SENATE BILL NO. 799

February 26, 2026, Introduced by Senators BAYER, SANTANA and CAVANAGH and referred to Committee on Housing and Human Services.

A bill to require the licensing of adult psychiatric residential treatment facilities; to allow for psychiatric services to be provided under a residential psychiatric program in adult psychiatric residential treatment facilities; to establish standards of care for adult psychiatric residential treatment facilities; to provide for the powers and duties of certain state departments and agencies; to allow for the promulgation of rules; to prescribe certain fees; and to provide for sanctions, penalties, and remedies.

the people of the state of michigan enact:

Sec. 1. (1) This act may be cited as the "adult psychiatric residential treatment facility licensing act".

(2) As used in this act, the terms defined in sections 3 to 3d have the meanings ascribed to them in those sections.

Sec. 3. (1) "Adult" means an individual who is 18 years of age or older.

(2) "Adult psychiatric residential treatment facility" or "APRTF" means a facility operated for the primary purpose of providing residential psychiatric services to adults under a residential psychiatric program. An APRTF does not include any of the following:

(a) A psychiatric hospital as that term is defined in section 100b of the mental health code, 1974 PA 258, MCL 330.1100b, or a psychiatric unit as that term is defined in section 100c of the mental health code, 1974 PA 258, MCL 330.1100c.

(b) An adult foster care facility as that term is defined in section 3 of the adult foster care facility licensing act, 1979 PA 218, MCL 400.703.

(d) A home for the aged, hospice, hospice residence, or nursing home licensed under part 213, 214, or 217 of the public health code, MCL 333.21301 to 333.21335, 333.21401 to 333.21420, and 333.21701 to 333.21799e.

(e) A facility with a licensed substance use disorder services program under part 62 of the public health code, MCL 333.6230 to 333.6251.

(f) A veterans' facility as that term is defined in section 2 of the Michigan veterans' facility authority act, 2016 PA 560, MCL 36.102.

(g) A hospital as that term is defined in section 20106 of the public health code, MCL 333.20106.

(3) "Community mental health services program" means that term as it is defined in section 100a of the mental health code, 1974 PA 258, MCL 330.1100a.

(4) "Department" means the department of licensing and regulatory affairs.

(5) "Director" means the director of the department or the director's designee.

Sec. 3a. (1) "Licensed health care professional" means an individual licensed, registered, or otherwise authorized to engage in a health profession under article 15 of the public health code, MCL 333.16101 to 333.18838.

(2) "Licensee" means a person that has been issued a license to operate an APRTF.

Sec. 3b. (1) "Person" means an individual, firm, partnership, agency, governing body, association, corporation, or other entity.

(2) "Personal care services" means services including, but not limited to, assisting individuals with activities of daily living, assisting individuals with self-administration of medication in accordance with rules promulgated under this act, and preparing special diets, other than complex therapeutic diets, for individuals according to the instructions of a physician or a licensed dietitian and in accordance with rules promulgated under this act. Personal care services do not include skilled nursing care.

(3) "Physician" means an individual licensed or otherwise authorized to engage in the practice of medicine under part 170 of the public health code, MCL 333.17001 to 333.17097, or to engage in the practice of osteopathic medicine and surgery under part 175 of the public health code, MCL 333.17501 to 333.17556.

(4) "Provisional license" means a license issued to a facility that has previously been licensed under this act but is temporarily unable to conform to the requirements of a regular license prescribed in this act or rules promulgated under this act.

(5) "Public health code" means the public health code, 1978 PA

368, MCL 333.1101 to 333.25211.

Sec. 3c. (1) "Regular license" means a license issued to an APRTF that is in compliance with this act and the rules promulgated under this act.

(2) "Resident" means an individual residing in an APRTF.

(3) "Residential psychiatric program" means a program that is provided by a public or private APRTF that offers a combination of residential, nutritional, supervisory, and personal care services, combined with mental health and psychiatric services in a comprehensive residential treatment setting. The program must be accredited by the Joint Commission.

(4) "Residential psychiatric services" means active psychiatric treatment provided in an APRTF to a resident with a persistent pattern of emotional, psychological, or behavioral dysfunction of a severity that requires 24-hour supervised care provided under the direction of a physician. Residential psychiatric services must be individualized and designed to achieve a less restrictive level of care at the earliest possible time. Residential psychiatric services must be certified by the physician in writing to be necessary in the setting in which the services are provided so that the services can reasonably be expected to improve the resident's condition or prevent further regression.

(5) "Rules" means rules promulgated under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328.

Sec. 3d. (1) "Skilled nursing care" means providing nursing care services, health-related services, and social services under the supervision of a registered professional nurse or an advanced practice registered nurse on a 24-hour basis.

