September 24, 2009, Introduced by Senators GLEASON, BRATER, JACOBS, CLARK-COLEMAN, CLARKE, SCOTT, CHERRY, ANDERSON, SWITALSKI, BASHAM and THOMAS and referred to the Committee on Health Policy.
A bill to amend 1974 PA 258, entitled
"Mental health code,"
by amending sections 100b, 116, and 206 (MCL 330.1100b, 330.1116,
and 330.1206), section 100b as amended by 2004 PA 499, section 116
as amended by 1998 PA 67, and section 206 as amended by 1995 PA
290, and by adding section 206a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 100b. (1) "Facility" means a residential facility for the
care or treatment of individuals with serious mental illness,
serious emotional disturbance, or developmental disability that is
either a state facility or a licensed facility.
(2) "Family" as used in sections 156 to 161 means an eligible
minor and his or her parent or legal guardian.
(3) "Family member" means a parent, stepparent, spouse,
sibling, child, or grandparent of a primary consumer, or an
individual upon whom a primary consumer is dependent for at least
50% of his or her financial support.
(4) "Federal funds" means funds received from the federal
government under a categorical grant or similar program and does
not include federal funds received under a revenue sharing
arrangement.
(5) "Functional impairment" means both of the following:
(a) With regard to serious emotional disturbance, substantial
interference with or limitation of a minor's achievement or
maintenance of 1 or more developmentally appropriate social,
behavioral, cognitive, communicative, or adaptive skills.
(b) With regard to serious mental illness, substantial
interference or limitation of role functioning in 1 or more major
life activities including basic living skills such as eating,
bathing, and dressing; instrumental living skills such as
maintaining a household, managing money, getting around the
community, and taking prescribed medication; and functioning in
social, vocational, and educational contexts.
(6) "Guardian" means a person appointed by the court to
exercise specific powers over an individual who is a minor, legally
incapacitated, or developmentally disabled.
(7) "Hospital" or "psychiatric hospital" means an inpatient
program operated by the department for the treatment of individuals
with serious mental illness or serious emotional disturbance or a
psychiatric hospital or psychiatric unit licensed under section
137.
(8) "Hospital director" means the chief administrative officer
of a hospital or his or her designee.
(9) "Hospitalization" or "hospitalize" means to provide
treatment for an individual as an inpatient in a hospital.
(10) "Individual plan of services" or "plan of services" means
a written individualized plan of services developed with a
recipient as required by section 712.
(11) "Licensed facility" means a facility licensed by the
department under section 137 or an adult foster care facility.
(12) "Licensed psychologist" means a doctoral level
psychologist licensed under section 18223(1) of the public health
code, 1978 PA 368, MCL 333.18223.
(13) "Medical director" means a psychiatrist appointed under
section 231 to advise the executive director of a community mental
health services program.
(14) "Medical necessity" means that a specific service, as
documented in an individual's plan of services, is clinically
appropriate, necessary to meet needs, consistent with the person's
diagnosis, symptomatology, and functional impairments, the most
cost-effective option in the least restrictive environment, and
consistent with clinical standards of care.
(15) (14)
"Mental health
professional" means an individual who
is trained and experienced in the area of mental illness or
developmental disabilities and who is 1 of the following:
(a) A physician who is licensed to practice medicine or
osteopathic medicine and surgery in this state under article 15 of
the public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(b) A psychologist licensed to practice in this state under
article 15 of the public health code, 1978 PA 368, MCL 333.16101 to
333.18838.
(c) A registered professional nurse licensed to practice in
this state under article 15 of the public health code, 1978 PA 368,
MCL 333.16101 to 333.18838.
(d)
Until July 1, 2005, a certified social worker registered
under
article 15 of the public health code, 1978 PA 368, MCL
333.16101
to 333.18838. Beginning July 1,
2005, a A licensed
master's social worker licensed under article 15 of the public
health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(e) A licensed professional counselor licensed to practice in
this state under article 15 of the public health code, 1978 PA 368,
MCL 333.16101 to 333.18838.
(f) A marriage and family therapist licensed under article 15
of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(16) (15)
"Mental retardation"
means a condition manifesting
before the age of 18 years that is characterized by significantly
subaverage intellectual functioning and related limitations in 2 or
more adaptive skills and that is diagnosed based on the following
assumptions:
(a) Valid assessment considers cultural and linguistic
diversity, as well as differences in communication and behavioral
factors.
(b) The existence of limitation in adaptive skills occurs
within the context of community environments typical of the
individual's age peers and is indexed to the individual's
particular needs for support.
(c) Specific adaptive skill limitations often coexist with
strengths in other adaptive skills or other personal capabilities.
(d) With appropriate supports over a sustained period, the
life functioning of the individual with mental retardation will
generally improve.
(17) (16)
"Minor" means an
individual under the age of 18
years.
