SB-0686, As Passed House, December 9, 2004                                  












                           HOUSE SUBSTITUTE FOR                                 


                           SENATE BILL NO. 686                                  










                                                                                 A bill to amend 1974 PA 258, entitled                                             


    "Mental health code,"                                                       


    by amending sections 100a, 100b, and 161 (MCL 330.1100a,                    


    330.1100b, and 330.1161), sections 100a and 161 as amended by               


    1998 PA 497 and section 100b as added by 1995 PA 290, and by                


    adding section 116a.                                                        


                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      


1       Sec. 100a.  (1) "Abilities" means the qualities, skills, and                


2   competencies of an individual that reflect the individual's                 


3   talents and acquired proficiencies.                                         


4       (2) "Abuse" means nonaccidental physical or emotional harm to               


5   a recipient, or sexual contact with or sexual penetration of a              


6   recipient as those terms are defined in section 520a of the                 


7   Michigan penal code, 1931 PA 328, MCL 750.520a, that is committed           


8   by an employee or volunteer of the department, a community mental           



1   health services program, or a licensed hospital or by an employee           


2   or volunteer of a service provider under contract with the                  


3   department, community mental health services program, or licensed           


4   hospital.                                                                   


5       (3) "Adaptive skills" means skills in 1 or more of the                      


6   following areas:                                                            


7       (a) Communication.                                                          


8       (b) Self-care.                                                              


9       (c) Home living.                                                            


10      (d) Social skills.                                                          


11      (e) Community use.                                                          


12      (f) Self-direction.                                                         


13      (g) Health and safety.                                                      


14      (h) Functional academics.                                                   


15      (i) Leisure.                                                                


16      (j) Work.                                                                   


17      (4) "Adult foster care facility" means an adult foster care                 


18  facility licensed under the adult foster care facility licensing            


19  act, 1979 PA 218, MCL 400.701 to 400.737.                                   


20      (5) "Applicant" means an individual or his or her legal                     


21  representative who makes a request for mental health services.              


22      (6) "Assisted outpatient treatment" or "AOT" means the                      


23  categories of outpatient services ordered by the court under                


24  section 433 or 469a.  Assisted outpatient treatment includes case           


25  management services to provide care coordination.  Assisted                 


26  outpatient treatment may also include 1 or more of the following            


27  categories of services:  medication; periodic blood tests or                

     Senate Bill No. 686 (H-1) as amended December 9, 2004


1   urinalysis to determine compliance with prescribed medications;             


2   individual or group therapy; day or partial day programming                 


3   activities; vocational, educational, or self-help training or               


4   activities; assertive community treatment team services; alcohol            


5   or substance abuse treatment and counseling and periodic tests              


6   for the presence of alcohol or illegal drugs for an individual              


7   with a history of alcohol or substance abuse; supervision of                


8   living arrangements; and any other services within a local or               


9   unified services plan developed under this act that are                     


10  prescribed to treat the individual's mental illness and to assist           


11  the individual in living and functioning in the community or to             


12  attempt to prevent a relapse or deterioration that may reasonably           


13  be predicted to result in suicide, the need for hospitalization,            


14  or serious violent behavior[.                                               








18                                                       ].  The               


19  medical review and direction included in an assisted outpatient             


20  treatment plan shall be provided under the supervision of a                 


21  psychiatrist.                                                               


22      (7)  (6)  "Board" means the governing body of a community                   


23  mental health services program.                                             


24      (8)  (7)  "Board of commissioners" means a county board of                  


25  commissioners.                                                              


26      (9)  (8)  "Center" means a facility operated by the                         


27  department to admit individuals with developmental disabilities             


1   and provide habilitation and treatment services.                            