(2) "Supervision" means guiding a resident in activities of daily living, including 1 or more of the following:

(a) Reminding a resident to maintain the resident's medication schedule, as directed by the resident's physician.

(b) Reminding a resident of important activities to be carried out.

(3) "Temporary license" means a license of limited duration issued under section 15.

Sec. 5. (1) A person shall not establish, maintain, or operate an adult psychiatric residential treatment facility unless licensed under this act. An application for a license must be made on a form provided, and in a manner prescribed, by the department. The application must be accompanied by the appropriate fee as follows:

(a) For an initial application fee, $2,000.00.

(b) For a temporary or renewal license, $1,000.00.

(d) For a provisional license, $500.00.

(2) Before issuing or renewing a license, the department shall investigate the activities and standards of care of the applicant and shall make an on-site inspection of the facility. On-site inspections conducted in response to the application may be conducted without prior notice to the applicant.

(3) If the department revoked, suspended, or refused to renew a person's license, or denied an application for a license, for an APRTF under section 13, the department may refuse to issue a license to or renew a license of that applicant for a period of 5 years after the suspension, revocation, or nonrenewal of the license, or denial of the application. During the 5-year period after the suspension, revocation, or nonrenewal of the license or denial of the application, the person shall not apply for a license under the adult foster care facility licensing act, 1979 PA 218, 400.701 to 400 737. The department may refuse to issue a license to or renew the license of an applicant if the department determines that the applicant has a relationship with a former licensee whose license under this act has been suspended, revoked, or nonrenewed under section 13. This subsection applies for 5 years after the suspension, revocation, or nonrenewal of the former licensee's license. For purposes of this subsection, an applicant has a relationship with a former licensee if the former licensee is involved with the facility in 1 or more of the following ways:

(a) Participates in the administration or operation of the facility.

(b) Has a financial interest in the operation of the facility.

(d) Has contact with residents or staff on the premises of the facility.

(e) Is employed by the facility.

(f) Resides in the facility.

(4) A separate license is not required under this act for a separate APRTF on the same campus if that facility is utilized to provide residential psychiatric services to adults under a residential psychiatric program under the same licensee.

(5) An individual residential building in an APRTF must not exceed housing for more than 20 individuals and is not required to accommodate dining, activities, therapeutic services, clinical services or other similar services in the building if these services are provided in the APRTF.

Sec. 7. (1) A residential psychiatric program being provided by an APRTF must meet 1 of the following not later than 1 year after the issuance of the APRTF's initial regular license:

(a) The standards pertaining to residential services contained in the "Comprehensive Accreditation Manual for Behavioral Health Care" published by the Joint Commission.

(b) The behavioral health standards pertaining to residential treatment published by the Commission on Accreditation of Rehabilitation Facilities.

(2) If any of the standards described in subsection (1) are revised after the effective date of this act, the department shall take notice of the revision. The department may promulgate rules to incorporate the revision by reference. If the department does promulgate rules to incorporate the revision by reference, the department shall not make any changes to the revision.

Sec. 8. (1) Only an APRTF that is operated under the direction of a physician may administer medication to residents. An APRTF that is operated under the direction of an individual other than a physician must have a medical director that is responsible for all residential psychiatric services. An APRTF that is operated under the direction of an individual other than a physician may do any of the following:

(a) Remind a resident when to take medication and watch to ensure that the resident follows the directions on the container.

(b) Assist a resident in the self-administration of medication by taking the medication from the locked area where it is stored, in accordance with rules promulgated under this act, and handing it to the resident. If the resident is physically unable to open the container, a staff member may open the container for the resident.

(c) Assist a physically impaired but mentally alert resident, including, but not limited to, a resident with arthritis, cerebral palsy, or Parkinson's disease, in removing oral or topical medication from a container and in consuming or applying the medication, on request by or with the consent of the resident. If a resident is physically unable to bring a dose of medicine to the resident's own mouth without spilling it, a staff member may place the dose in a container and bring the container to the mouth of the resident.

(2) This section does not prohibit a licensed health care professional from acting within the scope of that individual's license to administer medication at the request of a resident.

Sec. 9. (1) The director or personnel of another department or agency acting at the request of the director may enter the premises of an applicant or licensee at a reasonable time to make inspections, as permitted by applicable law, for any of the following purposes:

(a) To determine whether the applicant or licensee is complying with this act and the rules promulgated under this act.

(b) To determine whether the APRTF has completed a plan of correction required under subsection (2) and corrected deficiencies to the satisfaction of the department.