(18) (17)
"Multicultural services"
means specialized mental
health services for multicultural populations such as African-
Americans, Hispanics, Native Americans, Asian and Pacific
Islanders, and Arab/Chaldean-Americans.
(19) (18)
"Neglect" means an act or
failure to act committed
by an employee or volunteer of the department, a community mental
health services program, or a licensed hospital; a service provider
under contract with the department, community mental health
services program, or licensed hospital; or an employee or volunteer
of a service provider under contract with the department, community
mental health services program, or licensed hospital, that denies a
recipient the standard of care or treatment to which he or she is
entitled under this act.
Sec. 116. (1) Consistent with section 51 of article IV of the
state constitution of 1963, which declares that the health of the
people of the state is a matter of primary public concern, and as
required by section 8 of article VIII of the state constitution of
1963, which declares that services for the care, treatment,
education, or rehabilitation of those who are seriously mentally
disabled shall always be fostered and supported, the department
shall continually and diligently endeavor to ensure that adequate
and appropriate mental health services are available to all
citizens
throughout the state. To this end, the department shall
have
has the general powers and duties described in this
section.
(2) The department shall do all of the following:
(a) Direct services to individuals who have a serious mental
illness, developmental disability, or serious emotional
disturbance. The department shall give priority to the following
services:
(i) Services for individuals with the most severe forms of
serious mental illness, serious emotional disturbance, or
developmental disability.
(ii) Services for individuals with serious mental illness,
serious emotional disturbance, or developmental disability who are
in urgent or emergency situations.
(b) Administer the provisions of chapter 2 so as to promote
and maintain an adequate and appropriate system of community mental
health services programs throughout the state. In the
administration of chapter 2, it shall be the objective of the
department to shift primary responsibility for the direct delivery
of public mental health services from the state to a community
mental health services program whenever the community mental health
services program has demonstrated a willingness and capacity to
provide an adequate and appropriate system of mental health
services for the citizens of that service area.
(c) List on its website and include in its contracts with
community mental health services programs all elements of section
206(1).
(d) (c)
Engage in planning for the purpose
of identifying,
assessing, and enunciating the mental health needs of the state.
(e) (d)
Submit to the members of the house
and senate standing
committees and appropriation subcommittees with legislative
oversight of mental health matters an annual report summarizing its
assessment of the mental health needs of the state and
incorporating information received from community mental health
services programs under section 226. The report shall include an
estimate of the cost of meeting all identified needs. Additional
information shall be made available to the legislature upon
request.
(f) (e)
Endeavor to develop and establish
arrangements and
procedures for the effective coordination and integration of all
public mental health services, and for effective cooperation
between public and nonpublic services, for the purpose of providing
a unified system of statewide mental health care.
(g) (f)
Review and evaluate the relevance,
quality,
effectiveness, and efficiency of mental health services being
provided by the department and assure the review and evaluation of
mental health services provided by community mental health services
programs. The department shall establish and implement a structured
system to provide data necessary for the reviews and evaluations.
(h) (g)
Implement those provisions of law
under which it is
responsible for the licensing or certification of mental health
facilities or services.
(i) (h)
Establish standards of training and
experience for
executive directors of community mental health services programs.
(j) (i)
Support research activities.
(k) (j)
Support evaluation and quality
improvement activities.
(l) (k)
Support training, consultation, and
technical
assistance regarding mental health programs and services and
appropriate prevention and mental health promotion activities,
including those that are culturally sensitive, to employees of the
department, community mental health services programs, and other
nonprofit agencies providing mental health services under contract
with community mental health services programs.
(m) (l) Support
multicultural services.
(3) The department may do all of the following:
(a) Direct services to individuals who have mental disorders
that meet diagnostic criteria specified in the most recent
diagnostic and statistical manual of mental health disorders
published by the American psychiatric association and approved by
the department and to the prevention of mental disability and the
promotion of mental health. Resources that have been specifically
appropriated for services to individuals with dementia, alcoholism,
or substance abuse, or for the prevention of mental disability and
the promotion of mental health shall be utilized for those specific
purposes.
(b) Provide, on a residential or nonresidential basis, any
type of patient or client service including but not limited to
prevention, diagnosis, treatment, care, education, training, and
rehabilitation.
(c) Operate mental health programs or facilities directly or
through contractual arrangement.
(d) Institute pilot projects considered appropriate by the
director to test new models and concepts in service delivery or
mental health administration. Pilot projects may include, but need
not be limited to, both of the following:
(i) Issuance of a voucher to a recipient of public mental
health services in accordance with the recipient's individual plan
of services and guidelines developed by the department.
(ii) Establishment of revolving loans to assist recipients of
public mental health services to acquire or maintain affordable
housing. Funding under this subparagraph shall only be provided
through an agreement with a nonprofit fiduciary in accordance with
guidelines and procedures developed by the department related to
the use, issuance, and accountability of revolving loans used for
recipient housing.
