Bill Text: AZ SB1311 | 2024 | Fifty-sixth Legislature 2nd Regular | Chaptered
Bill Title: Mental health; oversight; data; documentation.
Spectrum: Moderate Partisan Bill (Democrat 6-1)
Status: (Passed) 2024-04-16 - Chapter 163 [SB1311 Detail]
Download: Arizona-2024-SB1311-Chaptered.html
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Senate Engrossed
mental health; oversight; data; documentation. |
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State of Arizona Senate Fifty-sixth Legislature Second Regular Session 2024
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CHAPTER 163
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SENATE BILL 1311 |
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An Act
amending sections 36-502, 36-520, 36-521, 36-523, 36-524, 36-527 and 36-531, Arizona Revised Statutes; relating to mental health services.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-502, Arizona Revised Statutes, is amended to read:
36-502. Powers and duties of the director of AHCCCS; rules; expenditure limitation; reporting requirements; definition
A. The administration is responsible for monitoring, overseeing and evaluating its contractors and the contracted agencies providing services under this chapter to ensure that the services are provided in a timely, clinically effective and efficient manner. The administration and its contractors shall monitor the performance of an agency providing services pursuant to this chapter. The administration shall take corrective action, which may include technical assistance, and impose civil penalties pursuant to section 36-2918, if appropriate, suspension and termination of contracts, for agencies that the administration finds to not be in compliance with county, state and federal laws and rules or to not be performing the services in a timely, effective and efficient manner.
A. B. The director shall make adopt rules that include standards for agencies other than the state hospital when providing services and shall prescribe forms as may be necessary for the proper administration and enforcement of this chapter. The rules shall be applicable to patients admitted to or treated in agencies, other than the state hospital, as set forth in this chapter and shall provide for periodic inspections of such agencies.
c. The director shall adopt rules, if necessary, and prescribe reporting requirements and standards for contractors and contracted agencies to collect, report and analyze information and data for the purpose of understanding the clinical effectiveness of services provided by the various agencies pursuant to this chapter. The administration shall analyze the information and data collected semiannually and shall report annually to the governor, the president of the senate and the speaker of the house of representatives beginning on or before December 31, 2025. For the purposes of this subsection, the information and data shall identify and measure clinical outcomes in the past year of members who have received a designation of serious mental illness, including all of the following:
1. The number of hospitalizations and rehospitalizations, the facilities where admissions occurred and the average length of stay by admitting diagnosis, for members for whom the administration or its contractor is the primary payor.
2. The number and percentage of members with a mental health disorder and co-occurring substance use disorder diagnosis who were admitted, discharged and subsequently readmitted to an inpatient psychiatric facility within the preceding year, for members for whom the administration or its contractor is the primary payor.
3. The number and percentage of members whose title XIX enrollment is placed in a no-pay status in a given year due to the member's incarceration status, stratified by the number of times enrollment is suspended.
4. The number of members for whom the administration or its contractor is notified of a release from incarceration and for whom the administration or its contractor conducts reach-in services.
5. The number of responses by the contracted crisis system that identify members with a serious mental illness designation, including:
(a) The number of crisis phone line calls received.
(b) The number of mobile teams dispatched.
(c) The number of members seen at psychiatric urgent care centers.
(d) The number of members with two or more distinct crisis system episodes.
6. The number of member deaths, the death rate and the cause of death in the preceding year.
7. The number of members who are homeless, unsheltered or inadequately housed and for what period of time, as identified through homeless management information system data or other available sources identified by the administration.
8. The number of title XIX members or non-title XIX grant-funded members, separately delineated, who are:
(a) Admitted to a behavioral health residential facility.
(b) Discharged from a behavioral health residential facility.
(c) For those members for whom the administration or its contractor is the primary payor, admitted to an inpatient psychiatric hospital within one year after discharge from the behavioral health residential facility.
9. The number and percentage of members who:
(a) Have received court-ordered treatment.
(b) Have requested and received the removal of a serious mental illness designation.
(c) Have received court-ordered treatment and are adherent to the court-ordered treatment.
(d) Did not receive a single behavioral health service.
10. The number of patients who have been discharged from the state hospital and admitted to a contracted psychiatric hospital within the preceding year.
11. The number of members who have been evaluated for a serious mental illness eligibility determination, the number of members whose eligibility determination resulted in receiving a serious mental illness designation and the number of members whose eligibility determination resulted in not receiving a serious mental illness designation.
12. The number of members who are also enrolled in medicare and when the member's medicare enrollment became known to the administration, separately reported by title XIX and non-title XIX members.