(2) In conducting an inspection under this act, the department may conduct an on-site examination and evaluation of the APRTF and the residential psychiatric program, its personnel, activities, and services. The APRTF shall give the department access to examine and copy all records, accounts, and any other documents relating to operating the APRTF, including records pertaining to residents, and access to the APRTF and the residential psychiatric program in order to conduct interviews with the owner or operator, staff, and residents. Following each inspection and review, the department shall complete a report listing any deficiencies and, include when appropriate, a timetable within which the owner or operator must correct the deficiencies. The department may require the licensee to submit a plan of correction describing how the deficiencies will be corrected.

(3) On-site inspections may be conducted without prior notice to the APRTF. A health and sanitation inspection of an APRTF must be conducted on the request of the department by 1 of the following:

(a) Department staff.

(b) The department of health and human services.

(4) The bureau of fire services created in section 1b of the fire prevention code, 1941 PA 207, MCL 29.1b, or local authorities, in carrying out this act, may visit an APRTF more often than annually to advise in matters affecting health or fire protection. Inspections must be made as permitted by law.

Sec. 11. (1) Not later than 6 months after the applicant files a completed application, the department shall issue a regular license, temporary license, or provisional license or shall renew the license. Receipt of the completed application is considered the date the application is received by the department. If the application is considered incomplete by the department, the department shall notify the applicant in writing or make notice electronically available not later than 30 days after receipt of the incomplete application, describing the deficiency and requesting additional information. If the department identifies a deficiency or requires the fulfillment of a corrective action plan, the 6-month period is tolled until either of the following occurs:

(a) On notification by the department of a deficiency, until the date that the requested information is received by the department.

(b) On notification by the department that a corrective action plan is required, until the date that the department determines the requirements of the corrective action plan have been met.

(2) The determination of the completeness of an application does not operate as an approval of the application for the license and does not confer eligibility of an applicant determined otherwise ineligible for issuance of a license.

(3) If the department fails to issue or deny a license in the time required by this section, the department shall return the license fee and shall reduce the license fee for the applicant's next renewal application, if any, by 15%. Failure to issue or deny a license in the time period required under this section does not allow the department to otherwise delay processing an application. The completed application must be placed in sequence with other completed applications received at that same time. The department shall not discriminate against an applicant in the processing of an application based on the fact that the application fee was refunded or discounted under this subsection.

(4) A regular license expires 2 years after the date of issuance, a provisional license expires 6 months after the date of issuance, and a temporary license expires 6 months after the date of issuance.

(5) As used in this section, "completed application" means an application complete on its face with all requested information provided and answers to all questions provided and submitted with any applicable licensing fees as well as any other information, records, approval, security, or similar item required by the department.

Sec. 13. (1) The department may deny, suspend, revoke, or refuse to renew a license, or modify a regular license to a provisional license, if the department finds 1 or more of the following:

(a) The APRTF or the residential psychiatric program being provided by the applicant or licensee has been cited for a pattern of serious noncompliance or repeated violations of this act or rules promulgated under this act during the period of current or previous licensure.

(b) The applicant or licensee submits false or misleading information as part of a license application, renewal, or investigation.

(2) An application for licensure must not be denied, a license must not be revoked, a renewal must not be refused, and a regular license must not be modified to a provisional license unless the department gives the applicant or licensee written notice of the grounds for the proposed denial, revocation, refusal to renew, or modification. If the proposed denial, revocation, refusal to renew, or modification is not appealed not later than 30 days after receipt, the department shall deny, revoke, refuse to renew, or modify the application or license. The applicant or licensee shall appeal in writing to the director not later than 30 days after receipt of the written notice. On receipt of the written request for appeal, the director shall conduct a contested case hearing under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328. Notice of the hearing must be given to the applicant or licensee by personal service or delivery to the proper address by registered mail not less than 2 weeks before the date of the hearing. The director shall issue a decision as soon as practicable after the hearing and forward it to the protesting party by registered mail. The formal notice and hearing requirement in this subsection does not apply if the licensee and the department comply with subsection (6).

(3) A license must not be denied, suspended, or revoked, a renewal must not be refused, and a regular license must not be modified to a provisional license unless the department gives the licensee or applicant written notice of the grounds of the proposed denial, revocation, refusal to renew, or modification. If the licensee or applicant appeals the denial, revocation, refusal to renew, or modification by filing a written appeal with the director not later than 30 days after receipt of the written notice, the director shall conduct a contested case hearing at which the licensee or applicant may present testimony and confront witnesses. Notice of the hearing must be given to the licensee or applicant by personal service or delivery to the proper address by registered mail not less than 2 weeks before the date of the hearing. The decision of the director must be made and forwarded to the protesting party by registered mail not more than 30 days after the hearing. If the proposed denial, revocation, refusal to renew, or modification is not protested not later than 30 days, the license must be denied, revoked, refused, or modified.