(e) Enter into an agreement, contract, or arrangement with any
individual or public or nonpublic entity that is necessary or
appropriate to fulfill those duties or exercise those powers that
have by statute been given to the department.
(f) Accept gifts, grants, bequests, and other donations for
use in performing its functions. Any money or property accepted
shall be used as directed by its donor and in accordance with law
and the rules and procedures of the department.
(g) The department has any other power necessary or
appropriate to fulfill those duties and exercise those powers that
have been given to the department by law and that are not otherwise
prohibited by law.
Sec. 206. (1) The purpose of a community mental health
services
program shall be is to provide a comprehensive array of
mental
health services appropriate to conditions of individuals
adults and minors who are located within its geographic service
area, regardless of an individual's ability to pay or medicaid
status. Services shall be effective and necessary to impact an
individual's condition and its effects on the individual's life.
The array of mental health services shall be designed and delivered
in a manner that promotes community inclusion and integration and
shall include, at a minimum, all of the following:
(a) Crisis stabilization and response including a 24-hour, 7-
day per week, crisis emergency service that is prepared to respond
to persons experiencing acute emotional, behavioral, or social
dysfunctions, and the provision of inpatient or other protective
environment for treatment.
(b) Identification, assessment, and diagnosis to determine the
specific needs of the recipient and to develop an individual plan
of services. This includes referral to, coordination with, and
collaboration with other health care, human service, and
educational systems.
(c) Planning, linking, coordinating, follow-up, and monitoring
to assist the recipient in gaining access to services.
(d) Specialized mental health recipient training, treatment,
and support, including therapeutic clinical interactions,
socialization and adaptive skill and coping skill training, health
and rehabilitative services, and pre-vocational and vocational
services.
(e) Inpatient treatment.
(f) Intensive community-based services that provide
alternatives to, or step-downs from, inpatient treatment.
(g) (e)
Recipient rights services.
(h) (f)
Mental Recipient and family
services that provide for
consumer and family orientation and involvement, consumer and
family information and education, mental health advocacy, and
mechanisms for addressing consumer complaints, grievances, and
appeal requests.
(i) (g)
Prevention activities that serve to
inform and educate
with the intent of reducing the risk of severe recipient
dysfunction.
(j) (h)
Any other service approved by the
department that is
specified in the department's contract with the community mental
health services program.
(2) Services shall promote the best interests of the
individual and shall be designed to increase independence, improve
quality
of life, and support community integration, and support
community inclusion, and help foster resiliency, recovery, skill
development, and stability in the community. Services for children
and families shall promote the best interests of the individual
receiving services and shall be designed to strengthen and preserve
the family unit if appropriate. The community mental health
services program shall deliver services in a manner that
demonstrates they are based upon recipient choice and involvement,
and shall include wraparound services when appropriate.
(3) A recipient shall not be terminated or discharged from
community mental health services program service if all of the
following conditions exist:
(a) Continued services are medically necessary.
(b) The recipient expresses a desire to continue to receive
services.
(c) The recipient meets the priority criteria for receipt of
services.
Sec. 206a. The department shall list on its website and
include in its contracts with community mental health services
programs a listing of service selection guideline principles to aid
consumers, families, providers, and service managers in matching
treatment and support options to a recipient's needs, desires, and
circumstances. The list of principles shall include, at least, all
of the following:
(a) Treatment planning, including initial and revised service
plans, shall be person-centered with involvement of all appropriate
parties facilitated as quickly as possible.
(b) Recipients shall be offered the most clinically
appropriate and culturally relevant and effective treatment and
support for their condition.
(c) The medical necessity criteria utilized shall be
transparent, open to public review, and updated regularly to
reflect advances in diagnosis and treatment.
(d) Medically necessary services identified in the plan of
service shall specifically identify the amount, scope, and duration
of each service to be provided, when the recipient can expect the
services to begin, and who will be responsible for providing them.
Services and supports identified in the plan of service shall not
be reduced, suspended, or terminated without advance notice to the
recipient. Under those circumstances, the recipient shall be
assisted in appealing the reduction, suspension, or termination of
services or supports.
(e) Protocols used by a community mental health services
program for responding to an acute psychiatric crisis shall be
well-defined and uniformly applied.
(f) Service selection criteria and protocols for individuals
meriting priority consideration under section 208 shall be well-
defined and uniformly applied.
(g) Service selection criteria and protocols shall cover both
adults and minors.
(h) Criteria for continuation of a service shall be flexible
so that clinically appropriate and effective decisions may be made
according to recipient needs and circumstances.
(i) Individuals with a co-occurring mental illness and
substance abuse disorder shall be offered integrated treatment.
(j) Service selection guidelines shall address collaborative
and boundary issues between mental health and other public and
private human service providers.
(k) Service selection guidelines shall be uniform and readily
understandable, across demographic, socioeconomic, and cultural
groups, by consumers, their advocates or representatives, and their
families.