B. D. The director shall make adopt rules concerning the admission of patients and the transfer of patients between mental health treatment agencies other than the state hospital. A patient undergoing court-ordered treatment may be transferred from one mental health treatment agency to another in accordance with the rules of the director, subject to the approval of the court.
C. E. The director may make adopt rules concerning leaves, visits and absences of patients from evaluation agencies and mental health treatment agencies other than the state hospital.
D. F. The total amount of state monies that may be spent in any fiscal year by the administration for mental health services pursuant to this chapter may not exceed the amount appropriated or authorized by section 35-173 for that purpose. This chapter does not impose a duty on an officer, agent or employee of this state to discharge a responsibility or create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose.
G. The requirements of subsection C of this section shall be implemented not later than October 1, 2025. On or before December 31, 2024, the administration shall file an interim report with the governor, the president of the senate and the speaker of the house of representatives that describes the plan of the administration in completing the requirements of this section. On or before December 31, 2025, the administration shall file a report with the governor, the president of the senate and the speaker of the house of representatives confirming the implementation of the requirements of this section.
H. For the purposes of this section, "member" has the same meaning prescribed in section 36-2901.
Sec. 2. Section 36-520, Arizona Revised Statutes, is amended to read:
36-520. Application for evaluation; definition
A. Any responsible individual may apply for a court-ordered evaluation of a person who is alleged to be, as a result of a mental disorder, a danger to self or to others or a person with a persistent or acute disability or a grave disability and who is unwilling or unable to undergo a voluntary evaluation. The application shall be made in the prescribed form and manner as adopted by the director.
B. The application for evaluation shall include the following data:
1. The name, and address if known, of the proposed patient for whom evaluation is applied.
2. The age, date of birth, sex, race, marital status, occupation, social security number, present location, dates and places of previous hospitalizations, names and addresses of the guardian, spouse, next of kin and significant other persons and other data that the director may require on the form to whatever extent that this data is known and is applicable to the proposed patient.
3. The name, address and relationship of the person who is applying for the evaluation.
4. A statement that the proposed patient is believed to be, as a result of a mental disorder, a danger to self or to others or a patient with a persistent or acute disability or a grave disability and the facts on which this statement is based.
5. A statement that the applicant believes the proposed patient is in need of supervision, care and treatment and the facts on which this statement is based.
C. The application shall be signed and notarized.
D. The screening agency shall offer assistance to the applicant in preparation of the application. On receipt of the application, the screening agency shall act as prescribed in section 36-521 within forty-eight hours of after the filing of the application, excluding weekends and holidays. If the application is not acted upon on within forty-eight hours, the reasons for not acting promptly shall be reviewed by the director of the screening agency or the director's designee.
E. If the applicant for the court-ordered evaluation presents the person to be evaluated at the screening agency, the agency shall conduct a prepetition screening examination. Except in the case of an emergency evaluation, the person to be evaluated shall not be detained or forced to undergo prepetition screening against the person's will.
F. If the applicant for the court-ordered evaluation does not present the person to be evaluated at the screening agency, the agency shall conduct the prepetition screening at the home of the person to be evaluated or any other place the person to be evaluated is found. If prepetition screening is not possible, the screening agency shall proceed as prescribed in section 36-521, subsection B.
G. If a person is being treated by prayer or spiritual means alone in accordance with the tenets and practices of a recognized church or religious denomination by a duly accredited practitioner of that church or denomination, such the person may not be ordered evaluated, detained or involuntarily treated unless the court has determined that the person is, as a result of mental disorder, a danger to others or to self.
H. Court-ordered evaluation or treatment pursuant to this chapter does not operate to change the legal residence of a patient.
I. If the application is not acted on because it has been determined that the proposed patient does not need an evaluation, the agency after a period of six months shall destroy the application and any other evidence of the application the medical director of the screening agency or the medical director's designee shall make a written statement of the reasons why the proposed patient does not need an evaluation and shall retain the application together with the medical director's statement and any records or reports concerning prepetition screening required pursuant section 36-521.
J. For the purposes of this section, "person" includes a person who:
1. Is under eighteen years of age.
2. Has been transferred to the criminal division of the superior court pursuant to section 8-327 or who has been charged with an offense pursuant to section 13-501.