2       (10)  (9)  "Certification" means formal approval of a program               


3   by the department in accordance with standards developed or                 


4   approved by the department.                                                 


5       (11)  (10)  "Child abuse" and "child neglect" mean those                    


6   terms as defined in section 2 of the child protection law, 1975             


7   PA 238, MCL 722.622.                                                        


8       (12)  (11)  "Child and adolescent psychiatrist" means 1 or                  


9   more of the following:                                                      


10      (a) A physician who has completed a residency program in                    


11  child and adolescent psychiatry approved by the accreditation               


12  council for graduate medical education or the American                      


13  osteopathic association, or who has completed 12 months of child            


14  and adolescent psychiatric rotation and is enrolled in an                   


15  approved residency program as described in this subsection.                 


16      (b) A psychiatrist employed by or under contract as a child                 


17  and adolescent psychiatrist with the department or a community              


18  mental health services program on March 28, 1996, who has                   


19  education and clinical experience in the evaluation and treatment           


20  of children or adolescents with serious emotional disturbance.              


21      (c) A psychiatrist who has education and clinical experience                


22  in the evaluation and treatment of children or adolescents with             


23  serious emotional disturbance who is approved by the director.              


24      (13)  (12)  "Children's diagnostic and treatment service"                   


25  means a program operated by or under contract with a community              


26  mental health services program, that provides examination,                  


27  evaluation, and referrals for minors, including emergency                   


1   referrals, that provides or facilitates treatment for minors, and           


2   that has been certified by the department.                                  


3       (14)  (13)  "Community mental health authority" means a                     


4   separate legal public governmental entity created under                     


5   section 205 to operate as a community mental health services                


6   program.                                                                    


7       (15)  (14)  "Community mental health organization" means a                  


8   community mental health services program that is organized under            


9   the urban cooperation act of 1967, 1967 (Ex Sess) PA 7,                     


10  MCL 124.501 to 124.512.                                                     


11      (16)  (15)  "Community mental health services program" means                


12  a program operated under chapter 2 as a county community mental             


13  health agency, a community mental health authority, or a                    


14  community mental health organization.                                       


15      (17)  (16)  "Consent" means a written agreement executed by a               


16  recipient, a minor recipient's parent, or a recipient's legal               


17  representative with authority to execute a consent, or a verbal             


18  agreement of a recipient that is witnessed and documented by an             


19  individual other than the individual providing treatment.                   


20      (18)  (17)  "County community mental health agency" means an                


21  official county or multicounty agency created under section 210             


22  that operates as a community mental health services program and             


23  that has not elected to become a community mental health                    


24  authority under section 205 or a community mental health                    


25  organization under the urban cooperation act of 1967, 1967                  


26  (Ex Sess) PA 7, MCL 124.501 to 124.512.                                     


27      (19)  (18)  "Dependent living setting" means all of the                     


1   following:                                                                  


2       (a) An adult foster care facility.                                          


3       (b) A nursing home licensed under article 17 of the public                  


4   health code, 1978 PA 368, MCL 333.20101 to 333.22260.                       


5       (c) A home for the aged licensed under article 17 of the                    


6   public health code, 1978 PA 368, MCL 333.20101 to 333.22260.                


7       (20)  (19)  "Department" means the department of community                  


8   health.                                                                     


9       (21)  (20)  "Developmental disability" means either of the                  


10  following:                                                                  


11      (a) If applied to an individual older than 5 years of age, a                


12  severe, chronic condition that meets all of the following                   


13  requirements:                                                               


14                                                                               (i) Is attributable to a mental or physical impairment or a                         


15  combination of mental and physical impairments.                             


16      (ii) Is manifested before the individual is 22 years old.                    


17      (iii) Is likely to continue indefinitely.                                    


18      (iv) Results in substantial functional limitations in 3 or                   


19  more of the following areas of major life activity:                         


20      (A) Self-care.                                                              


21      (B) Receptive and expressive language.                                      


22      (C) Learning.                                                               


23      (D) Mobility.                                                               


24      (E) Self-direction.                                                         


25      (F) Capacity for independent living.                                        


26      (G) Economic self-sufficiency.                                              


27      (v) Reflects the individual's need for a combination and                    


1   sequence of special, interdisciplinary, or generic care,                    


2   treatment, or other services that are of lifelong or extended               


3   duration and are individually planned and coordinated.                      


