as fentanyl contributing to high overdose fatalities;

(b) Addressing substance use disorders requires rigorous safety standards, improved provider accountability, and the integration of ethical principles to protect the health and safety of patients;

(c) The current treatment system often results in administrative discharges, fragmented care, and increased risk of preventable harm during transitions; and

(d) Hospitals and emergency departments are often the first point of contact for individuals experiencing overdose or acute substance-related crises, and the transitions that follow these encounters present heightened risks that require consistent safety practices. Recovery residences likewise serve as a key component of the treatment and recovery ecosystem, and variability in standards across these settings contributes to gaps in safety and continuity of care.

 

(2) The general assembly further finds that Colorado law currently requires parity in behavioral health coverage pursuant to section 10-16-104 (5.5)(a), Colorado Revised Statutes, and prohibits Medicaid from requiring prior authorization for medications for opioid use disorder pursuant to section 25.5-5-422 (2), Colorado Revised Statutes.

 

(3) Therefore, the general assembly declares that “Spencer’s Law” is intended to:

(a) Build on existing statutory foundations to ensure consistent protections across all insurers and care settings by establishing clear expectations for patient safety, continuity of care, and access to evidence-based treatment;

(b) Establish consistent safety expectations across care settings, including access to evidence-based treatment and medication, safe discharge and transfer practices, and continuity of care, in order to reduce preventable harm;

(c) Establish a legislative framework to promote transparency, accountability, patient-centered care, and recovery-focused practices through enforceable measures and oversight mechanisms; and

(d) Correct failures of the current treatment system by embedding safety and continuity into every stage of care.

 

SECTION 3. In Colorado Revised Statutes, 27-81-106 (6) is amended to read:

27-81-106. Standards for public and private treatment facilities — fees — enforcement procedures — penalties.

(6) A person shall not operate a private or public treatment facility in this state without approval from the behavioral health administration. The exception for private facilities that accept only private money and do not dispense controlled substances is removed. The district court may restrain any violation of, review any denial, restriction, or revocation of approval under, and grant other relief required to enforce the provisions of this section.

 

SECTION 4. In Colorado Revised Statutes, add 25-3-107 as follows:

25-3-107. Substance use disorder safety procedures across care settings.

(1) All licensed health care facilities, behavioral health entities, hospitals, free-standing emergency departments, and recovery residences that provide services to individuals with a substance use disorder or co-occurring mental health disorder shall maintain procedures to support patient safety, continuity of care, and access to evidence-based treatment.

(2) For purposes of this section, “evidence-based treatment” means care that is consistent with nationally recognized clinical guidelines, including the most recent edition of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, and relevant guidance issued by the Substance Abuse and Mental Health Services Administration.

(3) Procedures adopted pursuant to this section must include, at a minimum:

(a) Reasonable efforts to ensure access to medications approved by the federal Food and Drug Administration for the treatment of substance use disorders, alcohol use disorder, and co-occurring mental health conditions, when clinically indicated and within the facility’s scope of services;

(b) Discharge and transfer practices that anticipate and mitigate overdose risk, support continuity of care, and facilitate transition to an appropriate external provider when services are not available within the facility’s scope of services; and

(c) When clinically appropriate and with the patient’s consent, coordination of discharge and transition planning with the patient’s identified family members or other authorized supports.

(4) Nothing in this section requires a facility to provide services outside its scope of licensure or certification, or to establish new programs, staffing models, or clinical capabilities beyond those otherwise required by state or federal law.

 

SECTION 5. In Colorado Revised Statutes, 27-50-502, add (1.5) as follows:

27-50-502. Behavioral health entities — minimum standards — rules.

(1.5)(a) In addition to complying with the minimum standards developed pursuant to subsection (1) of this section, each behavioral health entity licensed or approved by the behavioral health administration that treats individuals with a substance use disorder or co-occurring mental health disorder is subject to a statutory duty to prioritize patient safety and provide care consistent with prevailing standards of care and guidelines from the most recent edition of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions.