3. Is under the supervision of an adult probation department.
Sec. 3. Section 36-521, Arizona Revised Statutes, is amended to read:
36-521. Preparation of petition for court-ordered evaluation; procedures for prepetition screening
A. On receiving the application for evaluation, the screening agency, before filing a petition for court-ordered evaluation, shall provide prepetition screening within forty-eight hours excluding weekends and holidays when possible to determine whether there is reasonable cause to believe the allegations of the applicant for the court-ordered evaluation, whether the person will voluntarily receive evaluation at a scheduled time and place and whether the person has a persistent or acute disability or a grave disability or is likely to present a danger to self or others until the voluntary evaluation as a result of a mental disorder, and whether the person will voluntarily receive evaluation at a scheduled time and place.
B. After prepetition screening has been completed, the screening agency shall prepare a report of opinions and conclusions. If prepetition screening is not possible, the screening agency shall prepare a report giving reasons why the screening was not possible and including opinions and conclusions of staff members who attempted to conduct prepetition screening or otherwise investigated the matter.
C. If the prepetition screening report indicates agency determines that there exists no reasonable cause to believe the allegations of the applicant for the court-ordered evaluation, it shall the APPLICATION for evaluation is to be denied, the denial shall be stated in writing on the application form and shall be reviewed and confirmed by the medical director of the screening agency or the medical director's designee. If the screening agency determines that although the person does not currently meet the criteria for court-ordered evaluation, there are reasonable grounds to believe that the person has a mental disorder, is in need of further evaluation or treatment and is able and willing to pursue private or public evaluation or treatment services available to the person in the community, the screening agency shall assist the proposed patient in finding specific evaluation or treatment services in the proposed patient's area and, if requested, make a direct referral to a person, agency or organization providing behavioral health services for the purpose of evaluation and treatment.
D. If, based on the allegations of the applicant for the court-ordered evaluation and the prepetition screening report or other information obtained while attempting to conduct a prepetition screening, the agency determines that there is reasonable cause to believe that the proposed patient is, as a result of mental disorder, a danger to self or to others or has a persistent or acute disability or a grave disability and that the proposed patient is unable or unwilling to voluntarily receive evaluation or is likely to present a danger to self or to others, has a grave disability or will further deteriorate before receiving a voluntary evaluation, the agency shall prepare a petition for court-ordered evaluation and shall file the petition, which shall be signed by the person who prepared the petition unless the county attorney performs these functions. If the agency determines that there is reasonable cause to believe that the person is in such a condition that without immediate hospitalization he is likely to harm himself or others, the agency shall take all reasonable steps to procure such hospitalization on an emergency basis.
E. The agency may contact the county attorney in order to obtain assistance in preparing the petition for court-ordered evaluation, and the agency may request the advice and judgment of the county attorney in reaching a decision as to whether the court-ordered evaluation is justified.
F. The county attorney may prepare or sign or file the petition if a court has ordered the county attorney to prepare the petition.
G. If a petition for court-ordered evaluation alleges danger to others as described in section 36-501, the screening agency, before filing such a petition, shall contact the county attorney for a review of the petition. The county attorney shall examine the petition and make one of the following written recommendations:
1. That a criminal investigation is warranted.
2. That the screening agency shall file the petition.
3. That no further proceedings are warranted. The screening agency shall consider the recommendation in determining whether a court-ordered evaluation is justified and shall include the recommendation with the petition if the agency decides to file the petition with the court.
H. The petition shall be made in the form and manner prescribed by the director.
I. If a petition for court-ordered evaluation is filed by a prosecutor pursuant to section 13-4517, a prior application for court-ordered evaluation or prescreening is not necessary.
Sec. 4. Section 36-523, Arizona Revised Statutes, is amended to read:
36-523. Petition for evaluation
A. The petition for evaluation shall contain the following:
1. The name, address and interest in the case of the individual who applied for the petition.
2. The name, and address if known, of the proposed patient for whom evaluation is petitioned.
3. The present whereabouts of the proposed patient, if known.
4. A statement alleging that there is reasonable cause to believe that the proposed patient has a mental disorder and is as a result a danger to self or others, has a persistent or acute disability or a grave disability and is unwilling or unable to undergo voluntary evaluation.
5. A summary of the facts that support the allegations that the proposed patient is dangerous, has a persistent or acute disability or a grave disability and is unwilling or unable to be voluntarily evaluated, including the facts that brought the proposed patient to the screening agency's attention.
6. If the petition is filed by a prosecutor pursuant to section 13-4517, any known criminal history of the proposed patient, including whether the proposed patient has ever been found incompetent to stand trial pursuant to section 13-4510.
7. A statement of any facts and circumstances that lead the petitioner to believe that the proposed patient may be safely transported to the evaluation agency by an authorized transporter, if available in the jurisdiction, without the assistance of a peace officer.