4       (b) If applied to a minor from birth to  age  5 years of age,               


5   a substantial developmental delay or a specific congenital or               


6   acquired condition with a high probability of resulting in                  


7   developmental disability as defined in subdivision (a) if                   


8   services are not provided.                                                  


9       (22)  (21)  "Director" means the director of the department                 


10  or his or her designee.                                                     


11      (23)  (22)  "Discharge" means an absolute, unconditional                    


12  release of an individual from a facility by action of the                   


13  facility or a court.                                                        


14      (24)  (23)  "Eligible minor" means an individual less than                  


15  18 years of age who is recommended in the written report of a               


16  multidisciplinary team under rules promulgated by the department            


17  of education to be classified as 1 of the following:                        


18      (a) Severely mentally impaired.                                             


19      (b) Severely multiply impaired.                                             


20      (c) Autistic impaired and receiving special education                       


21  services in a program designed for the autistic impaired under              


22  subsection (1) of R 340.1758 of the Michigan administrative code            


23  or in a program designed for the severely mentally impaired or              


24  severely multiply impaired.                                                 


25      (25)  (24)  "Emergency situation" means a situation in which                


26  an individual is experiencing a serious mental illness or a                 


27  developmental disability, or a  child  minor is experiencing a              


1   serious emotional disturbance, and 1 of the following applies:              


2       (a) The individual can reasonably be expected within the near               


3   future to physically injure himself, herself, or another                    


4   individual, either intentionally or unintentionally.                        


5       (b) The individual is unable to provide himself or herself                  


6   food, clothing, or shelter or to attend to basic physical                   


7   activities such as eating, toileting, bathing, grooming,                    


8   dressing, or ambulating, and this inability may lead in the near            


9   future to harm to the individual or to another individual.                  


10      (c) The individual's judgment is so impaired that he or she                 


11  is unable to understand the need for treatment and, in the                  


12  opinion of the mental health professional, his or her continued             


13  behavior as a result of the mental illness, developmental                   


14  disability, or emotional disturbance can reasonably be expected             


15  in the near future to result in physical harm to the individual             


16  or to another individual.                                                   


17      (26)  (25)  "Executive director" means an individual                        


18  appointed under section 226 to direct a community mental health             


19  services program or his or her designee.                                    


20      Sec. 100b.  (1) "Facility" means a residential facility for                 


21  the care or treatment of individuals with serious mental illness,           


22  serious emotional disturbance, or developmental disability that             


23  is either a state facility or a licensed facility.                          


24      (2) "Family" as used in sections 156 to 161 means an eligible               


25  minor and his or her parent or legal guardian.                              


26      (3) "Family member" means a parent, stepparent, spouse,                     


27  sibling, child, or grandparent of a primary consumer, or an                 


1   individual upon whom a primary consumer is dependent for at least           


2   50% of his or her financial support.                                        


3       (4) "Federal funds" means funds received from the federal                   


4   government under a categorical grant or similar program and does            


5   not include federal funds received under a revenue sharing                  


6   arrangement.                                                                


7       (5) "Functional impairment" means both of the following:                    


8       (a) With regard to serious emotional disturbance, substantial               


9   interference with or limitation of a minor's achievement or                 


10  maintenance of 1 or more developmentally appropriate social,                


11  behavioral, cognitive, communicative, or adaptive skills.                   


12      (b) With regard to serious mental illness, substantial                      


13  interference or limitation of role functioning in 1 or more major           


14  life activities including basic living skills such as eating,               


15  bathing, and dressing; instrumental living skills such as                   


16  maintaining a household, managing money, getting around the                 


17  community, and taking prescribed medication; and functioning in             


18  social, vocational, and educational contexts.                               


19      (6) "Guardian" means a person appointed by the court to                     


20  exercise specific powers over an individual who is a minor,                 


21  legally incapacitated, or developmentally disabled.                         