(4) If the department has revoked, suspended, or refused to renew a license, the former licensee must not receive or maintain in that facility an adult who requires residential psychiatric care. A person that violates this subsection is guilty of a felony punishable by imprisonment for not more than 5 years or a fine of not more than $75,000.00, or both.

(5) If the department has revoked, suspended, or refused to renew a license, relocation services must be provided to adults who were being served by the formerly licensed facility, on the department's determination that the adult or the adult's designated representative is unable to relocate the adult to another facility without assistance. The relocation services must be provided by the responsible agency, as defined in the rules promulgated under this act, or, if the adult has no agency designated as responsible, by the department of health and human services.

(6) The department may immediately suspend, revoke, modify, or refuse to renew a license or deny an application for a license without providing written notice of the grounds for the proposed action or giving the licensee or applicant 30 days to appeal if the licensee or applicant agrees in writing to do all of the following:

(a) Waive the requirement that the department provide written notice of the grounds for the proposed action.

(b) Waive the 30-day time frame in which to submit a written appeal to the proposed action.

(c) Waive the right to a contested case hearing under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328.

Sec. 15. (1) The department may issue a temporary license to operate an APRTF if both of the following conditions are met:

(a) The department determines that the closing of or the need to remove residents from another APRTF has created an emergency situation requiring immediate removal of residents and an insufficient availability of APRTF.

(b) The APRTF applying for a temporary license meets standards established for a temporary license in rules promulgated under this act.

(2) A temporary license is valid for 90 days and may be renewed by the director no more than twice. A proceeding initiated to deny an application for or to revoke a temporary license issued under this section is not subject to the provisions of section 13.

Sec. 17. (1) The following individuals may enter an APRTF at any time:

(a) A department employee designated by the director.

(b) An employee of a community mental health services program if the community mental health services program has an individual who is residing in the facility and receiving residential psychiatric services.

(2) An APRTF shall give the employees described in subsection (1) access to examine and copy all records, accounts, and documents relating to operating the APRTF, including, but not limited to, records pertaining to residents.

(3) For the purpose of investigation, an employee of the department may enter an institution, residence, facility, or other structure that has been reported to the department as, or that the department has reasonable cause to believe is, operating as an APRTF without a valid license.

Sec. 19. (1) The department may withhold the source of a complaint reported as a violation of this act if the department determines that disclosure could be detrimental to the department's purposes or could jeopardize the investigation. The department may disclose the source of a complaint if the complainant agrees in writing to disclosure and shall disclose the source on order by a court.

(2) A person that makes a complaint under this act, or a person that participates in an administrative or judicial proceeding resulting from a complaint under this act, is immune from civil liability and is not subject to criminal prosecution, other than for perjury, unless the person has acted in bad faith or with malicious purpose.

Sec. 21. (1) The director may petition the court of the county in which an APRTF is located or in Ingham County for an order enjoining a person from operating an APRTF without a license if, in the director's judgment, there is a present danger to the health or safety of a resident. The court has jurisdiction to grant injunctive relief on a showing that the respondent named in the petition is operating an APRTF without a license or there is a present danger to the health or safety of a resident.

(2) When the court grants injunctive relief under subsection (1), the court shall issue, at a minimum, an order enjoining the APRTF from admitting new residents and an order requiring the APRTF to assist with the safe and orderly relocation of the APRTF's residents.

(3) If injunctive relief is granted under this section and the person continues to operate without a license, the director shall refer the case to the attorney general for further action.

Sec. 25. (1) On petition by the director, the court may appoint a receiver to take possession of and operate an APRTF licensed under this act when conditions existing at the APRTF present a substantial risk of physical or mental harm to residents and no other remedies of law are adequate to protect the health, safety, and welfare of the residents.

(2) Petitions filed under this section must include all of the following:

(a) A description of the specific conditions that present a substantial risk of physical or mental harm to residents.

(b) A statement of the absence of other adequate remedies of

law.

(d) A statement that the facts have been brought to the attention of the licensee and that conditions have not been remedied within a reasonable period of time or that the conditions, though remedied periodically, habitually exist at the APRTF as a pattern or practice.

(e) The name and address of the person holding the license for the APRTF.

(3) A court in which a petition is filed under this section shall give notice regarding the filing to all of the following, as appropriate:

(a) The licensee.

(b) The owner of the APRTF.

(d) The residents of the APRTF.

(e) Any guardian of an APRTF resident and any family member of the APRTF resident who the resident or the resident's guardian has authorized to receive the notice described in this subsection.