8. Other information that the director by rule or the court by rule or order may require.
B. The petition shall request that the court issue an order requiring that the proposed patient be given an evaluation and shall advise the court of both of the following:
1. That the opinion of the petitioner is either that the proposed patient is or is not in such a condition that without immediate or continuing hospitalization the patient is likely to suffer serious physical harm or further deterioration or inflict serious physical harm on another person.
2. If the opinion of the petitioner is that the proposed patient is not in the condition described in paragraph 1 of this subsection, that the opinion of the petitioner is either that the evaluation should or should not take place on an outpatient basis.
C. The petition for evaluation shall be accompanied by the application for evaluation, by the recommendation of the county attorney pursuant to section 36-521 and by a prepetition screening report, unless the documents have not been prepared under a provision of law or in accordance with an order of the court. The petition for evaluation shall also be accompanied by a copy of the application for emergency admission if one exists.
D. A petition and other forms required in a court may be filed only by the screening agency that has prepared the petition.
E. If the petition is prepared but not filed because it has been determined that the person does not need no longer needs an evaluation, the medical director of the agency after a period of six months shall destroy shall make a written statement of the reasons why the evaluation was determined to be no longer necessary and shall retain the petition together with the medical director's statement and the various reports annexed to the petition as required by this section.
F. If the petition is not filed because it has been determined that the person does not need an evaluation and a prosecutor filed a petition pursuant to section 13-4517, the person shall be remanded for a disposition pursuant to section 13-4517. If the person is out of custody, the court may order that the person be taken into custody for a disposition pursuant to this section.
Sec. 5. Section 36-524, Arizona Revised Statutes, is amended to read:
36-524. Application for emergency admission for evaluation; requirements; immunity
A. A written application for emergency admission shall be made to an evaluation agency before a person may be hospitalized in the agency.
B. The application for emergency admission shall be made by a person with knowledge of the facts requiring emergency admission. The applicant may be a relative or friend of the person, a peace officer, the admitting officer or another responsible person.
C. The application shall be made on a prescribed form and shall include the following:
1. A statement by the applicant that the applicant believes that the person, as a result of a mental disorder, is a danger to self or others, or has a persistent or acute disability or a grave disability, and is unable or unwilling to undergo voluntary evaluation and that during the time necessary to complete the prepetition screening procedures set forth in sections 36-520 and 36-521 the person is likely without immediate hospitalization to suffer serious physical harm or serious illness or is likely to inflict serious physical harm on another person.
2. The specific nature of the harm or illness the person is likely to suffer or inflict without immediate hospitalization.
3. A summary of the facts that support the statements made by the applicant, including the observations of persons who witnessed the events described in the statements or the behaviors of the person who is the subject of the application.
4. The signature of the applicant.
D. A telephonic application may be made not more than twenty-four hours before a written application. A telephonic application shall be made by or in the presence of a peace officer unless the application is made by a health care professional who is licensed pursuant to title 32, chapter 13, 15, 17 or 19.1 and who is directly involved with the care of a patient who is in a health care institution licensed in this state. For an application made by a peace officer or a health care professional who is licensed pursuant to title 32, chapter 13, 15, 17 or 19.1, a copy of the application that contains the applicant's original signature is acceptable, does not have to be notarized and may be submitted as the written application.
E. If the person to be admitted is not already present at the evaluation agency and if the admitting officer, based on a review of the written or telephonic application and conversation with the applicant and peace officer, has reasonable cause to believe that an emergency examination is necessary, the admitting officer may advise the peace officer that sufficient grounds exist to take the person into custody and to transport the person to the evaluation agency. The peace officer, on the request of the admitting officer of the evaluation agency pursuant to this subsection, shall apprehend and transport the person to the evaluation agency. The admitting officer shall not be held civilly liable for any acts committed by a person whom the admitting officer did not advise to be taken into custody if the admitting officer has in good faith followed the requirements of this section.
F. If the application for emergency admission is denied, the application shall be retained by the evaluation agency together with a written statement by the medical director of the evaluation agency or the director's designee stating the specific reasons why the application was denied.
Sec. 6. Section 36-527, Arizona Revised Statutes, is amended to read:
36-527. Discharge and release; relief from civil liability
A. A person taken into custody for emergency admission may not be detained longer than twenty-four hours excluding weekends and holidays following such detention unless a petition for court-ordered evaluation is filed.
B. A person admitted for emergency evaluation may be released at any time if, in the opinion of the medical director in charge of the evaluation agency, release is appropriate. The medical director shall not be held civilly liable for any acts committed by a released patient if the medical director has in good faith followed the requirements of this article. The patient may continue care and treatment in the agency if he signs a voluntary application.