22      (7) "Hospital" or "psychiatric hospital" means an inpatient                 


23  program operated by the department for the treatment of                     


24  individuals with serious mental illness or serious emotional                


25  disturbance or a psychiatric hospital or psychiatric unit                   


26  licensed under section 137.                                                 


27      (8) "Hospital director" means the chief administrative                      


1   officer of a hospital or his or her designee.                               


2       (9) "Hospitalization" or "hospitalize" means to provide                     


3   treatment for an individual as an inpatient in a hospital.                  


4       (10) "Individual plan of services" or "plan of services"                    


5   means a written individualized plan of services developed with a            


6   recipient as required by section 712.                                       


7       (11) "Licensed facility" means a facility licensed by the                   


8   department under section 137 or an adult foster care facility.              


9       (12) "Licensed psychologist" means a doctoral level                         


10  psychologist licensed under section 18223(1) of the public health           


11  code,  Act No. 368 of the Public Acts of 1978, being section                


12  333.18223 of the Michigan Compiled Laws  1978 PA 368, MCL                   


13  333.18223.                                                                  


14      (13) "Medical director" means a psychiatrist appointed under                


15  section 231 to advise the executive director of a community                 


16  mental health services program.                                             


17      (14) "Mental health professional" means an individual who is                


18  trained and experienced in the area of mental illness or                    


19  developmental disabilities and who is 1 of the following:                   


20      (a) A physician who is licensed to practice medicine or                     


21  osteopathic medicine and surgery in this state under article 15             


22  of the public health code,  Act No. 368 of the Public Acts of               


23  1978, being sections 333.16101 to 333.18838 of the Michigan                 


24  Compiled Laws  1978 PA 368, MCL 333.16101 to 333.18838.                     


25      (b) A psychologist licensed to practice in this state under                 


26  article 15 of the public health code,  Act No. 368 of the Public            


27  Acts of 1978  1978 PA 368, MCL 333.16101 to 333.18838.                      


1       (c) A registered professional nurse licensed to practice in                 


2   this state under article 15 of the public health code,  Act                 


3   No. 368 of the Public Acts of 1978  1978 PA 368, MCL 333.16101 to           


4   333.18838.                                                                  


5       (d)  A certified social worker, a social worker, or a social                


6   worker technician registered in this state under article 16 of              


7   the occupational code, Act No. 299 of the Public Acts of 1980,              


8   being sections 339.1601 to 339.1610 of the Michigan Compiled                


9   Laws.  Until July 1, 2005, a certified social worker registered             


10  under article 15 of the public health code, 1978 PA 368, MCL                


11  333.16101 to 333.18838.  Beginning July 1, 2005, a licensed                 


12  master's social worker licensed under article 15 of the public              


13  health code, 1978 PA 368, MCL 333.16101 to 333.18838.                       


14      (e) A licensed professional counselor licensed to practice in               


15  this state under article 15 of the public health code,  Act No.             


16  368 of the Public Acts of 1978  1978 PA 368, MCL 333.16101 to               


17  333.18838.                                                                  


18      (f) A marriage and family therapist licensed under article 15               


19  of the  occupational code, Act No. 299 of the Public Acts of                


20  1980, being sections 339.1501 to 339.1511 of the Michigan                   


21  Compiled Laws  public health code, 1978 PA 368, MCL 333.16101 to            


22  333.18838.                                                                  


23      (15) "Mental retardation" means a condition manifesting                     


24  before the age of 18 years that is characterized by significantly           


25  subaverage intellectual functioning and related limitations in 2            


26  or more adaptive skills and that is diagnosed based on the                  


27  following assumptions:                                                      


1       (a) Valid assessment considers cultural and linguistic                      


2   diversity, as well as differences in communication and behavioral           


3   factors.                                                                    


4       (b) The existence of limitation in adaptive skills occurs                   


5   within the context of community environments typical of the                 


6   individual's age peers and is indexed to the individual's                   


7   particular needs for support.                                               


8       (c) Specific adaptive skill limitations often coexist with                  


9   strengths in other adaptive skills or other personal                        


10  capabilities.                                                               


11      (d) With appropriate supports over a sustained period, the                  


12  life functioning of the individual with mental retardation will             


13  generally improve.                                                          


14      (16) "Minor" means an individual under the age of 18 years.                 