(b)(I) The statutory duty extends to treatment in clinical settings, and to discharges and transitions of care in both clinical and non-clinical settings. It requires anticipating foreseeable risks, including overdose, and taking reasonable steps to mitigate those risks. The duty includes:

(A) Best efforts to support safe access to medications approved by the federal Food and Drug Administration for substance use disorder and mental health treatment, maintaining appropriate credentials for the care and treatment of patients with co-occurring mental health disorders, coordinating with authorized supports for shared decision-making and continuity of care, and assessing and mitigating overdose and fatality risks;

(B) Making reasonable efforts to discharge each patient with a documented safety plan, continuity of care, and transition support;

(C) Balancing patient safety with compliance with the federal “Health Insurance Portability and Accountability Act of 1996”, 42 U.S.C. sec. 1320d to 1320d-9, and, for programs subject to federal confidentiality requirements, 42 CFR part 2, and coordinating with authorized supports when a risk of overdose is present; and

(D) Truthful reporting of the scope and limitations of available services, including staffing credentials, in plain language accessible to patients and family members.

(II) A behavioral health entity shall inform staff of the statutory duty described in this subsection (1.5)(b) and may integrate this training into existing training required by the behavioral health administration.

(c)(I) A behavioral health entity shall not require a person to sign a waiver that exempts the entity from liability if the entity breaches its statutory duty described in subsection (1.5)(b) of this section.

(d)(I) A breach of statutory duty under this subsection constitutes a distinct basis for regulatory enforcement.

(II) A health-care provider who acts in good faith, within the scope of the provider’s license and consistent with prevailing standards of care, is not liable pursuant to subsection (1.5)(d)(I) of this section unless the breach was gross or willful, was with reckless disregard for patient safety, or exploits vulnerable individuals.

(e)(I) Each behavioral health entity shall build upon existing discharge requirements to enhance patient safety and mitigate overdose risk.

(II) A patient must not be discharged from an inpatient, residential, partial hospitalization, or intensive outpatient setting without a documented safety plan.

(III) The documented safety plan must include:
(A) Access to FDA-approved medication, if clinically indicated;
(B) A direct connection to ongoing treatment or telehealth services;
(C) Connection to ongoing peer support;
(D) Coordination with personal supports authorized by the patient;
(E) Connection to harm reduction services;
(F) Naloxone; and
(G) Overdose education.

(IV) The behavioral health entity shall document reasonable efforts to notify an authorized emergency contact or care team member, in accordance with section 27-50-110 and applicable privacy laws, when a patient is assessed to be at imminent risk of overdose death or serious harm.

(g) If a patient discharges against medical advice, the treatment provider shall make reasonable efforts to conduct a safety evaluation, provide naloxone and overdose education, immediately connect the patient to alternative treatment options, notify authorized supports, and take crisis intervention steps if the patient is at imminent risk for overdose.

(h) A behavioral health entity shall utilize a process for transitions of care that pairs patients with trained peer recovery specialists, staff members, or designated recovery supports to provide continuous engagement and at least one point of accountability during the transition of care process. The process must include:
(I) Intervention protocols if the patient exhibits signs of return to substance misuse or disengagement from care;
(II) Training related to harm reduction, crisis intervention, and overdose response; and
(III) Documentation of interactions to ensure compliance and prevent neglect.

(i)(I) A behavioral health entity shall ensure that prescribers consult the prescription drug monitoring program created in part 4 of article 280 of title 12 before initiating or continuing treatment that involves controlled substances.

(II) A behavioral health entity shall document coordination with other prescribers when multiple medications are involved in the patient’s care and treatment.

(III) The behavioral health administration shall develop standardized consent protocols to facilitate care coordination while complying with federal confidentiality requirements pursuant to HIPAA and 42 CFR part 2.

(IV) A behavioral health entity shall implement this subsection (1.5)(i) within existing resources and infrastructure, unless funding is otherwise appropriated.

(j) Pursuant to sections 10-16-104 (5.5)(a) and 25.5-5-422, a health benefit plan, commercial insurance, and the department of health care policy and financing shall provide coverage for substance use disorder and mental health treatment in accordance with ASAM standards and guidelines of care from the most recent edition of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions.

(k) The division may issue guidance within existing authority to ensure compliance. The division of insurance may review insurer compliance with state and federal parity laws as they relate to coverage of substance use disorder and mental health treatment, access to medications, and discharge services for continuity of care. The division may issue guidance within existing authority to support compliance.

 

SECTION 6. Safety clause.

The general assembly finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, or safety.