C. If a person admitted for emergency evaluation is released, the application for emergency admission shall be retained together with a written statement by the medical director of the evaluation agency stating why the release was appropriate.
Sec. 7. Section 36-531, Arizona Revised Statutes, is amended to read:
36-531. Evaluation; possible dispositions; release
A. A person who is being evaluated on an inpatient basis in an evaluation agency shall be released if, in the opinion of the medical director of the agency, further evaluation is not appropriate unless the person applies for further care and treatment on a voluntary basis.
B. If it is determined on an evaluation of the patient's condition that the patient is, as a result of a mental disorder, a danger to self or to others or has a persistent or acute disability or a grave disability, the medical director in charge of the agency that provided the evaluation, unless the person applies for further care and treatment on a voluntary basis, shall prepare, sign and file a petition for court-ordered treatment unless the county attorney performs the functions of preparing, signing or filing the petition as provided in subsection C of this section.
C. The agency may contact the county attorney to obtain assistance in preparing the petition for court-ordered treatment, and the agency may request the advice and judgment of the county attorney in reaching a decision as to whether court-ordered treatment is justified.
D. A person being evaluated on an inpatient basis in an evaluation agency shall be released within seventy-two hours, excluding weekends and holidays, from the time that the person is hospitalized pursuant to a court order for evaluation, unless the person applies for further care and treatment on a voluntary basis or unless a petition for court-ordered treatment has been filed pursuant to subsection B of this section.
E. If a prosecutor filed a petition pursuant to section 13-4517, the medical director of an evaluation agency shall provide notice within twenty-four hours to the court and the prosecuting agency of the medical director's intention to release the person under this section. If the person has been remanded to an evaluation agency pursuant to section 13-4517, the evaluation agency shall detain the person for an additional twenty-four hours to allow for the provision of any required notices. The medical director shall provide the patient's records, including medical and treatment records, to the court and the prosecuting agency.
F. The administration may conduct jointly with a school district, directly or indirectly, an educational evaluation pursuant to sections 15-765 and 15-766 for nonadjudicated youth. The evaluation information may be shared by and among authorized personnel employed by the administration and the department of education, or authorized personnel from the local education agency, for purposes of ensuring the provision of special education and related services as required by the individuals with disabilities education act (20 United States Code sections 1400 through 1415).
G. If a person being evaluated on an inpatient basis is released pursuant to this section, the medical director of the evaluation agency shall make a written statement on a form and in a manner prescribed by the director stating why further evaluation was not appropriate and why release was appropriate. A copy of this written statement shall be filed with the court that entered the order for court-ordered evaluation to be filed as a part of the court record and shall be made a part of the patient's medical record.
Sec. 8. Data gap workgroup; report; delayed repeal; definition
A. The director of the Arizona health care cost containment system administration shall develop recommendations on opportunities to improve the availability and transparency of information related to members with a serious mental illness designation, including how to facilitate the extraction of data in clinical records for reporting, including:
1. Screening, evaluation and services provided under title 36, chapter 5, articles 4 and 5, Arizona Revised Statutes, including information about members receiving services whose court-ordered treatment is not renewed after completion, members receiving amendments to court-ordered treatment and members who were determined to be adherent or not adherent to court-ordered treatment.
2. The reasons that members with a serious mental illness designation receiving services from the administration or its contractors are discharged from inpatient psychiatric or residential services.
3. Deaths in an incarcerated setting of individuals with a serious mental illness designation, by manner of death.
4. Employment status of members with a serious mental illness designation, by supported or not supported employment.
B. In the development of these recommendations, the director shall convene and seek the advice of a representative group of stakeholders, including screening, evaluation and treatment agencies, contractors, hospitals and physicians providing behavioral health services, family members and persons who have received screening, evaluation or treatment services pursuant to title 36, chapter 5, article 4 or 5, Arizona Revised Statutes, persons who have or who have had in the past a serious mental illness designation and who have received behavioral health services, attorneys with experience in title 36, chapter 5, Arizona Revised Statutes, or title 13, Arizona Revised Statutes, processes for persons with mental illness, counties and the courts.
C. On or before October 1, 2025, the administration shall report to the governor, the president of the senate and the speaker of the house of representatives on the stakeholder recommendations, including any statutory changes necessary to improve the availability of information.
D. This section is repealed from and after June 30, 2026.
E. For the purposes of this section, "member" has the same meaning prescribed in section 36-2901, Arizona Revised Statutes.
APPROVED BY THE GOVERNOR APRIL 16, 2024.
FILED IN THE OFFICE OF THE SECRETARY OF STATE APRIL 16, 2024.