15      (17) "Multicultural services" means specialized mental health               


16  services for multicultural populations such as African-Americans,           


17  Hispanics, Native Americans, Asian and Pacific Islanders, and               


18  Arab/Chaldean-Americans.                                                    


19      (18) "Neglect" means an act or failure to act committed by an               


20  employee or volunteer of the department, a community mental                 


21  health services program, or a licensed hospital; a service                  


22  provider under contract with the department, community mental               


23  health services program, or licensed hospital; or an employee or            


24  volunteer of a service provider under contract with the                     


25  department, community mental health services program, or licensed           


26  hospital, that denies a recipient the standard of care or                   


27  treatment to which he or she is entitled under this act.                    


1       Sec. 116a.  (1) The department shall make available on the                  


2   department's website an annual report concerning assisted                   


3   outpatient treatment services in this state.  The report shall              


4   include statewide information regarding the number of individuals           


5   receiving and completing assisted outpatient treatment and shall            


6   include the cost and benefit projections that are available                 


7   concerning assisted outpatient treatment in this state.                     


8       (2) The report shall include all of the following information               


9   regarding petitions filed under section 433:                                


10      (a) The number of assisted outpatient treatment petitions                   


11  filed.                                                                      


12      (b) The number of court rulings on petitions filed under                    


13  section 433 that resulted in an assisted outpatient treatment               


14  order.                                                                      


15      (c) The number of court rulings on petitions filed under                    


16  section 433 that did not result in an assisted outpatient                   


17  treatment order.                                                            


18      (3) To the extent possible if resources are available, when                 


19  evaluating the assisted outpatient treatment in this state, the             


20  department shall attempt to utilize expert assistance from                  


21  outside entities, including, but not limited to, state                      


22  universities.                                                               


23      Sec. 161.  In conjunction with community mental health                      


24  services programs, the department shall conduct annually and                


25  forward to the governor and the house and senate appropriations             


26  committees, and the senate and house committees with legislative            


27  oversight of  social  human services and mental health, an                  


1   evaluation of the family support subsidy program that shall                 


2   include, but is not limited to, all of the following:                       


3       (a) The impact of the family support subsidy program upon                   


4   children covered by this act in facilities and residential care             


5   programs including, to the extent possible, sample case reviews             


6   of families who choose not to participate.                                  


7       (b) Case reviews of families who voluntarily terminate                      


8   participation in the family support subsidy program for any                 


9   reason, particularly when the eligible minor is placed out of the           


10  family home, including the involvement of the department and                


11  community mental health services programs in offering suitable              


12  alternatives.                                                               


13      (c) Sample assessments of families receiving family support                 


14  subsidy payments including adequacy of subsidy and need for                 


15  services not available.                                                     


16      (d) The efforts to encourage program participation of                       


17  eligible families.                                                          


18      (e) The geographic distribution of families receiving subsidy               


19  payments and, to the extent possible, eligible minors presumed to           


20  be eligible for family support subsidy payments.                            


21      (f) Programmatic and legislative recommendations to further                 


22  assist families in providing care for eligible minors.                      


23      (g) Problems that arise in identifying eligible minors                      


24  through diagnostic evaluations performed under rules promulgated            


25  by the department of education.                                             


26      (h) The number of beds reduced in state facilities and foster               


27  care facilities serving severely mentally, multiply, and autistic           


1   impaired children when the children return home to their natural            


2   families as a result of the subsidy program.                                


3       (i) Caseload figures by eligibility category as  defined                    


4   described in section  100a(23)  100a(24).                                   


5       Enacting section 1.  This amendatory act does not take                      


6   effect unless all of the following bills of the 92nd Legislature            


7   are enacted into law:                                                       


8       (a) Senate Bill No. 683.                                                    


9       (b) Senate Bill No. 684.                                                    


10      (c) Senate Bill No. 685.                                                    


11      (d) Senate Bill No. 1464.