(4) The court shall hold a hearing on the petition not later than 5 business days after the time the petition was filed, except that the court may appoint a receiver before that time if the court determines that the circumstances necessitate appointing a receiver.

(5) Following a hearing on the petition, and on a determination that the appointment of a receiver is warranted, the court shall appoint a receiver and notify the department and appropriate persons of this action.

(6) In stating the powers of the receiver, the court may generally authorize the receiver to do all that is prudent and necessary to safely and efficiently operate the APRTF in accordance with the requirements of state and federal law but shall require the receiver to obtain court approval before making a single expenditure of more than $5,000.00 to correct deficiencies in the structure or furnishings of an APRTF. The court shall closely review the conduct of the receiver and shall require regular and detailed reports.

(7) A receivership established under this section must be terminated, following notification of the appropriate parties and a hearing, if the court determines either of the following:

(a) The APRTF has been closed and the former residents have been relocated to an appropriate facility.

(b) Circumstances no longer exist at the APRTF that present a substantial risk of physical or mental harm to residents and there is no deficiency in the residential psychiatric program that is likely to create a future risk of harm.

(8) Notwithstanding subsection (7)(b), the court shall not terminate a receivership for an APRTF that has previously operated under another receivership unless the responsibility for the operation of the APRTF is transferred to another person approved by the court and the department.

(9) Except for the department, no party or person interested in an action may be appointed a receiver under this section. To assist the court in identifying a person qualified to be named as a receiver, the director shall maintain a list of the names of qualified receivers. The department shall provide technical assistance to a receiver appointed under this section.

(10) Before assuming the duties of a receiver, the receiver must be sworn to perform the receiver's duties faithfully, and, with a surety approved by the court, judge, or clerk, execute a bond to a person, and in a sum as the court directs, to ensure that the receiver will faithfully discharge the duties of receiver in the action, and obey the order of the court.

(11) Under the control of the appointing court, a receiver may do both of the following:

(a) Bring and defend an action in the APRTF's name as receiver.

(b) Take and keep possession of property.

(12) The court shall authorize the receiver to do all of the following:

(a) Collect payment for all goods and services provided to the residents or others during the period of the receivership at the same rate as was charged by the licensee at the time the petition for receivership was filed, unless a different rate is set by the court.

(b) Honor all leases, mortgages, and secured transactions governing all buildings, goods, and fixtures of which the receiver has taken possession, but, in the case of a rental agreement, only to the extent of payments that are for the use of the property during the period of the receivership, or, in the case of a purchase agreement, only to the extent that payments become due during the period of the receivership.

(c) If a transfer of residents is necessary, provide for the orderly transfer of residents by doing any of the following:

(i) Cooperating with all appropriate state and local agencies in carrying out the transfer of residents to alternative community placements.

(ii) Providing for the transportation of residents' belongings and records.

(iii) Helping to locate alternative placements and develop plans for transfer.

(iv) Encouraging residents or guardians to participate in transfer planning except if an emergency exists and immediate transfer is necessary.

(d) Make periodic reports on the status of the APRTF to the court and the appropriate state agencies. Each report must be made available to residents, the residents' guardians, and the residents' families.

(e) Compromise demands or claims.

(f) Generally perform acts respecting the APRTF as the court authorizes.

(13) Notwithstanding any other provision of law, a contract necessary to carry out the powers and duties of the receiver does not need to be competitively bid.

Sec. 27. A person that violates this act is subject to an administrative fine of $500.00 for a first offense and $1,000.00 for each subsequent offense. An administrative fine may not be imposed under this section unless the person charged with the violation is given notice and an opportunity for a hearing under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328.

Sec. 29. (1) Subject to this section, the department shall promulgate rules to implement this act.

(2) Rules promulgated by the department must include, but are not limited to, provisions addressing all of the following:

(a) Mandatory residential psychiatric program components.

(b) Periodic assessment components.

(d) Treatment protocols and supportive services.

(e) Length of stay considerations.

(f) Admission planning requirements.

(g) Discharge planning requirements.

(h) Required staffing levels.

(i) Clinical documentation requirements.

(j) Safety and emergency protocols.

(k) Pharmacy service requirements.

(l) Medication administration protocols.

(m) Reporting requirements.

(3) Rules promulgated by the department may include, but are not limited to, provisions addressing physical plant requirements and subjecting a physical plant's engineering plans and projected costs to review by the department.

(4) In promulgating rules, the department shall seek input from adult psychiatric residential providers, relevant professional associations, and consumer groups.

Enacting section 1. This act takes effect 90 days after the date it is enacted into law.